GIS CLAIM APPLICATION

PROCEEDINGS OF THE MANDAL EDUCATIONAL OFFICER::……………………

PRESENT:……………………………………………..

Rc.No…………….. Dated:…………..

Sub:GROUP INSURANCE SCHEME Sri/Smt………………………………

……………………………………………………………………….....

Sanction of G.I.S. Savings/Insurance Amount of Rs……………………..

Orders – Issued.

Ref: 1) G.O.Ms.No. 293 F&P. Deptt. Dated: 9-10-1984.

2) G.O.Ms.No. 323 F&P. Deptt. Dated: 12-11-1984.

3) G.O.Ms.No. 367 F&P Deptt. Dated: 15-11-1994.

4) G.O.Ms.No. 193 F&P Deptt. Dated: 19-03-2002.

5) Govt.Memo.No.34520/147/Admn.II/A2/99, Dated:19-3-2002.

6) Other connected papers.

-x-x-x-

O R D E R :

Sri/Smt………………………………………………………………………………

Who retired from her/his service on the A.N. of -----------------/died while in service

on……………..

He/She subscribed an amoun t of Rs……../-P.M initially towards Group Insurance

Scheme from……….. and enhanced the amount to Rs……./- P.M from………..and

again enhanced the amount to Rs……./- P.M from………..to………………………

towards Savings amount of the incumbent.

Hence Sanctioned is hereby accorded for drawal of an amount of s…………..as

follows for final settlement of the G.I.S. claim.

1. Savings Amount …. Rs…………….

2. Insurance Amount …. Rs…………….

TOTAL…. Rs…………

The amount is payable to Sri /Smt……………………………………………..

who retire from his/her service on the A.N.of……………… in pursuance of the

Orders Issued in the reference read above.

The expenditure is debitable to the following Heads of Accounts.

8011 - Insurance & Pension Funds.

107 - State Govt. Employees GIS

02 - G.I.S. for P.R. Employees

001 - Isurance fund

002 - Savings fund. Mandal Educational Officer

Copy submitted to the S.T.O…………..

Copy to file.

ANDHRA PRADESH STATE EMPLOYEES GROUP INSURANCE SCHEME

G.O.Ms.No. 293 (F&P) Deptt. Dated:08-10-1984.

C H E C K L I S T

1. Name of the Employee and

Designation :

2. Scale of Pay :

3. Date of Commencement of Insurance cover

And the Group to which he/she si enrolled

Initially. :

4. Change of the Higher Group w.e.f :

5. Date of Retirement/Resignation/Death :

6. Name of the Nominee/Legal – heir in the

Event of death of the employee :

7. Calculation of Savings Fund and interest there

On as order from time to time. (A separate

Annexure copy of which should invariably be

Sent to Director of Insurance ) :

8. Total Amount sanctioned under Savings Fund

(Savings Fund + Interest there on ) :

9. Total Amount sanctioned under Insurance

Fund in the event of death of the Employee :

10. Head of Account for payment of Savings

Fund/Insurance Fund/Interest separately :

SIGNATURE.