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Hi one of my staff left the job after two years with proper resignation and notice period. His fnf couldn't happen in next cycle and before next cycle he committed suicide after his brother road accident death. He don't have any dependents as he is unmarried. He has farther mother and two sisters in his family. As per company records her mother is her nominee. Now I want to help her mother to claim all the fnf settlement amount, pf amount and any other things which can be claimed. My HR said she needs a affidavit and letter to company along with KYC of her mother and account details along with death certificate. Other things I have managed. But she is unable to get formats. I need the format of affidavit and letter to company. Please help me with this.

From India, Hyderabad
My HR unable to get the formats, need to help my HR and my staff mother to get the claim ASAP. As the mother needs the money badly as both of her earning sons died.
From India, Hyderabad
Please find the draft for your kind perusal, please amend as per your need

I Smt. ____________________ w/o _______________ and M/o______________________R/o ____________ do hereby

solemnly affirm and declare as under:-

1. That Sh. ____________________ S/o ___________________ expired at ______________ on _____________ and death was registered with MCD. Death Certificate No. _______________ dated ______________ is attached.

2. That after the death of my son Sh. _______________________, the following are the survival members in the family.

Sr. No. Name Age Relation with deceased






That the none other than mentioned above is the survival member in the family.

4. That Full and Final Settlement is required to be paid to the nominee who is the mother of the deceased and a survival member, including PF, ESI and other claim be processed to the survival member of the family.

5. That this is my true statement.


Verification: Verified at Delhi, this _____________ day ___________ that the contents of the affidavit are true & correct to the best of my knowledge and belief and nothing has been concealed therein.


Seniors or other members are welcomed to modify/change the formats if required

From India, Ahmadabad
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