Life insurance Corporation of India

Letter of admission and authority

To,
The Chief Administrative Officer,
Gujarat Water Supply & Sewerage Board,
"JALSEVA BHAVAN" Sector 10-A, CHH Road,
Opposite Air force Office,
GANDHINAGAR.
Ref :- GROUP SAVING LINKED INSURANCE SCHEMES
Respected Sir,
I wish to join the Group Saving Linked Insurance Scheme arranged with the LIFE
INSURANCE CORPORATION OF INDIA and request you to admit me as an Insured
Member of the Scheme with effect from DECEMBER - 2014. I hereby authorize you to
deduct a sum of Rs.223.50/- as contribution towards the scheme from my salary
starting from the salary for the month of DECEMBER - 2014.
I further agree that this letter of authority shall not be revoked by me so long as I am a
regular employee. My date of birth, as record in School Living Certificate sent herewith
is 17-12-1989. Date of joining in service 9- 07- 2012
Yours Faithfully
Himanshu Bipinchandra Soneji
(Signature)
Full Name

:- HIMANSHU BIPINCHANDRA SONEJI

(IN BLOCK LETTER)

Designation

:- ASSISTANT ENGINEER

Badge No OR Salary Roll No OR Membership No

Department/Office :- Deputy Executive Engineer's Office
Public Health sanitary sub. Division No. 2,
7th floor, Ruda Building,
Jamnagar Road,
Gujarat Water Supply & Sewerage Board,
RAJKOT-360001.

Deputy

Executive

Engineer

P.H. S. Sub. Div. No. 2

G.

W.

S.

Rajkot

&

S.

Board

Life insurance Corporation of India

Letter of appointment of beneficiary
I, Himanshu Bipinchandra soneji, Assistant Engineer an Insured Member of "B" Group
Saving Linked Insurance Scheme hereby appoint in terms of Rule No.13 headed
"APPOINTMENT OF BENEFICIARY" of the Rules governing the scheme. My Mother
Named Mrs. Indiraben Bipinchandra soneji and whose Address is MAA SHARDA,
Akshar Nagar street No-1, opp. Lakhno Bunglow, Gandhigram, Rajkot-360007 as the
person to be the beneficiary to whom the moneys payable in terms of the Rules of
scheme shall be paid in the event of my death.
Signed at RAJKOT this Friday of October th 2014

Himanshu Bipinchandra Soneji

(Signature of Insured Member)

WITNESSED BY
(1) Signature :Name
:- Shri Nautam.S. Rathod Jr. Clerk
Address :- Deputy Executive Engineer's Office
Public Health sanitary sub. Division No. 2,
7th floor, Ruda Building,
Jamnagar Road,
Gujarat Water Supply & Sewerage Board,
RAJKOT-360001.

(2) Signature :Name :- Shri Vallabh B. Chavda

Address :- Deputy Executive Engineer's Office
Public Health sanitary sub. Division No. 2,
7th floor, Ruda Building,
Jamnagar Road,
Gujarat Water Supply & Sewerage Board,
RAJKOT-360001.

Deputy

Executive

Engineer

P.H. S. Sub. Div. No. 2

G.

W.

S.

Rajkot

&

S.

Board


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