|
| ||||
Home>>Bare Acts>>Back to Index | |||||
| |||||
FORM 24A: MATERNITY BENEFIT AFTER THE DEATH OF AN INSURED WOMAN LEAVING BEHIND THE CHILD Regulation 89A CLAIM FOR BENEFIT Claim arising from the death on _______________________ of (insured woman)__________ wife/daughter of _______________ having Insurance No _____________ and last employed by ____________ I_________________________ (state relationship if any with the deceased _____ of the above named insured person, being her nominee/ her legal representative (she having left no nominee) claim maternity benefit for the period from ______ to ________ I declare that the deceased insured person died on ___________ leaving behind the child who is still alive/who also died on _____________ The amount due may be paid to me to money order or in cash at the Local Office. I declare that the particulars given above are true to the best of my knowledge and belief. Signature or thumb impression of the claimant Present address _____________________ Dated ____________ Certified that the declarations made above are true to the best of my knowledge and belief. Signature _____________ Designation _____________ (Rubber stamp or seal of the attesting authority) This certificate is to be given by (i) an officer of the Revenue, Judicial or Magisterial Departments of Government; or (ii) a Municipal Commissioner; or (iii) a Workmen's Compensation Commissioner; or (iv) the Head of Gram-Panchayat under the official seal of the Panchayat; or (v) the employer of the deceased insured person; or (vi) any other authority approved by the appropriate regional office. Note: Any person who makes a false statement or representation for purpose of obtaining benefit whether for himself or for some other person renders himself liable to prosecution. | |||||
| |||||
| |||||
| |||||
Home | Law Dictionary | Law Schools | Law Digest | Bare Acts | Disclaimer | Privacy Policy | |||||
| |||||
|
Copy right : Indu Info (All rights reserved)