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~W'/MobileNumber{IRt;r~~ ~/For OfficeUse Only1U1IT~ .. ~iftFfq~ ~104l(iI;:lf:~.)APPLICATIONFORMONTHLYPEN SIONFORM-IO-D( )~mt~.11l96(EMPLOYEES'PENSIONSCHEME,1995 )~ IN'JIcm ~ if 1I1f ~~/(ReadINSTRUCTIONS beforefillingIn this Form) 'et; &m WrI<PT ~~mn t ?By whomthe Pensionis claimed?2. GT<Il~ 'l{ ~<PT W/iRTypeof PensionClaimed(q) \jfi'<J~/3mj/Dateof Birth/Age(dd/rnmlyyyy)11111111113.(C/i) ~</iT "'fl1f~'lI1l'Rf1l) Member'sName(1nBlockLetters)(<if) 1Wr/ SEX: T) ~~/MaritalStatus@") furr/'lFct</iT "lJ1'I/Father's/Husband' "If. Wffi"ffi:lm/ >PT "' ~<PT ffiCIT" ' ~</iT 'Wl" q ' IT v ~&'<f-l( ~ Addressof the Establishmentin whichthe memberwas last ~~ ~ / DateofleavingService(dd/mmlyyyy):1 I 111 111 1 I 1~--~~==~==~~ ~</iT <IiR"T/ Reasonof leavingService'l?}}
~~1ffiI~~<f;~"'I~ 2 ~"'Ilffi1O~\iIl\[) (To be submitted in duplicated in respect of each person eligible for pension) ~ -M't <fiT fc'fcRur aIR~ ~ ~/~ f.rnT'l Descriptive roll of Pensioner and his/her Specimen SignaturefThumb impression
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SPECIMEN SIGNATURE AND SEAL CARD, Specimen, Specimen seal, SPECIMEN VERIFICATION CERTIFICATE FOR, SPECIMEN VERIFICATION CERTIFICATE, DP ID: Client Id, TERMINATION OF FINANCE / HYPOTHECATION, TERMINATION OF FINANCE/ HYPOTHECATION AGREEMENT, SYMBIOSIS CENTRE FOR DISTANCE LEARNING, SYMBIOSIS CENTRE FOR DISTANCE LEARNING SCDL, NEEDED FOR APPLICATION FOR REGISTRATION UNDER EGS, LIFE CERTIFICATE FOR THE YEAR 2017, Algol Universal Trust, PART-1