saat Pay srt Rupees LIFE INSURANCE CORPORATION OF INDIA ites. NATIONAL ELECTRONIC FUNDS TRANSFER - MANDATE FORM To LIFE INSURANCE CORPORATION OF INDIA Branch : 56 Service Request Number : 232411083216 ‘Sub: Receipt of policy payment through NEFT | am giving below the detaits of my Bank account for receiving policy payment through NEFT. Policy No: 564311892 imant Gaurav Mittal (1) Name of policy holder! (2) Bank Name : Kotak Mahindra Bank (3) Account Type: Saving (4) Account : 0149012000089 (5) IFS Code KKBK0000149 (6) Mobile : 9560607923 (7) E-Mail Id : mt.gaurav@gmail.com (8) Bank Branch Address : Kotak Mahindra Bank Ltd., Tera Tower,Bhuteshwar Road, Mathura- 281004, Uttar Pradesh (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 Bato copy ofthe page of Bank pass book containing details of Bank accounts number, IFS code ->1 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 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 Date: 05/09/2023 ee | _01490120000189 Payable Arm at a branch ection Gaurav Mittal wO00390" 28s48500e; 573397" 3h