‘aT. /Branch No. are Sahar ert sareetter GRterst ater Ferrer LUPE RSURANEE CORPORATION OF MUA ag fra / dag tise / MUMBAI DIVISION (orga afufran 1956 =a aaa dentit) (staat afr frre afifrat 1956 ent eafit) (Established by the Life Insurance Corporation Act of 1956) BRIBE TTT Tas omer TTT PHF TT (Matured) ‘ere seer fer ait aT a ea DISCHARGE OF MATURED POLICY No.___Dated on the Life of Shri/Smt. avers “aire ‘way agent Reais ———— on rgharten amrt ara aacit eur aaa aude sensor ‘Seeeretia oe] ai corp tet gar argent aan anger cere aera a 2a aati ‘arroen gatear oie: siferre: eames Fares nth agieereaes erect ans. anh wera eq HATS HevisaTTs Yet Hea gach 3A. ve ‘Bre arate Reais ————__—$ arvana rege Sa PB ae a HH a SAT" eae aA a a FR Reser ap age Bs re etre wee Y/Y ate one ater / ar at arate ene or ae ‘at oe ait fra ea wear / Fa Brest rat is —————- a pi at otk ot eg atte em at Te er & ford She ore We the Life Assured / Assignee by virtue of the assignment dated_________________do hereby acknowledge receipt from the Life Insurance Corporation of India, the sum of Rupees (In words) = including the amount of Bonus, in full and final satisfaction and discharge of all my/our claims and demands under the above mentioned Policy which maturedon_____ and which Policy is hereby delivered upto the said Corporation to be cancelled. frm cae / eat AEA ee nease ater a / wer fee ‘Sum Assured / Paid-up Value . . Rs. ‘Frfen er] array Fafa at7H SHE Vested Bonus alloted. ” . B/Rs. arafCH aH /Interim Bonus és fa 7 “ B/Rs. few sith We @ aif aT TAT Lucky Printers 10,000 - 8 / 2008 NOTE _:_ Incase of dispute in respect of interpretation of terms the Engish version shall stand valid. 4