INDEMNITY BOND
Whereas the State Life had required the claimant (Mother) to produce Guardianship Certificate for enabling her to collect the shares of her minor children on account of proceeds of Group Insurance Policy of her late husband Mr. Muhammad Aslam S/O Ahmad Hussain as Rodman at District Officer On-Farm Water Management Vehari and whereas the claimant expressed her inability to produce the Guardianship Certificate on account of certain difficulties and in view of this the State Life has agreed to make the payment. Therefore, in consideration of Payment of Rs……………..(Rupees…………………………………..……………………………Only) without the certificate the amount of claim made by the State Life Insurance Corporation of Pakistan, Group and Pension Division under Group Term Assurance Contract executed between Haseena Bibi and State Life Insurance Corporation of Pakistan Group & Pension Division on behalf of her minor children. We:- Haseena Bibi (Name of Claimant (Mother) Muhammad Amjad District Officer OFWM Vehari (Name of the Surety Class-I Officer) the undersigned do hereby declare and agree to bind ourselves to indemnify and save harmless the State Life Insurance Corporation of Pakistan, their executors, administrators or assigns severely and jointly to be the extent of the aforesaid amount of Rs. …………. with any other loss, cost of expenses which the Group & Pension Division might suffer in respect with and on account of making the said PAYMENT.
Signed at ________________this ________________ day of ______________2016
- _________________________ 2. __________________________
(Signature of Surety) (Signature of Claimant (Mother)
Name: Muhammad Amjad Name: Haseena Bibi
Designation District Officer Address: Chak Azeemwala
OFWM Danewal Town Vehari P.O. Tibba Sultan Pur Tehsil Mailsi
District Vehari
WITNESS WITNESS
Signature: ________________ Signature: __________________
Name: Muhammad Akhtar Name: Sh. Mazhar Hussain
Designation: Superintendent Designation: Senior Clerk
Address: O/O District Officer Address: O/O Dy. District Officer
OFWM Vehari OFWM Vehari
FORMAT ONLY
To,
The Deputy Manager Claims
State Life Ins. Corp. of Pakistan,
GROUP & PENSION DIVISION,
15-A, Sir Agha Khan Some Road
LAHORE
Sub: GROUP INSURANCE CASE OF MR. MUHAMMAD ASLAM RODMAN (LATE) TO IS FAMILY:
The Group Insurance case of Mr. Muhammad Aslam S/O Ahmad Hussain, was sent to your office vide letter under reference, but the response i still awaited.
The official died while working as Rodman (BS-3), on Regular basis in the office of District Officer OFWM. Vehari, on 16/04/2016. (May Allah rest his soul in peace).
He was a regular employee and Group Insurance was being deducted regularly from his pay. The following documents are enclosed herewith.
1) Death Certificate
2) Obituary Notice
3) Retirement Order
4) Computerized Pay Slip
5) Request of the widow
6) Pension Payment Order(PPO)
7) List of Family Members
8) CNIC of deceased and other family members
9) Copy of Service Book
10) Indemnity Bond
It is therefore requested that his case for Death Claim may kindly be processed.
OFFICE STAMP