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NEFT Form Null

The document is a NEFT mandate form submitted to LIC of India by a policyholder to receive policy payments via NEFT to their bank account. It includes the policyholder's details, bank account information, and authorization to deposit payments into the specified account.

Uploaded by

Satinath Roy
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124 views1 page

NEFT Form Null

The document is a NEFT mandate form submitted to LIC of India by a policyholder to receive policy payments via NEFT to their bank account. It includes the policyholder's details, bank account information, and authorization to deposit payments into the specified account.

Uploaded by

Satinath Roy
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 : 404 Service Request Number : 222311025966
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: 469337439

(1) Name of policy holder/ claimant Sati Nath Roy


(2) Bank Name : Bank Of India (3) Account Type : Saving
(4) Account : 439710110001623 (5) IFS Code : BKID0004397
(6) Mobile : 9434572507 (7) E-Mail Id : [email protected]

(8) Bank Branch Address : City Palace,Circus Maidan,Station Roadpo-Katwa,Dist-Burdwan,Pin-


713130,West Bengal
(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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