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    PDF ONLY 20241109 0003 Compressed

    Uploaded by

    Sangam gaur

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    PDF ONLY 20241109 0003 Compressed

    Uploaded by

    Sangam gaur
    2 views2 pages

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2 views2 pages

    PDF ONLY 20241109 0003 Compressed

    Uploaded by

    Sangam gaur

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    EIqr s{rifi qqd

    claim Application Form

    -d'.irnu eni6/.la m Re.uest Date 0e Nov.2024

    l+4 {d@/,qdq,/ Dear s r/Madam,

    d Fmn F" Name rala shanlar

    fr{Ali flfl/Fatherhusband Name 5/o chandram


    +"hl,'
    ^,lo
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    8oe

    , 9q6 nn F rrqratu4 t4 c @ e il
    {d !qr(4fMr!miii) .r trrffi <A + F\ rnn<1
    {n
    Dale ofBirth:01 01 1932, do hereby apply lor a. aim aqa n5t mv
    deposlt(s)/ .ontribut on(s) amount wrr ch is to becredited to mv folow n9 Bank:

    t0 @ qft d ftfl Fqftad dl


    Folow iq are my deposl details

    II III
    ITI
    dqofl / Declaration

    hereby de.a'. thai ram a qenune depositorme mhor .r taharavn U.ive,sal


    qitmate deposts in thisthese so.ety(ies) as per
    the details giv€n my app icaton subm tted in th€ cRcS sahara Refund Portal
    Hi qFfln 3ii{ ftn q s .ihs.rist{{Ncq}wshoads&n${E{t 6q4di/
    sqd+4i nl msaharavn universal Mult ipiv r m Fd 4 qt aq 3F n rdlr ;Gc oiiltlta
    {lq.n ff. llrm r*l4!r {FrA- {ffG +qcA ia.. dw cft mr 9Gln }ez atidltq +sia la..
    ffi Ao { I+ffi 22 or 2or2 F r.A }n 41 {ei i;Md'r?q ffi ra. i.w 6r <$ E ErF
    29 or.2023 bqiAelridlird ri]@orT{h3:qRiqft{qir
    2. The aforesaidinfomation given above istrue and core.t to rhe bestof my knowledqe and belief
    mad€ by me n
    and r have provid€d true prool ol dv depost and cla m. The sad depositls) were
    of my leqiumate income before
    22 ol.2o22 in .a.e of Sahara Credit coope.anve socreiv LLd. Lu.kfo!, saharayn unversa
    Mutipurpose so.ety Ltd., Bhopal and Humara ndia credlt cooperatve 50.ety Ltd., Ko kata and
    befor€ 29.03.2021 in case of staE Muipurpose cooperat v€ society Ltd , Hyderabad and
    in
    complian.ewith relevantln.om€iaxLaws.
    j.qR cr dlr rqq6r ff m " A G g'l {.FGq- qFqo "5r-'1o4n B '!ei iF
    6-.ia
    'i"ii, iJ".n^.t* arg r, . * ; tr* 4 r"r\q'"* €-' € rnaETFtn
    * . ,i *i"-a n itr- lB cE - eq.a lr n - ' F 4q rr r n d ?d @ a , rc
    3lfanvofthe nformaton qilen bv me Ln the above applicauonJorm i5 subseqlentlv proven to be
    I"-*i * r"t.", r hereb;u.deiake to retum the rerunded'saharaamount alons with the app cabe
    lnter€st to'sah acRcs R;iund Account and indemnfv the cRc5 Refund a"ounf to the
    sa d extent. sha I also not pursue the .la m in oth€r forums to the extent
    it is setlled bv the
    sahara CRCS Refund Account .

    .4 4 r"rn"nr"r 'rF ,@ )0.ooo/. B @ r o ,5a r -? ? ? r r dr{?


    -.q i ? q *,.l"e-_r-
    n "
    c:i-r nrqc sm |,.d q-, " r ,' r ri.@
    .i: ; # #Ei a.,,ri- ;q.;."iJ b;q srqr E l-qa *. d 5i oit cFrsi cBirodtuttF{ t
    FITA rd @ ili rci 50 ooo/ t 3fEn i)
    ent (upto Re.5o 000/ ) does not mean that the
    n;ccepted and ifrequ red lwou d furnsh such do.uments as mav be requ red
    ..f.aims and have no oble.non ifthese do.uments are share wilh relevant
    : tAppli.able tor depositors, whose aggregate claim dhount is Dore

    5. .qal qF{{n, lir$ lR.r a liq ,EF A <s n alF i q:flr ErS lifrd a oRfir fl{ ig t rn'<'a "i

    Frdher. sh.l aso b€ Liabl€ roranv civil or .riminal action in a'cordarce wth law' in 'are
    of an'v
    f als€hood or misr€presentanon

    3crfrdl 4T <frdreR/s 0nature


    -riiq/Date: 09 Nov. 2024 ot Dep6xar.
    \;T E>t,")?-
    qe{rrlP.lele , ,
    .. ->rol-a| ?eZ|:!! .vl.?it @ qqrddf 4rrq/Name of
    Depositor: lata shankar

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