Are you looking to surrender your driver's license in Missouri? If so, you'll need to complete the Lic Surrender Form. This form can be downloaded from the Missouri Department of Revenue (DOR) website. In this article, we'll provide a brief overview of the Lic Surrender Form and what it entails. We'll also provide instructions on how to complete the form.
Below is the data in regards to the file you were seeking to complete. It will tell you the span of time you will need to fill out lic surrender form, what parts you will need to fill in and some further specific details.
Question | Answer |
---|---|
Form Name | Lic Surrender Form |
Form Length | 3 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 45 sec |
Other names | lic withdrawal form, lic surrender form, lic of india policy surrender form, surrender form lic |
_____________ DIVISIONAL OFFICE
FORM OF RECEIPT FOR THE SURRENDER VALUE OF POLICY NO.
On the Life of ________________________________________________________________
For Rs._____________________________________________ dated __________________
I/We hereby declare that I/We have not served on any Office of the Life Insurance Corporation of India any Notice of assignment or reassignment in respect of the above POLICY/ POLICIES except those, if any already Registered by the Life Insurance Corporation of India or the Insurer who issued the above POLICY/POLICIES nor Shall I/We serve on any office of the said Corporation, any notice of assignment or reassignment before payment of the Loan Value/ Surrender Value or Survival benefit due on ________________________________ I have not
dealt with the Policy in any other way.
I/We_________________________________________________________________________
____________________________________________________________________________
do hereby acknowledge receipt from the Life Insurance Corporation of India of the sum of Rupees
*___________________________________________________________________ being the Surrender Value including Cash Value of Bonus and premiums refundable on account of occupation extra and / or DAB/EPDB extra of the above
Mentioned Policy, which is herewith delivered up to the said Corporation to be cancelled. In
witness whereof these presents are subscribed by me/us.
at_________________________________________________________________________on
Name of the place
the ______________________________day of _________________________________2000
Date |
Month |
SURRENDER VALUE (Inclusive of Cash Value of Bonus ) |
Rs. ______________ |
Premium refundable on account of occupation extra |
Rs._______________ |
Premium refundable on account of D.A.B. / EPDB extra |
Rs. _______________ |
Less : |
|
Loan |
Rs. _______________ |
Interest |
Rs. _______________ |
APL Debt |
Rs. _______________ |
Other Charges (to be specified ) |
Rs. _______________ |
|
Rs. _______________ |
|
Rs. _______________ |
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Signature : _____________________________ |
|
One Rupee |
|
||
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Revenue |
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Full Name : _____________________________ |
|
Stamp |
|
When |
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amount |
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|
|
|
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exceeds Rs. |
|
500/- |
(of the witness) |
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Occupation : ____________________________ |
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Address : ____________________________ |
Signature |
In Short in |
English |
______________________________________ |
|
Full |
Vernacular |
______________________________________ |
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___________________________________________________________________________ |
|||
* Gross amount of Surrender Value |
* Delete where not applicable |
___________________________________________________________________________
Note : Illiterate persons must affix their thumb marks which should be indentified by the attesting Magistrate under the seal of his office, or a Block Development Officer or a Gazetted Officer or a Principal/Headmaster of Local High School or Higher Secondary School run by the Government or an Agent of a Nationalised Bank or Class I Officer of the Corporation or a Development Officer of the Corporation with atleast Five Years' Service provided he/she is fully satisfied about the identify of the person(s) executing the form. Signature in Regional Languages must be attested by respectable
"The contents of this discharge form have been explained to ____________________________
______and he/she/they have/has signed the same/put thumb impression after fully understanding
the same.
SEAL OF OFFICE |
______________________ |
IF ANY |
|
|
Signature of the Witness |
If the Receipt is signed by more than one person and payment is desired to be made to only one of their number, then a letter of Authority as under must be completed and signed by all of them except the authorised person before Magistrate or a Block Development Officer or Gazetted Officer or a Principal/Head Master of Local High School or Higher Secondary School run by the Government or an Agent of a Nationalised Bank or a Class I Officer of the Corporation or a Development Officer of atleast 3 years' standing or confirmed Dev. Officer recruited from Agents who were D.M.'s or B.M.'s Club Members before joining provided he/she is fully satisfied about the identity of the executants. The Letter of Authority will also be required if payment is to be made to any person other than the parties signing the Receipt.
Place__________________
Date __________________
I/We hereby authorise and request Life Insurance Corporation of India to pay the above mentioned amount of Rs. ______________________________________________________
to ________________________________________________________________________
(Name of the authorised person)
Signed by the party or parties
______________________
Signature/s in full
__________________________________________________________________________
Magistrate or a Block Development Officer or a Gazetted Officer etc.
??I hereby certify that the contents of this note of Authority were explained by me in vernacular
to
____________________________________________________________________________
____________________________________________________________________________
and he/she has agreed to payment being made to ____________________________________
They have
______________________________________the party or parties authorised.
Magistrate or a Block Development Officer or a Gazetted Officer etc.
____________________________________________________________________________
??This endorsement is required to be completed and signed by the attesting Magistrate, or a Block Development Officer or a Gazetted Officer etc. when the Note of Authority is completed by an illiterate or Vernacular knowing person.
F.No. 5074/3510 (Rev.)
___________________