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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in block letters in the designated field for the member's name. Ensure accuracy as this will be used for identification.
Fill in the claimant's name and date of birth. This information is crucial for processing your claim.
Provide your father's or husband's name if applicable, followed by your last employed establishment's name and address.
Indicate your employment details, including the date of joining and leaving, along with the reason for leaving service.
Complete the family particulars section, listing spouse and children if relevant, ensuring all relationships are clearly defined.
Select your preferred mode of remittance for receiving benefits, either through postal money order or bank transfer, and provide necessary banking details.
Finally, review all entered information for accuracy before signing or providing a thumb impression to validate your submission.
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