{"id":2292,"title":"Discharge Receipt","purpose":"claim","insurer":{"slug":"lic","name":"Life Insurance Corporation of India"},"source_pdf":"https://licindia.in/documents/d/guest/gsli-discharge-pdf","sha256":"c1a8afcf6d7c9fb44d2dd0561c0993f775ab81ad32b4dd1555e43f1fb28a8e8f","pages":1,"collected":"2026-10-20","instructions":{"about":"This form is a discharge receipt acknowledging the full settlement of claims under a master policy by the policyholder or claimant.","notes":["Please affix a Re.1/- Revenue Stamp on the form."],"title":"Discharge Receipt","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Discharge Receipt Details","fields":[{"help":"Enter the master policy number","type":"text","label":"Master Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Enter the amount received in figures and words","type":"amount","label":"We, ----------------do hereby acknowledge receipt from Life Insurance Corporation of India, the sum of Rs ----------- ( Rupees ------------------------------------------------ only)","options":[],"required":null,"pdf_field":""},{"help":"Enter the place and date of signing","type":"date","label":"Dated at -------------------------------this ----------- day of --------------------------20","options":[],"required":null,"pdf_field":""},{"help":"Signature of the witness","type":"signature","label":"Witness Signature","options":[],"required":null,"pdf_field":""},{"help":"Designation of the witness","type":"text","label":"Designation","options":[],"required":null,"pdf_field":""},{"help":"Address of the witness","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Signature and seal of the Master Policyholder","type":"signature","label":"Signature of the MPH (With Seal)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or claimant"}],"deadlines":[],"applies_to":"claims under the master policy of Pension & Group Schemes","attachments":[],"declarations":["The claimant acknowledges receipt of the full claim amount in satisfaction and discharge of all claims under the master policy."],"dropped_labels":1},"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/2292-discharge-receipt"}