EFU LIFE ASSURANCE LTD

APPLICATION FOR POLICY SURRENDER

EFU Life House, Plot No. 112, 8th East Street, Phase 1, DHA, Karachi. Phone # (021) 111-EFU-111, 111-338-111

Client Service Call Center (021) 111-EFU-CSD, 111-338-273, Fax: (021) 34537519, Email: csd@efulife.com, Website: www.efulife.com

CS/3/023-8-1/2

Policy Number

Bank

Bank Account Number

Reason for Surrender

In accordance with the Provisions and Conditions of the above policy, I / We hereby request EFU Life Assurance to pay:

Regular Unit

The full cash value of the policy through its total surrender.

A sum of Rs. by surrendering appropriate number of units. I/We understand that in thisevent, the Sum Assured of the policy will be proportionally reduced.

number of units attached to the above policy through their surrender. I/We understand that

in this event, Sum Assured of the policy will be proportionally reduced.

Fund Acceleration Premium (FAP)

The full cash value of FAP units in the above policy through surrender.

A sum of Rs. by surrendering appropriate number of units allocated against FAP.

number of FAP units attached to the above policy through their surrender.

Consent on Zakat deduction

I/We wish to claim exemption of Zakat. The relevant sworn statement is attached.

I/We do not wish to claim exemption from deduction of Zakat. I/We understand that a sum equivalent to 2.5%of amount payable has to be deducted as zakat.

Branch

Cont: Page2

Name of Policy Holder

OR /

OR /

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I/We agree that the above-mentioned payment made in my/our favor and sent by post or courier service to the addressmentioned below, will discharge the Company from any liabil i t ies and claims arising under this policy.

I/We also hereby certify that I/We are entitled to the proceeds of the policy, and that the policy has niether in any way beenassigned or transferred, nor does any other person(s) have any right to the policy.

I/We understand that the surrender processing fees of Rs.500/- will be deducted from the cash value of my policy at thetime of full surrender of regular units.

Date Month Year Place

I/We have already returned the policy documents to EFU Life Assurance Ltd.

Signature of life assured:

(in case of a joint life policy, both lives need to sign)

(In case the signature has been changed, please provide both old and new signatures)

CorrespondenceAddress:

E-mail:

Witness:

Name of witness:

Signature of witness:

Computerized National Identity Card #

CorrespondenceAddress:

E-mail: Telephone No: Mobile No:

Telephone No: Mobile No:

CS/3/023-8-2/2 EFU Life House, Plot No. 112, 8th East Street, Phase 1, DHA, Karachi. Phone # (021) 111-EFU-111, 111-338-111

Client Service Call Center (021) 111-EFU-CSD, 111-338-273, Fax: (021) 34537519, Email: csd@efulife.com, Website: www.efulife.com