Life Insurance Corporation of India

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Life Insurance Corporation of India

FORM OF CHANGE OF NOMINATION


(For Instruction Re: Execution of a change of Nomination See Revers)

I……………………………………………………………………………………………………………………………………….
here by nominated my ………………………………………………………………………………………………………………

aged ………………………. Years to be the person to whom the moneys secured by the within Policy
shall paid in the event of my death in lieu of …………………………………………………………………………….
named in the text of the within policy / endorsement on the within policy dated at.
……………………………………………………………… the ………………………………………………………………day

WITNESS (Signature of the Assured)

Signature ………………………………………………………………………………………………….

Full Name …………………………………………………………………………………………………

Designation ………………………………………………………………………………………………

Address …………………………………………………………………………………………………….

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