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Application For Policy Refund Form 2021

This document is an application form for a policy refund from Jubilee Life Insurance Limited. It requests the applicant's personal details such as name, policy number, address, and contact information. The applicant then ticks their reason for requesting a refund, such as stopping deductions, deductions having stopped, or requesting a refund of premiums paid. Space is provided for the applicant to specify if they want a lump sum refund or to use the refund for another policy. The applicant must sign and provide a witness to agree to the refund terms.

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43 views1 page

Application For Policy Refund Form 2021

This document is an application form for a policy refund from Jubilee Life Insurance Limited. It requests the applicant's personal details such as name, policy number, address, and contact information. The applicant then ticks their reason for requesting a refund, such as stopping deductions, deductions having stopped, or requesting a refund of premiums paid. Space is provided for the applicant to specify if they want a lump sum refund or to use the refund for another policy. The applicant must sign and provide a witness to agree to the refund terms.

Uploaded by

Gims Ventures
Copyright
© © All Rights Reserved
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
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APPLICATION FOR

POLICY REFUND FORM


JUBILEE LIFE INSURANCE LIMITED

Head Office:
Jubilee Insurance House, Wabera Street
P.O. Box 30376 - 00100 GPO, Nairobi, Kenya
Tel: +254 20 328 1000
Fax: +254 20 325 1150
Email: [email protected]
www.jubileeinsurance.com
Date: DD/MM/YYYY

Name:

Policy No.:

Address: Telephone:

Email Address:

RE: REFUND OF PREMIUM/EXCESS LOAN REPAYMENT- MATURED/WITHDRAWN/PREMIUM CEASED/ERONEOUS DEDUCTIONS

I hereby request you to ;- (Please tick your request)

STOP DEDUCTIONS: Kindly stop deductions from my employer /bank.



Employer/Bank name Payroll/A/c No

DEDUCTIONS STOPPED: Deductions towards your company have stopped.

REFUND: I wish to be refunded the premiums under this policy

A single lump sum

Kshs.
Utilize towards payment /repayment of for
policy number

I agree with the stipulated terms and I have submitted all the requirements for the above transaction.

Reason for refund

Witness:

Signature: Signature of Proposer/Life Assured

Name: Address:

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