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    Chinmayee (Pm-Sym)

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    sssadangi
    CHINMAYEE

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    © All Rights Reserved
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    Chinmayee (Pm-Sym)

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    CHINMAYEE

    Original Title

    CHINMAYEE (PM-SYM)

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    © © All Rights Reserved

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    CHINMAYEE

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    10 views1 page

    Chinmayee (Pm-Sym)

    Uploaded by

    sssadangi
    CHINMAYEE

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    12/08/2022, 14:58 Pradhan Mantri Shram Yogi Maandhan - (PM-SYM)

    श्रम एव रोज़गार मंत्रालय


    प्रधानमंत्री श्रम योगी मानधन योजना
    Ministry of Labour & Employment

    Government of India Pradhan Mantri Shram Yogi Maandhan Yojana
    असंगठित कामगारों के लिए पेंशन योजना

    APPLICATION-CUM-MANDATE FORM (UIN


    512G312V01)

    PERSONAL DETAILS

    Shram Yogi Pension Account Number : 705449116643 Periodicity of Contribution : Monthly

    Name of the Beneficiary (As on Aadhar Card) : Chinmayee Sandhibigraha Date of Birth : 12-06-1986

    Age : 36 Gender : Female Category : GEN Marital Status : Married

    Name of Spouse : INDRAJIT PANDA Occupation : Other

    Name of Nominee : Dipanshu Panda Nominee Relation with Beneficiary : Son

    Additional Details
    (In case of Minor Nominee
    )

    Date of Birth : 30-10-2016 Guardian’s Name : Indrajit Panda

    I am not member of ESIC/EPFO/NPS or income-tax assessee : No

    I am also remitting the Monthly Beneficiary Contribution : INR 160/- For assured monthly pension amount of : INR 3000/-

    Declaration & Authorization by Beneficiary's


    I fulfil the prescribed eligibility criteria
    under
    Pradhan Mantri Shram Yogi Maandhan. I have read and understood the
    terms and conditions of the scheme. I hereby agree to the same. I
    declare that the information furnished by me is true and correct
    to
    the best of my knowledge and belief.Further I do not hold any
    pre-existing account under Pradhan Mantri Shram Yogi
    Maandhan. I
    understand that I am fully liable for submission of any false or
    incorrect information or documents given above. I have read / been
    explained and I have understood Pradhan
    Mantri Shram Yogi Maandhan
    guidelines.
    I hereby authorize Ministry of Labour and
    Employment/LIC/CSC SPV/ to use My Aadhaar details for Pradhan
    Mantri
    Shram Yogi Maandhan and authenticate my identity through the
    Aadhaar
    Authentication System in accordance with the provisions of the
    Aadhaar (Targeted Delivery of Financial and Other Subsidies,
    benefits & Services) Act 2016 and Rules and
    Regulations notified
    there under.I have been given to understand that my information
    submitted to herewith, shall not be used for any purpose other
    than
    mentioned above or as per
    requirement of law.

    Date : 12-08-2022 Signature/Thumb Impression* of subsciber


    Place : (*LTI in case of Male/RTI in case of Female)

    NOTE BENEFICIARY IS NOT REQUIRE TO PAY ANY ADITIONAL FEE OR CHARGE


    FOR ENROLLMENT OTHER THAN FIRST CONTRIBUTION
    This is subscription cum computer generated acknowledgement and
    does not require signature. Shram Yogi Pension Card received.
    जिनकी मेहनत देश का आधार, उनकी पेंशन का सपना साकार

    UMRN                                         Date 12-08-2022


     
    Tick (✓)
    Sponsor Bank
    Code 259 Utility Code NACH00000000022197
     CREATE
    (✓)  
     MODIFY I/We hereby authorize LIFE
    INSURANCE CORPORATION OF
    INDIA To debit (tick ✓) SB/CA/CC/SB-NRE/SB-NRO/OTHER
     CANCEL Bank A/C
    Number 30365169016

    With Bank State Bank Of India IFSC SBIN0000094 or MICR                  

    An amount of Rupees One Thousand, Nine Hundred   Twenty Only.   1920/-

    Frequency
    Monthly

    Qtly

    H-Yrly

    Yrly
    As & when presented Debit
    Type
    Fixed Amount

    Maximum Amount

    Reference 1 705449116643 Phone No. 8895940645


    Reference 2 Email ID [email protected]
    I agree for the debit of mandate
    processing charges by the
    bank whom I am authorizing to debit my account as per latest schedule of charges
    published by the bank.

    PERIOD
    From 12-08-2022 Signature Primary Account Holder   Signature of Account holder   Signature of Account holder

    To                
    or
    Until Cancelled Chinmayee Sandhibigraha   2 . Name as in bank records   3 . Name as in bank records

    This is to confirm
    that the declaration
    has been carefully read, understood & made by me/us. I am authorising the user
    entity/ corporate to
    debit my account, based on the instruction as agreed
    and signed by me. I have
    understood that I am
    authorized to cancel/amend this mandate by appropriately communicationg the
    cancellation/ amendment
    request to the User entity/corporate or
    the bank where I have authorized the
    debit.

    https://maandhan.in/pmsym/closing/print_receipt 1/1

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