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Request For Change in Policy Details Form English

This document outlines the process and requirements for changing personal details like name, date of birth, or premium payment frequency on an insurance policy. Name changes require supporting documents like marriage certificates. Date of birth corrections require age proofs. Premium payment frequency can be changed to annual, half-yearly, or quarterly. All changes are subject to policy terms and underwriting guidelines.

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successinvestment2005
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65 views

Request For Change in Policy Details Form English

This document outlines the process and requirements for changing personal details like name, date of birth, or premium payment frequency on an insurance policy. Name changes require supporting documents like marriage certificates. Date of birth corrections require age proofs. Premium payment frequency can be changed to annual, half-yearly, or quarterly. All changes are subject to policy terms and underwriting guidelines.

Uploaded by

successinvestment2005
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Reason for Change (In case of Surname / Complete name Change) ________________________________________________________________

• Change will be incorporated in all existing policies of the customer. For minor spelling corrections, supportings needs to be submitted
• For married women with a change in surname, Marriage certificate or Declaration signed by two witnesses along with a copy of marriage invitation is
required.
• For all other requests involving significant change, a Gazette copy is required.

New
D.O.B.:
2. Correction in Date of Birth Policy Holder Nominee Life Beneficiary
Lif
e Assured Appointee
(
D.O.B) :
Old D.O.B.: D D M M Y Y Y YD D M M Y Y Y Y

Reason for Change: ______________________________________________________________________________________________________


Supportings attached: Birth Certificate School Certificate Passport PAN Driving Licence Others_________________________
* Standard Age proof should be Self Attested and verified by Gazette Officer / SBI Life official (Assistant Manager or above)
In case Aadhaar card is provided as ID or Address proof

I hereby give my voluntary consent to SBI Life Insurance Company Limited (SBI Life) and authorise the Company to obtain necessary details like Name, Address,
Mobile Number, Email, Photograph through the QR code available on my Aadhaar card / XML File shared using the offline verification process of UIDAI. I understand and
agree that this information will be exclusively used by SBI Life only for the KYC purpose and for all service aspects related to my policy/ies
3. Change in Premium Payment Frequency: Kindly change my payment frequency (Please tick the desired option)
to:

I have understood the meaning and scope of the change request form and take
complete responsibility of the changes submitted by me. Any changes in the Policy / Thumb impression / Signature
Personal details are subject to the policy terms and conditions and relevant of Policy Holder
underwriting guidelines.
(If policyholder is illiterate or is signing in a language other than the language of this form, his/her thumb impression/signature must be attested by any Gazzetted Officer,
Notary, his/her Banker or SBI Life Official not below the rank of Assistant Manager with his/her official seal after explaining the content of this form.)

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Received by: _________________________________________ Employee ID: _____________________________

SBI Life Insurance Company Limited: Registered and Corporate Office: Natraj, M.V. Road & Western Express Highway Junction, Andheri (East), Mumbai - 400 069. Tel.: (022) 61910000. Central Processing
Center: 7th Level (D-Wing) & 8th Level, Seawoods Grand Central, Tower 2, Plot No. R-1, Sector-40, Seawoods, Nerul Node, Navi Mumbai - 400 706. Tel.: (022) 66456000. IRDAI Registration No. 111 | CIN:
L99999MH2000PLC129113. | Toll Free No. 1800 267 9090 (customer service timing: 24x7) | Visit: www.sbilife.co.in | E-mail: [email protected]
PS-41.Ver.07 05-22 ENG

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