4 Reasons Why You Should Not Surrender Your Policy: Think Again

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4 REASONS WHY YOU SHOULD NOT SURRENDER YOUR POLICY

1 2 3 4
YOUR LIFE INSURANCE YOU MAY HAVE YOU LOSE THE YOUR NEW LIFE
COVER STOPS TO PAY TAX ON YOUR OPPORTUNITY TO INSURANCE POLICY
SURRENDER AMOUNT GROW YOUR MONEY WILL COST YOU MORE
THINK AGAIN
Are you sure you want to surrender?
On Surrendering, your LIFE COVER ceases, depriving you and your family of the policy benefits.
Buying Insurance later may prove to be expensive with increasing age.
POLICY INFORMATION
POLICY NO
POLICY OWNER NAME F I R S T N A M E M I D D L E N A M E L A S T N A M E
CONTACT DETAILS MOBILE EMAIL ID
LAND LINE (STD CODE)
REASON FOR Financial Reasons Personal Expenses
SURRENDER Dissatisfied with Services Unsatisfactory Returns
OTHER REASONS, PLEASE SPECIFY____________________________________________________________________________
POLICY HOLDER IDENTIFICATION DETAILS
PAN No
AADHAR No
CKYC No
EIA No
DOCUMENTATION (Mandatory Requirement )
Are you holding a citizenship of any country other than India? YES NO Yes, I have submitted the policy document
Yes, I have submitted Indemnity bond duly notarised in lieu of
Are you a tax resident of any country other than India? YES NO policy bond
Yes I have attached a cancelled cheque with preprinted name of
Note: If the response to any of the above question is YES, please submit a FATCA_CRS form available on
our website. the account holder /self-attested Bank statement or Pass-book
I agree to submit a new form within 30 days if any information or certification on
this form becomes incorrect or changes.
copy duly attested by Bank.
Incase of NRE/NRO account details please submit a FATCA_CRS form available on our website. Yes, I have submitted Self attested Photo Id Proof
BANK DETAILS FOR PAYOUT

ACCOUNT HOLDER NAME F I R S T N A M E M I D D L E N A M E L A S T N A M E
BANK NAME AND BRANCH
BANK ACCOUNT NUMBER
ACCOUNT TYPE SAVINGS NRE / NRO *
IFSC CODE
* For NRE bank account,letter from Bank/bank statement confirming premiums are received from the NRE account is mandatory.
* In case cancelled cheque copy is of New Account, self attested copy of bank statement is mandatory.
Note: IFLI will not be responsible in case of non - credit to customer's account for reasons of incomplete/incorrect bank account information provided by the customer
Acknowledgment Slip
Received a request for Surrender against policy no _______________________ on D D M M Y Y Y Y
Before 3:00 pm After 3:00 pm
Seal /Stamp of the Branch with Signature

FOR OFFICE USE
DATE D D M M Y Y Y Y TIME (Tick ) BEFORE 3:00 pm AFTER 3:00 pm
STAMP OF BRANCH SIGNATURE OF OFFICIAL
DECLARATION
I/We understand that the surrender of the policy results in the termination of the policy and that I/We are required to return the original policy document to
the Company. I/ We also understand and agree that the policy shall be deemed to have been duly surrendered and the company discharged of all liabilities
under it upon the payment of surrender value, not withstanding the non production of the original policy document to the company, for any reason. Where
the policy is not submitted to the Company, the policy owner here by agrees to indemnify the Company against all liabilities that the Company may incur on
account of any claim being made by any other person on the basis of possession of the policy document or otherwise. I/We also understand that the contract
of insurance shall be deemed to have been duly terminated on my/our signing this application form for surrender of the policy.
RESIDENTIAL DECLARATION BY POLICY HOLDER

“I am a Non Resident Resident of India within Section 6 of the Income Tax Act, 1961.In the event there is any income tax demand (including interest,
charges or levies) raised in India in respect of these amounts, I/we undertake to pay the demand forthwith and indemnify and hold IDB IFederal Life
Insurance Company Ltd. harmless from any income tax demand (including interest, penalty, charges or levies) raised in India on the IDBI Federal life
Insurance Company Ltd. on account of any misstatement / misrepresentation/ errors of omission or commission by me or any other person, and provide IDBI
Federal Life Insurance Company Ltd. with all information/documents that may be necessary for any proceedings before Income-tax / Appellate Authorities in
India.”
DISCHARGE RECEIPT
I/We hereby agree to accept the payout amount and confirm of having understood and agree to all the conditions and information mentioned in
the form.
I / We discharge the company, IDBI Federal Life Insurance Co Ltd of all my / our claims or demands and responsibilities under the above
mentioned policy.
Affix One Rupee

Revenue Stamp
& Sign Across
Note: Discharge Voucher stands cancelled incase request made towards policy payment is rejected by IDBI Federal Life Insurance Co Ltd
PLACE
Signature of the Policy
Holder/ Assignee
(having understood and
agreed to above declaration) DATE D D M M Y Y Y Y
DECLARATION (By Person filing the form on behalf of the policy holder for forms signed in Vernacular languages or Thumb Impression)
I _______________________________________________________________, having known the policy holder for a period of __________________________
do declare that I have explained the nature of questions contained in this form to the policy holder. I have also explained that the answers to the
questions form the basis for accepting this request for Surrender.
Signature of the Person PLACE

filling the form on
behalf of the policy
holder
(For forms signed in Vernacular
Language/ Thumb Impression) DATE D D M M Y Y Y Y
GENERAL INSTRUCTION
1. Amount Payable on Surrender is as per the policy terms and conditions.
2. All the required details in the form should be completely filled in.
3. The cut off time for NAV application in respect of allocation and redemption of units is 3:00 pm.This implies that if the application for surrender is received
up to 3:00 pm on a week day except holiday, the same day's unit value will be applicable.However if the application is received after 3:00 p.m. the next
declared NAV will be applied.
4. In case policy is assigned, payout will be made to the Assignee and request needs to be signed by Assignee, if payout is required to be made to Assignor
then Assignment form is required first.
5. TDS will be applicable as per the prevailing tax laws of India. NRE customer, may submit Form 10 F and TRC for tax exemption,subject to it's validity.
6.Request must be received from Life Assured upon auto vesting.

4 Reasons Why You Should Not Surrender Your Policy: Think Again

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(Kindly fill in Block Letter and Use Black Ink)

4 REASONS WHY YOU SHOULD NOT SURRENDER YOUR POLICY

BANK DETAILS FOR PAYOUT

Received a request for Surrender against policy no _______________________ on D D M M Y Y Y Y

Before 3:00 pm After 3:00 pm

Seal /Stamp of the Branch with Signature

STAMP OF BRANCH SIGNATURE OF OFFICIAL

RESIDENTIAL DECLARATION BY POLICY HOLDER

Affix One Rupee

Signature of the Person PLACE

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