Janata Grami P.A P.Claim Form- PDF - The New India Assurance ...

jp epa+ ,e;jpah m#ud;]; fk;ngdp ypkpnll;
gjpT kw;Wk; jiyik mYtyfk; : epa+ ,e;jpah m#ud;]; gpy;bq;> 87> vk;.[p. NuhL> /NghHl;> Kk;ig –
400 001
[djh / fpuhkpd; jdpegH tpgj;J ghyprp Nfhhpf;ifg; gbtk;
,g;gbtk; toq;fg;gLtij itj;J nghWg;ig Vw;Wf;nfhs;tjhf fUjf;$lhJ.
Nfhhpf;ifg;gbt vz;:................................................................................................................................................................................
gphpT I (midj;J Nfhhpf;ifg; gbtq;fspYk; epug;gg;glNtz;Lk;)
1. (a) fhg;gPl;Ljhuhpd; ngaH:......................................................................................................................
(b) Kfthp: : ......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
(c) taJ: .................................................................................................................
2. (a) ghyprp vz;: ......................................................................................................................
(b) fhymsT: ......................................... njhlq;fp ..................................................tiu
(c) toq;fg;gl;l ,lk; ......................................................................................................................
3. (a) tpgj;J gw;wpa tptuq;fs;: Njjp Neuk; ,lk;
(b) tpguq;fs;
fhty;Jiwf;F jfty; jug;gl;ljh: Mk; / ,y;iy
4. (a) tpgj;jpw;F gpwF cldbahf ePq;fs; kUj;Jtkidf;F nfhz;Lnry;yg;gl;BHfsh? Mk; / ,y;iy
(b) Mk; vdpy;> kUj;Jtkidapd; Kftup:
5. (a) NtW VNjDk; [djh jdpegH tpgj;J ghyprp cq;fsplk; cs;sjh? Mk; / ,y;iy
(i) Mk; vdpy;> epWtdj;jpd; ngaH :.................................................................................
(ii) ghyprp vz;.: .........................................................................................................................
(iii) fhymsT: ................................ Mz;Lfs;..................................njhlq;fp..............................tiu
(iv) toq;fg;gl;l ,lk;:....................................................................................................................................
(b) NtW ve;j kUj;Jt / kUj;Jtkidapy; mDkjpf;fg;gLtjw;fhd jpl;lj;jpd; fPo; kUj;Jt /
kUj;Jtkidapy; jq;fp rpfpr;irf;fhd nryTfis kPz;Lk; ngw cq;fSf;F chpikAs;sjh?
Mk; vdpy;> (i) jpl;lj;jpd; jd;ik
(ii) toq;fg;gl;l my;yJ toq;fg;glNtz;ba njhif:
gphpT II (kUj;Jtkid mYtyHfshy; epug;gg;glNtz;baJ)
1. kUj;Jtkidapd; ngaH kw;Wk; Kfthp:....................................................................................................

2. mDkjpf;fg;gl;l Njjp:........................................................................................................................................
3. b];rhH[; nra;ag;gl;l Njjp:.............................................................................................................................
4. (a) fhaj;jpd; jd;ik:...........................................................................................................................................
(b) rpfpr;irapd; tptuq;fs;
5. gzpia Nkw;nfhs;tij my;yJ njhopypy; jaTnra;J tptuq;fisj; juTk;.
6. kUj;Jtkidr; nryT (xhp[pdy; gpy;fis jaTnra;J ,izf;fTk;)
Njjp............................
kUj;Jtkidapd; Kj;jpiu kUj;Jtkid / eHrpq;N`hkpd;
mjpfhuk;ngw;w eghpd; ifnahg;gk;
gphpT III (fhg;gPl;LjhuH caphpof;f NeHe;jhy;> thhpRjhuuhy; epug;gg;glNtz;Lk;)
thhpRjhuhpd; tptuq;fs;
gjtp:..................................
(a) KOg;ngaH:..................................................................................................................................
(b) Kfthp:..........................................................................................................................................
(c) taJ:.............................................................................................................................................
(d) ,we;jtUldhd cwTKiw:................................................................................................
Njjp:.......................................................... .........................................................
fPo;tUk; Mtzq;fis jaTnra;J ,izf;fTk;:
1. ,wg;Gr; rhd;wpjo;
2. gpNujg; ghpNrhjid mwpf;if
3. urPJld; xhp[pdy; ghyprp Mtzk;
fhg;gPl;LjhuH / chpikf;NfhUgtH my;yJ thhpRjhuuhy; (fhg;gPL nra;ag;gl;ltH
caphpoe;jpUg;ghNuahdhy;)> ifnahg;gkplNtz;ba mwptpf;if.
thhpRjhuhpd; ifnahg;gk;
Nkw;$wg;gl;l tptuq;fs; midj;J tiffspYk; cz;ikahdit vd;W ehd; / ehq;fs; ,jd; %yk;
cWjpaspf;fpNwhk; kw;Wk; cj;jputhjkspf;fpNwhk;. jtwhd my;yJ cz;ikaw;w mwpf;ifia ehd; /
ehq;fs; nra;jpUe;jhy;> my;yJ nra;jhy;>kw;Wk; kiwj;jhy; my;yJ ntsptuhky; jLj;jhy;>
,og;gPl;bw;fhd vdJ / vq;fsJ chpikia ehq;fs; ,oe;JtpLNthk; vd;Wk; ehd; / ehq;fs;
xg;Gf;nfhs;fpNwd;/Nwhk;.

,g;ghyprpapd; fPo;> fhg;gPL nra;j egUf;F kw;Wk; / my;yJ mtH / mtsJ rl;lg;G+Ht thhpRfSf;F
cq;fsJ nghWg;GWjpfis KOikahf tpLtpf;fpd;w tpjkha; ehd; / ehq;fs; ,j;njhifapid
ngw;Wf;nfhs;fpNwhk; vd;Wk; kw;Wk; ,g;ghyprpapd; fPo;> NtW ve;j egH my;yJ egHfshy; chpk
Nfhhpf;if VjhtJ nra;ag;gLk; NeHtpy; ehd; / ehq;fs; cq;fis rl;l tpyf;Fhpik /