‘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:-