‘aver ferry
saree ore
FE NSbRANCECORPORITION OF OK
uestionnaire to be submitted with surrender af
ic
n/ Discharge form
Policy no- Name of life assured:
Date of surrender
(Kindly, select only one option for each question)
‘Question | Question ‘options
No
1 ‘Are you aware that surrender of LIC i,_Yes
policy means losing life cover and 2 No
financial loss to you?
z Reasons for surrender of the LIC 7. Urgent financial need
policy? 2. Not satisfied with terms and
Conditions of the plan
3._Not satisfied with service
‘4. Any other reason.
3 ‘Whether surrender amount is being i. Yes
invested in any other LIC product? 2_No
| heteby declare that | have understood the surrender value calculation fully and signing the
discharge form after understanding the same.
Signature of life assured
Name of life assured:-
Mobile/ contact number:-