FORM OF ASSIGNMENT OF LIFE POLICY

Single
For valuable consideration, I hereby assign all my right, title and interest in the within policy and
the moneys payable thereunder to Pallavan Grama Bank, its successors or assigns and declare that the
receipt
of Pallavan Grama Bank, its successors or assigns for any sum of money becoming due and payable
under the
within policy and paid by Insurance Company to Pallavan Grama Bank, its successors or assigns shall be a
good and sufficient discharge to the Insurance Company for such payment.
Dated
at
...........................................
of ...........................................20.....................

on

this

..................................

day

(Signature of the Assignor)

Witness 1

Witness 2

Signature

Name

Address..

....

Joint
For valuable consideration we hereby assign all our right title and interest in the within policy
and the money payable thereunder to Pallavan Grama Bank, its successors or assigns and declare that the
receipt of Pallavan Grama Bank, its successors or assigns for any sum of money becoming due and
payable
under the within policy and paid by Insurance Company to Pallavan Grama Bank, its successors or assigns
shall
be a good and sufficient discharge to the Insurance Company for such payment.
Dated at ........................................on this ..................................... day of ........................................... .
20..........................

(Signature of the Assignor)

Witness 1

Witness 2

Signature

Name

Address..

....
.

Note:1. In certain cases special or modified forms of assignment are called for but in all ordinary cases the branch should take the assignments in the above
version on the Policy itself.
2.Witnesses should write their names in Block Letters also

F
42
NOTICE OF ASSIGNMENT OF LIFE POLICY TO INSURANCE COMPANY

Place
Date.

From

To
.(Name and address of Insurance Company)

Dear Sirs,
Policy No....................................... for Rs.........................in the name of
........................................................................................
I/We hereby give you notice that I/We have assigned all my/our right, title and interest in
this policy for
valuable consideration to Pallavan Grama Bank,..Branch.
Yours faithfully

Signature of Assignor(s)