AFFIDAVIT

I, Kashmir Kaur Widow of S. Avtar Singh R/o V.P.O. Tarmala, Tehsil Malout,
Distt. Sri Muktsar Sahib, do hereby solemnly affirm and declare as under :1.

That my son Sohan Singh S/o S. Kashmir Singh purchased a Policy from
your esteemed company.

2.

That my above said Son Sohan Singh was died due to Heart Attack on
dated 16-06-2014, Tuesday.

3.

That my husband S. Kashmir Singh has already been died since long.

4.

That I am only legal heir of my son Sohan Singh and have rights to get the
amounts of said Insurance Policy.

5.

That hence the amount of the said LIC Policy be paid to me being the only
L/R of my son Sohan Singh.
Deponent
Kashmir Kaur

Verification :Verified that the contents of para no. 1 to 5 of my above said affidavit are
true and correct to the best of my knowledge and belief and nothing has been
concealed therein.
Deponent

Kashmir Kaur