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Nift Form

NEFT

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51 views1 page

Nift Form

NEFT

Uploaded by

akshaybajaj74
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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DIRECT CREDIT AUTHORISATION FORM

Instructions:
1 IRDA Has mandated all Payouts through National Electronic Funds Transfer (NEFT). Please submit your form today.
2 A Single request form shall apply to all policies where you are Policy holder.
3 Form to be filled by the Assignee in case of Assigned policies.
4 In case of non personalized Cheque, please also provide Bank attestation/Bank Pass book/Bank statement.**
5 In case policy holder / Account holder / Assignee is a company, please affix stamp of the company along with signature.#
6 This form shall be ineffective when the Policy is endorsed as Married Women Property Act (MWPA).

Policy Details
Policy Number

Policy Holder/Assignee Name Mr/Mrs/M/S.

Address of Policy Holder/Assignee


(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.


(Exactly as per Bank records)

Bank Name

Branch

Account Type Savings Current NRO NRE (For NRE account, payout cheque with NRE letter will be processed)

** Original blank personalized cancelled cheque 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/Assignee# Signature of 1st Account Holder Signature of 2nd Account Holder
(As on Policy Application) (As per bank records) (As per bank records)

Date - / /
D D / M M / Y Y Y Y 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.

/ /
D D / M M / Y Y Y Y
Bank Authorized Signatory with Emplyoee ID Bank Branch stamp Date

!"" #$% & %'( )


* + , ( -. / 0 /& . 1 & 2/ 3 1 # / 0 & ./ # 4 ( )
- / 5 .. $ . . 6 ' %"7 88"" .. '" %"" 88"" . . . 3#3 93 5 : ;'''' .
< 5 0 4 , 000
* =# =% )=> = 8? ; &

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