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Intimation Form Dd44e4

This document is an intimation form for retirement, death, or leaving service from the SCI Employee Superannuation Scheme. It requests information such as the member's name, pension ID, date of birth, date of exit, cause of exit if death, final contributions, pension option selected, and payment details in order to process the disbursement of pension benefits. The form notes that selecting one of the pension options at point 9 is necessary to initiate the pension disbursement process.

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Manoj Mantri
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103 views

Intimation Form Dd44e4

This document is an intimation form for retirement, death, or leaving service from the SCI Employee Superannuation Scheme. It requests information such as the member's name, pension ID, date of birth, date of exit, cause of exit if death, final contributions, pension option selected, and payment details in order to process the disbursement of pension benefits. The form notes that selecting one of the pension options at point 9 is necessary to initiate the pension disbursement process.

Uploaded by

Manoj Mantri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SCI EMPLOYEE SUPERANNUATION SCHEME

MASTER POLICY NO GSCA/706002139

TO: LIFE INSURANCE CORPORATION OF INDIA


P&GS DEPARTMENT/MDO I
YOGAKSHEMA, 4TH FLOOR, EAST WING
MUMBAI 400 021

INTIMATION OF RETIREMENT/DEATH/LEAVING SERVICE

1. Name of Member : ______________________________________________

2. (a) Pension ID : ______________________________________________

(b) EC No. : ______________________________________________

3. Date of Birth : ______________________________________________

4. Date of Exit : ______________________________________________

5. (a) Cause of Exit : ______________________________________________

(b) In case of Death, cause of death


(Death Certificate to be attached) : _______________________________________________

6 (a) Final Contribution, if any, on


Cessation of service (compulsory) : NOT APPLICABLE

7. Whether Option to commute part of


Pension exercised or not? (Tick
Appropriate column) : NOT APPLICABLE

8. If the answer is YES, what Proportion?


(Tick applicable Column) : NOT APPLICABLE

9. Type of Pension Option elected


(Tick appropriate option) :

a. Pension ceasing at death with payout of whole life assurance.


b. Pension with guaranteed payments for 10 years + Life
c. Pension with guaranteed payments for 5 years + Life
d. Pension with guaranteed payments for 15 years + Life
e. Pension with guaranteed payments for 20 years + Life
f. Joint life and last survivor pension
g. Life and 50% to last survivor
h. Joint life and last survivor pension with return on capital
i. Life pension without any guaranteed payments
j. Pension increasing at simple rate 3% p.a.

If Joint Life Pension – Name of Spouse - __________________________________


(compulsory)
Date of birth of Spouse - _____________________________

10. Mode of annuity : Mly / Qly / Hly / Yly :

11. In case Pension is Immediate, particulars


of Member or Beneficiary : _______________________________________________

(i) Your Residential Address with PIN


No, Dist.,/Taluka/State _______________________________________________

_______________________________________________
(ii) If pension to Beneficiary Name and
Date of Birth of the Beneficiary :

(iii) 2 Specimen Signatures of Member or Beneficiary :

_____________________________________________________________________________________

(iv) Name, Address of Bank and Account


No. to which Pension is to be credited: _______________________________________________

_________________________________________________
IFS Code: _____________________________________
MICR: _______________________________________

(v) Whether docket to be transferred to nearest servicing unit to your correspondence address Y / N ?
if ‘Y’ which __________________________________________

(vi) Your Telephone No (with STD Code)


& E mail ID for effective communication purpose:
(T) _________________ E mail: ______________________

For SCI Employee Superannuation Trust

Signature: _________________________

TRUSTEE

Note: Please select one of the options at point no. 9 to enable us to initiate the process of disbursement of Pension.

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