Pension Related Information / Instructions for Retired Employee Employee having superannuated from the services of EIL on or after 1.1.2007 are required to submit duly filled in pension forms alongwith nomination form, prescribed ECS mandate form with photocopy of crossed cheque-leaf and pre-discharge receipt (amount not to be indicated). The formats for the same are available on the retired-employees portal. Fields pertaining to Account number/Pension number/Annuity number in the formats can be left blank. In order to locate nearest LIC Divisional Office please visit website of LIC. Before filling up the claim form, please ascertain the balance standing to your credit in the Pension fund. Pension amount You can ascertain your pension amount(indicative) by inserting the accumulations* standing to your credit in one of the annuity tables depending upon the quantum of corpus amount and accordingly indicate your option in the claim form. The four categories of annuity tables are as under : Table No. Corpus Amount ------------ --------------------

1 Less than 1.51 lacs 2 1.51 lacs to < 3.0 lacs 3 3.0 lacs to < 5.0 lacs 4 5.0 lacs and above.

Important

1. Employees having corpus amount of less than Rs.68,670/- to their credit shall have to compulsorily choose annual mode of payment only without commutation.

2. * Denotes accumulations standing to your credit after commutation. 3. Click to view Annuity Tables for Pension amount calculation

http://retdemp.eil.co.in/pdf2010/pension%20opt-rev.xls

APPLICATIONFORPENSIONONRETIREMENT

Page 1 of 2

Format No. 3-3041-0004 Rev.0 Copyright EIL All rights reserved

EILEMPLOYEESDCSPENSIONTRUST 1.Name&Emp.No.ofMember: 2.PensionNo.:3.Addressatwhichpensionpaymentistobemade:

4.DateofAppointment:5.DateofentryintotheScheme:6.Dateofexit(Leaving):7.Modeofexit(Specify):8.DateofBirth:9.Name,relation&DOBofbeneficiary10.Optiontochoosepension

(i) Lifepensionceasingatdeath,Nopurchasepriceshallbepaidondeathtobeneficiary.Noguaranteedpayments.

(ii) Lifepensionwithguaranteedpaymentsfor5/10/15/20years.No.purchasepriceshallbepaidondeathoratendof5/l0/l5/20yearsguarantee.Onsurvivaltoguaranteedpaymentspensionshallbecontinuedtobepayabletilllife.(Pleasespecifyperiod)

(iii) Life pension ceasing at death of member with return of capital (purchase price) tobeneficiaryalongwithgrouppensionterminalbonusdeclaredbyLIC.

11.Modeofpaymentofpension(specify):MLY/QLY/HLY/YLY.12.StatewhethermemberwantscommutationofpensionasperprevalentIncomeTaxRules:

(Membercancommutemaximum1/3rd(33.33%).(yes/no)

13. IfyouwishtotransferyourannuityservicingtoyournearestLICDivisionalOfficepleasespecify

thearea____________

14.BankA/cdetailsfortransferofannuity(PleasesubmitfilledupECSMandateformdulycertifiedbythebank)

PTO

APPLICATIONFORPENSIONONRETIREMENT

Page 2 of 2

Format No. 3-3041-0004 Rev.0 Copyright EIL All rights reserved

15.Remittanceparticularsafterlastschedule(tobefurnishedbypayrolltotrust).(Signatureofwitness) (Signatureofthemember)__________________________________________________________________________________ForwardedtoTrustees,EILEmployeesDCSPensionTrust.TheparticularsatSLNO.1to9havebeenverifiedatourendandwecertifythatthesearecorrect.

Head(Establishment)/HeadFieldPersonnelCell ___________________________________________________________________________

DearSir,

Re:MasterPolicyNo.GS/CA/332436 FavouringMr.

WeareforwardingtheclaimpaperscontainingECSmandate,nominationform,formC,formNandtwodischargereceiptsdulysignedbymemberandoneofourexistingtrusteesaffixedwithrevenuestamp. Yoursfaithfully,

(SignatureofTrustee)TheManager(P&GS)LICofIndiaDelhiDivisionalOflice1JeevanPrakash,6th,7thFloor,25,K.G.Marg,NewDelhiIl0001

Divisional Office I, P& GS Unit, Jeevan Prakash, 7th Floor, 25, K. G. Marg, New Delhi 110 001

Phone No.: (011) 23350678, Fax : (011) 23350832

ECS /NEFT MANDATE FORM

Annuitants desire to receive payment through

Credit clearing mechanism

1. ANNUITANTS NAME : ______________________________

2. AMOUNT OF ANNUITY________________________

3. ANNUITY NO. : ______________________________

4. PARTICULARS OF BANK ACCOUNT :

A BANK NAME

B BRANCH NAME &

ADDRESS

C 9 DIGIT CODE NO. OF BANK

& BRANCH APPEARING ON

THE MICR CHEQUE OR

IFSC CODE

D ACCOUNT TYPE ( S B

ACCOUNT / CURRENT

ACCOUNT OR CASH CREDIT)

WITH CODE 10/11/13

E ACCOUNT NO (AS

APPEARING ON THE

CHEQUE BOOK)

F ENCLOSE A CANCELLED CHEQUE LEAF

I hereby declare, that the particulars given below are correct and complete. If the

transaction is delayed or not effected at all for reasons of incomplete or incorrect

information, I would not hold LIC responsible.

Date : (______________________)

Signature of Annuitant

Above mandate will be acceptable for following stations only:

1. DELHI 2. CHANDIGARH 3. JAIPUR 4. AHMEDABAD 5. MUMBAI

6. NAGPUR 7. HYDERABAD 8. BANGALORE 9. CHENNAI 10.PUNE

11. TRIVENDRUM 12. KOLKATA 13.BHUBHNESHWAR 14.GUWAHATI

15. PATNA 16. KANPUR 17.SOLAPUR 18. VADODRA 19. COIMBATORE

ENGINEERS INDIA LIMITED

NOMINATION AND DECLARATION FORM

DECLARATION AND NOMINATION FORM UNDER THE ENGINEERS INDIA LIMITED EMPLOYEES DEFINED

CONTRIBUTION SUPERANNUATION SCHEME.

1. . ./Name & Empl.No.___________________ _______________________

( /In Block Letters) 6. ./Account No. 2. / _______________________ 7. _______________________________

Fathers/Husbands Name Permanent Address 3. ____________________________ 8.

Date of Birth Temporary Address __________________________ 4. /Sex _____________________________ 5. /Marital Status _____________________

- PART-A

) ( / ) ( / ) ( / I hereby nominate the person(s)/cancel the nomination made by the previously and nominate the person(s) mentioned below to receive the amount standing to my credit in the ENGINEERS INDIA LIMITED EMPLOYEES DEFINED CONTRIBUTION SUPERANNUATION SCHEME in the event of my death. / (%) Name & Share (%) of the nominee/ nominees

Address

Nominees relationship with the member

Date of Birth

If the Nominee is a minor, name & relationship & address of the guardian who may receive the amount during the minority of nominee.

1

2

3

4

5

( ) Signature of Witness (With name and address) Signature or thumb impression of the subscriber

-

(PART-B)

(THE ENGINEERS INDIA LIMITED EMPLOYEES DEFINED CONTRIBUTION SUPERANNUATION SCHEME

/CERTIFIED BY EMPLOYER

// ____________________ , / Certified that the above declaration and nomination has been signed/thumb impressed before me by Shri/Smt./Kum____________________________________ employed in my establishment after he/she has read the entries/entries have been read over to him/her by me and got confirmed by him/her.

/Place: _________ Signature of the employer or other officers authorised of the establishment

/Date: _________ /Designation ____________________________________ /

Name & Address of the Factory/ Establishment or Rubber Stamp thereof.

DISCHARGE RECEIPT

Received a sum of Rupees _________________ ( Rupees________________________________) from the in full and final Settlement of my claims and demands under Master Policy No. ______________ on my resignation/retirement from the services on _____________________ Dated at ________________ on this _________________ day of _____________ 20 Name of the member : Signature of the Member WITNESS: SIGNATURE__________________ NAME _______________________ ADDRESS ____________________ ______________________________ ______________________________

across Rs. 1/- Revenue stamp