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Life Insurance Assignment Application

This document is an application form for assigning an insurance policy. It provides instructions for completing the form, including that the assignor and assignee must satisfy themselves before forwarding the policy document, only a full assignment is allowed, and an assignment will cancel any existing nominations. The form collects information about the policy, assignor, assignee, consideration (payment) for the assignment, and signatures of both parties. It notes the assignment is subject to section 38 of the Insurance Act and must be delivered to IDBI Federal Life Insurance to take effect.

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vijayindia87
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75 views2 pages

Life Insurance Assignment Application

This document is an application form for assigning an insurance policy. It provides instructions for completing the form, including that the assignor and assignee must satisfy themselves before forwarding the policy document, only a full assignment is allowed, and an assignment will cancel any existing nominations. The form collects information about the policy, assignor, assignee, consideration (payment) for the assignment, and signatures of both parties. It notes the assignment is subject to section 38 of the Insurance Act and must be delivered to IDBI Federal Life Insurance to take effect.

Uploaded by

vijayindia87
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Tradeview, Oasis Complex, Kamala City, P. B. Marg, Lower Parel (W). Mumbai - 400013.

Toll Free: 1800 102 5005 (For non-MTNL subscribers), 1800 22 1120 (For MTNL subscribers). E-mail: support@[Link]. [Link]

APPLICATION FOR ASSIGNMENT


(Kindly fill in Block Letters)

INSTRUCTIONS
l Parties to the assignment should satisfy themselves before forwarding the policy document to the company, for the registration of assignment. l form must be filled by the owner of the policy. A conditional assignment may be made, part assignment of a policy is not allowed. This l assignment in favor of survivor/s shall be valid. An l assignment of a policy shall automatically cancel any nomination made in the policy, except where the policy is assigned to the insurer, in which case the nominees' right The

shall be affected to the extent of the insurer's interest in the policy.


l form shall be accompanied by the original policy document in respect of which the assignment is made. This l assignment shall not be effectual against the company unless it is duly completed and delivered to IDBI Federal Life Insurance Co. Ltd. The l assignment will be as per the section 38 of insurance act. The

GENERAL INFORMATION POLICY NUMBER ASSIGNOR DETAILS NAME Address SUM ASSURED

City State TELEPHONE NUMBERS (STD CODE) SIGNATURE OF THE ASSIGNOR Executed on this
D D M M Y Y Y Y

PIN

Residence Office Mobile

at

I, Mr. / Ms. / Mrs. / Title _______________________________________________________________________________________, as the owner of the above named policy assign this policy to the assignee named herein, and I hereby give you the notice of same. CONSIDERATION (IF ANY) Please strike out parts which are not applicable. Consideration received Rs In words, ______________________________________________________________________________________________ From the assignee ______________________________________________________________________________________ I hereby acknowledge the receipt of the above mentioned consideration from the assignee. OR The policy has been assigned out of natural love and affection and no other consideration has been received from the assignee. ASSIGNEE DETAILS NAME Address

City State TELEPHONE NUMBERS (STD CODE) RELATIONSHIP TO THE POLICY OWNER PTO
IFLI/PS/ASSGform/v1.0/0308 PSR : 3002 Page 1

PIN

Residence Office Mobile

Gender SIGNATURE OF THE ASSIGNEE Executed on this WITNESS DETAILS NAME Address
D

Male

Female

Date Of Birth

M M

M M

at

City SIGNATURE OF THE WITNESS


(age should be more than 18 years)

State PIN

Future premiums will be paid by: (Tick as applicable)

Assignee

Assignor

Signature/ thumb impression of Assignor


D D M M Y Y Y Y D

Signature of Assignee
D M M Y Y Y Y

IFLI/PS/ASSGform/v1.0/0308

PSR : 3002

Page 2

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