ReLIANCe Life Insurance cma lice tolam eld) Name of the Policy Holder Contact No. Polley No (Gata: Number Name of the Pian (The above fields are mandatory for processing all service requests) | wish to redirect my future premiums in my above mentioned policy as follows Source Fund (From) or Amount Destination Fund (To) or Amount (Previous Fund) mons (New Fung) won [AlleasLone colact ne laine or edie) ‘ime day, Prenium erection request receive after 3.00pm wile procestea onthe next woking Premium resection requests receved at branch between Fda post 3.00 pre Sunday wil eal Mondaprolowg woring da. Incase of cheque payment, promium redtecton requests willbe processed subject realsaton Promium regrection ansacton willbe applicable ony ete future fonds, Ta crange esting alloesvon, fund seh needs to be sfrectes Paley holders mandatory or processing sl ret the allocation of ture premiums ee neh up 3.00 pm ram Money to Fay Wl ing requests sper he customer request the NAV oh flowing *Weaquiy tnd i elected then capital quarante sal cease merely. Capital Guarani carne bee out equty tue (On fo apoticabie Pans date of Request: I] I OOOO Signature of policy holder {signature is in vernacular, please complete the folowing declaration: {herby Sclre hat have tly explained / transite he enters mentions inthe request form 0 lae 2 pley one an tuther declare ha e/shethey fly “Understood te meaning erect cee OOo Signature of declarant yt ota banat ir at) the contents in (Langsage anahave undersign the same —__ ote: I] Oo Ooo Signature of poley Felder DS ensaiiernty Srnehime te IO I Oe nce Company Limited i Pec