Lic SUP Withdrawal Instruction
Content
Instruction for filling the LIC Superannuation Withdrawal Form
* Kindly first go through the below mentioned Important Notes and then start filling the form and take the print of form on 'LEGAL
Section :- I Shri / Smt:For payment of Pension for Type of Bank A/c Bank A/c No. In the Bank Address My Address for Correspondence Signature of Annuitant Date Write Full Name Choose any one option . Mention the Type of Bank A/c Mention Bank A.c No. Write Bank Name Write complete Branch Address of Bank Write your complete address , with contact No. and e mail id. Put your Signature Mention the Date
SIZE' Paper
Section :- II Shri / Smt:LIC of India Sum of Rs. Rupees Commuted Value Rs. Monthly Instalment Pension due Rs. Total Rs. Signature of Annuitant Witness Address Place & Date Write Full Name Keep it Blank Keep it Blank Keep it Blank Keep it Blank Keep it Blank In the mentioned Box Put 1 Rs. Revenue Stamp and Sign across the same. Mention Witness Signature ( Any Person can be a witness ) Mention Witness Address Mention Place and Date
Section :- III Shri / Smt:Pan No. Commuted Value Rs. Total Pension Instalments dues to Total Amt, Less Income Tax & Net Amt Payable Place & Date Signature of Trustees Write Full Name Put your Pan No. (If Place is not mentioned for Putting PAN No. then put it any where in Section III as it is mandatory) Keep it Blank Keep it Blank Keep it Blank Mention Place and Date Here Trustee will sign ( You should not sign here )
Section :- IV Shri / Smt:Nominate Shri / Smt. Age Related to me as Signature of Annuitant Signature of Nominee Witness Address Place & Date Write Full Name Mention Nominee Name Age of Nominee Relation with Nominee Put your Signature Nominee Signature is required Mention Witness Signature ( Any Person can be a witness ) Mention Witness Address Mention Place and Date
Last Page Intimation of Retirement / Death / Leaving Service 1 2 (a) (b) 3 4 Name of Member LIC Membership Number Salary Roll No. / Identity No. Date of Birth Date of Exit Select whichever is applicable Write Full Name Put LIC Policy No. as 611672 and your Lic ID Mention Your Employee No. Mention your Birth Date Mention your Resignation Date
5 (a) (b) 6(a)
Cause of Exit In Case of Death , Cause of Death Final contribution, if any , on cessation of sercies Whether Option to commute Part of Pension exercised or Not
Mention Reason for Exit Keep it Blank ( applicable in Death Case only) Keep it Blank
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Here Tick Yes if you want some portion of your corpus as lumsum commutation and some portion as pension Tick NO. If you want only Pension on whole Corpus.
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If the answer Yes , what Proportion
Tick 1/3 if your service is more then 5 yrs with ICICI Tick 1/2 if your Service is less then 5 yrs with ICICI
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Type of Pension Option elected Select 6. Choose the option
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Mode of annuity In case of Pension is immediate , Particulars of Member of Beneficiary Address If pension to Beneficiary Name and Date of Birth of the Beneficiary 2 Specimen Signature of Member & Beneficiary Name , Address of Bank & A.c No.
Select How you want the pension Mly / Qly / Hly / Yly
Write Full Name Write your complete address , with contact No. and e mail id. Write Nominee's Name and Birth date Mention your and your Nominee's two specimen signature Mention your Bank Name , A.c No. and Branch address
11 (i)
(ii) (iii) (iv)
Importants Notes.
If services is less then 5 Yrs :- then 50% of the corpus will be paid Lumsum within 45 days from submission of form to LIC & on balance 50% pension will be payable, Mly/QlyYly as per option selected
1
If services is more then 5 Yrs :- then 1/3 of the corpus will be paid a s Lumsum within 45 days from submission of form to LIC & on balance 2/3 pension will be paid Mly/QlyYly as per option selected 2 3 4 5 Pension will start from next financial year , from which a form is submitted to LIC Your Pan Card No. is Mandatory. Pls. attach a copy of your Pan Card Attach a Blank Cancelled Cheque
6 7
Annuitant means Employee himself In LIC for Pension you can contact Mrs. Shraddha or Sunita on 66599104 /105 / 106
Pls. send the form at the following address : PF Section - Payroll Team BANK LTD ICICI 5th Floor, Near Floral Near Seepz, Andheri ( E ) Trans Trade Centre, Deck Plaza, MIDC, Mumbai 400 093
* Kindly first go through the below mentioned Important Notes and then start filling the form and take the print of form on 'LEGAL
Section :- I Shri / Smt:For payment of Pension for Type of Bank A/c Bank A/c No. In the Bank Address My Address for Correspondence Signature of Annuitant Date Write Full Name Choose any one option . Mention the Type of Bank A/c Mention Bank A.c No. Write Bank Name Write complete Branch Address of Bank Write your complete address , with contact No. and e mail id. Put your Signature Mention the Date
SIZE' Paper
Section :- II Shri / Smt:LIC of India Sum of Rs. Rupees Commuted Value Rs. Monthly Instalment Pension due Rs. Total Rs. Signature of Annuitant Witness Address Place & Date Write Full Name Keep it Blank Keep it Blank Keep it Blank Keep it Blank Keep it Blank In the mentioned Box Put 1 Rs. Revenue Stamp and Sign across the same. Mention Witness Signature ( Any Person can be a witness ) Mention Witness Address Mention Place and Date
Section :- III Shri / Smt:Pan No. Commuted Value Rs. Total Pension Instalments dues to Total Amt, Less Income Tax & Net Amt Payable Place & Date Signature of Trustees Write Full Name Put your Pan No. (If Place is not mentioned for Putting PAN No. then put it any where in Section III as it is mandatory) Keep it Blank Keep it Blank Keep it Blank Mention Place and Date Here Trustee will sign ( You should not sign here )
Section :- IV Shri / Smt:Nominate Shri / Smt. Age Related to me as Signature of Annuitant Signature of Nominee Witness Address Place & Date Write Full Name Mention Nominee Name Age of Nominee Relation with Nominee Put your Signature Nominee Signature is required Mention Witness Signature ( Any Person can be a witness ) Mention Witness Address Mention Place and Date
Last Page Intimation of Retirement / Death / Leaving Service 1 2 (a) (b) 3 4 Name of Member LIC Membership Number Salary Roll No. / Identity No. Date of Birth Date of Exit Select whichever is applicable Write Full Name Put LIC Policy No. as 611672 and your Lic ID Mention Your Employee No. Mention your Birth Date Mention your Resignation Date
5 (a) (b) 6(a)
Cause of Exit In Case of Death , Cause of Death Final contribution, if any , on cessation of sercies Whether Option to commute Part of Pension exercised or Not
Mention Reason for Exit Keep it Blank ( applicable in Death Case only) Keep it Blank
7
Here Tick Yes if you want some portion of your corpus as lumsum commutation and some portion as pension Tick NO. If you want only Pension on whole Corpus.
8
If the answer Yes , what Proportion
Tick 1/3 if your service is more then 5 yrs with ICICI Tick 1/2 if your Service is less then 5 yrs with ICICI
9
Type of Pension Option elected Select 6. Choose the option
10
Mode of annuity In case of Pension is immediate , Particulars of Member of Beneficiary Address If pension to Beneficiary Name and Date of Birth of the Beneficiary 2 Specimen Signature of Member & Beneficiary Name , Address of Bank & A.c No.
Select How you want the pension Mly / Qly / Hly / Yly
Write Full Name Write your complete address , with contact No. and e mail id. Write Nominee's Name and Birth date Mention your and your Nominee's two specimen signature Mention your Bank Name , A.c No. and Branch address
11 (i)
(ii) (iii) (iv)
Importants Notes.
If services is less then 5 Yrs :- then 50% of the corpus will be paid Lumsum within 45 days from submission of form to LIC & on balance 50% pension will be payable, Mly/QlyYly as per option selected
1
If services is more then 5 Yrs :- then 1/3 of the corpus will be paid a s Lumsum within 45 days from submission of form to LIC & on balance 2/3 pension will be paid Mly/QlyYly as per option selected 2 3 4 5 Pension will start from next financial year , from which a form is submitted to LIC Your Pan Card No. is Mandatory. Pls. attach a copy of your Pan Card Attach a Blank Cancelled Cheque
6 7
Annuitant means Employee himself In LIC for Pension you can contact Mrs. Shraddha or Sunita on 66599104 /105 / 106
Pls. send the form at the following address : PF Section - Payroll Team BANK LTD ICICI 5th Floor, Near Floral Near Seepz, Andheri ( E ) Trans Trade Centre, Deck Plaza, MIDC, Mumbai 400 093
