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Group Product Surrender Request Form English 21102021

This document is a surrender request form for an insurance policy. It provides instructions that any claims payout will be subject to applicable tax laws and the policyholder should consult their tax advisor. The form requests information such as the policy account number, date of account closure, signatures of the member and bank manager to confirm closure, and whether the original insurance certificate is enclosed. It also includes a direct credit mandate for the policyholder to provide their bank account details to receive payments via NEFT transfer.

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Subin S
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852 views2 pages

Group Product Surrender Request Form English 21102021

This document is a surrender request form for an insurance policy. It provides instructions that any claims payout will be subject to applicable tax laws and the policyholder should consult their tax advisor. The form requests information such as the policy account number, date of account closure, signatures of the member and bank manager to confirm closure, and whether the original insurance certificate is enclosed. It also includes a direct credit mandate for the policyholder to provide their bank account details to receive payments via NEFT transfer.

Uploaded by

Subin S
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Surrender Request Form: Includes instructions and fields for surrendering a policy, requiring personal and policy details.
  • Direct Credit Mandate: Details the procedure and information required to set up a direct credit transfer for policy payments.

Surrender Request Form - Super Suraksha / Dhanaraksha / RinnRaksha

Instructions :
All claims payout shall be subject to TDS provisions applicable as per the prevailing Income tax laws and are subject to change
from time to time. Kindly consult your tax advisor for further clarification
____________

Foreclosure / Surrender of Loan account no. ______________________

My Suraksha Account No._________________has been closed on ________________(dd/mm/yyyy)

Signature of Member

Signature of member

Confirmation by Banker

Member's Suraksha Account No._________________has been closed on _____________(dd/mm/yyyy)


(applicable only for Bank Paid policies)

The Original Certificate of Insurance is enclosed herewith / not received (Tick any one)

Signature of Branch Manager

Signature of branch manager

branch:
BANK SEAL

1800 267 9090

[Link].06 10-21 ENG


DIRECT CREDIT MANDATE
To
SBI Life InsuranceCo. Ltd.
Branch: __________________________

Sub: Receipt of policy paymentthroughNEFT

I am giving belowthedetails of my Bank account forreceivingpolicy paymentthroughNEFT.

Policy No.

Name of Policyholder

Bank Name

Bank Branch Address

AccountType (Please  appropriateitem) Savings Current NRE

Account N

Mobile Number

E - mail ID

I have enclosed the following document to this effect. (Please  appropriate item)

Original chequeleaf along with preprinted name and account number.


If Cheque does not contain preprinted name then please submit self attested copy of Bank Passbook showing preprinted
bank account no., account holder name & IFS Code along with a copy of the recent transactions (not more than 1-month old).
My Suraksha Account No._________________has been closed on ________________(dd/mm/yyyy)

I agree that:
1) For NRE account, letter from the bank is required for the direct credit of the surrender proceeds.
2) SBI Life reserves the right to reverse any payment made erroneously into your account and to exercise a lien to recover
such excess amount credited to your account.
3) SBI Life reserves the right to pay the amount through cheque where the payout via NEFT cannot be processed.

“I hereby declare that the policy details and the bank account details provided by me herein above are true and correct and I
hereby authorize SBIL to credit the proceeds under the above policy to my bank account given above, at my risk.”

Date D D / M M / Y Y Y Y

Place: ___________________________ Signature of the Policy holder

1800 267 9090


[Link].06 10-21 ENG

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