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Nominee form

Rajkumar Kamarsu
Rajkumar Kamarsu

1. The document is a nomination form submitted by an individual to nominate beneficiaries for life insurance policies in case of demise. 2. The individual nominates specific persons listed in the schedule and the amounts against their names. 3. It is understood that this nomination will not affect the individual's right to surrender policies or receive amounts upon maturity.

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B.巽続.巽続.i..辿.俗丹綻.3 A.P.G.L.I.D.NO. 3 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 ANDHRA PRADESH DIRECTORATE OF INSURANCE 卒谷臓竪耽 竪綻 y狸綻巽続s樽端 M辿辿竪耽竪綻 OFFICE OF THE REGIONAL DEPUTY DIRECTOR OF INSURANCE To y丹綻丹耽M脱端t脱耽 B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 i竪綻 竪綻 辿Q, 嘆則脱綻辿損棚則綻 (B.巽続.) THE DIRECTOR, ANDHRA PRADESH GOVERNMENT LIFE INSURANCE DEPARTMENT Hyderabad (Andhra Pradesh) B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 i竪綻 竪綻 辿Q (属竪耽竪綻竪綻達淡属 (即V脱端竪綻 単綻鱈続俗竪綻) 31竪綻 属竪耽竪綻竪綻 俗竪綻俗竪綻巽_ ________________ M脱端W俗竪綻 __________________________ A俗竪綻 俗坦綻俗竪綻, M狸端則脱綻 A俗竪綻巽_M脱端淡 単綻鱈続俗竪綻 竪綻N蔵俗竪綻 俗坦綻俗竪綻 ^竪綻属卒湛耽俗竪綻 丹耽y脱綻 辿/ B丹綻/A竪綻属 探続脱耽N/探続脱耽N 単綻鱈続俗竪綻 丹綻竪綻蔵竪綻俗竪綻 卒歎則脱綻rN A俗竪綻測M脱端蔵V辿 C則脱綻 竪綻竪綻俗竪綻 俗辿俗坦綻r ^坦綻竪耽y脱綻丹綻俗竪綻即. In terms of Rules 31, Andhra Pradesh Government Life Insurance Department Rules (Reproduced below) I, .......................................................... (designation) .................................................. hereby nominate the persons specified in the schedule as beneficiaries to receive the amounts state against their / his /her, names in case of my demise. 巽巽 俗竪綻則脱綻 担綻即M狸端 竪綻則脱綻V辿 俗坦綻俗竪綻 E則淡V脱端竪綻 竪綻俗竪綻M旦俗竪綻族 丹耽y脱綻 卒谷誰俗竪綻 A袖^竪綻rN 担箪則辿 卒谷誰 巽続 ^丹綻即俗竪綻 則脱綻r 俗坦綻俗坦綻 巽竪耽竪綻V辿 丹綻竪綻蔵 臓巽M旦俗竪綻rN 俗辿N俗竪綻族 巽NPN 俗辿俗坦綻巽俗竪綻 H 束脱綻竪綻V辿 多脱箪V脱端竪綻 M脱端W^竪綻則脱綻属 多棚^竪綻竪綻単箪俗竪綻. It is however, understood that this nomination, will in no way affect my right to surronding the policies in case of my ceasing to be in service before the date of maturity or to receiving amount myself on maturity of the policy. A俗竪綻巽_ 俗辿俗坦綻s柅 SCHEDULE NOMINEES 竪綻脱耽巽 巽 Q 俗辿賊 探続脱耽 竪綻y狸綻 探続脱耽淡 巽 Names of the 竪綻竪耽巽 Sl. No. nominous with father's name Age 卒谷誰則辿脱耽y狸綻淡 V脱端 巽尊束脱綻竪綻 俗辿俗坦綻r ^坦綻竪耽 卒谷誰 竪綻脱耽竪綻 Particulars of Polices to be Nominated 卒谷誰 丹綻竪綻蔵巽続 属巽袖蔵 竪綻脱耽P 卒谷誰 俗丹綻. 丹綻竪綻蔵 Relation to Remarks Policy No. Amount H竪綻耽俗竪綻 Es坦端 Policy Policy-holder Amount if any 1 2 3 4 5 6 7 197 ......... 俗丹綻 ..................................... 担綻息俗竪綻 巽≒竪綻M脱端丹綻俗竪綻即. Signed this .................................................. day of ...................... 197 卒谷誰則辿脱耽 巽≒竪綻M脱端竪綻 Signature of the Policy-holder 嘆続 巽≒竪綻M脱端竪綻 .............................................. V辿 N竪綻脱耽y丹綻俗竪綻 ................................. 則脱綻属 束脱綻竪綻巽続脱耽^竪綻丹綻俗竪綻即 Certified that the above signature is of ................................................................ son of ................................... V脱端hs丹端y綻 A測M辿 探続脱耽 Name of the Gazetted Officer V脱端hs丹端y脱綻 A測M辿 巽淡則辿 Designation of the Gazetted Officer 担綻即 ................................ 197 Dated ..................................... 197 V脱端hs丹端y脱綻 A測M辿 巽≒竪綻M脱端竪綻 Signature of the Gazetted Officer OFFICE SEAL M辿辿竪耽 竪綻則脱綻

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Nominee form

  • 1. B.巽続.巽続.i..辿.俗丹綻.3 A.P.G.L.I.D.NO. 3 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 ANDHRA PRADESH DIRECTORATE OF INSURANCE 卒谷臓竪耽 竪綻 y狸綻巽続s樽端 M辿辿竪耽竪綻 OFFICE OF THE REGIONAL DEPUTY DIRECTOR OF INSURANCE To y丹綻丹耽M脱端t脱耽 B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 i竪綻 竪綻 辿Q, 嘆則脱綻辿損棚則綻 (B.巽続.) THE DIRECTOR, ANDHRA PRADESH GOVERNMENT LIFE INSURANCE DEPARTMENT Hyderabad (Andhra Pradesh) B束脱綻巽続則坦綻柈 巽続多脱箪竪綻 i竪綻 竪綻 辿Q (属竪耽竪綻竪綻達淡属 (即V脱端竪綻 単綻鱈続俗竪綻) 31竪綻 属竪耽竪綻竪綻 俗竪綻俗竪綻巽_ ________________ M脱端W俗竪綻 __________________________ A俗竪綻 俗坦綻俗竪綻, M狸端則脱綻 A俗竪綻巽_M脱端淡 単綻鱈続俗竪綻 竪綻N蔵俗竪綻 俗坦綻俗竪綻 ^竪綻属卒湛耽俗竪綻 丹耽y脱綻 辿/ B丹綻/A竪綻属 探続脱耽N/探続脱耽N 単綻鱈続俗竪綻 丹綻竪綻蔵竪綻俗竪綻 卒歎則脱綻rN A俗竪綻測M脱端蔵V辿 C則脱綻 竪綻竪綻俗竪綻 俗辿俗坦綻r ^坦綻竪耽y脱綻丹綻俗竪綻即. In terms of Rules 31, Andhra Pradesh Government Life Insurance Department Rules (Reproduced below) I, .......................................................... (designation) .................................................. hereby nominate the persons specified in the schedule as beneficiaries to receive the amounts state against their / his /her, names in case of my demise. 巽巽 俗竪綻則脱綻 担綻即M狸端 竪綻則脱綻V辿 俗坦綻俗竪綻 E則淡V脱端竪綻 竪綻俗竪綻M旦俗竪綻族 丹耽y脱綻 卒谷誰俗竪綻 A袖^竪綻rN 担箪則辿 卒谷誰 巽続 ^丹綻即俗竪綻 則脱綻r 俗坦綻俗坦綻 巽竪耽竪綻V辿 丹綻竪綻蔵 臓巽M旦俗竪綻rN 俗辿N俗竪綻族 巽NPN 俗辿俗坦綻巽俗竪綻 H 束脱綻竪綻V辿 多脱箪V脱端竪綻 M脱端W^竪綻則脱綻属 多棚^竪綻竪綻単箪俗竪綻. It is however, understood that this nomination, will in no way affect my right to surronding the policies in case of my ceasing to be in service before the date of maturity or to receiving amount myself on maturity of the policy. A俗竪綻巽_ 俗辿俗坦綻s柅 SCHEDULE NOMINEES 竪綻脱耽巽 巽 Q 俗辿賊 探続脱耽 竪綻y狸綻 探続脱耽淡 巽 Names of the 竪綻竪耽巽 Sl. No. nominous with father's name Age 卒谷誰則辿脱耽y狸綻淡 V脱端 巽尊束脱綻竪綻 俗辿俗坦綻r ^坦綻竪耽 卒谷誰 竪綻脱耽竪綻 Particulars of Polices to be Nominated 卒谷誰 丹綻竪綻蔵巽続 属巽袖蔵 竪綻脱耽P 卒谷誰 俗丹綻. 丹綻竪綻蔵 Relation to Remarks Policy No. Amount H竪綻耽俗竪綻 Es坦端 Policy Policy-holder Amount if any 1 2 3 4 5 6 7 197 ......... 俗丹綻 ..................................... 担綻息俗竪綻 巽≒竪綻M脱端丹綻俗竪綻即. Signed this .................................................. day of ...................... 197 卒谷誰則辿脱耽 巽≒竪綻M脱端竪綻 Signature of the Policy-holder 嘆続 巽≒竪綻M脱端竪綻 .............................................. V辿 N竪綻脱耽y丹綻俗竪綻 ................................. 則脱綻属 束脱綻竪綻巽続脱耽^竪綻丹綻俗竪綻即 Certified that the above signature is of ................................................................ son of ................................... V脱端hs丹端y綻 A測M辿 探続脱耽 Name of the Gazetted Officer V脱端hs丹端y脱綻 A測M辿 巽淡則辿 Designation of the Gazetted Officer 担綻即 ................................ 197 Dated ..................................... 197 V脱端hs丹端y脱綻 A測M辿 巽≒竪綻M脱端竪綻 Signature of the Gazetted Officer OFFICE SEAL M辿辿竪耽 竪綻則脱綻