cared ager nerf Life Insurance Corporation of India stra Branch (ty @ @) 6) 6 ® ® (10) «ny *(12) (a) @) xe2reaT er /Cancoled cheque lat: (@) ©) wee R de REN Ae Re wr de a mio, aR Bs VIN ane oe de ORAGTON For Be ()( (3) (@) va: eed pm tc we Sel atested photocopy of PAN Card (3) (@) %: macht THRE Wiel He/ Self attested photocopy of Passport farra /Sub : offeretta 4a ga ¥ we & (NEFT) are frswararaa / Receipt of Policy Payment Through NEFT afer 8 rf ew Gh (NEFT) ayer Proscar tga es ace me eater. |.am giving below the details of my Bank account for receiving policy payment through NEFT. “ier sores /Policy Nos. _aderee eter are /Name of Policy holder claimant. ‘yaaa /Bank Name ‘Sper eebar [Bank Branch Address ‘arte rae rg ede! ihe a! ‘Account Type: Savings/CurentiCash Credi/NRI ‘We aTOTAT PTE NRE ha pen rar eta sraT aA He OS aa A RATA NRE MTA ART 8 ar (aR re PH 2000 PTT) ((faccount type is NRE, kindly enclose a bank certificate or bank statement certified by your bank, which certifies that all policy monies are paid through NRE account. This is mandatory to ensure that the proceeds paid are in compliance to RBI's FEMA 2000 guidelines) ‘aia males / Account No. I I (ard apna sidings said’ freer. /Bank Account Number should be written from left right) ‘ara gs HAAS /IFS Code (=a ‘Arak wrig [Mobile Number: [+ | 9] 1 ‘Serer /E-mall ID: ‘Prenat seule ard eaeal fa ak Meoarerdl Ge ee rertar ? eet | ae ‘Are you willing to receive SMSIE-mail, on matters related to your LIC policies: [Yes | No ‘amar rd / Aadhaar Card No. ‘rm. /PAN: ‘araeté amie /Passport Number: RGR eR NRE areca sTeaté wales 2a darters /Passport Number mandatory if A/c type is NRE. wa denia arta arrest sits snea. (Gra ata can ¥ @eIaI.)/ Ihave enclosed the following document to this effect. (Please ¥ appropriate item) {cheque is not having the name of bank holder then Photo copy of the page of BanlePass book containing | details of Bank accounts number, IFS Code. (c) a: erate ata asta G21 He / Self attested photocopy of Aadar Card (ed sea NRE sre deere sa) / (Mandatory itl type fs NRE) : (art same NRE area) Ae ch Bec Te NRE are Te aA | (lf A/c type is NRE) : | Confirm that the premium were paid through my NRE Account only. (Certificate from Bank attached) tie] ne cons wt on ‘ifareheearal ware] Singnature ofthe policy holderscnferdtareat / arctan at orden Pact Ft areca overt : @ ® © @ © 0 @ ) 0 seve eer rH Ry HN ge BY Slew oR HRT HG a eT a 6 PARA TA eel Fy are a ST eT | edad ar antes a Bae err & aH ar eRe BT A oT GA | fare reas / ender wr are feeaferea Peet flee gar Bey wr oa oT Teg / tes yw A rehaa reel sas art aE Aer Bt Se ae ee | Bey FHP ee shee aS om ey a A Sey reH HAT AAT 8 ct Gre eH er wigs BE | aera exes seat ar TATRA TEI Bs eA A arena eT | HURT HT HA gS TTA care / MTR BY hey ae Tree HT ey A aay Fs ee wy eS TT | ere eres / eI or a ep ware i et TTS Het ara AAR TET ge Peer AT SAT | AR, HS. GA I... Be PT Ter PA FG ATA me: er AeA rer ee Fa Fam aT FST, Hg aT SY es erator et fo AY RT: SR, ST. HFS aKa / MIE B aT 8 A ae Se aN aT eT. £. OF. SBR aa) rk 1. BG Be Reon TAY Be Ge AR ae Be eT FA eo ar aa a at GH: STRAT Ta AAT RIT | WH8.Uw Ft (NEFT) rar BoA aiferebees/ araeretenten sree TPA: (a) @ (#) @) @) () @) ® @® See ore freer a ae RAO TA, EAE TG raeT MENA TA ATA TS HA, (A (NEFT) rer a nen eho ae eT ToT TAT MES aT STR (TANIA) ST. ieee ender we cen Feo Bear ges ar sen eves GI A ATT TE aR PA se A Stet arta. areas ha Raa ee ae Te are a A a se Te ere TET. archer etc es ar es a earem aT SFA AE a. freon a rarer aOR aA IT PET A.A (NET) ahortde ae rT TNH era. ‘afer ere’ ahr de area rah Gea RS sea a AE. ce ace (Sma) er ar. Pro are er a. Ge PRANA RAN (7.ST) ear PAR eee lear a A ORY ARR. HR aT TT. ATE A, parts, ero: (NEFT) uh re Ree oe rr aR i EEE STAT ART HT TATA. Necessary information to the Policy holdericlaimants opting for NEFT : (a) (b) (©) @) e) (f) (9) (hn) w RPITLAC Fome-11/16 oe All the items mentioned in the enclosed mandate form should be filled correctly. This mandate can be used for 6 different policy numbers. The application for NEFT should be sent to our Branch as per address given above or to customer zone. The policy holder / claimant should also submit either a cancelled blank cheque leaf or the photo copy of the page of the passbook/cheque book where details of the account are mentioned. If within two days of the due date, the amount is not credited to your bank account, contact our branch office. The account of the policy holder/annuitant should be operational at the time obreceoipt of policy payment. Before submitting the mandate form, the policyholder/ claimant should confirm from his bank that it is NEFT enabled. Policy holder's /claimants name under the policy should match with that of Bank A/c., else it is likely to be rejected. NRI accounts are guided by FEMA regulations. LIC has decided not to include NRI accounts for fund transfer. So policy holders / annuitants are requested not to submit their NRI account details. After submission of NEFT details, if there is any change in bank details, then fresh mandate form will Oe Se er ai ae ego eae eer i aed oe Rea fh argh aren & fee sttoh oe & a aeT TET in case of cispuioin respect of ntrpetaton of terms the English version shal stand al,