TRANSFER FORM A

Life Insurance Corporation of India

TO BE COMPLETED BY MEMBER

I, __________________________________________________________________a member of
the
___________________________________________________________________
Scheme/Fund
hereby
request
the
Trustees
of
________________________________________________Scheme/Fund
to
transfer
in
accordance with Rule __________________________________ of the Rules of the said
Scheme/Fund the value of the benefits secured under the Assurance/ Annuities by the
contribution paid by Messrs ________________________________________ in my respect
upto the date of my leaving the said __________________________________ (company) on
______________________________ (Date of leaving service of the employer) to
______________________ Scheme/Fund of M/s. ___________________________________ of
which I have become a member having joined their service.
In consideration whereof, I hereby agree and declare that this authority and the transfer
made in pursuance of such authority shall constitute of complete & sufficient discharge in full
satisfaction of all my claims and rights secured by the contributions amounting to
Rs.___________________________________________________________________________
paid by the Trustees to the Life Insurance Corporation of India under the_______________________________________________________________ Scheme/Fund and
the Master Policy No. ______________________________________
Dated at _____________________ this ___________ day _________ 20 _______
Revenue Stamp of Re. 1 .00

Signature in Full
(Member)
WITNESS
Signature
Designation
Name in full
Address

:
:
:
:
:

This is to certify that we have included name of Sh. _________________________ Under Ass
No. ____________in our scheme. We have been allowed to accept transfer of equitable interest
by income tax authorties.
(New Trustees )

TRANSFER FORM B

Authority Letter cum Discharge Receipt

( TO BE COMPLETED BY TRUSTEES OF SCHEME FROM WHICH
TRANSFER IS TO BE MADE )

Shri ______________________________________________ has ceased to be a member

of __________________________________________________________ Superannuation Fund
with effect from ___________ by virtue of his having left the services of ___________________
and has now become member of M/s. __________________________________ Superannuation
Fund ________________________ w.e.f. _______________ he having joined their service. The
said Shri _______________________________________________________ desires to transfer
his equitable interest in the __________________________ Superannuation Fund corresponding
to the contributions paid on his behalf by M/s ________________________________________
Superannuation Fund .
We, the Trustees of ____________________________ fund have obtained the consent of
M/s. _______________________________________ and the Revenue Authorities to effect such
a transfer and have also ascertained from the Trustees of ___________________________ Fund
that they are willing to accept such a transfer.
We hereby direct authorise and empower the Life Insurance Corpn of India to effect the
transfer of the value of Assurance/Annuities with the Corporation in respect of
Shri___________________________________________________ secured by the contributions
amouting to Rs. _______________________ paid to M/s. ____________________________ in
accordance with the provision of the Rules of ___________________________________
Superannuation Fund to the Trustees of _________________________________ Fund.
We further agree and declare that such a transfer shall constitute a complete, sufficient
and valid discharge to the Corporation in full satisfaction of all our claims and demands under
the Master Policy No.___________________, in respect of the said Shri
______________________
dated
at
_____________________________
on
this
________________________________ day of____________ 20 ________________.
Revenue Stamp of Re. 1
for Self & Co-Trustees of Fund
WITNESS

Signature

Designation

Name in Full

Address