Return of Corpus (RoC) for NTPC SCSB and NDCPS-2007 : Checklist

1. Summary Sheet
2. Freshly filled LIC Form N (containing the details of the RoC nominee and signed by
him/her) along with the Annuity no. and Policy no.
3. Discharge receipt (signed by the RoC nominee)
4. ECS/EFT Form (containing the bank details of the RoC nominee)
5. Copy of Passbook OR Cancelled cheque of the RoC nominee
6. Photo Identity proof of RoC nominee like PAN card, Voter ID, Aadhar card, Passport etc.
7. Death certificate of the Annuitant (Original OR Copy duly attested and stamped by HR
executive)
8. Copy of the nomination paper (PTF6/ NDCPS Form no. 6) submitted originally by the
annuitant

*If there are more than one RoC nominees, a different set of the above forms should be filled
by each nominee.

Joint Life pension for Spouse of Annuitant for

NTPC SCSB and NDCPS-2007 : Checklist

1. Summary Sheet
2. Freshly filled LIC Form N (SCSB PTF-6/ NDCPS Form no. 6) (containing the details of the
Spouse of Annuitant and signed by him/her) along with the Annuity no. and Policy no.
3. Discharge receipt (signed by the Spouse of Annuitant)
4. ECS/EFT Form (containing the bank details of the Spouse of Annuitant)
5. Copy of Passbook/ Cancelled cheque of the Spouse of Annuitant
6. Photo Identity proof of Spouse of Annuitant like PAN card, Voter ID, Aadhar card,
Passport etc.
7. Death certificate of the Annuitant (Original OR Copy duly attested and stamped by HR
executive)
 Summary Sheet
For Return of Corpus (RoC)/ Joint Life Pension Claim

The Manager (P&GS)

LIC of India, Delhi Divisional Office-I
Jeevan Prakash, 6th, 7th Floor,
25, K. G. Marg,New Delhi-110001

Dear Sir/Madam,

I request for _____________________________{Return of Corpus (RoC)/ Joint Life Pension}.

The details are as follows:

1. NTPC Employee no.: _______________________________________________________

2. Annuity no.: ______________________________________________________________
3. Master Policy No.: _________________________________________________________
4. Name of Annuitant: ________________________________________________________
5. Date of Death of Annuitant: __________________________________________________
6. Name of Nominee: _________________________________________________________
7. Date of Birth of Nominee: ___________________________________________________
8. Relationship with the Annuitant: ______________________________________________
9. Share percentage: __________________________________________________________
10. PAN no. of Nominee (if any): ________________________________________________
11. Phone no./ Mobile no.: ______________________________________________________
12. Email id: _________________________________________________________________
13. Address of Nominee: _______________________________________________________
_________________________________________________________________________

Yours Faithfully,

(Signature of the beneficiary) (Signature of Head of HR) (Signature of Secretary Trust)

Name Name: Name:
Date: Date: Date:
Seal: Seal:
LIC Form N

Annuity No.-________________________________
Master Policy No.-___________________________
The Manager (P&GS)
LIC of India, Delhi Divisional Oflice-1
Jeevan Prakash, 6th, 7th Floor,
25, K. G. Marg,New Delhi-I l0001

Dear Sir/Madam,

Name of Member: ----------------------------------------------------------------------- Emp. No: ---------------------------

We hereby direct, authorize & empower you to pay on our behalf as our agent to the under mentioned members, who have left or
retired from service of NTPC Limited/died while in service of NTPC, the respective pension amounts shown against their names
in the list below after deduction of Income Tax and other taxes & duties, particulars of which have also been given below:
.
Membership Name & Address of Due date of pension Amount of Pension Income Tax Net amount payable
No. the member/ deduction if any
beneficiary
Refer note below at Refer note at # Pension payable minus
$ below tax if any

$: Based on the accumulated corpus in member account at the time of vesting and as per the pension option chosen by him/her. /
#: As per the applicable provisions of Income Tax Act.

We likewise direct, authorize & empower you to pay on our behalf and as our agent, to the under mentioned beneficiaries of
deceased member the pension payments shown against their names in the fist below after deduction of Income Tax and other
taxes & duties if any applicable, particulars of which have also been given below:

Name & Address of the Date of birth of Amount of Purchase price Income Tax Net amount
nominee with nominee(s) refundable (specify % share net deduction payable
Relationship to the payable to each nominee in if any
Annuitant case of more than one
nominee).
As applicable Purchase price
minus tax if
any.

We hereby admit and acknowledge that the above mentioned payments which shall be made by you shall be in full settlement of
payments due to us and we hereby declare that receipts signed by the payee shall be sufficient, valid and legal discharge to you
for the respective payments made to them and shall be fully binding on us as if the payments had. been made to us and the
receipts signed by us.

Dated at__________________ this____________day of__________20--

Yours Faithfully,

(Signature of the beneficiary) (Signature of Head of HR) (Signature of Secretary Trust)

Name Name: Name:
Date: Date: Date:
Seal: Seal:
 DISCHARGE RECEIPT

Received a sum of Rupees ____________________________/-

(Rupees_________________________________________________________)
from the Life Insurance Corporation of India , Delhi DO-I, in full and final
settlement of my claims and demands under Master Policy No. ___________ on
death of Sh/ Smt ___________________, Emp. No__________________on
___________________

Dated at _____________ on this ____________ day of _____________ 20___

Witness by:
Head of HR of Unit Signature of the RoC nominee/ Spouse:
Signature Name of the RoC nominee/ Spouse:
Name & Seal Contact No:
Date& place Name of Member (Employee):

Signature of Secretary Trust

Seal:
LIC NECS/ NEFT Form

LIFE INSURANCE CORPORATION OF INDIA

Divisional Office-1, Pension & Group Schemes Unit
"Jeevan Prakash", 6th & 7th Floor, 25, KG Marg,
New Delhi – 1100001, Ph. 011 23350678, Fax 011 23350832

Master Policy No. _________________

Annuity No. ___________________________
1. Name of A/c Holder: ______________________________________________________

2. Particulars of Bank Account :

A. Bank Name :

B. Branch Address and Brach Code No. if any :

C. 11 digit IFS Code (IFSC) :

D. Account type (Saving/ Current/

Cash Credit Account) :

E. Account Number :
(Pl mention complete core banking account number and also enclose a blank cancelled cheque
issued by bank for verifying the account number and IFSC or a Clear copy of the Passbook)

I, hereby, declare that the particulars given above are correct and complete. If the transaction is
delayed or not effected at all for reasons of incomplete or incorrect information, I would not hold
the user institution responsible. I have read the option invitation letter and agree to discharge the
responsibility expected of me as a participant under the scheme.

___________________
Signature of the A/c holder

Mobile No. ___________________

Email id :____________________

(Attestation by Bank Officials is optional)

Certified that the particulars furnished above are correct as per bank records.

Bank's Stamp: Signature of Authorized official

from the bank

Tel/Fax No.______________
(Attestation of Bank Officials is advisable for correct bank particulars but not is mandatory)