FORM OF ASSIGNMENT OF POLICY FOR VALUABLE CONSIDERATION
(Absolute Assignment)
Note : THIS FORM SHOULD NOT BE FILLED IN. The wording of the form, if found suitable,
should be copied out either on the back of policy itself, or in the alternative, on a proper stamp
paper of the requisite value.
(FOR INSTRUCTIONS RE: EXECUTION OF AN ASSIGNMENT SEE REVERSE)
I, in
Consideration of the sum of Rupees
Paid to me by
the receipt Of which I hereby acknowledge, do hereby as beneficial owner assign unto the said
Aged years his Heirs, Executors
Administrators and Assigns the policy Of Assurance on the life of myself granted to me by the
Life Insurance Corporation of India assuring the sum of Rupees
And numbered and bearing date
the day of 1999 /2000 and the sum assured thereby and all other moneys
benefits and Advantages to be received thereunder.
Dated at this day of year 2000
WITNESS :
Signature :- ______________________________
Full Name :- ______________________________ _________________________
Signature of Life Assured
Designation :- _____________________________
Address :- ________________________________
Place : _____________________
Date :- _____________________
The Senior / Branch Manager,
Branch No. ________________
Life Insurance Corporation of India,
Policy No. ________________________Own Life
Dear Sir,
I hereby give you notice that I have assigned the above policy to :
Shri. ________________________________________
____________________________________________
_____________________________________________
_____________________________________________ } Here mention the name and
address of the assignee.
On ___________Please acknowledge receipt of this notice and forward the enclosed Policy/Deed
Of Assignment to ___________________after registering the assignment thereon in your Books
Certified that the thumb impression here in is
That of _______________________________________________
Who admits having affixed the same after understanding the
contents hereof
Yours faithfully
___________________________
Signature of Witness (Signature/Thumb Impression of Assignor)
