Death Claim Facing Sheet
Date: 08/04/2018 AD
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Serial No
|
|
|
|
1
|
Project
|
Islami
Insurance
|
|
2
|
Death Claim
No
|
Serial No-
64/17
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|
3
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Insurance
Letter No
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203300051-6
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|
4
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Insurance
Receiver Name
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Fatema Begum
|
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5
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Insurance
Receiver Profession
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House wife
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6
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Age at
beginning (Prove)
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43 years
|
|
7
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Age at the
time of death
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44 years (As
per National Identity No)
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|
8
|
Insurance
Amount
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4,80,000/-
(Four Lakhs Eighty Thousands )
|
|
9
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Description
of Lien
|
Not necessary
|
|
10
|
Amount of
paid installment
|
01 piece of premium
(40,272x1)=40,272/-
|
|
11
|
Premium which
is cut off
|
Not necessary
|
|
12
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Amount of
total premium with cut off
|
Not necessary
|
|
13
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Amount of
expected given facilities
|
Not necessary
|
|
14
|
Description
of due debt
|
Not necessary
|
|
15
|
Cooperation
Insurance
|
Not necessary
|
|
16
|
Project and
validity
|
16/16
|
|
17
|
Premium given
system
|
Yearly
|
|
18
|
FPR issue
date
|
24/04/2016
|
|
19
|
Date to start
insurance
|
24/04/2016
|
|
20
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Date of
receiving risks
|
24/04/2016
|
|
21
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Date of
receiving final premium
|
24/04/2016
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|
22
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Date to pay
liability
|
24/04/2017
|
|
23
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Pleasing
duration
|
23/05/2017
|
|
24
|
Policy
situation at the time of death
|
On going
|
|
25
|
Time of
policy is active automatically
|
Not necessary
|
|
26
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Number of
final given installment
|
01
|
|
27
|
Date of final
PR and O/R
|
18/02/2016
and 24/04/2016
|
|
28
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Date of death
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10/01/2017
|
|
29
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Real reason
of death
|
Heart Attack
|
|
30
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Related
reason of death
|
Not necessary
|
|
31
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The time to
have the policy active
|
08 months 16
days
|
|
32
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Whether the
claim form is submitted?
|
yes
|
|
33
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Whether the
claim has been investigated?
|
|
|
34
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Whether the
post mortem report has been submitted
|
Not necessary
|
|
35
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Name of
nominee
|
Mohammad Ali,
age- 25 years, relation- son
|
|
36
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Guardian
|
Not necessary
|
Principle
amount of insurance amount taka = 480000/= (Four Lakhs Eighty Thousands Taka
Only), The time to have the policy have been validated 08 months 16 days, as is
seen observing the received documents that insurance receiver last date
10/01/2017 AD has got dead. The reason of death is heart attack. In that case the
death claim is payable. Son of insurance receiver and policy nominee Mr
Mohammad Ali can be given the death claim.
Page No- 2
As for death claim taka 48,0000/=
(Four Lakhs Eighty Thousands Taka Only) for approval there can be presented the
file to the death claim committee.
Sd/ Illegible
12/04/2018 AD
Muhammed Masudul Hassan
Executive Officer, ID No- 095
Death Claim Dept
Rupali Life Insurance Co. Ltd.
Head Office, Dhaka- 1000
(Seal)
SVP (UW claim Dept)
Sd/ Illegible
02/04/2017
Md. Abdullah
Senior Vice President
Claim Department
Rupali Life Insurance Co. Ltd
Head Office, Dhaka.
(Seal)
Page No- 3
(Monogram)
Final report of death claim
investigation
Serial No- 64/17
Policy no- 203300051-6
Reason of death: Heat Attack
Name of insurance receiver: Fatema
Begum
Amount of insurance: 4,80,000/-
All of the
information which has been found as investigating physically the claim of death
of Mrs Fatema Begum as per reference letter no- RLI/ claim/1583/2017, dated-
08/10/2017 AD based on the roder letter of the chief executive officer that is
mentioned as follows:
(1)
Description
nominee:
Name of the
nominee- Md Ali, Father- Osiur Rahman. As per description of the nominee, Late
Fatema Begum, is in relation of mother with the nominee, she has been dead on
dated 10/01/2017 AD. I have been got informed discussing with the nominee as
going to the home in the mentioned address that, Insurance receiver Fatema
Begum as was healthy before the death. Suddenly as has been fallen in illness
there has been given general treatment from the doctor. He has got dead on
dated 10/01/2017 AD in the mentioned disease. Doctor informed us the reason of
the death is heart attack.
(2)
Interviews with
the local people:
I have been got
informed as meet with local people, Mrs Fatema Begum has got dead as because of
heart attack becoming illness suddenly. He has been dead on dated 10/01/2017
AD.
Interview of
the doctor:
Dr Abdus Salam,
MBBS, BCS, Shevron Clinical Lab Hospital Shorok, Cox’s Bazar who has given
treatment has informed us that he has given treatment Fatema Begum before
death. The death certificate as mentioned is given by him.
(3)
Interview by
the Chairman:
Mr Md. Younus
Vutta, Chairman, 8 no South Mithachari, Ram, Cox’s Bazar, after seeing the
death certificate Fatema Begum has gor dead on dated 10/01/2017 AD.
(4)
Interview with
mam Leader:
(5)
Imam Mr Md. Sad
Uddin informed me, hehas been accomplished the activities the funnel prayer of
Fatema Begum.
Therefore, the
death claim is presented for taking next decision.
Sincerely,
Sd/ Illegible
05/11/2017 AD
Md. Abdul Kader
E. O (Duplicate
Department)
Bahaddar Hat
Service Cell,
Chattagram.
Page No- 4
Dr Abdus Salam
MBBS, BBS (Health), PGT (Medicine)
MD (Cardiology) Course (CMC)
Medicine, Heart Disease, Agma, Oain
Disease
Liver and Kid ney disease expert
Cox’s Bazar Medical College, Cox’s
Bazar
(Monogram)
Shevron
Clinical Labratory Cox’s Bazar
Name:
Rx
Death Certificate
This is to certify that Mrs Fatema
Begum, age- 40 son o Ashik Rahman, village- Sikder Para, Ward no- 01, U/ P
South Mitali, P/ O- Knasi=ulia, P/ S: Sadar, dist- Dhaka is hereby examined me-
she was expereo at 7.00 am on 10/01/2017 AD following awate keest attached.
I pray for his departed soul.
Sd/ Illegible
03/11/2017 AD
Dr Abdus Salam MBBS DCS (Health), PCR
Chamber: Shevron (New building, 2nd
floor), Hospital Road, Cox’s Bazar.
Phone for serial of the patient:
01815-080212, 01862-375555, 01759-395829
Page No- 5
Bismillahir Rahmanir Rahim
Government of the People’s Republic of Bangladesh
8 No South Mithachari Union Parishad
Post Office: Kharulia, Upazilla: Ramu, District: Cox’s Bazar
Md. Younus Vutta
Chairman
(Monogram)
Mobile: 01830-175382
Date: 02/02/2017 AD
Death Certificate
This is to certify on that, Fatema
Begum, husband- Asiur Rahman, Mother- Rokeya Begum, village- Sikder Para, Ward
no- 01 (one), Union- South Mithachari, Post Office- Kharulia (4730), Upazilla-
Ramu, District- Cox’s Bazar. He is permanent resident of this union and she is
the citizen of Bangladesh. As far I know, as per death registrar book of the UP
he has been got dead on dated 10/01/2017 AD. At the time of death he was 43
years old.
I pray for mercy of her departed
soul.
Sd/ Illegible
Date: 08/11/2017 AD
Md. Younus Vutto
Chairman
8 no South Mithachari Union Parishad
Ramu, Cox’s Bazar
Page No- 6
Bismillahir Rahmanir Rahim
Sikder Para Jame Moshjid Operation Committee
Village- Sikder Para, Post Office- Kharulia, Upazilla- ramu,
District- Cox’s Bazar
Reference: Date:
15/02/2017 AD
Burial Certificate
This is to certify on that, Fatema
Begum, Husband- Late Asiur Rahman, Address- Sikder Para, Post Office- Kharulia,
Upazilla- Ramu, District- Cox;s Bazar. He has been dead becoming attacked by
the heart disease in his own home at 07 AM in the morning on last dated
10/01/2017 AD Inna Lillahi Oinnailaihi Raziun. She has been buried in local
social grave after the funnel prayer at 5.00 PM in afternoon.
I pray mercy for her departed soul.
President
Sd/ Illegible
15/02/2017 AD
Sikder Para Jame Moshjid Operation Committee
Sikder Para, Post Office- Kharulia,
Upazilla- Ramu, District- Cox’s Bazar
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