Gq Adamiee Life Assurance Co.Ltd Page 1 of 1
adamjeelife — eee :
Aamioe Lite Assurance Co. Ls
Wendt Roe Kame 7460 PAKISTAN
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Policy Surrender Financial Reasons At
‘Aahoe Surender > Uncatisfatory Returns ee foe
Paral Poy Withdrawal ars Unsatsactoy Service ry Boon
Parial Adhoe Withdrawal Sabre Sonso Others ‘ae
‘Amount PAR le ocr
‘Amount in wares pape a ess
Do you want your Pay Out through; wade
Direct Transtorin IBFT Account FUE wt 6 edad O cheque -&
Account Status iat: CJActive 136 Dormant hes
In case of account, status is inactive or dormant a cheque wil be _— oes fez Miafaralce
dispatched at your provided correspondence address, WL dea ie 30 Si wer Stee Ha ae
‘Account Tile (2 Haseeh Sal tea
‘ecount Number 0
Bank Name J: WE
¥ For Partial Policy withdrawal the sum assured willbe reduced bythe same emoynt.as that of pata wihcrawal amount.
Sab 200 S80 2 FF SEE BE oi § MERAH
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1 ecb Ss holding Poicy »_ boo / S697 with Adamjee Life hereby put
forward the request of surrender [Withdrawal arom my policy and demand for payment of the resulting valve (If any) after adjusting forall
‘applicable charges” am aware of any financial loss that | might incur as a result! deciare thatthe information above is true to the best of my
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“Surender Foes of Rs.350/- applicable + Surrender Charges (See the atsches Surender Charges Sheet)
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complete Original Policy Documents (For Complete Surender Cases)
T)zekat Decoration Form (Tobe made ona stamp paper of PAR. 20/- duly noizec)
Paine Ay Si
‘WW oeh L2)¢ DickissiISLAMIC REPUBLIC OF PAKISTAN
Name
Haseeb Sajjad
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'S60-£0c98CD180005200
tow Denomination
Amount Rs 100/-
Description ‘ceanicaTe om otweR oocuMtent-19,
Aoplant ASEEB SAJIAD[36101-5751724:3)
‘SALA AHMAD N
Arent self
adress SARGODKA 5
Issue Date, 6-Dee-2023 9:56:28 AM Gq
Delsted Or/vatidity: 13-Dec-2023 .
AmountinWords: One Hundred Rupees Only
Reason FoR 250
Vendor formation: Abdul Rarag | PE-SGO-179 | Dist. Courts
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en cb dateStanp Numbers a 8199
uted On
jal Stamp Paper Of Rs.100/-)
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