Inward Date _________________ Time__________

Apne liye. Apno ke liye.

ARE YOU SURE?

For treatment of
AFFIX
of Children, YOUR RECENT
Purchase of Financial Instrument self or spouse PHOTOGRAPH HERE

Other, please specify

SURRENDER/PARTIAL WITHDRAWAL APPLICATION FORM

Policy No:

` Only

In case of surrender of Saral Pension / Smart Pension policy /

#For E. account, l r from the ba nk is ired for direct credit of the p ayment.

Bank Name & Address:

Account Type (Please appropriate item): Savings Current NRE

Account No.
IFS Code:

Proof of Bank Account Original cheque leaf with preprinted name and account number.

Country of
Copy of PAN Card PAN* Resident NRI^ Residence

ID Proof : Driving License Passport Pan Card Aadhar Card Armed Forces ID Card

Others

Address Proof : Driving License Passport Aadhar Card

Others

I/we Customer’s Name

Aadhaar Consent:
I, < Customer’s Name > , hereby give my voluntary consent to SBI Life Insurance Company Limited (SBI Life) and authorise the Company to obtain necessary details like Name, DOB,

Thumb Impression / Signature of Policy holder

Signature of Witness
or Assignee (if assigned)

Page of PS-12.Ver.07 05-22 ENG

 Name : Name :

Present Address: Present Address:

Contact No and Email ID: Contact No and Email ID:

Place: Place:

Date : D D M M Y Y Y Y Date : D D M M Y Y Y Y

Af x One
upee
` (in /-, e enue
(`__________________________________________________________________________________________________________
stamp & sign
across

Name :
Address:

Page of PS-12.Ver.07 05-22 ENG