Form No. 8 Application Form for Nomination for Benefits Under The Central Government Employee's Group Insurance Scheme.1980. I (when the Government Servant has a family and wishes to nominate one member or more than one member thereof.) hereby nominate the person (s) mentioned below who is/are member (s) of my family, and confer on him/them the right to receive to the extent specified below any amount that may be sanctioned by the Central Government under the Central Government Employee's Group Insurance Scheme my death while in service of which having become payable on my attaining the the age of superannuation may remain unpaid at my death. Name & addresses of Nominee/nominess.Sl.No. Relationship With Govt.Servant Age 1. 2. 3. 4. 5. 6. JHARKHAND GOVERNMENT Published on National Portal of India (india.gov.in) Share of Amount to be paid to each. (Rs.) Conting encies On the happening of which the nomination shall become invalid. Name, address relationship the person, if any, to whom right of the nominee shall pass in the event of his predeceasing the Government servant. N. B.:- The Government Servant should draw lines across the blank space below his least entry to prevent insertion of any names after he has signed. Dated at Signature of Government Servant. This column should be filled in so as to cover the whole amount that may be payable under the Insurance Scheme. Published on National Portal of India (india.gov.in) Signature of two witnesses:
