{"id":2305,"title":"CLAIM FORM (For claiming benefits under an annuity upon the death of the Annuitant)","purpose":"claim","insurer":{"slug":"lic","name":"Life Insurance Corporation of India"},"source_pdf":"https://licindia.in/documents/d/guest/annuity-claim-forms","sha256":"9e6b73a1701bf649bb8bfc1f0e0928570bd9f785b4cdaf5135fd7d6510cc3c2d","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for trustees under the Master policy to claim annuity benefits upon the death of the annuitant.","notes":["Please specify the shares of the nominees / heirs if there are more than one nominee / heir to whom the claim is to be paid and particulars of separate Bank A/C Nos.","Kindly return the discharge voucher after having dated, duly stamped and signed, and witnessed.","Please affix a Re.1/- Revenue Stamp on the discharge voucher."],"title":"CLAIM FORM (For claiming benefits under an annuity upon the death of the Annuitant)","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Scheme and Master Policy Details","fields":[{"help":"","type":"text","label":"Name of the Scheme","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Master Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Full Name & Address of the Master Policy Holder","options":[],"required":null,"pdf_field":""}],"filled_by":"trustees"},{"title":"Annuitant Details","fields":[{"help":"","type":"text","label":"Full Name of the Annuitant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Annuity No","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Vesting of Annuity","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of Death","options":[],"required":null,"pdf_field":""},{"help":"Specify cause of death","type":"text","label":"Cause of Death","options":[],"required":null,"pdf_field":""}],"filled_by":"trustees"},{"title":"Beneficiary Details","fields":[{"help":"Full name and address","type":"text","label":"Name and Address of the Beneficiary to whom the claim amount is payable","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship of the Beneficiary with the Annuitant","options":[],"required":null,"pdf_field":""},{"help":"Provide guardian details if beneficiary is minor","type":"text","label":"If the Beneficiary is a minor, state name & address of the guardian","options":[],"required":null,"pdf_field":""},{"help":"Provide mobile number and email id","type":"text","label":"Mobile No. and Email id of the nominee:","options":[],"required":null,"pdf_field":""}],"filled_by":"trustees"},{"title":"Beneficiary's Bank Details","fields":[{"help":"Account number of the nominee","type":"text","label":"A/c No of the nominee","options":[],"required":null,"pdf_field":""},{"help":"Name of the bank where account is held","type":"text","label":"Name of the bank","options":[],"required":null,"pdf_field":""},{"help":"Branch of the bank","type":"text","label":"Branch Name","options":[],"required":null,"pdf_field":""},{"help":"IFSC code of the bank branch","type":"text","label":"IFS Code of the bank branch","options":[],"required":null,"pdf_field":""}],"filled_by":"trustees"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature and seal of the trustee","type":"signature","label":"SIGNATURE OF THE TRUSTEE (With seal)","options":[],"required":null,"pdf_field":""}],"filled_by":"trustees"},{"title":"Form of Discharge for Payment of Return of Capital on Death of the Annuitant","fields":[{"help":"","type":"text","label":"Master Policy No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Annuity No(s)","options":[],"required":null,"pdf_field":""},{"help":"Amount in rupees","type":"amount","label":"Return of Capital Amount","options":[],"required":null,"pdf_field":""},{"help":"Specify due dates and amount","type":"amount","label":"Annuities due prior to death (Due date from to )","options":[],"required":null,"pdf_field":""},{"help":"Specify due dates and amount","type":"amount","label":"Excess annuities paid after date of death (Due date from to )","options":[],"required":null,"pdf_field":""},{"help":"Total amount payable","type":"amount","label":"Total Amount Payable","options":[],"required":null,"pdf_field":""},{"help":"Place and date of signing","type":"text","label":"Dated at this day of 20","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":""},{"help":"Signature of witness","type":"signature","label":"Witness Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"trustees"}],"deadlines":[],"applies_to":"benefits under an annuity upon the death of the Annuitant under the Master policy","attachments":["Photocopy of cover page of Pass Book of the above account or a cancelled cheque leaf"],"declarations":["The answers to all the above questions are true in every respect.","The above employee was a member of the Group Superannuation/Group annuity Scheme.","Request to credit the claim amount to the Claimant's Savings Bank A/C by NEFT mode.","Trustees acknowledge receipt of the payment in full satisfaction and discharge of all claims and demands due to the death of the annuitant."],"dropped_labels":3},"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/2305-claim-form-for-claiming-benefits-under-an-annuity-upon-the-death-of-the-annuitan"}