{"id":2291,"title":"AIM FORM FOR PAYMENT OF GRATUITY","purpose":"claim","insurer":{"slug":"lic","name":"Life Insurance Corporation of India"},"source_pdf":"https://licindia.in/documents/d/guest/gratuity-claim-form","sha256":"7b468c0c667565aa191fc5b715405831b576581b42dd16ac8cbc1a770733acf7","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for submitting a gratuity claim under a group insurance scheme, to be filled by the claimant or authorized signatory.","notes":["Please affix a Re.1/- Revenue Stamp.","Original Death Certificate or Death Extract must be enclosed in case of death."],"title":"AIM FORM FOR PAYMENT OF GRATUITY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claim Details","fields":[{"help":"","type":"text","label":"Master Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Scheme","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"LIC identification number of the member","type":"text","label":"LIC ID No","options":[],"required":null,"pdf_field":""},{"help":"Member's date of birth","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Date when the member was appointed","type":"date","label":"Date of Appointment","options":[],"required":null,"pdf_field":""},{"help":"Member's normal retirement date","type":"date","label":"Date of normal retirement","options":[],"required":null,"pdf_field":""},{"help":"Date when the member exited service","type":"date","label":"Date of Exit","options":[],"required":null,"pdf_field":""},{"help":"Cause of death if applicable","type":"text","label":"b) In case of Death Cause of Death","options":[],"required":null,"pdf_field":""},{"help":"Place where death occurred","type":"text","label":"Place of Death","options":[],"required":null,"pdf_field":""},{"help":"Time of death","type":"text","label":"Time of Death","options":[],"required":null,"pdf_field":""},{"help":"Basic salary plus Dearness Allowance at exit date","type":"amount","label":"Salary (Basic + DA) as on the date of exit","options":[],"required":null,"pdf_field":""},{"help":"Dates of any break in service","type":"text","label":"Break in Service (if any) 1. From / to","options":[],"required":null,"pdf_field":""},{"help":"Total qualifying years of service","type":"number","label":"Number of years of service qualifying for Gratuity","options":[],"required":null,"pdf_field":""},{"help":"Amount of gratuity payable as per rules","type":"amount","label":"Gratuity Payable as per rules","options":[],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of authorized person","type":"signature","label":"Signature of the Authorised Signatory","options":[],"required":null,"pdf_field":""},{"help":"Official seal","type":"text","label":"Seal","options":[],"required":null,"pdf_field":""}],"filled_by":"Authorized Signatory"},{"title":"Form of Discharge for Payment of Benefits","fields":[{"help":"Master policy number","type":"text","label":"MASTER POLICY NO :","options":[],"required":null,"pdf_field":""},{"help":"Amount received in rupees","type":"amount","label":"Sum of Rs.","options":[],"required":null,"pdf_field":""},{"help":"LIC ID of member","type":"text","label":"LIC ID","options":[],"required":null,"pdf_field":""},{"help":"Name of member","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Employee number","type":"text","label":"Employee Number","options":[],"required":null,"pdf_field":""},{"help":"Date of exit","type":"date","label":"Date of Exit","options":[],"required":null,"pdf_field":""},{"help":"Select mode of exit","type":"choice","label":"Mode of Exit (Death/ Maturity/ Resignation)","options":["Death","Maturity","Resignation"],"required":null,"pdf_field":""},{"help":"Claim amount in rupees","type":"amount","label":"Claim amount Rs.","options":[],"required":null,"pdf_field":""},{"help":"Date of discharge","type":"date","label":"Dated at this day of 20","options":[],"required":null,"pdf_field":""},{"help":"Signature of witness","type":"signature","label":"Witness Signature","options":[],"required":null,"pdf_field":""},{"help":"Signature and seal of trustees","type":"signature","label":"Signature of the Trustees (With Seal)","options":[],"required":null,"pdf_field":""}],"filled_by":"Trustees"}],"deadlines":[],"applies_to":"","attachments":["Original Death Certificate / Death Extract (to be enclosed if applicable)","Re.1/- Revenue Stamp"],"declarations":["The answers to all the questions are true in every respect.","The trustees acknowledge receipt of the claim amount in full satisfaction and discharge of all claims under the Master Policy."],"dropped_labels":10},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/lic/2291-aim-form-for-payment-of-gratuity"}