APPLICATION FOR GRANT OF COMPENSATION IN RESPECT OF ACCOUNTABLE ARTICLE (Speed Post/Register/VPL/VPP) NO. 1. 2. 3.

Name & address of the sender: Name & address of the addressee: Accountable article description & No.: Date of Booking: Office of Posting: VPL/VPP Amount: 4. (A) Postage paid on the article:

(B) Contents & their value [Excluding postage]: 5. (A) Is there any documentary proof of the contents having been enclosed. If so, furnish details: (B) Is a bonafide order from the sender available with you? (If so please attach a copy) 6. Basic for the claim [Loss/damage/abstraction of the article] and any other aspect: I hereby declare that if the article is subsequently traced or if the amount of the claim subsequently found to have been paid in contravention of the Rules of orders in force, I shall indemnify the Government for the sum so sanctioned and paid to me in respect of the above mentioned article.

DATE PLACE:

SIGNATURE OF THE SENDER

DEPARTMENT OF POSTS, INDIA

From: Supdt. Of Post Offices, Bhusawal Division, BHUSAWAL-425201 To,

By RL

The Jai-Balaji Industries, Chorwad, Bhusawal,

No.: CR-3/425100-04880/10 Dated. At Bhusawal the 08.11.10 Sub: Regarding Compensation against non-delivery of your article no. Register Post No. 5287 dated 04.06.10 booked at Bhusawal HO Ref: Your complaint. Sir, ***

This is regarding non delivery of article No Register Post No. 5287 dated 04.06.10 booked at Bhusawal HO Posted by your office If, the disposal of the said article is known to you, then please intimate to this office, otherwise fill up the Compensation Forms attached in duplicate with this letter and forward to this office at an earliest. Encl: Compensation Forms Yours faithfully,

Supdt.of Post Offices, Bhusawal Division, BHUSAWAL- 425201.

CASE No.: CR-3/425100-02701/07 Dtd. At Bhusawal the 10.07.2007

IF DELIVERED: I (a). I came to know that the article was delivered to the addressee on.............. I (b). The article was returned back and delivered to me on........... IF NOT DELIVERED: II (a). I came to know that the article was neither delivered to the addressee nor returned back to me. II (b). I have no information about the delivery of article so far. II(c). The contents of the article are ............................... II (d). The intrinsic value of the article is Rs............ (in words)........................ II (e). Other relevant information, if any .......................... PLACE: .................... DATE :............ NAME : ADDRESS :_ SIGNATURE