Address: ________________________________

________________________________
________________________________
Contact No’s. ________________________________
Email ID: ________________________________
Date: ________________________________
To, PAN Card: ________________________________
Trustees,
SKF Bearing India Ltd., Superannuation Fund Scheme,
Chinchwad,
Pune – 411 033.

Subject: Settlement of my superannuation dues

Dear Sir,

I, the undersigned, ____________________________________ was in the Employment of your

company and have Resigned / vol. Retired / Retired / Terminated from the service of the
Company. My employment details are as under:

1. Date of Joining: _______________ 2. Emp. No.: ___________________

3. Date of Birth: _________________ 4. Date of Leaving: _____________

I am selecting one of the under given option for settlement of my Superannuation Dues (Tick
any one option)

a) As I do not intend take employment elsewhere, I request you to settle my

Superannuation dues, at the earliest.
b) At present I am in the employment with M/S ____________________________
____________________________ which does not have superannuation scheme. I,
therefore, request you to settle my superannuation dues, at the earliest.
c) As I am leaving India on _________________ and intend to settle abroad permanently,
I request you to settle my superannuation dues, at the earliest.

I would not/like to opt for commutation of 1/3rd amount of superannuation dues.

Thanking you,

Yours faithfully,

_________________________
Name:
 Life Insurance Corporation of India
P&GS Unit
-FORM OF ECS OPTION (ANNUITY PAYMENT)

To,
DIVISIONAL MANAGER(P&GS),
LIC OF INDIA,
PUNE, DIV. OFFICE,
JEEVAN PRAKASH, UNIVERSITY ROAD,
SHIVAJINAGAR, PUNE 411 005

DEAR SIR,

1. NAME OF ANNUITANT __________________________________

(BLOCK LETTERS)

2. ANNUITY NUMBER __________________________________

3. PARTICULARS OF BANK ACCOUNT

A) BANK NAME __________________________________

B) BRANCH NAME & ADDRESS_______________________________

4. 9-DIGIT CODE NO. OF THE BANK & BRANCH

APPEARING ON THE MICR CHEQUE ISSUED
BY THE BANK __________________________________
(PLEASE ATTACH THE XEROX COPY OF A
CHEQUE / A BLANK CANCELLED CHEQUE
ISSUED BY YOU BANK FOR VERIFYING
THE ACCURACY OF CODE NO _______________________________

5. ACCOUNT NUMBER ___________________________________

(APPEARING ON THE CHEQUE BOOK)

6. ACCOUNT TYPE (S.B./CURRENT A/C,

CASH CREDIT ACCOUNT) _____________________________

7. RESIDENTIAL ADDRESS WITH PIN CODE _____________________

8. CONTACT NUMBER ____________________________________

I HEREBY DECLARE THAT THE PARTICULARS GIVEN ABOVE ARE

CORRECT AND COMPLETE THE TRANCTION IS DELAYED OR NOT
EFFECTED AT ALL FOR REASONS OF INCOMPLETE OR INCORRECT
INFORMATION, I WOULD NOT HOLD THE LIC RESPONSIBLE I HAVE READ THE
OPTION INVITATION LETTER AND AGREE TO DISCHARGE THE RESPONSIBILITY
EXPECTED OF ME AS A PERTICIPANT UNDER THE SCHEME.

PLACE:
DATE: SIGNATURE OF THE ANNUITANT

PS CONFIRMATION HAVING STARTED PAYMENTS BY THE ECS SYSTEM

 GS CA FORM – 2

Name of the Company: ______________________________________________________________

Master Policy No.: __________________________________________________________________

Name of the employee: ______________________________________________________________

Emp. No. / LIC id no.: _______________________________________________________________

Address: __________________________________________________________________________

___________________________________________________________________________________

Date of Birth: _______________________________ Date of Joining: _________________________

Date of Exit: ________________________________ Cause: ________________________________

1/3 rd commutation if the member receives gratuity (1/2 if gratuity is not payable): is opted? Yes/No____

1/3 or 1/2 _________________________________________

Name of the spouse ______________________________ date of birth of spouse ____________________

Pension Options : 1. Life pension with return of capital.

2. Life pension with guaranteed payment for 5 years.
3. Life pension with guaranteed payment for 10 years.
4. Life pension with guaranteed payment for 15 years.
5. Life pension with guaranteed payment for 20 years.
6. Life pension ceasing at death.

Three specimen signatures of the member ________________ ________________ ________________

Three specimen signatures of the nominee ________________ ________________ ________________

Witnessed by: ______________________

Signature of Member .
Name & Address ___________________
__________________________________

Signature & Seal of the Trust

 LIFE INSURANCE CORPORATION OF INDIA
PUNE DIVISIONAL OFFICE
P&GS DEPTT.

APPOINTMENT OF BENEFICIARY

TO,
The Trustee.
_____________________
_____________________
_____________________

Dear Sir / Madam,

I, ____________________________________, a member of the group superannuation scheme, hereby

Appoint in the term of the “RULE” headed “APPOINTEMENT OF BENEFICIARY” in the rules
governing the scheme, my _____________(Relationship) named _________________________________
age _______ Years and whose Address is ____________________________________________________
_____________________________________ as the person to be the beneficiary to whom the money
payable under the scheme shall be paid in the event of my death.

Alternate nominees in case of the death of the first nominee are:

Name & Address Relation Payment ratio

Signed at ____________ this ______ day of ________ 20

Signature of the member

Sign & Seal of the Trustees
 LIFE INSURANCE CORPORATION OF INDIA
Pension And Group Scheme Deptt.
Pune Divisional Office – I

CERTIFICATE OF EXISTENCE

Annuity No ______________

I, _____________________________________ (Neighbor / Doctor / Bank Class -1 Officer / LIC

Class -1 Officer) hereby certify that, Shri / Smt. __________________________ son

/ daughter of ____________________________ was alive on ____________ having

personally seen him / her on / after that date.

Place: _____________

Annuitant Signature: __________________

Certifier By

Signature __________________

Name & Profession (in BLOCK LETTER)

 LIFE INSURANCE CORPORATION OF INDIA
Pension And Group Scheme Deptt.
Pune Divisional Office – I

CERTIFICATE OF EXISTENCE

Annuity No ______________

I, _____________________________________ (Neighbor / Doctor / Bank Class -1 Officer / LIC

Class -1 Officer) hereby certify that, Shri / Smt. __________________________ son

/ daughter of ____________________________ was alive on ____________ having

personally seen him / her on / after that date.

Place: _____________

Annuitant Signature: __________________

Certifier By

Signature __________________

Name & Profession (in BLOCK LETTER)

As per Superannuation Trust Deed and Income Tax rules, following options are available for
Settlement of Superannuation for employee who have opted for VRS / Resigned:

CHOICE A

Not available – As we got intimation from Income-Tax for revocation of this rule.

CHOICE B

Employee can opt for

- 1/3 amount payment which will be tax deductible. (At the rate of average income tax for
last three years)
- 2/3 amount will be paid thru LIC as monthly pension.

Form 16 for the Last 3 Years along with Income Tax Return copy for all the 3 years to be
attached.

CHOICE C

Employee can opt for the option that:

Entire amount is handed over to the LIC with monthly Pension payable to employee.

Choice: _________

_____________________
Name & No.
 LETTER OF AUTHORITY FOR PAYMENT OF PENSIONS

To,

LIFE Insurance Corporation of India,

P & GS Department,
Pune Divisional Office,
‘Jeevan Prakash’,
University Road,
PUNE – 411 005.

Dear Sir,

Re: Master Policy No. 639694, 709002356, 709004951

Name of Scheme SKF Bearing India Ltd, Superannuation Scheme

We hereby direct, authorize the empower you to pay on behalf and as our agent to the
undermentioned members who have retired from service, the respective pension amounts
shown particular of which have also been given in the list.

Master Pol. Name Due Dt. of Amount of I-Tax Debt. Net amount
Sr No. Pension Pension If any 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 we hereby declare that
the receipts signed by us.

Dated at Pune this _________ day of ________________ 20

Trustees of SKF Bearing India Ltd ______________________

Superannuation Scheme ______________________

______________________
Following documents are to be attached along with this set
1. Date of Birth Proof – Self
Nominee

Proof to be attached on of the following (Xerox Copy)

a) School Leaving Certificate
b) PAN Card
c) Passport

2. Xerox Copy of PAN Card

3. Cancelled Cheque

4. ITR’s of the Last three Years. e.g. (2019-20, 2020-21, 2021-22)

(If you opted CHOICE B)