General Application Format

Date:----/-------/----------      

To,                                                                                                                                                                                                                                                                                                                             The Branch Manager, LIC of India.                                                            

Branch No.............................

Respected Sir/ Madam,                                                                        

Sub: - Proposal / Policy No..................................  of Mr/ Mrs..................................................................

 With reference to the above I request you to arrange compliance as per following serial No/s.............

                               

1.  Please revive my policy under special / ordinary / loan cum revival or S.B. cum revival scheme.                                                                                                                                              

2.    I have lost my policy. Please convey the formalities which I have to comply.

3.    I have not received the policy bond. Please arrange to send immediatel

4.    Please make a change in my address as per the details given below.

................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

5.    Please let me know the loan / Surrender / Discounted value available under the above policy. 

6.    I authorise Mr./ Mrs............................................................................... to collect my policy Bond, Loan / Maturity / S.B. cheque, who is an agent / D.O. of year/ ................................... Branch.

7.    Please issue a premium paid certificate for the financial year...................for Income Tax purpose

8.    Please transfer my policy record to Branch No ............................................................................

      I have paid the YLY/ HLY/QLY/MLY premium due dated ..............................................................

9.    I become major and wish to secure DAB, please register the fresh nomination as per enclose

10.  Please alter the mode of payment from YLY/ HLY/QLY/MLY   to    .............................................

11.  Please refund outstanding / Proposal deposit B.O.C. No .........................dated...........................

12.  Mr/ Mrs...................................................... Expired on date............................ I have enclosed original death certificate. Please send necessary claim forms.

13.  Please acknowledge the specimen signature’s 

1}                              2}                                     3}

14.  Please change the bank for ECS deduction. The name of new bank is as below.

 .........................................................................................................................................................

Thanking you in an anticipation of doing needful and acknowledge the receipt of the letter and enclosures.

     Yours faithfully,

      Signature  of Policyholder                                                                                                                                           

Encl:-

 1).......................... 

2)................................

3) ..............................      

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