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Notice-Cum-Change Of: (Full Name of The Nominee)

The policyholder is notifying the insurance company of a change in nomination. They are nominating Mr/Mrs/Ms [name omitted] as the new person to receive any money secured by the policy in the event of the policyholder's death. The policyholder has signed the form to officially change the nomination on the policy.

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sreenivasulureddy.ch
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70 views

Notice-Cum-Change Of: (Full Name of The Nominee)

The policyholder is notifying the insurance company of a change in nomination. They are nominating Mr/Mrs/Ms [name omitted] as the new person to receive any money secured by the policy in the event of the policyholder's death. The policyholder has signed the form to officially change the nomination on the policy.

Uploaded by

sreenivasulureddy.ch
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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NOTICE-CUM-CHANGE OF

The Manager
Life Insurance Corporation of India
Suva.
Dear Sir
Policy No._________________
I hereby give you notice that I have now nominated under section 152 of Insurance Act 1998
Mr/Mrs/Ms______________________________ as the person to whom moneys secured by
(full name of the nominee)

the above policy shall be paid in the event of my death. Given under is form of change of
nomination.
Signature of Witness: ________________
Name:___________________________
Address:_________________________
__________________________

________________________
[Signature of Life Assured]
Address:___________________
___________________

I _________________________________hereby nominate under Section 152 of Insurance Act


1998, my ________________

Mr/Mrs/Ms ________________________________________

(Relationship)

(Name of the new nominee)

aged ______ years to be the person to whom the moneys secured by the within policy shall be
paid in the event of my death.
Dated at ______________ on this_________ day of_____________20____.
IF NOMINEE IS A MINOR (AGED BELOW 18 YRS)PLEASE ALSO FILL THIS BOX
I hereby appoint_____________________________ f/n______________________ as the person
to receive and hold the policy monies in the event of my death during the minority of my
nominee.
I hereby give my consent to act as the appointee

________________________
Signature of the Life Assured

Signature of Witness;________________________
Name:________________________
Address:______________________

_________________________
Signature of the Appointee

_______________________
(Signature of Life Assured)

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