FORM NO.8 (SEC.PARA 19.7) NOMI NATION FOR BENEFITS UNDER THE CENTRAL GOVERNMENT EMPLOYEES GROUP INSURANCE SCHEME, 1980
(When the Government Servant has a family and wishes to nominate one member or more than
one member thereof)
I, hereby nominate the person/ persons mentioned below who is/ are member(s) of my family, and confer on him/her the right to receive to the extent specified below any amount that may be sanctioned by Central Government under the Central Government Employees Group Insurance Scheme, 1980 in the event of my death while in service or which having become payable on my attaining the age of superannuation may remain unpaid at my death.
Name & Address(es)
of Nominee/Nominees
Relationship
with Govt.
Servant
Age
*Share
of amount
to be
Paid to
Each
Contingencies on the happening of which the nomination shall become invalid
Name, address & relationship of the person, if any, to whom the right of nominee shall pass in the event of
His/her predeceas-
Ing the Govt.
service
(1)
(2)
(3)
(4)
(5)
(6)
Enter name of Nominee
Full Address
Relationship
Years
100%
Death/Insanity
----------
Dated this day of at
Two witnesses to Signature
(With name,designation,emp.code)
Signature of Govt. Servant
Name:
Designation:
Emp. Code:…
Tel : Intercom:
………………………………………………………………………………………………………
N.B. : The Government Servant should draw line across the blank space below his last entry to prevent the insertion of any name after he has signed.
* This column should be filled in so as to cover the whole amount may be payable under the Insurance Scheme.
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