Application to start family pension

Name:- ______________
Date :- _______________
Fule Address:- __________
The chief/ Branch Manager.
State Bank of India
_________ Branch
(Branch will hand over the application to PPG Deptt at Lho )
Dear sir,

Family pension
Will deep sorrow, I am to convey that my husband ShriBiswanathDatta .P.F
Index no :-112852 expired on __________
The Realative Death certificate (original forverification) issued by
_____________is enclosed for your information and record. He was drawing
SBI pension from your Branch savings bank A/c NO : 30054332882 A copy of
the advice …… of pension/ family pension issued bythe bank at the time of
retirement of my husband is enclosed for your ready Reference I am
beneficiary member of the deceased Pensioner for drawing Fanily pension
and certify that I am not Re-Married I shall therefore be glad if you will
pleasearrange to make payment of family pension to me with effect
from(date of Death Of the pensioner) _______________ at the Extantrate.I
shall be glad if you will please arrange to give we a fresh advice of Family
Pension at extant rate for my record. I am also enclosing Xerox copeOf my
pan card .Adhar card for yourreference.
Yours faithfully

(Signature)
Enclosed: 1 copy ofAdhar card 2 Life certificate 3 copy of pan card 4. Passport size
photo 5. Copy of Death certificate 6.Latter of undertaking 7copy of Pension payment
advice.

(Xerox copy should be self attasted)

copy to The secretary, SBI Pensioners Association (Local unit at Serampore)With a

request to look into the matterand arrange to get Family Pension Atanearly date

__________

Signature

Associate Member No.Aso 1926

LETTER OF UNDERETAKING BY THE FAMILLY PENSIONER

DATE:_____________

The chief/Branch Manager

State Bank of India

__________ Branch
Dear, sir

I, SmtGouriDatta, wife of BiswanathDutta ,reside at 139/ PanditIshan Chandra Road Bangur park po :
RishraDist : Hooghly, pin 712248 Undertake as under :

In consideration of your having at my request agreed to make payment of pension due to me every
month by credit to my account with you I,The undersigned, agree and undertake to Return or make
good any amount to which I am not entitled. I farther hereby undertake and agree to Bind myself and
my Heirs , Successors , Executors and administratiors to indemnify the bank from against any loss ,
suffered or incurred by the bank so crediting my pension to my account under the scheme and to
Forthwith pay thesame to the bank also Irrevocably Authorre the Bank to recover the amount due by
debit to mysaid account or any other account/deposits belonging to me in the possession of the Bank.
I, hereby, agree that the Bank is entitled to exercise even without a prior notice the right of set off on
account of any wrong, excess or over payment made to my account against the balance standing to my
credit in the account and /or in any other account in my name and any other funds / securities held or
come to be held on my behalf by the bank

Years faithfully

(signature)

Name :-_____________

Address :________________

Witnesses:

1 SIGNATURE 2 SIGNATURE
_____________________ _______________________
Name Address :-Name Address
________________________ __________________________
3 SIGNATURE 4 SIGNATURE

_________________________ ___________________________

Name Address :- Name Address

___________________________ _____________________________