……. The court

PLAINTIFF :

Acting :

DEFENDANT :

Subject: prompt determination of optional insurance.

INSTRUCTIONS

1 -) My client …, … with the insurance registration number S.S.K.it is registered at. My client … has paid his premiums from the optional insurance branch of the Insurance Department as of / … / … date.

2 -) My client, the defendant institution …/…/… date and … record no.petition to retire, institution …/…/… day and … numbered reply letter, they do not have such a file, my client’s request was rejected, therefore the optional insured is not considered.

3 -) The defendant has initially accepted my client’s request to be insured on demand, …/…/… – …/…/… he collected all premium payments during the period between the dates and did not give any warning that the premiums paid were invalid.

4 -) … Insurance Directorate, … / … / … date and … no.receipt retroactively paid premiums with delay increase together with the printed “optional insurance Pirim collection receipt” has charged. For these reasons, it has become mandatory for my client, whose claim for retirement was not accepted, to sue for the determination of his optional insurance.

Legal reasons: 506 S. K. m. 85 and related legislation.

Legal evidence: S.S.K. records, receipts, expert examination, witness statements and

other evidence

RESULT AND PROMPT

For the reasons described above, I respectfully request from the Supreme Court that the premiums paid as of the date/…/… are discretionary insurance premium and that my client is discretionary insured as of the date / … / … and that the costs of the trial be charged to the defendant. …/…/…