Claim For Permanent Disablement Benefit Deed Format

Claim For Permanent Disablement Benefit

Claim For Permanent Disablement Benefit Deed Format

I, ……………………………………………, s/w/d of ……………………… Insurance No.  ……………………having been declared as permanently disabled by

the Medical Board/Appeal Tribunal claim permanent disablement benefit accordingly for the period from ………… to ……………

The amount due may be paid to me by money order/in cash at local office.

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Date …………                                         Signature or thumb impression

Present Address ………………

             ANOTHER FORM

I,  …………………………………   s/w/d of  ………………………………………

Insurance No. ……………… declare that,  because of sickness/temporary  disablement, I have not been at work since the date of last/first certificate sent to you.

I no longer claim to be sick/temporarily disabled ………… from ……… day of ……… 19…………  and I shall/did not take up any work for remuneration before that day, I claim benefit accordingly. I desire payment in cash at local office/by money order.


Signature or thumb impression

Date …………                                                   Local office ……………

Present Address …………………

Claim For Permanent Disablement Benefit Deed Format

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