Surrender Request Form - Super Suraksha / Dhanaraksha / RinnRaksha

Date: ____________SBI Life Insurance Company Ltd, Branch _____________________.

Dear Sir / Madam,

Re: Foreclosure / Surrender of Loan account no. ______________________ under Dhanaraksha /Super Suraksha/ Rinn Raksha Policy (Tick any One).

I have foreclosed the loan as on __________ (loan closure date) and the captioned loan account is closed as on date. I request you to foreclose / surrender the policy & refund the surrender amount as per terms and conditions of the products at the earliest.

Thanks & Regards,

__________________________________________Name of the member(s):

Date: Place:

Recommendation from banker The loan account no. ______________ (New No.) /________________(Old No.) was covered under Dhanaraksha SP / Dhanaraksha LPPT /Super Suraksha/ Rinn Raksha. The loan account has been foreclosed on____________.

The original Certificate of Insurance is enclosed herewith / not received (Tick any one). We have no objection in the member surrendering the policy.

Bank seal:

Name of branch manager:_______________________ Name of the bank branch:_______________________ Branch code: _________________________________ Date:___________

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Copy of PAN Card PAN*

Residential Status : Resident NRI^ Contry of Residence___________________

Instructions : 1) TDS at 2% is deductible on payments which are not exempt under Sec. 10(10D) of IT Act 1961,2) *TDS rate shall be 20% if PAN is not provided3) ^TDS rate shall be 30.9% for NRIs for payment upto Rs. 1 Cr and 33.99% for payments above Rs. 1 Cr.

BANK SEAL

Signature of Branch Manager

Signature of member(s)

Signature of Member(s)

Signature of branch manager

SBI Life Insurance Company Limited.Reg. & Corp Office: "Natraj", M.V Road & Western Express Highway Junction, Andheri (East), Mumbai 400069. IRDA Regn. No. 111 Tel No. (022) 61910000

Central Processing Center: Kapas Bhavan, Plot No.3A, Sector No.10, CBD Belapur, Navi Mumbai 400614

DIRECT CREDIT MANDATE

ToSBI Life Insurance Co. Ltd.Branch: __________________________

Sub: Receipt of policy payment through NEFT

I am giving below the details of my Bank account for receiving policy payment through NEFT.

Policy No.

Name of Policyholder

Bank Name

Bank Branch Address

Account Type (Please appropriate item) Savings Current #NRE

Bank Account Number

Mobile Number

E- mail ID#For N.R.E. account, letter from the bank is required for direct credit of the payment.

Original cheque leaf along with preprinted name and account number.If Cheque does not contain preprinted name then please submit self attested copy of Bank Passbook showing preprinted bank account no., account holder name & IFS Code along with a copy of the recent transactions (not more than 1-month old).

I agree that:1) For NRE account, letter from the bank is required for the direct credit of the surrender proceeds.2) SBI Life reserves the right to reverse any payment made erroneously into your account and to exercise a lien to recover

such excess amount credited to your account.3) SBI Life reserves the right to pay the amount through cheque where the payout via NEFT cannot be processed.

“I hereby declare that the policy details and the bank account details provided by me herein above are true and correct and I hereby authorize SBIL to credit the proceeds under the above policy to my bank account given above, at my risk.”

Signature of the Policy holder

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SBI Life Insurance Company Limited.Reg. & Corp Office: "Natraj", M.V Road & Western Express Highway Junction, Andheri (East), Mumbai 400069. IRDA Regn. No. 111 Tel No. (022) 61910000

Central Processing Center: Kapas Bhavan, Plot No.3A, Sector No.10, CBD Belapur, Navi Mumbai 400614

IFS Code

I have enclosed the following document to this effect. (Please appropriate item)

Date D D M/ M / Y Y Y Y

Place: ___________________________