/ NACH
/ NACH
NACH
Application No. / Policy No. Frequency (i.e. yearly/half
yearly/Quarterly/Monthly)
Request for Payment Mode change to NACH / Direct Debit OR Deactivation of NACH /DD mandate should be submitted 15 days prior to the due date or same would be effective from the next premium due date.
NACH
NACH
I/We hereby authorize the Bank to debit my account to wards charges for DD .
mandate verification if anyapplicable.
NACH D D M M Y Y Y Y
Mandate
IndiaFirst Life Insurance Company Ltd.
Common ECS Mandate Form/V2/May 2020
Debit type Fixed Amount
Application No. Mobile No.
Policy No.
I agree for the debit of mandate processing charges by the Bank whom I am authorizing to debit my account as per the latest schedule of charges of the bank.
D D M M Y Y Y Y
D D M M Y Y Y Y
This is to conrm that the declaration has been carefully read, understood & made by me / us. I am authorizing the user entity / corporate to debit my account.
I have understood that I am authorized to cancel / amend this mandate by appropriately communicating the cancellation / amendment request to the user entity / corporate or the bank where I have authorized the debit.
IndiaFirst Life Insurance Company Ltd., Tel: +91 22 6165 8700 Fax: +91 22 6857 0600 Toll Free: 1800-209-8700
12th and 13th Floor, North [C] Wing, Tower 4, Nesco IT Park, Nesco Center,
Western Express Highway, Goregaon (East), Mumbai – 400063,
IRDAI Regd. No. 143 | CIN: U66010MH2008PLC183679. E-mail: customer.rst@indiarstlife.com Website: www.indiarstlife.com
