Lic Reassignment Form Sample Filled Jun 2026

"Full repayment of loan amount" or "Nil" (if done for love/affection) Rajesh Kumar (Your Full Name) Policy Number Sum Assured ₹5,00,000 Date of Original Policy 15th January 2018 Place & Date Mumbai, 10th May 2026 Witness Signature Must be signed by a third party (not a relative) Step-by-Step Instructions for Filling

| Field | Filled Value | |--------|----------------| | We, the Assignee, accept the above assignment and agree to be bound by its terms. | | | Signed by (Assignee) | R. N. Krishnamurthy | | Designation | Branch Manager – SBI, Pune | | Place | Pune | | Date | 18/01/2025 | | Witness 1 Name | Neeta Joshi | | Witness 1 Signature | (signed) | | Witness 2 Name | Amit Khanna | | Witness 2 Signature | (signed) | lic reassignment form sample filled

The is used to transfer a life insurance policy back to the original policyholder (the assured) after it was previously assigned to a third party, such as a bank or financial institution, typically for a loan. When to Use This Form "Full repayment of loan amount" or "Nil" (if

: Clearly state that the reassignment is in consideration of the repayment of the loan. Krishnamurthy | | Designation | Branch Manager –