PSRF176726121811 | Comp/Dec/Int/4924
HDFC Life Reassignment Form
Details of Assignee
Name of the Assignee:
(E.g. Policyholder)
DETAILS OF ASSIGNOR
Relationship with Nominee:
Details of Appointee (in case the Nominee is a minor)
D D M M
Y Y Y Y
Date of Birth:
Name of the Appointee:
DETAILS OF ASSIGNOR
Details of Nominee
D D M M Y Y Y Y
Date of Birth:
Relationship with Assignee:
Name of the Nominee:
Details of Assignor
Name of the Assignor:
If existing Nominee
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HDFC Life Reassignment Form
Branch:
Received at branch on:
Received by:
Interaction ID:
Policy No. : E-Insurance Account No.:
(Only for Demat)
IMPORTANT
1. A transfer made in accordance with Section 38 of the Insurance Act, 1938 as amended from time to time shall automatically cancel a nomination except in case of assignment to HDFC
Life in consideration of a loan granted by HDFC Life on the security of the policy within its surrender value, or its reassignment on repayment of the loan, nomination shall not be cancelled,
ro eengissA eht yb dengissaer si ycilop eht nehw deviver yllacitamotua dnats llahs refsnart eht nopu tneuqesnoc dellecnac yllacitamotua neeb sah hcihw ,noitanimon ehT .ycilop eht ni
retransferred by the transferee in favour of the policyholder on repayment of loan other than on a security of policy to HDFC Life.
Signature of Third Person
I hereby declare that the content of this application form has been explained to the Policyholder/Witness/Assignee(if individual) and have truthfully recorded
Third party declaration
Declaration for Reassignment
This is to inform you that the policy above which was assigned in my/our favour, is being re-assigned by me/us in favour of the Assignor as per the details
Signature & Round Seal /Stamp of Re-Assignor
Signature/thumb impression of Policyholder
Signature of Witness
2 For cases where the assignment is in favour of an individual or Financial institution apart from our channel partners, then the Assignor must get the signature of the Authorised Signatory
on the company seal.
3. Policy servicing charges may be levied as applicable. Please refer to your policy document for details.
4. As per section 194DA of the Income Income-tax Act, 1961, tax will be deducted at source from the payments made to residents of any sum under a life insurance policy including the sum
5. Assignor will not have the right to execute any policy alteration or processing without the written consent of the Assignee except as otherwise provided under No Objection For Servicing
Transactions.
6. Tax laws are subject to change.
7. Nominee’s address will be considered to be the same as the Policyholder’s address.
under the policy in accordance to the underwriting guidelines of HDFC Life.
9.
shall submit the policy document with the assignee's documents.
11.Once you have reassigned, all the rights are transferred to the new Assignee. For all future assignment/reassignment within the policy, please submit all required documents as per
the Company's Terms and Conditions.
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Date:___________
Place:___________
DD/MM/YYYY
SIGN HERE SIGN HERE SIGN HERE
Name: ______________________________________________________________________________________
Date: __________________ Place: ______________________________
Address: _____________________________________________________________________________________
DD/MM/YYYY
SIGN HERE
HDFC Life Insurance Company Limited (HDFC Life). CIN: L65110MH2000PLC128245. IRDAI Registration No. 101.
Regd. Off: 13th Floor, Lodha Excelus, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai - 400 011.
L65110MH2000PLC128245.
Customer Acknowledgement Copy (Assignment/Reassignment form)
Policy No.: _______________________ Interaction ID No.: _______________________________
Policyholder Name: ______________________________________________________________
Branch Stamp
Customer Acknowledgement Copy (Reassignment form)
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