Maturity-Form-2 (2)

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ADAMJEE LIFE ASSURANCE Page 1 of 1

Policy
� Maturity Form
Adamjee Life Assurance Co. Ltd
� �� � ��� �� �‫�رم ���ا‬
�‫�ر‬
3rd Floor, Adamjee House,
I.I. Chundrigar Road, Karachi - 74000 PAKISTAN

� � � �
Date / �‫ ��ر‬:____________ Policy Number / � ��� �� :________________ Name of Policy holder / ‫ �� ��� ��ر � ��م‬:______________________

Plan / ‫ �ن � ��م‬:____________ CNIC / � ‫ �� �رڈ‬:___________________________ Contact Number / � �‫ را‬: ______________________
� ���
� �‫ا‬
Email Address / �‫�ر‬ � � ‫ اى‬:________________________________________________________________________________________
� �
Maturity Claim � ��
‫�ر� � د�ى‬ Zakat Deduction �� ‫ز�ٰة‬

� � Do you want Zakat


� to be deducted from your Maturity proceeds?
� ��
Maturity Claim / ‫�ر� � د�ى‬ � � �
Yes ‫ �ں‬No � � �� ‫� � آپ � ز�ٰة‬ � �� � �� � �� ‫�� آپ‬
� �‫�ر‬
If No (Please provide Zakat Declaration Form) � �
� � � �����‫� �ز�ۃ ڈ‬
� �‫�� �رم ��ا‬
�� � �‫ا‬
� �
Declaration ��� ‫ا��ار‬
I _____________________________________holding policy # ____________________with Adamjee Life hereby put forward the request for
the Maturity of my policy and the payment of Maturity Proceeds (less any indebtedness) as per the terms and conditions of the company. I also
acknowledge that the payment of the Maturity Proceeds will lead towards the cessation of my policy and therefore any right to claim. I affirm
that I accept this payment as full and final settlement from Adamjee Life Assurance.
� � � � � � ��
‫ �� �ں اور � اس ���ت � ا��ار‬/ � �� � �� � ��� �� �‫__________________ � � آد� �� � �رى �دہ � ا‬# ��� �� �� __________________________________ �
� � �‫�ر‬
� �‫� در�ا‬ �
�� � � � � � � �
� �
� ‫ادا� � ذ� دار � �� اور‬ � � � � � �‫ادا� � � آد� �� ا�ر‬ � � �‫ �� �ں � اس ر‬/ �� � �� � �
�� � ‫�� اور � اس ���ت‬ � � ‫��د � ادا‬ �
� �� �‫ادا� � � �ا� و �ا‬ � � �‫ �� �ں � ر‬/ ���
� � �
. �� �‫ادا‬� � ‫ �� �ں � �� ر� آد� �� ا�ر� � �ف � � اور‬/ ��� �� � � � ‫اس ���ت‬
ّ
*I hereby undertake that the maturity amount payable on the date as agreed in the policy document , shall be the subject to the prevailing cash
� � � � � � � � � � �
value of that date.
� � �� � �‫و‬ �
� � � �� � ��� �� ‫� دى � ��ر� � � �� ��� ���ر �� اور‬ � ‫د�و��ات‬ � ��� �� � ‫ �� �ں‬/ ��� ��� � ‫� اس ���ت‬�
. � � �� �‫�ر� � ��ر‬ *
The Bank is acting as a corporate insurance agent of Adamjee Life Assurance which underwrites policy and the Bank shall not be held
responsible for any liability under the policy in any manner whatsoever to the policyholder(s) or claimant(s).( In Incase of bancassurance policy)
�� �� �� � ��� � � �� �� �� � �
،‫� �� ا�ر� �� ��� � � � ����� دار‬� ‫ا� � �ر � �م � ر� � � � �� ��� ا �� ر را� � اور‬ �‫�� � ��ر�ر‬ � � �� �‫� آد‬ � � ‫�ف �� ������ ا�ر� � �رت‬
� �
‫� ��۔‬ � � ����� � � ‫ا� ���ار �� ور��ء � � � �ح‬
� ���� � ‫ز��ارى‬

� �
Pay Out Confirmation ��� �
� �‫ادا‬
� �
Do you want your Pay Out through; �
� �� �‫ادا‬
�‫�ر‬
� � �
� �‫ا�ؤ‬ �� �
� � � �‫آ� � �ا‬ ��
Direct Transfer in IBFT Account �‫� �ا‬ Cheque �
� � �� � �

Account Status /���� ‫ا�ؤ� ا‬ : � �
Active / �‫ا‬ Dormant /�‫دور‬
In case of account, status is inactive or dormant a cheque will be
‫� � � � ار�ل �د�� ���۔‬�� �
� �
� ‫ا�� �� � �رت‬ � �
‫ ان‬/ �‫ا�ؤ� ڈور‬
dispatched at your provided correspondence address.
� �
Account Title / ���� �‫ا�ؤ‬ : ____________________________________________________________________________________________
Account Number / � �‫ا�ؤ‬ � � : __________________________________________________________________________________________
� ��
Bank Name / ‫� � ��م‬ � : ______________________________________________________________________________________________

Documents Required ‫��ات در�ر‬



Complete Original Policy Documents �
‫د�و��ات‬ �� ‫�� ��� � ا� اور‬
Zakat Declaration Form (to be made on a stamp paper �
� ‫�� �ہ‬� � ‫��� �� �� � �( اور ��ى‬ � �
� � � �� ����‫ رو� � ا‬20 � �) ��
� �� � � � �����‫ز�ۃ ڈ‬
� �‫�� �رم ��ا‬
of PKR. 20/- duly notarized)
� � � �
� �‫�ر‬
Maturity Extension �� � ��
� � � � �
Extension to Maturity /
� �
�� � �‫�ر‬
� �� Date/Years / ‫�ل‬/�‫ ��ر‬: _________________ / _________________

Note: Please note in case you are interested in extending your Policy Maturity, the policy will be subjected to NAV updates and Monthly
deductions as per the normal practice and as per conditions laid out in the Provisions and Conditions of the policy.
� � � � � �
�� � � �)
� � � �‫و��( اور ��� �� � � �ا� و �ا‬
� � ‫��د � ادا‬ � ‫ � �ا��ر �����ؤ‬NAV� �‫ر‬
� � � � ‫�وا� �� � �� � ���ا� ����� اس ���ت‬
� � �
�� � �‫�ر‬
� �� �‫ ا� آپ ا‬: ‫�ٹ‬

__________________ __________________ __________________

��
Adamjee Life Approval Bank Approval Signature / Thumb Impression of Policy Owner
�� ��
‫آد� �� � �رى‬ ‫� � �رى‬� ��� �� �� ��‫ ��ن ا‬/ �‫د‬

� � �‫و‬ ��
Customer Service Call centre: (92-21)111-11-5433(LIFE), Fax: (92-21)35362621, Email: help_csd@adamjeelife.com, Website: www.adamjeelife.com
www.adamjeelife.com: �� � � help_csd@adamjeelife.com: ���� ‫( اى‬92-21)35362621: ���� (92-21)111-11-5433(LIFE): �
� � ‫� �وس �ل‬

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