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NEFT_Form_2425110666524_

The document is a National Electronic Funds Transfer (NEFT) mandate form submitted to the Life Insurance Corporation of India by policyholder Alok Singh for receiving policy payments. It includes personal and bank account details, authorization for payments, and a declaration regarding the policy. The form is accompanied by a cancelled cheque and a copy of the PAN card as supporting documents.

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amoghsingh95
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12 views1 page

NEFT_Form_2425110666524_

The document is a National Electronic Funds Transfer (NEFT) mandate form submitted to the Life Insurance Corporation of India by policyholder Alok Singh for receiving policy payments. It includes personal and bank account details, authorization for payments, and a declaration regarding the policy. The form is accompanied by a cancelled cheque and a copy of the PAN card as supporting documents.

Uploaded by

amoghsingh95
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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LIFE INSURANCE CORPORATION OF INDIA

NATIONAL ELECTRONIC FUNDS TRANSFER – MANDATE FORM

To
LIFE INSURANCE CORPORATION OF INDIA
Branch : 23 Service Request Number : 2425110666524
Sub : Receipt of policy payment through NEFT

I am giving below the details of my Bank account for receiving policy payment through NEFT.

Policy No: 232757474

(1) Name of policy holder/ claimant Alok Singh


(2) Bank Name : State Bank of India (3) Account Type : Saving
(4) Account : 30234207462 (5) IFS Code : SBIN0000219
(6) Mobile : 9450153820 (7) E-Mail Id : [email protected]

(8) Bank Branch Address : FAZALGANJ,KANPUR, DISTT. KANPUR NAGAR, UTTAR PRADESH
208012
(9) Are you willing to receive SMS/E-mail, on Yes
matters related to
->if cheque is not having the name of bank holder then
Photo copy of the page of Bank pass book containing
details of Bank accounts number, IFS code

->I authorize LIC of India to make any payments due to


me into this account and such payments made shall be
considered as valid discharge of all the liabilities copy of Pan card
against my policy for the purpose for which payment is
made

-> I declare that the above mentioned policy/ies


has/have not been assigned

I have enclosed the following document to this effect.


A. Cancelled cheque leaf
B. Copy of Pan card

___________________________
Signature of the policyholder Date :

Cancelled Cheque

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