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Change of Ownership Form - Oct24 - 01

The document is a Change of Ownership Form for an insurance policy, requesting the transfer of ownership from the current policyholder to a new proposer. It includes sections for personal details of the new proposer, authorization from legal heirs, and terms and conditions regarding the change. The form must be filled out and signed by all Class I legal heirs in the event of the current policyholder's death.

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32 views2 pages

Change of Ownership Form - Oct24 - 01

The document is a Change of Ownership Form for an insurance policy, requesting the transfer of ownership from the current policyholder to a new proposer. It includes sections for personal details of the new proposer, authorization from legal heirs, and terms and conditions regarding the change. The form must be filled out and signed by all Class I legal heirs in the event of the current policyholder's death.

Uploaded by

peaksstore143
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
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Date

Change of ownership Form


I would request you to change the ownership of policy number which is currently owned
by ___________________________________________________________ in the favor of ________________________ Photo of
Details of New proposer new
Full Name
proposer
Father's Name

Date of Birth

Residence Address

Pincode

Landline Mobile

Email

PAN Number provided Yes No PAN Number

Gender Male Female Transgender


Marital Status Unmarried Married widower Divorced
Occupation (Please tick) Salaried Self Employed/Business Unemployed Housewife Others
Nationality Indian Non-Indian
Whether the Life to be Insured/Proposer/Nominee(s)/Appointee(s)/Premium payor is/are Politically Exposed Person(s)* Yes No
(*Politically Exposed Persons (PEPs) are individuals who are or have been entrusted withprominent public functions. PEP norms may also be applied to the accounts of the family
members or close relatives of the above referred individuals.)
Residential status Indian Non-Resident Indian (NRI) Country, if NRI ______________________________________________
Residence for Tax purposes in Jurisdiction(s) outside India Yes No
(If Yes then mandatory to fill the FATCA/CRS declaration)

If existing client, pls mention client ID

Reason for change of ownership

Relation with the existing proposer

Signature of the Life Assured/ Policyholder

AUTHORIZATION OF ALL THE CLASS I LEGAL HEIRs OF THE DECEASED PROPOSER

Relation with the


Full name Date of birth Complete Address Signature
deceased Proposer
Change of ownership Form/version 1/August 2024

Note: We, the signatories to the authorisation above do hereby declare that we are the only Class I Legal Heirs of the deceased and are entitled to succeed to the
estate of the deceased Policyholder. We hereby declare that the particulars furnished above are true, complete and correct in all respects. In the event any of the
particulars is found to be incorrect / false, we undertake to indemnify the Company against all losses, damages, costs and expenses (including the costs of any
litigations) that the Company may incur or may be put to as a consequence thereof.
If the signature is in vernacular language, please complete the following declaration
I hereby declare that I have fully explained/ translated the contents mentioned in the Declaration to
F I R S T L A S T
and I further declare that he/ she/ they fully understood the meaning there of.

Signature of the Declarant


Date D D M M Y Y Y Y
(Declarant should not be an employee/ advisor of Reliance Nippon Life Insurance)

Name & Address of the Declarant F I R S T L A S T

Correspondence address/ Usual place of residence F I R S T L A S T F L A T N O.

B U I L D I N G R O A D N A M E / N O.

L A N D M A R K 1

D I S T R I C T / T A L U K A L A N D M A R K 2

C I T Y / V I L L A G E S T A T E Pincode
STD ISD Code L A N D L I N E M O B I L E 1 EMAIL ADDRESS

I hereby confirm that I have been explained the content in (Language) and have understood the same.

Signature of the Life Assured/ Policyholder

Terms and conditions


• Filling up this form and submitting the same would help the Company in recording the new owner for the above-mentioned Policy
• The Proposer of an Insurance Policy is the owner of the Policy (also referred to as the Policyholder) entitled to receive any benefit there under and has the right to carry out any
transaction under the Policy.
• Change in the Owner is allowed in case of death of the Proposer. The form is to be duly filled and signed by all the Class I legal heirs.
• Class I legal heirs are the immediate family members of the deceased person. E.g. As per the Hindu Succession Act, the legal heirs of a man are wife, children and the mother/
father.
• Where the Life Assured is minor, the New Owner shall remain as the Owner of the Policy only till the Life Assured turns major. The Policy automatically vests in the Life Assured on
he/she is becoming major.
• In case the Life Assured is selected as the New Owner. Please submit a separate nomination form to enable the company to record the nomination.
• All future communications will be sent to the new Owner.
• Please submit separate request for bank and Pan details update to receive future benefits in your bank account once ownership is changed
• For existing client all communication will be sent to the existing communication details available in records, hence submit a separate request for any modification of contact
details (like Address, mobile ,email ) with KYC/ Applicable proof .

FOR OFFICE USE ONLY


• Customer has personally visited the branch
• Self-attested customer identity proof verified with original.
• Documents has to be collected as per checklist

Branch Stamp and Date

Name and Sign of CCE

Customer Acknowledgement

Policy No.

Service request no
MKTG/MID/Change of ownership Form/version 1/August 2024

Branch Stamp and Date

Name and Sign of CCE

Reliance Nippon Life Insurance Company Limited. IRDAI Registration No. 121. Registered & Corporate Office: Unit Nos. 401B, 402, 403 & 404, 4th Floor, Inspire-BKC, G Block, BKC Main Road, Bandra Kurla
Complex, Bandra East, Mumbai - 400051. India. T +91 22 6896 5000. For more information or any grievance, 1. Call us between 8 am to 8 pm, Monday to Saturday (except public holidays) on our Toll-Free
Number - 1800 102 1010 or 2. Visit us at www.reliancenipponlife.com 3. Email us at: [email protected]. 4. Chat with us on our WhatsApp number (+91) 7208852700. Trade logo displayed
above belongs to Anil Dhirubhai Ambani Ventures Private Limited & Nippon Life Insurance Company and used by Reliance Nippon Life Insurance Company Limited under license.

BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS: IRDAI clarifies to public that: 1. IRDA or its officials do not involve in activities like sale of any kind of insurance or financial
products nor invest premiums. 2. IRDAI does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along with details of phone call, number.
Page 3 of 3 CIN: U66010MH2001PLC167089

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