Form For Change of Nomination: Residence Office Mobile

Form for Change of Nomination
Terms & Conditions:

1) The registration of nomination is subject to the receipt of this notice and the form by SBI Life Insurance Co. Ltd
2) All previous nominations and / or Appointee shall be automatically cancelled on execution of this form and the nomination and/or Appointee last
received by the company shall prevail over all previous nominations and/or Appointee.
3) In case of more than one nominee, a joint discharge voucher would be taken from all the nominees and the claim proceeds would be paid
accordingly.
4) If nomination is in favour of a minor, an appointee who is a major must be named. Please fill the Appointee form.
5) On Assignment of a policy the existing nomination automatically stands cancelled.
6) The Company expresses no opinion as to the validity of the nomination
Date: D D M M Y Y Y Y Policy No:
Name of the Policy Holder:
Address:
Contact no: Residence Office Mobile
Email ID:
All fields are mandatory (At least one contact no is mandatory for processing your request. Contact nos. mentioned above will be updated for future
communication)
NOTICE OF NOMINATION
To,
SBI Life Insurance Company Ltd.,
Branch ____________________________________
Dear Sir,
Re: Notice for change in Nominee for Policy Number
I hereby give you notice that I have now nominated the following as the person(s) to whom the moneys secured by the above Policy shall be paid in the
event of my death. I also confirm that this nomination shall automatically cancel all previous nominations made by me and named in the text / vide
endorsements to the above Policy.
Name Date of Birth* Relationship with Insured** Communication Address
* In case the NOMINEE is MINOR, “APPOINTEE DETAILS” form is also to be MANDATORILY filled
**Nomination made to any person other than parent, spouse or children will be considered as a "collector nominee".
A collector nominee can merely collect the policy moneys from the company and give a valid discharge. No beneficial rights are conferred on him/her.
I have read and understood all terms and conditions given at the top of this form.
Please acknowledge receipt of this notice and the Original Policy Document and return the Policy Document after registering the nomination in your books Yours faithfully,
#Signature or Thumb
Impression of Policyholder
Endorsement for Nominee on the Policy Document

I______________________________ hereby nominate the following as the person(s) to whom the moneys secured by the this Policy shall be paid in the
event of my death. This nomination shall cancel all previous nominations made by me and named in the text / vide endorsements to the this Policy.
Name Date of Birth Relationship with Insured** Communication Address
#Signature or Thumb Impression

Signature of Witness
of Policyholder
Name & Address of Witness_________________________________________________________________________________________________

# In case of signatures in a vernacular language or Thumb Impression, the vernacular language declaration below is to be filled.
Declaration to be given when the signature of the Policy holder is in a vernacular language or has affixed thumb impression:
I hereby declare that I have explained the contents of this form to the policy holder in __________________ Language and that the policy holder has affixed
his/her Signature / Thumb impression on the form in my presence, after fully understanding the contents thereof.
Name:
Signature of the Person
Address:
making the Declaration:
Occupation: Contact No.:

SBI Life Insurance Company Limited: Registered and Corporate Office: Natraj, M.V. Road & Western Express Highway Junction, Andheri (East), Mumbai - 400 069. Tel.: (022) 61910000.
Central Processing Center: 7th Level (D-Wing) & 8th Level, Seawoods Grand Central, Tower 2, Plot No. R-1, Sector-40, Seawoods, Nerul Node, Navi Mumbai - 400 706. Tel.: (022) 66456000.
IRDAI Registration No. 111 | CIN: U99999MH2000PLC129113. | Toll Free No. 1800 22 9090 (From 9.00am to 9.00pm) | Visit: www.sbilife.co.in | E-mail: info@sbilife.co.in
Page 1 of 1 PS-18/Ver 09/05/17 ENG

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Form For Change of Nomination: Residence Office Mobile

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Form for Change of Nomination

Terms & Conditions:

Date: D D M M Y Y Y Y Policy No:

Name of the Policy Holder:

Contact no: Residence Office Mobile

Name Date of Birth* Relationship with Insured** Communication Address

Endorsement for Nominee on the Policy Document

Name Date of Birth Relationship with Insured** Communication Address

#Signature or Thumb Impression

Name & Address of Witness_________________________________________________________________________________________________

Occupation: Contact No.:

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