ADDITIONAL CLAIM OF GROUP LIFE INSURANCE OF WAPDA EMPLOYEES

Notice is hereby given to the Postal Life Insurance Northern, Pakistan Lahore of death of the employee of
the Water and Power Development Authority particularized below:-
We hereby warrant that this employee was insured under the Group Contract and died while in our
employment and our Pay Roll continuously from the date of insurance on his life as effect to the date of his death. We
hereby certify that the under mentioned particulars about this employee are correct according to the service records and
have been duly verified:

1. Name of the deceased Wapda Employee with Father’s Name: _____________________ S/o
_____________________

2. a) Designation _____________________

b) Sr. No. of the particulars of employees list in which name included _____________________
i.e. in the list as stood on.
_____________________
3. Amount of Insurance Payable:
i) Previously recommended: Rs.________________/-
ii) Additional Claim: Rs. ________________/-
iii) Rest amount payable: Rs. ________________/-

4. Date of Death: _____________________

5. Date of Birth: _____________________
6. Date of Employment: _____________________
7. Rate of last Basic Pay drawing at the time of death & Basic Pay _____________________
Scale No.2
8. Name and Address of nominated beneficiary: _____________________

_____________________

_____________________

_____________________

9. The Death Certificate attested issued by M.C./Union Council, _____________________

Govt. Hospital is enclosed:
10. Cause of Death: _____________________

11. Office Bank A/C No. with Name of Bank: _____________________

_____________________
12. It is certified that:
I. The claim of Late __________________was not submitted before to Director (Insurance) for payment.
II. The Late ___________was a Regular Wapda Employee at the time of his death and not deputationist.
III. _____________________was married at the time of his death.
IV. Mst. _____________________ widow of late employee was not judicially separated during the life of
her husband.
Encl: 1. Attested copy of GLI Nomination Form.
2. Attested copy of Death Certificate.
3. List of employees as stood on _____________________

General Manager,
Postal Life Insurance,
Northern Pakistan, Lahore
Accountant Concerned Drawing & Disbursing Officer
with Official Stamp with Official Stamp