LIFE INSURANCE CORPORATION OF INDIA

NANONAL ELECTRONIC FUNDS TRAilSFER - TIAT.IDATE FORH

To
LIFE INSURANCE CORPORATION OF INDIA
Branch:-

$ub r Recslol ol pgllcv oavment throuqh NEFT

I am giving below the details of my Bank account for receiving policy payment through NEFT.

(1) Policy No/s

Name of policy holder/ claimant :

(2) Bank Name :

(3) Bank Branch Address :

(4) Account Type : Savings/CurrenUCash CrediVNRl

( Bank account number should be written from

(6)

(8) FMail ld :

(e) Are you willing to receive SUSIE-maiffiff related to your LIC policies : '

I have enclosed the following document to this effect (Please { appropriata item)
A. Cancelled cheque leaf
B.ifchequeisnothavingthenameofbankho|derthenPhotocopyofthe
p€e of Bank pass book containing details of Bank accounts number, IFS code

Signature of the policy holder Date:

(ln iase of change in Bank details, ptease fitt this mandate form again and submit the same to Our Branch '
officq)
'lf ylour answer to Q no 9 is 'Yes', then we Mtt be abte to send you a message when LIC transfers money to
your Account through NEFT. This message witl contaln the UTR ( Unique Transaction Reference)number which
can be used to make any enquiry regarding the payment.