FORM -OISBSF I APPLICATION FOR ADMISSION Name : S. Code/Reg No: Department: 4. Date of Birth: 5. Date of Joining Service: 6. Date of Joining the Fund: 7. Permanent Address: 8. Details of Previous Membership Sl No. Name of the Organisation Date of Joining Date of Separation *(Confirmation of the previous organisation is to be attached) I being an employee of Oil India Limited, hereby request for membership of Oil India Superannuation Benefit Scheme Fund. Signature of the Applicant Witness : Name Emp ID Address Signature........ We hereby certify that the applicant is an employee of Oil India Limited. He may be admitted to membership of Oil India Superannuation Benefit Scheme Fund under Rule 5 of the Fund. We also certify that the particulars from Sl. No. 1 to 8 given above by the applicant are correct. ADMISSION Admission sanctioned from OISBSF Membership No. ADDITIONAL SECRETARY / SECRETARY FOR TRUSTEES
FORM-OISBSF- II APPLICATION FOR NOMINATION Name: S. Code/Reg No: Marital Status: 4. Address for Correspondence: I hereby nominate the following members of my family( as per para 2(L)of the Trust Rules) who would be eligible to receive pension in the event of my death. Or Certified that I have no family as defined in para 2(L) of of the Trust Rules and should I acquire a family hereafter I shall furnish particulars thereon in the above form. I hereby nominate the following person(s) for receiving the pension in the event of my death without leaving any eligible family member for receiving pension. Signature of the member _ CERTIFICATE BY EMPLOYER We hereby certify that the above declaration and nomination has been signed/thumb impressed before me by Shri/Smti./Kum who is an employee of OIL India Limited after he/she has read the entries/entries have been read over to him/her by me and got confirmed by him/her.
FORM - OISBSF- III PENSION CLAIM FORM I hereby furnish the following particulars for payment of my pension. (a) Name : (b) Permanent Address : Mobile No: Email (c) Bank Name : (d) Bank Branch: (e) Bank Account No : (f) Bank IFSC : (g) Annuity Option Opted: (Choose any one of the following) (i) Single Life (ii) Single Life with ROC (iii) Joint Life with ROC In case of Option (iii) ie Joint Life with ROC is opted: (a) Name of Spouse: (b) Date of Birth of Spouse: Signature of the member Enclosure: S.Code /Regd. No : (i) Photocopy of Bank Passbook Department : (ii) NEFT Mandate We hereby certify that the applicant is an employee of Oil India Limited and is entitled for pension under Oil India Superannuation Benefit Scheme Fund. We also certify that the particulars given above by the applicant are correct. For Office use only (Finance Department, Superannuation Section): Annuity Number allotted:
FORM -OISBSF- IV NOMINATION AND DECLARATION FOR RETURN OF CAPITAL (Applicable in case Annuity option exercised is Single Life with ROC or Joint Life with ROC) I hereby nominate the following members of my family who could be eligible to receive the Return of Capital, in the event of my death: * In case option opted is Joint Life with ROC, nominee for ROC cannot be the spouse. Or Certified that I have no family as defined in para 2(L) of the Trust Rules and should I acquire a family hereafter I shall furnish particulars thereof in the above form. I hereby nominate the following person(s) who could be eligible to receive the Return of capital, in the event of my death. I request you to take this on record and forward to LICI for necessary action. Signature of the member S.Code /Regd. No : Department : Witness : Name Emp ID Address Signature........ We hereby certify that the applicant is an employee of Oil India Limited and is entitled for pension under Oil India Superannuation Benefit Scheme Fund. We also certify that the particulars given above by the applicant are correct. For Office use only(finance Department, Superannuation Section):
FORM OISBSF- V To, Branch Manager (P&GS) L.I.C of India P&GS Unit, Jorhat Divisional Office Jeevan Prakash Rajabari Jorhat-785014, Ph.0376 2360997 Ref. : Option for NEFT Payment (Direct Credit to Bank A/C) of OISBSF Pension Dear Sir, I am interested to receive my annuity amount through NEFT system. For this purpose I furnish below the required details: Name of the Annuitant :- Master Policy No :- 407000898 Annuity Bond No :- 4. Bank Name :- 5. Bank Address :- 6. Account type: Current/Savings:- 7. Account No (Single) :- 8.Bank IFS Code :- 9.Bank MICR Code :- 10.Tel.No/Mobile No :- 1 E.mail ID :- Kindly arrange to transfer my Annuity amount as per above details through NEFT system. Date:- ----------------------------------- Signature of the Annuitant This is to certify that name, Bank A/C No & Branch, IFS Code, MICR code given above are correct as per our records. Date:- -------------------------------------- Signature of Bank official with Office Seal
Form No. VC-OISBSF GM (F&A) Oil India Limited Duliajan Attn. SMFA (Establishment) Sub :Voluntary Contribution towards Oil India Superannuation Benefit Scheme Fund I do hereby authorized the recovery of contribution as applicable from my salary as Voluntary Contribution towards as per the rules framed under the said Scheme as opted below: My Voluntary Contribution from 002007 to 302015 is given vide at par cheque number.. dated drawn on. bank payable to. I shall contribute as Voluntary Contribution towards the tax deducted w.e.f. 004.2015. I understand that this is an one time option and hereby agree to continue above option during the tenure of my service with Oil India Limited. Place: Signature : Date: Name : OIL ID :.. Note: Please tick the check box for the option opted.