PART C:

We __________________________________________________________________________ hereby acknowledge receipt from Life Insurance Corporation of India a sum of Rs. ___________________ (Rupees ____________________________________________________________________________ ) in full and final satisfaction and discharge of all our claims under the above master policy on the life of member ______________________________________.


Dated at _________________ this _________________ day of _______________ 200 .

PART D:

Please send the claim amount by cheque to the credit of Savings Bank A/C. No.______________ held by the beneficiary with ________________________________________________________________ ___________________________________________________________________________________

(Name and Address of the Bank)