Life Certificate against THDCIL Employees’s Defined Contribution Superannuation Pension Fund Master

Policy No. NGSCA 20444240 is to be mandatorily submitted by each pensioner as per Pension option
which is as below:

A. Annuity for life with Return of Capital (ROC) : Life Certificate is to be submitted once in 05 Years to
LIC Office

B. Annuity for Life : Life Certificate is to be submitted every year to LIC Office

C. Annuity for 5 Years certain & Life thereafter : Life Certificate is to be submitted after 05 years and
their after in every year to LIC Office.

D. Annuity for 10 Years certain & Life thereafter: Life Certificate is to be submitted after 10 years and
their after in every year to LIC Office.

E. Annuity for 15 Years certain & Life thereafter : Life Certificate is to be submitted after 15 years and
their after in every year to LIC Office

F. Annuity for 20 Years certain & Life thereafter: : Life Certificate is to be submitted after 20 years and
their after in every year to LIC Office

G. Annuity for Life with a provision for 100 % of the annuity payable to the spouse on death of
annuitant : Life Certificate is to be submitted every year to LIC Office

H. Annuity for Life with a provision for 100 % of the annuity payable to the spouse on death of
annuitant with return of Capital (ROC) purchase price on death of last annuitant : Life Certificate is to
be submitted once in 05 Years to LIC Office

Format of Life Certificate is enclosed

 LIFE INSURANCE CORPORATION OF INDIA
LIC P&GS UNIT, NEW CONNAUGHT PLACE,
..,era ncl-, A*REI" f47.1
LIFE INSURANCE CORPORATION Of INDIA DEHRADUN-248001
TEL : 0135-2715793, 2715155, 2711541
E-mail : bo_g204(glicindia.com FAX NO : 0135-2652764
Existence Certificate
This is to certify that Shri/Smt./Km

S/o, W/o, D/o, Shri the annuitant

beneficiary underAnnuity No

appeared before me today in person and appended his/her signature/thumb impression here under in my

presence.

Signature / Thumb Impression

Signature to the Attesting Authority

Date
Date

Date of Birth of the Name

Annuitant/beneficiary

Designation

Gross Installment Amount Address

(Annuity amount p.m)

Office Seal

Address

Mobile No

Email Id

This certificate may be obtained from a Magistrate! Gazetted Officer! Bank Manager!
/ LIC Class-I Officer! Principal of any College by the annuitant/ beneficiary by presenting himself
/ herself before the Authority.

NOTE : IF THERE IS ANY CHANGE IN YOUR ADDRESS AND CONTACT MOBILE NO.
PLEASE WRITE DOWN YOUR NEW ADDRESS.