Name of the company Employees Superannuation Scheme hereby nominate ShriSmt

Name of the company employees superannuation scheme

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(Name of the company) Employees’ Superannuation Scheme, hereby nominate Shri/Smt_ ANITHA S aged_48 years who is related to me as WIFE to receive the Pension in the event of my death during the guaranteed period as per the Rules of the Scheme/the Pension Corpus on my death. I further agree and declare that upon such payment, the Corporation will be discharged of all liability in this respect under the Master Policy No WILL EB FILLED BY COMPANY. Witness 1 NAME AND SIGNATURE Address Place Date ( To be completed by the annuitant and witnessed by the Trustees) I, Shri/Smt. SHANKAR KARNAM do hereby acknowledge receipt from the Life Insurance Corporation of India, the sum of Rs.___________(Rupees---------------------------------------------- ----------------------------------------------)_in full satisfaction and discharge of my under mentioned claims and demand under the Master Policy No_________. -----------------------------------------Installments of [email protected] Rs------------------------------- due from ____________________to___________________ Rs_____________________ Total Rs-------------------------------- SIGN (Signature of the Annuitant) Witness MY ADDRESS Address Place BENGALURU PHONE NO :XXXXX Date 13.11.2018 EMAIL ID ; XXXX.GMAIL.COM Specimen signature 1. XXXX 2. XXXX (Member residing away from Bangalore may opt for transfer of annuity records to the nearest P&GS Unit) 2.
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4 ANNEXURE-I SECTION I (To be completed by Trustees) GROUP SUPERANNUATION SCHEME, MASTER POLICY NO.___________ We hereby direct, authorize and empower you to pay on our behalf to Shri/Smt------- --------------------------------------, Membership No,________________, the pension amount as per option elected by him/her named above after deduction of Income Tax and other taxes & Duties as given below. 1. Commuted Value @ _________of pension Rs._________ 2. Total of Pension installments due from ________ to _________ (i.e. during the current financial year) TOTAL AMOUNT LESS INCOME TAX NET AMOUNT PAYABLE We hereby admit and acknowledge that the above mentioned payments which shall be made by you shall be in full settlement of the payments due to us and hereby declare that the receipts signed by the payees shall be sufficient, valid and legal discharge to you for the respective payments made to them and shall be fully binding upon us as if the payments had been made to us and the receipts signed by us. N.B:- If no tax is to be deducted against any of above account, please write ‘NIL’. Signature of the Trustees P&GS Unit, “Jeevan Prakash”, IV Floor, J.C. Road, Bangalore – 560 002 Ph : 2292647, FAX : 2293471, E-mail : [email protected]
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