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Ed in by the person legally entitled to the policy moneys) (All answers to be filled in legibly. Answers must be given in words, strokes of the pen or dots or dashes cannot be accepted as replies) In connection with claim under Policy No . For Rs. . on the life of I, as the claimant under the (insert full name of the deceased) policy make the following statement: 1. Particulars regarding the claiman.

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