Dated : __________________

To,

The Branch In Charge

Tata AIA Life Insurance Co. Ltd.

_______________ Branch

Dear Sir / Madam,

Reg : Policy no: ____________________________

With respect to above policy I would like to state that my residential Status is Non-Resident for this
financial year.

I would further like to state the following:

a. my residential Status is NRI since ______________________

b. my current country of residence is _____________________

Request you to consider above details for processing Surrender / Partial Withdrawal request.

Regards,

Signature of Policy Holder :______________________

Name of Policy Holder :_______________________