affidavit
AFFIDAVIT KNOW ALL MEN BY THESE PRESENTS THAT
I/We, the persons named herein below:
(A) Mr. Naresh Kewalram Jamnani (S/o Late Shri. Kewalram Assandas Jamnani) aged about 42 years, an Indian Inhabitant, residing at Room no. 303, 3rd floor, Sai Sarthak society, Patharli Gaon, Kalyan Road, Near Manjunath School, Tilaknagar, Dombivili (East), Thane, Mumbai, Maharashtra – 421 201. And
(B) Mr. Mahesh Kewalram Jamnani (S/o Late Shri. Kewalram Assandas Jamnani aged about 37 years, an Indian Inhabitant, residing at Room no. 303, 3rd floor, Sai Sarthak society, Patharli Gaon, Kalyan Road, Near Manjunath School, Tilaknagar, Dombivili (East), Thane, Mumbai, Maharashtra – 421 201. And
(C) Smt. Sushila Kewalram Jamnani (W/o Late Shri. Kewalram Assandas Jamnani, aged about 59 years, an Indian Inhabitant, residing at Room no. 303, 3rd floor, Sai Sarthak society, Patharli Gaon, Kalyan Road, Near Manjunath School, Tilaknagar, Dombivili (East), Thane, Mumbai, Maharashtra – 421 201. do hereby solemnly affirm, declare and sincerely state on oath as follows :
1. That Late Shri. Kewalram Assandas Jamnani was holding Policy in Star Health & Allied Insurance. Where the Policy No. is P/171117/01/2014/009458 and Claim No. is 0243256.
2. That we hereby submitted aforesiad medical claim papers pertaining to treatment of Late Shri. Kewalram Assandas Jamnani who passed away on 29/04/2014.(copy of Death Certificate is enclosed).
3. That Late Shri. Kewalram Assandas Jamnani had died intestate and has neither left behind a will nor registered any nominee in respect of the aforesaid STAR HEALTH MEDI – CLAIM.
4. That we are the surviving legal heirs of Late Shri. Kewalram Assandas Jamnani;
5. That we are authorizing Mr. Naresh Kewalram Jaminani to receive money of aforesaid Insurance. And He has made / is proposing to make request to transmit the aforesaid Policy in Star Health & Allied Insurance in his name;
6. That I/we hereby
I/We, the persons named herein below:
(A) Mr. Naresh Kewalram Jamnani (S/o Late Shri. Kewalram Assandas Jamnani) aged about 42 years, an Indian Inhabitant, residing at Room no. 303, 3rd floor, Sai Sarthak society, Patharli Gaon, Kalyan Road, Near Manjunath School, Tilaknagar, Dombivili (East), Thane, Mumbai, Maharashtra – 421 201. And
(B) Mr. Mahesh Kewalram Jamnani (S/o Late Shri. Kewalram Assandas Jamnani aged about 37 years, an Indian Inhabitant, residing at Room no. 303, 3rd floor, Sai Sarthak society, Patharli Gaon, Kalyan Road, Near Manjunath School, Tilaknagar, Dombivili (East), Thane, Mumbai, Maharashtra – 421 201. And
(C) Smt. Sushila Kewalram Jamnani (W/o Late Shri. Kewalram Assandas Jamnani, aged about 59 years, an Indian Inhabitant, residing at Room no. 303, 3rd floor, Sai Sarthak society, Patharli Gaon, Kalyan Road, Near Manjunath School, Tilaknagar, Dombivili (East), Thane, Mumbai, Maharashtra – 421 201. do hereby solemnly affirm, declare and sincerely state on oath as follows :
1. That Late Shri. Kewalram Assandas Jamnani was holding Policy in Star Health & Allied Insurance. Where the Policy No. is P/171117/01/2014/009458 and Claim No. is 0243256.
2. That we hereby submitted aforesiad medical claim papers pertaining to treatment of Late Shri. Kewalram Assandas Jamnani who passed away on 29/04/2014.(copy of Death Certificate is enclosed).
3. That Late Shri. Kewalram Assandas Jamnani had died intestate and has neither left behind a will nor registered any nominee in respect of the aforesaid STAR HEALTH MEDI – CLAIM.
4. That we are the surviving legal heirs of Late Shri. Kewalram Assandas Jamnani;
5. That we are authorizing Mr. Naresh Kewalram Jaminani to receive money of aforesaid Insurance. And He has made / is proposing to make request to transmit the aforesaid Policy in Star Health & Allied Insurance in his name;
6. That I/we hereby