Claim Application Form Um SFP AATIaley HoqeN Daves OF Uhid AOR er eatsepebas Otay iPad, 4.98804, Full HamosSayatl tethi Feast Tan eect wes Pari at hae Gin — ate of Birth: 26.06.2957. da hereby apply foro claim aNlaat My depositts}/ contribution(s) amount which is to be credited to my following Bank Sereram/Bank Naime: [NtiA Posy ParMNEWTS paniK Attar et fem Benet: Following aré my deposit details: mT | fermen cet eer at ge [ot footy fs Veco Ren [ete Account wa, [nnewip|Coticate!| loenesit [taanfeoan Posse foparing|cormrbusion| erties aera omen nant [Rev Ie jessvévocser| —— fresezr [GAP see Declai ceva! gre fie aa 4 sivatl loth qugr chert ern @ fA Sabor Ciedit Cooperative Society bimitea! ¥.cm sre orem Safe meng tor rayne om ok eB en 3 ter corr ofa rome a fee ea 6 ‘Swat! ath hereby ceclare that 1m @ genuine depositor/member of Sahara Credit Cooperative and have made lugitimate deposits in thisithese Societylins) 3s per the details I. ‘given my application submitted in the CACS-Sahara Refund Fortal Euppives centre eae eT ee ee Ge ae SR ERT ‘Sahara_Credit Cognerath A, eee emo qPada meets ety) f., ai ere glean sei wtativtiee tare (8. when Sm ete 8 Se ET NRE Ms RO SS a 2D ation areas eee & aren 4 fare 8) (© Scanned with OKEN ScannerSan eats Fenaycraien Request ‘Dote: 07 Des. 2028 ‘feu SBteurritem) Dar SéryMadam, A Wr, Full eamie-Siran iat) ‘Ren on Py FatnerrH abana Nomie:D/O Narendra Kumar loth Sin hie abadcahetae } Pde baer iene, ba Ty Apner aoaaoes, ses er rear St aero L Bee eee afer cad yates at Sign sicinas vie proto Se: 7: do hareby apply tora claim aginst my. ‘eposits)t contibutlen(s) amount which isto be credited to my fallaying Bank :- ‘frmspank Nome: wioia bor A TT a ae: Rea Seiten by Following are my deposit detais: sone pe er be TT Ld wrest on em ont ah ea TR es on fae fee heer wm eto er 7 anf Serene (Swati tith) hereby ditthare Uhl | arn a gendihve depasitbrimeniber of Sahara Creal jmited and have made legitimate deposits in thisithese Society(ies) as per the details given my application submitted in the CHCS:Sahara Refund Portal, zy soe seer rent oh ra ry nk bits ae eat tk pee tomer cases aaheits A hy ape ame aT oo sare pes eeieth mee, Sia teen fa 3, seo Oa Rees DDB DEED Feed ai fed coos woe sig? Beowe Gem 4 Pie 29.03.2023 5 sag iter ere er se 9 Be a fh _! (© Scanned with OKEN Scanner2 The aferésae t ig il formats given ative te tae ani correct to the best of iy nwa Seance ere of of my deposit and claim, The Said depostte) ware rune tye my" > he ‘ut of ry legitimate Income before 22.0) 202 fag’ Setiees Crest Cooperative Society ud, Luckrow: Seharsin Univertel Mulipumose Sous cose of stag nt Mumara lidia Credit Cooperative Society Ltd. Kolkata anid before: 29 guatas lh i, ‘i ‘ inh relavar\ IncorraTax Layee PPOs? Comparative Society Ltd. Hyderabad snd in'cornpllance W att ae are wre fg wr nc a sr gh i aes 4 Si "aesacviae Ges sur rane wel oh sare Horelee tre oes A ees a aE eet Seer te bc rms tie ar ae es to ye 8 ed 9) Bed SO 3. M any-at the information given ty tne in the’ ative aplication form is subsequently proven 10 he Incorrect or false, 1 hereby tindertake te tetum the retindd ‘amount alang Gin ie ‘opplical {nerest to ‘Sahara‘GRCS Retund Account” and indemnity the “Sahara CRES Refund Account’ te the 22/4 extent. | shall also not pursue the claim in athar forums to te avant bi setied BY tha “Sanara-CRCS. Retund Account’ aah rr fk tne spree Fa 9 gy foe ani gp-agl fgg St ar Serer et moan 4 tere mena ey Cotas Bree et toh Ara teenie am ej are, ar mrt ary, BRA spe bi Fa 50 000 aaah) SRN ST i ea °A, | Swati jethi agree thst receiving part payment (unto Rs $0\09%) doesnot mean that the entire claim has been accepted and it required, | Would fumish such documents as:may be required for further processing of claims and | have no objection ifthese documents are share with relevent for (Applicable depositors, whase claim amouat is mare than Rx.50,000/-) SORT ESATS ENUF mM Se Ne a ame Pe Se re gz i eine by oe 4 ‘5. Further, |-shall algo be liabte far any civil or criminal action in ezcordance with law, Incase of any falsetoad or miste presentation. ge ermal wi BERT Signa ture ‘Avea/Date: OF Dec. 2024 of Depesitor: TUrYPlace: i ~ “aids, urea wraryName of Depositar:_ Swati lethi A (© Scanned with OKEN Scanner