Life Insurance

Aditya Birla Sun Life Insurance Company Ltd.

Maturity Form
Any alterations/corrections made in the form need to be signed by the policy owner. Please use a separate request form for each policy.
Policy Number: EIA A/c number: Date: D D M M Y Y Y Y
Name of the Policy Owner:
Contact details/Call back number (Mandatory): Mobile: Telephone (R) No.: STD Code

Email id: ________________________________________________________________________________________________________________________

Kindly note, this email id will be used for registration of 'Go Green' and will lead to discontinuance of physical statements.

1. Are you holding citizenship of any other country? Yes No If yes, please provide country name/s: _________________________________
2. Are you a tax resident of any other country? Yes No If yes, please provide unique Tax Identification Number/s: _________________
Note: If the response to any of the above questions is yes, please submit a detailed NRI questionnaire available with our branch office.
PAN: Mandatory
Note: As per Government of India and IRDAI Notification it is mandatory to update PAN/Form60 details in All your policies before 31st March. 2018
to ensure uninterrupted services for your policy(s).

Bank Account Details (All fields are mandatory)

Bank Name: ____________________________________________________ Branch Name: ________________________________________________
Bank Address:
Bank Account Holder's Name: Account Type: Saving Current NRE# NRO
Bank Account Number: 11 Digit IFSC Code:
(You can get this code from your bank)
Note: Aditya Birla Sun Life Insurance will not be responsible in case of non credit to your account or if transaction is delayed or not effected at all for reasons of
incomplete/incorrect information provided or rejected by your bank. In case of requisite information for direct credit is not received or transaction rejected by bank the payout
will be made vide cheque.

Maturity Details (All fields are mandatory)

Plan: ____________________________________________________________________________________________________________________________
For pension plans: Maximum amount you wish to commute: Rs. ___________________________________________ /- (Allowable limit max. 1/3rd of total
maturity value)
*For Pension Plans, please fill up a separate Open Market Option Form.
Cheque for the balance amount to be in favour of _______________________________________ (Name of the company from where you want to purchase
the annuities)

Mandatory documents
Original Policy document for Pension Plan In case the cancelled cheque does not have preprinted name and
account number or "New Account" is mentioned on the cheque, pass
Self attested copy of PAN is Mandatory., carry original book copy/bank statement having preprinted name & account number.
for verification at Branch. NRE# bank statement reflecting any premiums paid from a NRE account
Original Cancelled Cheque with pre printed name & account number. (applicable only for NRI customers)

*Open Market Option Form.

Discharge Receipt: I/ We have not assigned the said policy to anyone or have not dealt with same in any manner. I/we understand that upon surrender policy contract will
be terminated and I/We will not be eligible for any benefits from said policy. I/we hereby agree to accept the surrender value and declare that I understand and agree to all
the conditions and information given in this form. I/we also agree and understand that in case of non submission of valid PAN, 20%TDS may be deducted from the payout
value due to me. I hereby agree to accept the maturity/surrender amount as full and final settlement per the terms and conditions of the policy contract and discharge Aditya
Birla Sun Life Insurance Company Limited (ABSLI) of its liability under this Policy. I also and understand and agree that no further claims of whatsoever nature shall be payable
to me under this Policy
I hereby declare and agree that the contents in the form have been fully explained to me and understood by me.
I hereby agree to have the given bank details to be linked to all my policies under my client id for any company initiated payments in future.
FOR/9/17-18/803

Witness Name: _______________________________

Date: _______/______/_______ Please affix
`1 Relationship with Policy Owner: _________________
revenue stamp Address: ____________________________________
Place: ______________________ and
Witness Contact No.: _________________________
Signature of Policy Owner/ sign across
Assignee in case the policy is assigned Witness Signature: ___________________________
IMPORTANT GUIDELINES
1. If request for Unit Linked Product is received up to 3:00pm IST on a weekday (Mon-Fri), the same day’s NAV will be applicable. However, if the
request is received after 3:00pm IST, then the next declared NAV will be applicable. If the request is received on Saturday, then the next declared
NAV will applicable.
NAV applicability will be subject to receipt of the request along with the policy document and requirements as applicable.
2. No Surrender request will be accepted without policy document.
3. Self attested copy of PAN is Mandatory. List of Valid Photo ID proofs are given below:
• Passport - Bankers Certificate/Employer’s Certificate with Photograph
• PAN Card (Mandatory) - Driving License
(For payout request received along with request for change in signature, only the above mentioned 4 photo ids are valid).
• PIO Card with photograph • ESIC Card with photograph
• Armed Force ID cards with Photograph • Post Office Savings A/c, PPF A/c with photograph
• Employees ID card with Photograph • Bar Council ID for Lawyers of with photograph
• Letter issued by Unique Identification (UIN) Authority of India containing details of name, address is accepted as valid KYC Identification (Photo
ID) and Address proofs
Please note that Valid Photo ID of customer and 3rd party can be attested by Customer Service Executive – other documents by authorized
signatories.
• All MDRT, COT, TOT and CEO club members qualified for the last calendar year are also authorized signatories. Either of these documents needs
to be attested any of the following authorised signatories
• (As mentioned in the existing form)
4. For Bank Details, please note:
• Original Cancelled cheque with pre-printed name & account number is mandatory
• In case the cancelled cheque does not have the policy owner’s name and account number pre-printed, then a copy of the Bank Statement/Bank
Passbook with account number and account holder’s name needs to be submitted. Computerized Bank statement displaying pre-printed name
and account number of the policy owner can be accepted if the same is attested by authorized Aditya Birla Sun Life Insurance Company Limited
(ABSLI) personnel.
• In case cancelled cheque carries pre-printed name and account number, but has “New Account” printed on it, kindly submit an attested copy
of the passbook/bank statement bearing pre-printed or handwritten name and account number. Please carry original passbook/bank
statement to the branch for verification purposes. -
Cheque submitted along with payout requests should be cancelled/defaced. While doing so, please ensure that the account number /IFSC
code is clearly visible.
• Cheque should not be signed
Important: Only the front page of the passbook/portion of the bank statement that shows the account holder’s name, address, account number
and IFSC code should be submitted. Pages showing transactions should not be submitted.
5. For payout forms where thumb impression is affixed - (Requests received from walk in customers & or through third party) - The payout
form to be witnessed by a person (not the advisor/employee of the Company) who knows the Policy Owner. The same to be attested by Magistrate,
Notary Public or Special Executive Magistrate.
6. For payout forms where thumb impression is affixed - (Requests received from walk in customers) - The payout form to be witnessed by a
person (not the advisor/employee of the Company) who knows the Policy Owner. The same to be attested by Magistrate, Nota_ Public or Special
Executive Magistrate.
Finance Act 2014 has introduced a new TDS provision under Section 194DA in the Income Tax Act 1961 on the insurance policies.
Policy Issue Period Exemption Criteria
On or before 31st March 2003 No criteria prescribed (TDS Not applicable)
On or after 1st April 2003 but Annual Premium should be maximum 20% of the Actual capital Sum Assured in any of the years OR
on or before 31st March 2012 Actual capital Sum Assured should be minimum 5 times Premium in any of the years
Annual Premium should be maximum 10% of the Actual capital Sum Assured in any of the years OR
On or after 1st April 2012
Actual capital sum assured should be minimum 10 times Premium in any of the years

As per the new section (applicable from 1st October 2014), if the policy proceeds are not eligible for exemption under Section 10 (10D) of the Act and
your total payout value for a year exceeds Rs. 100,000, then the tax deductions will be as under:
• At 1% (for valid PAN registered with us)
• At 20% (for valid PAN not registered with us)
The applicable deduction will be withheld by us before releasing the payment and the same shall be deposited with Government authorities
In case valid PAN details are not available with us, TDS certificates would not be generated from Income Tax website. Also, in the absence of PAN, TDS
credit would not get reflected in Form 26AS

Important points:
1. In case the TDS to be deposited with Government authorities is more than payout value, then the balance TDS shall be recovered from the existing
fund of the policy.
2. In case the available Fund value post payout is also not sufficient for the TDS, then the surrender request shall be declined by ABSLI.
3. For NRI - TDS will be applicable as per relevant provisions of Income Tax Act 1961 or as per Double Taxation Avoidance Agreement between India
and country of residence of Policy Owner.
4. As per Government of India and IRDAI Notification it is mandatory to update PAN/Form60 details in All your policies before 31st March.2018 to ensure uninterrupted
services for your policy(s).
 For Branch Use Only (All fields are mandatory)

Fund Transfer submitted by Customer Advisor Third person Date: D D M M Y Y Y Y Before 3 PM Before 3 PM

ABSLI Staff's Name, Employee ID and Signature: ________________________________________________________________

Branch
Reference No. ________________________ Stamp

Please collect stamped, signed and filled up acknowledgment slip, which you can refer to for all your communications in regard to this request.

Acknowledgment Slip

Maturity request: Reference No.: __________________ Date: D D M M Y Y Y Y Before 3 PM Aer 3 PM

FOR/9/17-18/803

Policy Owner: Name of the Policy Owner: _________________________________

Date Stamp and Time
Branch:___________________________ Received by:_______________________
Note: In case you have opted for NACH/ECS/DD and your due date is with 10days within request, your account might get debited for the premium due.
However, same shall be refunded to you within 3 working days into the same account from where the money was debited.
We thank you for choosing Birla Sun Life as your preferred insurance partner and hope that you will reconsider our products in the near future.

Aditya Birla Sun Life Insurance Company Limited

(Formerly known as Birla Sun Life Insurance Company Limited)
Regn. No.: 109. Regd Office: One Indiabulls Centre, Tower 1,
16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg,
Life Insurance
Elphinstone Road, Mumbai - 400013
+91 22 6723 9100 | CIN: U99999MH2000PLC128110
Aditya Birla Sun Life Insurance Company Ltd.
www.adityabirlasunlifeinsurance.com

“The Trade Logo “Aditya Birla Capital” Displayed Above Is Owned By ADITYA BIRLA MANAGEMENT CORPORATION PRIVATE LIMITED (Trademark Owner) And Used By ADITYA BIRLA SUN LIFE INSURANCE COMPANY LIMITED
(ABSLI) under the License.”