Tata AIA Life Insurance Company Limited
Form of Assignment
Instructions
1. All fields are Mandatory.
2. Assignor is the Policyholder intending to Assign the Policy. Assignee is any person and whose favour the policy is assigned.
3. Absolute Assignment is unconditional transfer of all the rights, interest, title & obligations to the Assignee.
4. Assignment shall be governed as per Section 28 of the Insurance Act as amended from time to time.
5. TALIC reserves the right to decline the assignment, if it has sufficient reason to believe that the assignment is not bonafide, not in the interest of policyholder or not in the public interest, assignment
is for the purpose of trading of the indurance policy or such other reason.
6. Witnesses for the Assignee should be different.
7. In partial Assignment, upon assignment, all the rights, interest, title & obligations of the policy is bestowed with the Assignee to the extent of the partial assigned value. for the Assignee should be .
different.
8. Nomination made before assignment of the policy, shall stand auto revived when the policy is reassigned by the assignee or retransferred by the transferee in favour of the assignor.
9. If there is any payout that is already in process, the payout amount will be paid to Policy owner only.
10. If the Assignee is an Entity(such as Company, Partnership, Trust or unincorporated association or body of individuals), in addition to the KYC documents, Beneficial Ownership form and Senior
Management Form will also be required.
11. Pension Product launched post Sept 2023, on assignment to Individual-" On Maturity / Surrender Only 60% of Proceeds will be payable as commuted value and Balance 40% immediate Annuity
policy to be purchased by Assignee" if it is applicable as per policy T&C.
Pension Product launched post Sept 2023, on assignment to Non-Individual-" On Maturity / Surrender Only 60% of Proceeds will be payable as commuted value to Assignee and Balance 40%
immediate Annuity policy to be purchased by Assignor" if it is applicable as per policy T&C.
Policy Details
Policy Number EIA Number
IPIN
Name of Policyholder:Mr/Mrs/M/S.
(Assignor details)
Address
Landmark City
State Pin Code
Contact Numbers
STD Residence STD Office Extn Mobile
Email ID
Notice of Assignment
I the Assignor, hereby give you notice that I have assigned the above Policy to
(Assignee Name) his/her Legal heirs, Executors, Administrators and Assigns, all monies,
benefits and advantages to be received there under to the extent of outstanding College fee amount and the assignment period will be restricted to the
fee paying tenure. Please acknowledge receipt of this notice and forward the enclosed Policy after registering the assignment thereon in your boo ks.
Assignee Details-(Please submit duly filled NEFT form along with a personalised cancelled cheque)
Name of Assignee:Mr/Mrs/M/S.
Alias name(If applicable)
Communication Address
Landmark City
State Pin Code
Contact Numbers
STD Residence STD Office Extn Mobile
Email ID
Principal Place of Business(if different from Registered Address)
Communication Address
Landmark City
State Pin Code
Entity Type Individual Non Individual(If non-individual, Fill Annexurel attached)
Date of Birth / Incorporation D D M M Y Y Y Y Gender Male Female
Nationality Resident Indian NRI PIO / OCI Foreign National(Nationality)
Residence for Tax Purpose in Jurisdiction(s) outside india: No Yes(iF Yes' then FATCA & CRS-Self Certification Form to be mandatorily completed)
Relationship of Asignee with the Assignor Are you a NGO No Yes
Are you a Non-Profit Organization (NPO) No Yes If Yes, Please provide CIN No.
Are you registered on the Drapan Portal No Yes If Yes, share registration no.
If No, I hereby declare that i will get the entity registered on Darpan Portal.
Non-profit organization(N POI means any entity or organization, constituted for religiousor charitable purpose referred to in clause(15) of section 2 of be Income-tax Act 196 (143 of 1961), that is registered as a trust or a
society under the Societies Registration Act, 1860(21 of 1860) or any similar State Legislation or a Company registered under the section B of the Companies Act, 2013(18 of 2013)
Are you connected to the Insurance Industry? No Yes (Please provide details)
Are you a politically exposed person(PEP)?** No Yes
Are any of your family members or close relative a Politically Exposed Person(PEP)** No Yes
If, “Yes” please provide details
**Definition of PEP: "PEPS are individuals who have been entrusted with prominent public functions by a foreign county. including the heads of States or Governments, senior politicians, senior government or judicial or
military officers, senior executives of state-owned corporations and important political party officials;". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity) or
through marriage or similar (civil) forms of partnership. Close associates are individuals closely connected to a PEP, either socially or professionally'
Future premium to be paid by Assignor Assignee
If Future Premiums are paid by Assignee & Amual Premium in the policy is ₹1,00,000/- & above then Income Proof is Mandatory
KYC Documents required of Assignee Photo Identity Proof PAN (Mandatory) 10 Digit PAN Number
Address Proof (Aadhaar card/Driving License/Passport/Voter ID/NPR/Job card issued by NREGA duly
signed by an officer of State Government)
Type of Assignment
Type of Assignment Absolute Partial Conditional
Reason for Assignment
Valuable consideration of Rs. received
If Partial Assignment mention the Sum Assured
by me from Assignee with respect to the aforesaid Assignment
Rs.
Out of Love & Affection without valuable consideration
Keyman
Terms of Assignment is to be mandatorily enclosed.
Appointment of fresh nominee(s) / change of Assignee(s)
All the money secured by the above policy shall be paid to the nominee(s) in the event of my death.
DOB Relationship wit h
Share
Name of Nominee Gender Mobile No. & Email ID Communication Address
DD/MM/ YYYY Life Assured (100%)
Appointee details: (mandatory if nominee is a minor)
Name of Appointee Gender
While the nominee is a minor, I hereby, appoint the below appointee to receive the money secured by the stated policy, in
Relationship with
the event of my death
Nominee
Mobile No. & Email ID
DOBCommunication Address
Relationship wit h
Name of Appointee Gender Mobile No. & Email ID Communication Address
DOB
DD/MM/ YYYY Life Assured
While the nominee is a minor, I hereby, appoint the
below appointee to receive
Declaration
I/We hereby agree that shall not misuse the original policy document for obtaining loan/secure against mortgage/not create further charge/further assign
the policy or any other purpose until effect of assignment stands valid.
I/We hereby agree, declare and am/are fully aware that in case of partial assignment, the Assignor shall be entitled to all the future payouts including
x x
policy monies, benefits and advantages e cept to the e tent of outstanding college fee amount.
"I/We hereby agree, declare and am/are fully aware that in case of conditional assignment, all the proceeds under the policy shall become payable to
the assignor or to his nominee"
(in the event assignee predecease the assignor) or the assignor survives the Policy Term.
Also in conditional assignment, the assignee shall not be entitled to obtain a loan on the Policy or surrender the Policy.
Jurisdiction(s) of Tax Residence for FATCA/CRS purpose: I / We undertake to declare and disclose any changes in tax jurisdiction within 30 days from
the date of such change that may take place in the information provided in this proposal form or any anne xure or documents related thereto, or any
changes in any certification under FATCA/CRS and provide fresh self-certification along with documentary evidence. I am further aware of the
applicability of relevant tax laws as per the resident status of Individual, for e.g. irrespective of nationality, every United States citizen is a 'resident' of
United States of America for the purpose of tax assessment, since US imposes tax on global income of its citizen.
hereby agree to indemnify the Company for any loss or damage that the Company may sustain or incur as a conse quence of unauthorized usage of
original policy document post assignment.
I give my consent to download my KYC Records from the Central KYC Registry (CKYCR), only for the purpose of verification of my identity and address
from the database of C KYCR Registry. I understand that my KYC Record includes my KYC Records /Personal information such as my name, address,
date of birth, PAN number etc.
On
Signature & Seal of Policyholder (Assignor) Signature of the assignor ’s Witness Date of Signing Assignment form Place
On
Signature & Seal of Assignee Signature of the Assignee Witness Date of Signing Assignment form Place
Witness Details
Name of Assignors Witness : Mr/Mrs/M/S. Age
Alias name(If applicable)
Address
Landmark City
State Pin Code
Contact Numbers
STD Residence STD Office Extn Mobile
Email ID
Name of Assignee Witness : Mr/Mrs/M/S. Age
Alias name(If applicable)
Address
Landmark City
State Pin Code
Contact Numbers
STD Residence STD Office Extn Mobile
Email ID
Vernacular Declaration (In case the Assignor is affixing a thumb impression or is signing in verncacular)
I (Assignor's witness name) with
(identity type) (identity number) hereby declare
that I have explained the contents of the Notice and Assignment Form to the Assignor in language
and that the Assignor has signed / affixed his/her thumb impression on the Assignment Form after fully understanding the contents thereof.
Signature of the Assignor's witness Signature/ Thumb impression of Assignor
NOTE:
1. Policy holder names (assignor) should be written as they appear in the Policy.
2. The witness has to be 18 years old and above and should not be a beneficiary of this policy.
3. Thumb impression affixed, if any shall be certified by a Notary or a Gazetted Officer
Annexure 1
(To be filled in case assignee is a Non-Individual)
Policy Number
Name of Assignee
Section A
Legal Entity Type (Please tick the appropriate box)
Sole Proprietorship Limited Company
Partnership Society
Limited Liability Partnership Trust
HUF (Hindu Undivided Family) Others (please specify)
Section B
Please submit attested copies of the below as applicable (as per the legal constitution.)
Reserve Bank of India
Securities & Exchange board of India (please mention the stock exchange where listed )
Insurance Regulatory & Development Authority
National Housing Ban
Holding Company (Name )
Section C (To be filled in case the legal entity / the holding company is not regulated by any regulator as mentioned in section B above)
Please submit attested copies of the below as applicable (as per the legal constitution.)
PAN Card copy (Mandatory) 10 Digit PAN Number
Partnership deed with registration certificate
Certificate of incorporation and Memorandum & Articles of Association
Trust Deed with registration certificate
Please provide Name, Address & Contact number of the individuaI/s having majority holding or Controlling ownership interest** in the
Assignee. (Please attach Address and Identity proof for each individual mentioned
1.
2.
3.
** Controlling Ownership interest means ownership of /entitlement to
(I) more than 10% of shares or capital or profits of the Assignee entity in
(ii) more than 15% of capital or profit of the Assignee entity in case of partnership
(iii) more than 15% of the property or capital or profit in case unincorporated association or body of individuals
Whereas, no natural person exerts control as defined above (Controlling ownership), the person holding the position of the senior managing
official should be deemed to have controlling ownership interest
Or
Signature & Seal of Assignee Date of Signing Assignment form Place
Direct Credit Authorisation Form
Instructions
IRDA of India Has mandated all Payouts through National Electronic Funds Transfer (NEFT). Please submit your form today.
A Single request form shall apply to all policies where you are Policyholder.
*Form to be filled by the Assignee in case of Absolute and Conditional Assigned policies.
Form to be filled by the Assignor in case of Partial Assigned policies.
Case of non personalized Cheque, please also provide Bank attestation/Bank Pass book/Bank statement.**
In case policyholder / Account holder / Assignee is a company, please affix stamp of the company along with signature.#
Section C (To be filled in case the legal entity / the holding company is not regulated by any regulator as mentioned in section B above)
Policy Number
Absolute Assignment Partial Assignment Conditional Assignment
Policyholder/Assignee
Name*: Mr/Mrs/M/S.
(In case of change - Attach address proof)
Landmark City
State Pin Code
Contact Numbers
STD Residence STD Office Extn Mobile
Email ID
Bank Account Details
Bank Account Number 11 Digit IFSC code
First Account Holder
Name: Mr/Mrs/M/S.
Bank Name
Branch Name
Account Type Savings Current NRO NRE
Original blank personalized cancelled cheque attached Yes No
Declaration
I/We hereby declare that the information given above are correct and complete and shall inform you for changes if any . Tata AIA Life shall not be
responsible for delay in credit, amount not credited, amount credit to incorrect account, due to incomplete or incorrect information herein. I/we
understand that the information provided by me/us may be shared with third parties as per legal or regulatory requirements.. I/We understand and
agree that where NEFT cannot be processed for whatsoever reason, the payout may be processed through cheque.
Signature of Policyholder or Assignee* as applicable
Signature of 1st Account Holder
Signature of 2nd Account Holder
(As on Policy Application) (As per bank records) (As per bank records)
Date: Place:
Certification By Account Holder's Bank: (for Bank Use Only)
We certify that the particulars furnished above are correct as per our records & that this account is currently operational. We confirm that the account
details & account holder's signature(s) above are as per our records.
Date:
Bank Authorized Signatory with Emplyoee ID Bank Branch stamp
Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110) CIN: U66010MH2000PLC128403. Registered & Corporate Office: 14th Floor, Tower A, Peninsula
Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life
Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our insurance Advisor/Intermediary or visit Tata AIA
Life’s nearest branch office or Visit us at : [Link] L&C/Misc/2025/Feb/0127.
BEWARE OF SPURIOUS PHONE CALLS IRDAI or its officials do not involve in activities like selling insurance policies, announcing bonus or
AND FICTITIOUS/FRAUDULENT OFFERS investment of premiums. Public receiving such phone calls are requested to lodge a police complaint.
Contact Us
Chat on WhatsApp Customer Service Department: 9th Floor, Tower B, 1-
[Link]
(7045669966) & Website Think Lodha Techo Campus, Off Pokharan Road Number
2, Thane(West) - 400604.