a ‘Application No.: obo00000000 {Date and Time of Reccot POLICY SURRENDER FORM (70°22 i a i FOR OFFICE USE ONLY ! oon0o0o0o0o0o000 Errccenes oy Received |! og Sl signature, Stamp ! } : SURRENDER OF POLICY 1 ‘would ike to surrender the above-mentioned Policy due to the feliowing reason ~ {Thereby request you to please refund the surrender value a applicable. Iam also enclosing the Policy Document along with this form: understand that in accordance with the Guidelines of IRDA, for Unit Liked Products, if my surrender request is submited before 3:00 PM on @ business day at the Insurance Company's Office, the request would be processed as per the closing NAV of the same day and ifthe surrender requests submited after 3:00 PM on a business day request would be processed as per the closing NAV ofthe next business day. mentioned in the Terms & Conditions ofthe Policy Document, the surrender valve shale arrived at after deducting appropriate surrender charges fom my fund value. Note: + Policy will acquive 2 Surender Value as per the product specication. If surender request is received within the lock-in peed then the surrender valves peidat theendofthe lockin ered + Incase of insure Smart Pen, 'Guerenteed NAV shel nt poly for calculating the surrender value "ally understand the meaning end scope of this Policy Servicing request and em submitting the completed form fm onn vltion.. Name ot Policy Holder/ Assignee oe 00/00/0000 Signature/Thumb Impression of Policy Holder Signature/Thumb Impression of Assignee (Require in Case of Absolute Assignment of Pocy) Declaration, if this Form is signed in Vernacular/Thumb Impression above 1 SoryDaughter of . aman adult and residing at ‘ nereby declare on solemn affirmation as under: have read outandully ‘explained the contents ofthe frm and allather documents language inckental fo make the necessary changes in the Policy to Mr Mrs./ Ms, ‘and he/she has understood the significance ofthe change, Iheve truthfully end ‘correctly recorded therapies given by the Poy Holder /Assignce and that the Policy Holder /Assignoc hac affixed the signature/thumb impression ‘above after fully understanding te contents thereof. - Solemniyatfirmedat i onms OO/O0/O000 Declarant Signature Note: Processing ofthe requests ill beiniiated on reeit ofthis form at any of our Company's Office. Upon receipt ofthis form etour Companys Office, the ‘Scinowlacgement ip nllbesartte you. Pleseeretam te acknowecgemant sip forfuture reference, ae ee. ACKNOWLEDGEMENT roteyne. Appicatinne. I IO OOOU00U00 Received Stamp Type ofRequest Received by Date andTne of Receipt Signaturebeen left blank intentionally a<- ACKNOWLEDGEMENT \Wenoveresavedyeurraqueetond youl nartem us wathin 100s. The change the rouse lib on recip htorm stay of our Company's subject comalton lrequreddocments, Foran) qucespleseconiectuset ‘Tol reeot 800-103-0005 /1800-380-0003 (BSNL, MIML Users) & Sssto77e030003| B Emalvsoteastomerservicedeanaronsolitain {© aero ssrnatanewonw-eaaransi.com| Incaaeyauerenetsatarects reser presided, yauray ois yeurfeedbokt our Compl RedresslUnt at eraBeanarahsbelifsin ‘ana HSBC Orval Bak f Conner Ue Irsurce Cano Unite, Ure Tate Cee, 2nd Fer, Shar Le, Pee Sector 49, Gusnen 2206, Hanan, Io