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Loan application

Rajkumar Kamarsu
Rajkumar Kamarsu

This document is an application for a loan from the Directorate of Insurance, Government of Andhra Pradesh. It requests key details about the applicant such as their name, designation, employer, subscriber or policy number, amount of loan requested, purpose of loan, repayment terms, monthly income, existing deductions, and bank account details. The applicant declares that the information provided is accurate and agrees to use the loan only for the stated purpose. They authorize the Directorate to recover loan amounts and interest from their salary according to department rules. A certifying officer also verifies the applicant's details and loan repayment status.

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B.巽続.巽続.i..辿Q 俗丹綻.41 DIR. OF INS. NO. 41 B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 竪綻 y丹綻丹耽M脱端t脱耽 M辿辿竪耽竪綻 GOVERNMENT OF A.P. DIRECTORATE OF INSURANCE 卒谷臓竪耽 竪綻 y狸綻続s狸端 y丹綻耽丹 M脱端耽脱 M辿辿竪耽竪綻. .............. 巽 t OFFICE OF THE REGIONAL DEPUTY DIRECTOR OF INSURANCE ............ 尊}箪竪綻 M旦脱耽N 則脱綻脱耽R棚巽蔵 Application for Loan (巽^竪綻俗竪綻 M旦脱耽N 鱈続袖 ^竪綻y脱綻y脱綻) 1. ^竪綻則辿 則辿脱耽属 探続脱耽 竪綻y狸綻 探続脱耽 巽淡則辿 (For instructions, Please see overleaf) Name, father's name and the designation of the subscriber 2. ________________________________ A竪綻y脱綻 巽続属^坦綻巽蔵俗竪綻族 M辿辿竪耽竪綻 探続脱耽 The name of the office where he is employed 3. ________________________________ ^竪綻則辿 則辿脱耽 俗丹綻尊脱耽 担箪M脱端 卒谷誰 俗丹綻尊脱耽 Subscriber No. or Policy No. 4. ________________________________ 則脱綻脱耽R棚巽蔵淡 M淡俗竪綻 脱耽卒谷竪耽 丹綻竪綻蔵竪綻 The amount of the loan applied for 5. ________________________________ 尊}箪竪綻 則坦綻属M旦脱耽N A竪綻脱耽竪綻 (丹綻俗竪綻M脱端 V脱端 ^竪綻俗竪綻俗竪綻 巽 巽 則脱綻鱈t淡 竪耽^竪綻M旦属 則脱綻脱耽R棚巽蔵淡 担箪M脱端 息属淡 巽続巽続 担箪Q淡 竪綻脱耽竪綻俗竪綻 単綻巽続竪綻単箪俗竪綻). The object or objects for which the loan is required (full particulars may please begiven in the covering letter or application keeping in view the instructions printed overleaf) 6. ________________________________ 尊}箪竪綻 W H属族 辿耽則辿淡 ^丹綻^竪綻 則脱綻^竪綻M旦俗辿族脱耽 The number of instalments in which the loan is proposed to be repaid. (Not exceeding 48 according to Rules 46) 7. 8. ________________________________ ^竪綻則辿 則辿脱耽 卒歎則坦綻 丹綻竪綻蔵竪綻 俗丹綻巽 i竪綻竪綻 坦綻竪綻俗竪綻竪綻 俗竪綻y狸綻 竪綻WY巽続 Total monthly emoluments drawn by the subscriber ________________________________ Deductions from pay (G) (村) B.巽続.巽続.i..辿Q 尊}箪竪綻 辿耽則辿 (鱈) ________________________________ B.巽続.巽続.i.. 辿Q 誰続竪耽竪綻 H則脱綻耽俗辿 C竪綻脱耽 巽巽M辿脱耽 巽Z竪綻 担箪M脱端 巽Z竪綻 辿耽則辿 丹綻竪綻蔵 A.P.G.L.I. Dept. Premum ________________________________ A.P.L.I.D. Loan instalment ________________________________ Instalments of any other Co-operative Society a Societies ________________________________ (y狸綻) 損棚N 尊}箪竪綻 Bank Loans (C) ________________________________ 巽続多脱箪竪綻竪綻 竪綻l脱耽 ^坦綻鱈俗竪綻 丹綻s棚脱耽 M辿脱耽 尊}箪竪綻 担箪M脱端 V脱端巽 属辿}箪竪綻 Motor Car Loan or House Building Loan sanctioned by Government ________________________________ (G貼揃) B則辿竪耽巽続 巽続俗竪綻族 Income Tax (h) ________________________________ H竪綻耽俗辿 C竪綻脱耽 竪綻WY巽続 Any other deductions ________________________________ 丹綻竪綻蔵竪綻 T otal 9. The name of the Treasury or branch of the State Bank where the payment of loan is desired. 10. ________________________________ 尊}箪竪綻 ^丹綻^竪綻 M淡脱耽 s坦端f 担箪M脱端 探tr 損棚N 損棚_ 探続脱耽 ________________________________ _脱耽俗辿竪綻 Address ________________________________
嘆続俗竪綻 単綻鱈続俗竪綻 竪綻脱耽竪綻, f竪綻 巽続脱耽^竪綻尊y狸綻俗竪綻 則脱綻脱耽R棚巽蔵淡 単綻鱈続俗竪綻 巽竪耽竪綻 巽丹耽俗竪綻竪綻属竪耽 嘆続 単綻鱈続俗竪綻 A竪綻巽脱耽竪綻 担箪M脱端 A俗竪綻竪綻巽脱耽竪綻 属竪綻蔵竪綻 竪綻竪綻坦綻 嘆続M脱端竪綻俗竪綻 Q脱耽a ^坦綻竪耽V脱端俗竪綻属竪耽 C則脱綻 竪綻竪綻俗竪綻 巽続M脱端s狸端^竪綻^竪綻俗辿族俗竪綻. 辿Q 属竪耽竪綻竪綻達 俗竪綻俗竪綻巽_ B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 竪綻 辿Q M辿脱耽則脱綻M狸端 属脱耽~耽^竪綻 巽続則脱綻速竪綻俗竪綻, 坦綻竪綻俗竪綻竪綻 俗竪綻_ 尊}箪竪綻, 竪綻y狸綻z 竪綻XY巽続俗竪綻 ^坦綻竪耽 E竪綻蔵脱耽 g棚 ^坦綻竪耽rN C則脱綻 竪綻竪綻V辿 辿M狸端 A測M辿脱耽竪綻 C^竪綻a^竪綻俗辿族俗竪綻. I hereby declare that the particulars stated above as well as those mentioned in the covering application are correct and that I shall spend the amount received only on the object or objects, mentioned above. I hereby authorise the Director Directarate of Insurance Department Government of Andhra Pradesh to pass orders to effect recoveries of Loan and interest from my salary in the manner as may be prescribed by him in accordance with the rules of the Department. 担綻即 : 則脱綻脱耽R棚巽蔵 則辿脱耽 巽≒竪綻M脱端竪綻 担箪M脱端 損旦^竪綻俗竪綻 坦綻 竪綻則脱綻 Date ....... 197 Signature of Thumb Impression of the applicant 嘆続 則脱綻脱耽R棚巽蔵淡 単綻鱈続俗竪綻 竪綻脱耽竪綻 俗辿N 単綻鱈俗竪綻≒竪綻 坦綻脱耽N 俗坦綻俗竪綻 竪箪鱈^竪綻俗竪綻≒竪綻 竪綻脱耽N 竪耽則辿脱耽側竪綻属竪耽, 嘆続 巽≒竪綻M脱端竪綻 担箪M脱端 損旦r俗竪綻 坦綻 竪綻則脱綻 ...................................................... V辿 則脱綻属竪耽 C則脱綻 竪綻竪綻V辿 束脱綻M脱端^竪綻y脱綻丹綻俗竪綻即. B竪耽俗竪綻 B.巽続.巽続.i.. 辿Q 俗竪綻y狸綻 脱耽. .................................... 尊}箪竪綻 臓巽M旦属 竪耽俗辿族脱耽. C則脱綻 CM脱端俗竪綻 脱耽. .................................... 損棚M樽端 竪耽俗辿族脱耽. It is hereby certified that the particulars stated in the above application are correct to the best of my knowledge and belief and that the above signature or thumb/impression is of Shri ........................................................... He ad obtained a loan of Rs. ........................... from A.P.G.I. Dept. out of which Rs. ..................... are still outstanding. 束脱綻M脱端^竪綻 V坦端hs丹端ty綻 A測M辿 巽≒竪綻M脱端竪綻 Signature of the certifying Gazetted Officer ___________________ 担綻即: 束脱綻M脱端^竪綻 A測M辿 探続脱耽 Date ... 197 Name of the certifying Officer _________________ M辿辿竪耽竪綻 竪綻則脱綻 巽淡則辿 Office Seal Designation _______________________________ V脱端竪綻属M脱端:& 則脱綻脱耽R棚巽蔵 則辿脱耽 C即竪綻脱耽M坦端 竪綻 辿Q 俗竪綻y狸綻 尊}箪竪綻 臓巽N俗竪綻族 丹耽y脱綻 嘆続 束脱綻竪綻 巽続竪綻竪綻嘆続 則脱綻脱耽R棚巽蔵 則辿脱耽属, A竪綻竪綻鱈竪綻 E俗竪綻族淡則淡W 巽≒竪綻M脱端竪綻 ^坦綻竪耽竪綻単箪俗竪綻. Note:- In case the applicant has already obtained loan from Insurance the above certificate should be signed by the applicant's immediate superior.
巽続即 嘆続巽 谷t巽続 B.巽続.巽続..M辿.{樽綻.俗丹綻.40 Stamp 20 P. DIR. OF INS. F. NO.40 脱耽則脱綻 RECEIPT V脱端竪綻属M脱端:& 丹綻竪綻蔵竪綻 脱耽. 20 N _俗竪綻 Gy脱綻 谷t巽続 As狸端^竪綻竪綻単箪俗竪綻. Note:- If the amount exceeds Rs. 20, this receipt should be duly stamped. /竪綻 ...................................................................... V辿 竪綻 / 卒谷y丹綻r 巽揃y脱綻/尊}箪竪綻/ 損淡俗竪綻巽 丹綻竪綻蔵竪綻俗竪綻N 巽尊即_俗竪綻 ^竪綻則辿則辿脱耽 俗丹綻尊脱耽 ................................... 脱耽則脱綻 .................................. A耽俗竪綻 俗坦 綻 俗竪 綻 C則脱 綻 竪 綻 竪 綻 V辿 B束脱 綻 巽 続 則坦 綻 箪 巽 続 多脱 箪 竪 綻 竪 綻 M辿辿竪 耽 竪 綻 , 嘆 則 脱 綻 辿損棚則脱 綻 俗竪 綻 y狸 綻 脱 耽 卒谷竪 耽 (AM丹 端 淡) ................................... (A脱綻脱耽竪綻淡) .................................................................. 巽竪耽竪綻V辿 / 竪 綻 .................................................................. 則辿辿 ................................................................. 担綻息 V脱端 .................................... 俗丹綻尊脱耽 ^丹綻NP & 損棚N y辿巽揃t 則辿辿 竪綻s狸端t俗竪綻r 単綻竪耽巽続脱耽^竪綻^竪綻俗辿族俗竪綻. Receipt regarding the amount of Insurance / Provident Fund / Loan / Bonus of Sri/Smt. .............................................................................. Subscriber No. .................................................... I .............................................................................. hereby knowledge receipt of Rs. (in figures ......................................... ) (in words ........................................................................................................ ) From the Directorate of Insurance, Hyderabad per self, Sri/Smt. .............................................................................. Attorney/Bearer * per Cheque / B.D. No. ........................................ Dated ....................................... 19 臓巽N俗竪綻族 辿 巽≒竪綻M脱端竪綻 Signature of receipient . 卒谷誰則辿脱耽 & M丹端耽竪綻則辿脱耽 丹耽M脱端P 巽≒竪綻M脱端竪綻 担箪則辿 損旦r俗竪綻坦綻 竪綻則脱綻 Signature of thumb-Impression of the Policy holder/ Claiment. [P.T.O.
俗辿 巽竪綻脱綻竪綻淡 巽≒竪綻M脱端竪綻 ^坦綻鱈俗竪綻 嘆続 巽≒竪綻M脱端竪綻 & 坦綻 竪綻則脱綻 ____________________________ 辿 束脱綻M脱端脱耽}箪竪綻 /竪綻 ...................................................... 巽続脱耽巽P^竪綻M旦属 嘆続 ^丹綻NP俗竪綻 巽竪耽竪綻V辿 A則脱綻g担箪竪耽y脱綻丹綻俗竪綻即. 俗坦綻俗竪綻 C則脱綻 竪綻竪綻V辿 束脱綻竪綻巽続脱耽^竪綻^竪綻俗辿族俗竪綻. ______________________________________ I hereby certify that the above signature/thumb impression is of Sri/Smt. ______________________ On the strength of certification of _______________________________________________ the above cheques reserved personally . who has signed in my presence. V脱端hs丹端y脱綻 A測M辿 探続脱耽 1. Name of the Gazetted Officer______________ ___________________________________ ___________________________________ 巽淡則辿 2. 巽巽続s丹端y丹綻r Designation __________________________ Superintendent 巽竪耽 巽^辿Ny脱綻, 竪綻 Asst. Director of Insurance 束脱綻M脱端_俗竪綻 担綻即 3. Date of Attestation ______________________ M辿辿竪耽巽続 竪綻則脱綻 OFFICE SEAL V脱端竪綻谷蔵 Clerk 束脱綻M脱端_俗竪綻 A測M辿 巽≒竪綻M脱端竪綻 Signature of the Certifying Gazetted Officer V脱端竪綻属M脱端:& B束脱綻巽続則坦綻柈 巽巽淡 竪耽俗竪綻族 V脱端hs丹端y脱綻 A測M辿^坦綻 V辿属, A多脱箪速 辿甲竪綻 丹綻巽続 属竪綻鱈巽蔵俗竪綻族r耽俗竪綻^淡 坦綻h探tr^坦綻 脱耽則脱綻 束脱綻 竪綻巽続脱耽^竪綻竪綻単箪俗竪綻. Note:- The receipt should be certified by a Gazetted Officer of Andhra Pradesh Government in Service or by a Magistrate if the applicant is residing outside the State.

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Loan application

  • 1. B.巽続.巽続.i..辿Q 俗丹綻.41 DIR. OF INS. NO. 41 B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 竪綻 y丹綻丹耽M脱端t脱耽 M辿辿竪耽竪綻 GOVERNMENT OF A.P. DIRECTORATE OF INSURANCE 卒谷臓竪耽 竪綻 y狸綻続s狸端 y丹綻耽丹 M脱端耽脱 M辿辿竪耽竪綻. .............. 巽 t OFFICE OF THE REGIONAL DEPUTY DIRECTOR OF INSURANCE ............ 尊}箪竪綻 M旦脱耽N 則脱綻脱耽R棚巽蔵 Application for Loan (巽^竪綻俗竪綻 M旦脱耽N 鱈続袖 ^竪綻y脱綻y脱綻) 1. ^竪綻則辿 則辿脱耽属 探続脱耽 竪綻y狸綻 探続脱耽 巽淡則辿 (For instructions, Please see overleaf) Name, father's name and the designation of the subscriber 2. ________________________________ A竪綻y脱綻 巽続属^坦綻巽蔵俗竪綻族 M辿辿竪耽竪綻 探続脱耽 The name of the office where he is employed 3. ________________________________ ^竪綻則辿 則辿脱耽 俗丹綻尊脱耽 担箪M脱端 卒谷誰 俗丹綻尊脱耽 Subscriber No. or Policy No. 4. ________________________________ 則脱綻脱耽R棚巽蔵淡 M淡俗竪綻 脱耽卒谷竪耽 丹綻竪綻蔵竪綻 The amount of the loan applied for 5. ________________________________ 尊}箪竪綻 則坦綻属M旦脱耽N A竪綻脱耽竪綻 (丹綻俗竪綻M脱端 V脱端 ^竪綻俗竪綻俗竪綻 巽 巽 則脱綻鱈t淡 竪耽^竪綻M旦属 則脱綻脱耽R棚巽蔵淡 担箪M脱端 息属淡 巽続巽続 担箪Q淡 竪綻脱耽竪綻俗竪綻 単綻巽続竪綻単箪俗竪綻). The object or objects for which the loan is required (full particulars may please begiven in the covering letter or application keeping in view the instructions printed overleaf) 6. ________________________________ 尊}箪竪綻 W H属族 辿耽則辿淡 ^丹綻^竪綻 則脱綻^竪綻M旦俗辿族脱耽 The number of instalments in which the loan is proposed to be repaid. (Not exceeding 48 according to Rules 46) 7. 8. ________________________________ ^竪綻則辿 則辿脱耽 卒歎則坦綻 丹綻竪綻蔵竪綻 俗丹綻巽 i竪綻竪綻 坦綻竪綻俗竪綻竪綻 俗竪綻y狸綻 竪綻WY巽続 Total monthly emoluments drawn by the subscriber ________________________________ Deductions from pay (G) (村) B.巽続.巽続.i..辿Q 尊}箪竪綻 辿耽則辿 (鱈) ________________________________ B.巽続.巽続.i.. 辿Q 誰続竪耽竪綻 H則脱綻耽俗辿 C竪綻脱耽 巽巽M辿脱耽 巽Z竪綻 担箪M脱端 巽Z竪綻 辿耽則辿 丹綻竪綻蔵 A.P.G.L.I. Dept. Premum ________________________________ A.P.L.I.D. Loan instalment ________________________________ Instalments of any other Co-operative Society a Societies ________________________________ (y狸綻) 損棚N 尊}箪竪綻 Bank Loans (C) ________________________________ 巽続多脱箪竪綻竪綻 竪綻l脱耽 ^坦綻鱈俗竪綻 丹綻s棚脱耽 M辿脱耽 尊}箪竪綻 担箪M脱端 V脱端巽 属辿}箪竪綻 Motor Car Loan or House Building Loan sanctioned by Government ________________________________ (G貼揃) B則辿竪耽巽続 巽続俗竪綻族 Income Tax (h) ________________________________ H竪綻耽俗辿 C竪綻脱耽 竪綻WY巽続 Any other deductions ________________________________ 丹綻竪綻蔵竪綻 T otal 9. The name of the Treasury or branch of the State Bank where the payment of loan is desired. 10. ________________________________ 尊}箪竪綻 ^丹綻^竪綻 M淡脱耽 s坦端f 担箪M脱端 探tr 損棚N 損棚_ 探続脱耽 ________________________________ _脱耽俗辿竪綻 Address ________________________________
  • 2. 嘆続俗竪綻 単綻鱈続俗竪綻 竪綻脱耽竪綻, f竪綻 巽続脱耽^竪綻尊y狸綻俗竪綻 則脱綻脱耽R棚巽蔵淡 単綻鱈続俗竪綻 巽竪耽竪綻 巽丹耽俗竪綻竪綻属竪耽 嘆続 単綻鱈続俗竪綻 A竪綻巽脱耽竪綻 担箪M脱端 A俗竪綻竪綻巽脱耽竪綻 属竪綻蔵竪綻 竪綻竪綻坦綻 嘆続M脱端竪綻俗竪綻 Q脱耽a ^坦綻竪耽V脱端俗竪綻属竪耽 C則脱綻 竪綻竪綻俗竪綻 巽続M脱端s狸端^竪綻^竪綻俗辿族俗竪綻. 辿Q 属竪耽竪綻竪綻達 俗竪綻俗竪綻巽_ B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 竪綻 辿Q M辿脱耽則脱綻M狸端 属脱耽~耽^竪綻 巽続則脱綻速竪綻俗竪綻, 坦綻竪綻俗竪綻竪綻 俗竪綻_ 尊}箪竪綻, 竪綻y狸綻z 竪綻XY巽続俗竪綻 ^坦綻竪耽 E竪綻蔵脱耽 g棚 ^坦綻竪耽rN C則脱綻 竪綻竪綻V辿 辿M狸端 A測M辿脱耽竪綻 C^竪綻a^竪綻俗辿族俗竪綻. I hereby declare that the particulars stated above as well as those mentioned in the covering application are correct and that I shall spend the amount received only on the object or objects, mentioned above. I hereby authorise the Director Directarate of Insurance Department Government of Andhra Pradesh to pass orders to effect recoveries of Loan and interest from my salary in the manner as may be prescribed by him in accordance with the rules of the Department. 担綻即 : 則脱綻脱耽R棚巽蔵 則辿脱耽 巽≒竪綻M脱端竪綻 担箪M脱端 損旦^竪綻俗竪綻 坦綻 竪綻則脱綻 Date ....... 197 Signature of Thumb Impression of the applicant 嘆続 則脱綻脱耽R棚巽蔵淡 単綻鱈続俗竪綻 竪綻脱耽竪綻 俗辿N 単綻鱈俗竪綻≒竪綻 坦綻脱耽N 俗坦綻俗竪綻 竪箪鱈^竪綻俗竪綻≒竪綻 竪綻脱耽N 竪耽則辿脱耽側竪綻属竪耽, 嘆続 巽≒竪綻M脱端竪綻 担箪M脱端 損旦r俗竪綻 坦綻 竪綻則脱綻 ...................................................... V辿 則脱綻属竪耽 C則脱綻 竪綻竪綻V辿 束脱綻M脱端^竪綻y脱綻丹綻俗竪綻即. B竪耽俗竪綻 B.巽続.巽続.i.. 辿Q 俗竪綻y狸綻 脱耽. .................................... 尊}箪竪綻 臓巽M旦属 竪耽俗辿族脱耽. C則脱綻 CM脱端俗竪綻 脱耽. .................................... 損棚M樽端 竪耽俗辿族脱耽. It is hereby certified that the particulars stated in the above application are correct to the best of my knowledge and belief and that the above signature or thumb/impression is of Shri ........................................................... He ad obtained a loan of Rs. ........................... from A.P.G.I. Dept. out of which Rs. ..................... are still outstanding. 束脱綻M脱端^竪綻 V坦端hs丹端ty綻 A測M辿 巽≒竪綻M脱端竪綻 Signature of the certifying Gazetted Officer ___________________ 担綻即: 束脱綻M脱端^竪綻 A測M辿 探続脱耽 Date ... 197 Name of the certifying Officer _________________ M辿辿竪耽竪綻 竪綻則脱綻 巽淡則辿 Office Seal Designation _______________________________ V脱端竪綻属M脱端:& 則脱綻脱耽R棚巽蔵 則辿脱耽 C即竪綻脱耽M坦端 竪綻 辿Q 俗竪綻y狸綻 尊}箪竪綻 臓巽N俗竪綻族 丹耽y脱綻 嘆続 束脱綻竪綻 巽続竪綻竪綻嘆続 則脱綻脱耽R棚巽蔵 則辿脱耽属, A竪綻竪綻鱈竪綻 E俗竪綻族淡則淡W 巽≒竪綻M脱端竪綻 ^坦綻竪耽竪綻単箪俗竪綻. Note:- In case the applicant has already obtained loan from Insurance the above certificate should be signed by the applicant's immediate superior.
  • 3. 巽続即 嘆続巽 谷t巽続 B.巽続.巽続..M辿.{樽綻.俗丹綻.40 Stamp 20 P. DIR. OF INS. F. NO.40 脱耽則脱綻 RECEIPT V脱端竪綻属M脱端:& 丹綻竪綻蔵竪綻 脱耽. 20 N _俗竪綻 Gy脱綻 谷t巽続 As狸端^竪綻竪綻単箪俗竪綻. Note:- If the amount exceeds Rs. 20, this receipt should be duly stamped. /竪綻 ...................................................................... V辿 竪綻 / 卒谷y丹綻r 巽揃y脱綻/尊}箪竪綻/ 損淡俗竪綻巽 丹綻竪綻蔵竪綻俗竪綻N 巽尊即_俗竪綻 ^竪綻則辿則辿脱耽 俗丹綻尊脱耽 ................................... 脱耽則脱綻 .................................. A耽俗竪綻 俗坦 綻 俗竪 綻 C則脱 綻 竪 綻 竪 綻 V辿 B束脱 綻 巽 続 則坦 綻 箪 巽 続 多脱 箪 竪 綻 竪 綻 M辿辿竪 耽 竪 綻 , 嘆 則 脱 綻 辿損棚則脱 綻 俗竪 綻 y狸 綻 脱 耽 卒谷竪 耽 (AM丹 端 淡) ................................... (A脱綻脱耽竪綻淡) .................................................................. 巽竪耽竪綻V辿 / 竪 綻 .................................................................. 則辿辿 ................................................................. 担綻息 V脱端 .................................... 俗丹綻尊脱耽 ^丹綻NP & 損棚N y辿巽揃t 則辿辿 竪綻s狸端t俗竪綻r 単綻竪耽巽続脱耽^竪綻^竪綻俗辿族俗竪綻. Receipt regarding the amount of Insurance / Provident Fund / Loan / Bonus of Sri/Smt. .............................................................................. Subscriber No. .................................................... I .............................................................................. hereby knowledge receipt of Rs. (in figures ......................................... ) (in words ........................................................................................................ ) From the Directorate of Insurance, Hyderabad per self, Sri/Smt. .............................................................................. Attorney/Bearer * per Cheque / B.D. No. ........................................ Dated ....................................... 19 臓巽N俗竪綻族 辿 巽≒竪綻M脱端竪綻 Signature of receipient . 卒谷誰則辿脱耽 & M丹端耽竪綻則辿脱耽 丹耽M脱端P 巽≒竪綻M脱端竪綻 担箪則辿 損旦r俗竪綻坦綻 竪綻則脱綻 Signature of thumb-Impression of the Policy holder/ Claiment. [P.T.O.
  • 4. 俗辿 巽竪綻脱綻竪綻淡 巽≒竪綻M脱端竪綻 ^坦綻鱈俗竪綻 嘆続 巽≒竪綻M脱端竪綻 & 坦綻 竪綻則脱綻 ____________________________ 辿 束脱綻M脱端脱耽}箪竪綻 /竪綻 ...................................................... 巽続脱耽巽P^竪綻M旦属 嘆続 ^丹綻NP俗竪綻 巽竪耽竪綻V辿 A則脱綻g担箪竪耽y脱綻丹綻俗竪綻即. 俗坦綻俗竪綻 C則脱綻 竪綻竪綻V辿 束脱綻竪綻巽続脱耽^竪綻^竪綻俗辿族俗竪綻. ______________________________________ I hereby certify that the above signature/thumb impression is of Sri/Smt. ______________________ On the strength of certification of _______________________________________________ the above cheques reserved personally . who has signed in my presence. V脱端hs丹端y脱綻 A測M辿 探続脱耽 1. Name of the Gazetted Officer______________ ___________________________________ ___________________________________ 巽淡則辿 2. 巽巽続s丹端y丹綻r Designation __________________________ Superintendent 巽竪耽 巽^辿Ny脱綻, 竪綻 Asst. Director of Insurance 束脱綻M脱端_俗竪綻 担綻即 3. Date of Attestation ______________________ M辿辿竪耽巽続 竪綻則脱綻 OFFICE SEAL V脱端竪綻谷蔵 Clerk 束脱綻M脱端_俗竪綻 A測M辿 巽≒竪綻M脱端竪綻 Signature of the Certifying Gazetted Officer V脱端竪綻属M脱端:& B束脱綻巽続則坦綻柈 巽巽淡 竪耽俗竪綻族 V脱端hs丹端y脱綻 A測M辿^坦綻 V辿属, A多脱箪速 辿甲竪綻 丹綻巽続 属竪綻鱈巽蔵俗竪綻族r耽俗竪綻^淡 坦綻h探tr^坦綻 脱耽則脱綻 束脱綻 竪綻巽続脱耽^竪綻竪綻単箪俗竪綻. Note:- The receipt should be certified by a Gazetted Officer of Andhra Pradesh Government in Service or by a Magistrate if the applicant is residing outside the State.