AFGIS – 224

(In Duplicate copy)

AIR FORCE GROUP INSURANCE SOCIETY
(Nomination Form for AVIC Benefit)
ORIGINAL / DUPLICATE Date of Discharge………..………
Married / Single / Widower Date of Birth………………………

1. I, Service No…..……. .Rank ……………...……Name……………….. ……………………………….…

c/o.………..………….………………………….hereby subscribe for AVIC benefit and nominate the
under mentioned person(s) / Organisation(s) and confer on them the right to receive the amount on
account of Air Veterans Insurance Cover that may be payable in the event of my death. The
photograph(s) and signature(s) of nominee(s) duly attested by me is/are affixed.
Sl Nominee Name Permanent Address Date of Relationship %
No Birth with of
Insured share

Alternate Nominee

Photograph of Photograph of Photograph of

1st 2nd Alternate
Nominee Nominee Nominee duly
duly attested duly attested attested by
by member by member member

First Nominee Second Nominee Alternate Nominee

Mob No :…………….................. Mob No :…………….................. Mob No :……………..................

Aadhaar :.…….…………………...… Aadhaar :.…….…………………...… Aadhaar :.…….…………………...…

2. In case, any of the nominee(s) mentioned above predeceases me, I undertake to intimate AFGIS changes in
the nomination along with the photograph and specimen signature of the new nominee(s). In the absence of such
intimation and if either of the nominee(s) predeceases me, the entire amount will be payable to the surviving
nominee(s).
3. This nomination overrides previous nomination, if any.
4. I have read and understood all the terms and conditions pertaining to AVIC Scheme and shall abide by them.

Date:……………….
E Mail Id: …………………………………….. Signature of the Member
Place: ……………………………………..… Mob/Tel No: …………..……………
Witnesses

(1) Signature ………….………..…. (2) Signature ……..……..…….…..

Name ………………………………. Name ……………………………....
Address ………………………..….. Address ……………….………...…
…………………………………….. ……………………………………..

Countersigned Accepted

Adjt / CO / Stn Cdr / AOC / Zila Sainik Board / AFA Authorised Signatory, AFGIS

Date …………… ……… Date ………………………

(Back side)
 GUIDELINES FORFILLING AVIC NOMINATION FORM
Refer IAP-3601 Section-B of Chapter 1 (Para-43) Revised

1. Nomination of Non Beneficiary. A member can nominate any person other than beneficiaries
to receive a share not exceeding 25% of the Death cover. In case any organization/ institution is
nominated, the head of the organization/ institution with his appointment/ designation must be
indicated. The balance will be payable to the beneficiaries as stated below :-

2. Nomination of Beneficiary

(a) Male Members. A male member can nominate any of his family members viz wife,
parent(s), children, minor brother(s), unmarried sister(s), deceased son’s widow and children,
where no parent of the member is alive, a paternal grand parent can be nominated.

(b) Female members. In case of female Members, she can nominate the husband,
parent(s), children, minor brother(s), unmarried sister(s), deceased son’s widow and children,
where no parent of a subscriber is alive, a paternal grand parent can be nominated.

(c) Unmarried Member. An unmarried member/ widower without any children may
nominate any person(s) to receive the amount that stands to his credit. Nomination made by
unmarried member/ widower stands automatically cancelled on marriage.(Child means a
legitimate child and includes an adopted child where adoption is recognized by personal law)

3. Nomination Forms (AFGIS-224) are to be competed in duplicate and submitted along with
Survival Benefit claim (AFGIS-212).

4 The photograph of the nominee(s) is/ are to be affixed on each copy of the nomination and
attested by the Member with his signature.

5. Any amendment (i.e deletion, addition, alteration) without authentication by Member will make
the nomination invalid.

6. Change of Nomination, if required, to be executed by submitting a fresh set of Nomination

Form.

7. In case a Member nominates more than one nominee, member should specify the percentage
of share payable to each of the nominees in such a manner to cover whole of amount of insurance
cover.

8. Every nomination made by a member, to the extent that it is valid, takes effect from the date on
which it is accepted by AFGIS.

9. In the absence of the nomination the sum payable would become payable to the beneficiaries
mentioned in succession certificate issued by Court of Law.

10. Nomination made to HDFC/LIC/Banks as per para 1, will be cancelled only after receiving a
confirmation from HDFC/ LIC/ Bank in writing.

Note : ALL AMENDMENTS should be authenticated by the member.