Place:-Ulhasnagar

Date:- 22/04/2023
The Senior/Branch Manager
Branch No. 92F
Life Insurance Corporation of India
Ulhasnagar
Policy No 923231536 Own Life
Dear Sir,

I hereby given you notice that I have assigned the above policy to:
Shiv Kala Urban Co-op. Credit Society Ltd.
Office No.B-3, Ganpati Plaza
UMC Road,Chopra Court
Ulhasnagar-421 003

on please acknowldge receipt of this notice and forward the enclosed policy/deed
of assignment Society after registering the assignment thereon in your Books.

Certified that the thumb impression here in is

That of
Who admits having affixed the same after understanding the content hereof

Yours Faithfully
Signature of Witness (Signature/Thumb Impression of Assignor)
(Anand C Khatri)