Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697803821464.pdf (India)
PRE-RECEIPT FOR PAYMENT OF NGIF SURVIVAL BENEFIT 1.

Date of joining NGIS_______ Service in lower deck(if any) ________ to _______P.No.

(Sailor) _____ 2.

Date of promotion to Midshipman ______________________ 3.

Date of Birth _________________ 4.

Date of Commission ____________________ 5.

Date of Retirement ______________________ 6.

Whether eligible for cover under PRDIES-82 : YES/ NO 7.

Received from the Secretary, NGIF a sum of Rs.


_____________________ (Rupees _____________ ____________________) on account of following payable :- (a) Survival benefits from General Scheme (b) Survival benefits (Service as Sailor) (c) Terminal bonus (General Scheme) (d) Survival benefits from Addl Scheme for___________ (Aviators/ Submariners/ Chariators) (e) Terminal bonus (Additional Scheme) ___________ (f) Sum Assured for Disability ........ % 8.
Deductions :- (a) Single non-refundable premium towards PRDIES-82 (b) Recovery of outstanding balance of NGIF HBL (c) Recovery of outstanding balance of ____________ (d) Recovery of outstanding balance of ____________ Amount Payable (__________________________ ) : Rs.

_________________________ : Rs.

_________________________ : Rs.

_________________________ : Rs.

_________________________ : Rs.

_________________________ : Rs.

_________________________ Total : Rs.

_________________________ : Rs.


_________________________ 9.

Certified that :- (a) I have not received any amount on account of above earlier.
(b) I have been on deputation to ______________________ from ____________ to _____________ (c) I am/am not member of Addl GIS (Aviators/Submariners/IMSF) from____________ to ________ (d) I have/have not availed NGIF housing loan amounting to Rs.

__________ in the year _____ for the house/flat at _________.

I have paid _______ instalments of Rs.

______ each.

(Fill dd/mm/yyyy).

(e) I have/have not availed membership of SCUP through NGIF.

(f) I have/have not received INBA loan of Rs.


_____________ during 20_______ 10.

The amount may please be credited to my Bank Account.

My bank particulars are as follows :- (a) Bank Account No.
____________________________________________________________ (b) IFS Code _________________________________ (A leaf of cancelled cheque enclosed) (c) Name & full address of Bank (in block letters) ____________________________________________ ____________________________________________ ____________________________________________ Post Retirement Address :- ________________________________ ______________________________ Signature ________________________________ (Over one rupee revenue stamp) ______________________________ Name __________________________________ PIN ___________ Contact No.
____________ Rank _______________ P.No.

_____________ II COUNTERSIGNED Ship/Estb : Station : Date : APPLICATION FOR POST RETIREMENT DEATH INSURANCE EXTENSION SCHEME-1982 1.

Name ................................................................ Rank ........................... P.No.

...................... 2.

Last Ship/Estab......................................................................................................................... 3.
Reason of retirement – Superannuation/ Premature/ Invalidment/ Expiry of Engagement.

4.

Date of (a) Birth ....................................... (b) Commission/Enrolment .................................. (c) Type of Commission : Pmt/ SSC (d) Date of Retirement/discharge .............................. 5.
(a) Age on retirement......................................... Medical Category on retirement ................... (b) Percentage of disability awarded if any : % (c) Whether you were/are a member of Additional Naval Group Insurance Schemes for Aviators/Submariners/IMSF and if so, period of membership as Aviator/Submariner/IMSF from .......................... to .............................. (d) Service rendered in lower deck from ................. to ................ {P.No.
(Sailor) .....................} 6.

Post retirement contact address ......................................................................... e-mail ID : …………………….. ............................................................................ Landline No.

............................ ............................................................................

Mobile No.

................................ ....................................................PIN................... 7.
Name, relationship & full address of the nominee(s) for PRDIES (in capital letters) :- Name/Address of nominee(s) Relationship with individual Date of birth (DD/MM/YY) Amount payable to each in percent age Name, address and relationship of persons if any, to whom the right conferred in the event of the nominee predeceasing the nominee dying after the death of the individual receiving payment individual or before but the Amount payable in percent age Date : Signature of member ................................ Certified that the service particulars furnished by the above named officer are correct.
II Place : Date : CO/ Head of Department 2 ANNEXURE TO APPLICATION FOR POST RETIREMENT DEATH INSURANCE EXTENSION SCHEME-1982 JOINT PHOTOGRAPH OF MEMBER WITH NOMINEE(S) AND SPECIMEN SIGNATURE OF NOMINEE(S) OF P.No.......................... Rank ...................... Name ............................................ JOINT PHOTOGRAPH OF MEMBER WITH NOMINEE(S) Three specimen signatures each, of the nominee(s) Name Specimen Signatures (a) ................................................ (1) ............................ (2) ............................ (3) ........................ (b) ................................................ (1) ............................ (2) ............................ (3) ........................ (c) ................................................ (1) ............................ (2) ............................ (3) ........................ (d) ................................................ (1) ............................ (2) ............................ (3) ........................ (e) ................................................ (1) ............................ (2) ............................ (3) ........................ Place : Date : Signature of member ............................ --------------------------------------------------------------------------------------------------------------- FOR USE OF GIS SECTION Amount recovered for PRDIES ₹ ….............................
Date of recovery made Certificate No.

Allotted ................................. ................................. Period of insurance from ................................... to .....................................