To

The Branch Manager,

CB-18, LIC of INDIA,
Musheerabad, Hyderabad-48. Dated:

Respected Sir,

Subject: Request for Reinstatement / Reappointment of

Terminated LIC Agency

Reference Name: Agency Code:

The Agent with the above Agency Code No could not

complete the Minimum Business Gurantee as prescribed by the Corporation and
was terminated. This has happened due to Personal Problems / Unavoidable
Circumstance / Out of Station/ (any other reason) etc.
as cited by the terminated Agent.

The concerned Agent has assured that he/she would attend all the
Meetings/Seminars to update and upgrade his knowledge and to conduct the life
insurance business regularly & successfully.

The agency may be reinstated / reappointed at the earliest, so that the business on
hand can be completed.

Yours faithfully.