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I also understand and agree that in case of foreclosure of the policy, the policy shall automatically stand cancelled and no
further benefits will accrue under the said policy.
Mode of Payment: Cheque Direct Credit (Tick any one option mandatory)
* The payment will be made by cheque, only in cases where the customer /applicant does not have an account with any of the Scheduled Banks.
BANKER’S ATTESTATION
We hereby certify that the account details mentioned above are correct and as per our records.
PS-30/Ver1.3/22.3.2011 Page 1 of 2
NOTE:
9 There should not be any corrections in the form. In case of corrections, a fresh form has to be used. The form is liable to be
rejected if there are any corrections/overwriting/erasures.
9 Account Details are mandatory .In case the account number is not mentioned in the form, the payment will not be processed.
9 For NRI/NRE account, letter from the bank stating that premiums are paid through the said account is required, to credit the
partial withdrawal amount to the account.
9 Please provide any one of the following to effect direct credit to bank account:
• Cancelled/ photocopy of cheque leaf along with preprinted name where cheque facility is available.
• Attestation by branch manager of the bank where the bank account is being maintained.
• Photocopy of Passbook front page with photograph and transactions of last six months (Verified by
SBI life Branch official.)
9 Partial Withdrawal facility is not available for pension plans.
9 You are advised to check the fund value before applying for Partial withdrawal to avoid unintended foreclosures.
9 In case of a defective application for withdrawal, the date of receipt of a fresh and valid application for partial withdrawal alone
shall govern in determining the applicable NAV.
Disclaimer: Please note that payment through Direct Credit will be made only when such a facility exists and is allowed by the Bank
concerned. SBI Life will not be responsible or liable for any losses incurred due to incorrect account details provided by the policyholder.
Present Address: ________________________ Present Address(Address & Id Proof is Mandatory for policies
issued before 01.08.2006)
_____________________________________________ ____________________________________________
_______________________________________ ______________________________________
Declaration of English Knowing Person in Case the Proposed insured/ Policyholder is illiterate or signing in vernacular.
I hereby declare that I have explained the contents of this form to the Policy Holder in __________________ language and that the
Policy Holder has affixed his/her Signature / Thumb impression on the form in my presence, after fully understanding the contents hereof.
PS-30/Ver1.3/22.3.2011 Page 2 of 2