Scribd
Upload
8K views1 page

Maturity Claim Form PDF

This document is a claim form for collecting the maturity value of a postal or rural postal life insurance policy. It requests information such as the name and occupation of the insured, policy details including the policy number and dates, payment details including the desired post office and bank account number, and a list of required documents like the policy document and premium receipt book. The form must be filled in capital letters and signed by the insured along with their contact information.

Uploaded by

bsobanbabu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
8K views1 page

Maturity Claim Form PDF

This document is a claim form for collecting the maturity value of a postal or rural postal life insurance policy. It requests information such as the name and occupation of the insured, policy details including the policy number and dates, payment details including the desired post office and bank account number, and a list of required documents like the policy document and premium receipt book. The form must be filled in capital letters and signed by the insured along with their contact information.

Uploaded by

bsobanbabu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

CLAIM FORM FOR MATURITY VALUE OF POSTAL/ RURAL POSTAL LIFE INSURANCE POLICY

(Please fill in the columns in CAPITAL letters)

1. Name of Insurant (Mr./ Mrs./ Ms.)


First Name Middle Name Last Name

2. Occupation

3. Communication Address

Village Taluka
City District
State Country PIN

4. Particulars of Policy
i. Policy No.

ii. Sum Assured iii. Date of Acceptance iv. Date of Survival Benefit Due (AEA Policy)
` / - / / / /
v. Date of Maturity
/ /
5. (i) Designation and Address of Drawing and Disbursing Officer during last six months

Village Taluka
City District
State Country PIN

ii. Name of the Post Office where premia were paid during last six months.

a) b) c)

d) e) f)

6. Name of the Post Office (if it is Sub Office, write the name of Head Office as well) at which the payment is desired.
i. Name of Sub Post Office

ii. Name of Head Post Office

7. For payment of loan through cheque, please provide following information about your Post Office/Bank account:-

i. Account No.

ii. Name of Post Office/ Bank

iii. Branch Name:

Documents attached:

( a) Policy document.
(b) Loan Repayment Receipt Book if loan was taken.
(c) Premium Receipt Book
(d) Certificate of Pay Disbursing Officer regarding recovery of premia from pay for the last six months.
(e) Any other document

Date:________________
Signature of Insurant
Name:
Phone no.:
Office:
Residence:
Mobile no. :

You might also like