Golden Forests India Ltd — settlement of claim

Please provide me the detailed information to fill up the claim form a i have no certificates / receipts with me.
1. I have deposited rs.25000/- vide acknowledgement no.009939b on dt. 03.02.2001 / vide cuttack branch office statement no.25/3 dated 28.02.2001.

Kindly co-operate me to get my money at an earliest
Premananda mati
At/p. O - kusiapal, district - kendrapara