Bajaj Allianz Surrender Form PDF Details

The Bajaj Allianz Surrender Form is a crucial document for policyholders who decide to discontinue their life insurance policy with the Bajaj Allianz Life Insurance Company, headquartered at GE Plaza, Airport Road Yerawada, Pune. This form serves as a formal request for surrendering the insurance policy, requiring specific details such as the policy number, the name of the policyholder, assignment status, and the reason for the surrender. Additionally, it marks the date of the surrender request and necessitates the submission of the policy bond. Importantly, the form also elucidates upon the electronic payout methods available for the disbursement of any funds due to the policyholder, including options like National Electronic Fund Transfer (NEFT), the Electronic Clearing System (ECS), and Direct Credit for selected banks. The process mandates the submission of a cancelled cheque or a recent bank statement or passbook copy to facilitate the electronic payout. Through ensuring the collection of comprehensive information and adherence to procedural requirements, the form plays a pivotal role in streamlining the surrender process, making it both efficient and secure for the policyholder and the insurance company alike.

QuestionAnswer
Form NameBajaj Allianz Surrender Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
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Form Preview Example

BAJAJ ALLIANZ LIFE INSURANCE COMPANY LT GE Plaza, Airport Road Yerawada, Pune 411006

SURRENDER REQUEST FORM

1.

Policy Number

____________________________________

2.

Name of Policy Holder

____________________________________

3.

Is the Policy Assigned

Yes / No

4.

Name of Assignee (if (2)above is Yes)

_____________________________________

5.

Number of years Premium Paid

_____________________________________

6.

Reason for Surrender

_____________________________________

7.

Surrender Request Date

____DD____MM_____YYYY

Enclosure : Policy Bond

Signature of Policy Holder

Signature of Assignee

Name

Name

Date :___DD____MM_____YYYY

Date :___DD____MM_____YYYY

Contact No _________________

Contact No _________________

PFOO5

Branch Address & Contact Numbers

 

 

BAJAJ ALLIANZ LIFE INSURANCE COMPANY LT

 

 

 

 

 

 

GE Plaza,

Airport Road Yerawada, Pune 411006

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

!"#$!%#!

$&&'

Electronic Payout Methods:

Please Tick one of the Options:

National Electronic Fund Transfer (NEFT)

Electronic Clearing System (ECS)

Direct credit (Select Banks)

Note: Cancelled copy of Cheque/ Bank Statement/ Bank Passbook Copy not more than 6 months old as on date to be submitted along with Electronic Payout Request.

Account Holder Name:

Bank Name:

Branch Name:

Bank Account Number:

Type Of Account: MICR Code

Savings

Current

IFSC Code:

The payout mode selected in the Form will be used by company to generate any payouts to the policy holder (Claimant). Payouts would be done in accordance and subject to terms and conditions of the policy

_____________________________

___________________________________

Signature of Policy Holder

Signature of Bank Account Holder

Banks Verification

Stamp & seal of Bank for Verifying Customers Bank Account Number

PFOO5

Branch Address & Contact Numbers

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This PDF requires specific info to be entered, thus you should definitely take whatever time to type in what's asked:

1. The bajaj allianz policy surrender value requires particular information to be entered. Make certain the subsequent blank fields are finalized:

can i surrender my bajaj allianz policy online conclusion process detailed (portion 1)

2. After the previous section is done, it's time to include the required details in Name, Date DDMMYYYY, Contact No , Name, Date DDMMYYYY, Contact No , and PFOO Branch Address Contact so that you can move forward further.

can i surrender my bajaj allianz policy online completion process outlined (step 2)

3. This next part is going to be simple - fill out every one of the form fields in Please Tick one of the Options, National Electronic Fund Transfer, Electronic Clearing System ECS, Direct credit Select Banks, Note Cancelled copy of Cheque Bank, Bank Name Branch Name Bank Account, Current, Savings, and Type Of Account MICR Code IFSC to complete the current step.

Savings, Note Cancelled copy of Cheque Bank, and Bank Name Branch Name Bank Account of can i surrender my bajaj allianz policy online

Always be really mindful when filling out Savings and Note Cancelled copy of Cheque Bank, because this is the section in which many people make some mistakes.

4. This particular subsection comes next with these blanks to consider: Type Of Account MICR Code IFSC.

Guidelines on how to fill out can i surrender my bajaj allianz policy online part 4

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