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Form preview Licensing act 2005 age verific... LICENSING (SCOTLAND) ACT 2005 AGE VERIFICATION POLICY STAFF DECLARATION PREMISES AGE VERIFICATION POLICY NAME AND ADDRESS OF PREMISES ................................................................................................ ........................
Form preview Payment and policy notificatio... Hinds Community College Office of Financial Aid Payment and Policy Notification Please read carefully and answer all questions as it relates to you. Student s Last Name Student s Social Security #
Form preview How extreme sports can affect... 1 of 2Macquarie Life Hazardous sports and pastimes questionnaireMacquarie Life Hazardous sports and pastimes questionnaire This statement should be completed by the person to be insured.1Details of
Form preview Life insurance policy form Vantis Life Insurance Company POLICY CHANGE REQUEST FORM 200 Day Hill Road, Windsor, CT 06095 P: 1-866-826-8471 n F: 1-860-298-5483 www.VantisLife.com w GENERAL INFORMATION (Please Print) Name of
Form preview Life insurance policy form pdf... OMB Approved No. 2900-0012 Respondent Burden: 10 minutes APPLICATION FOR POLICY LOAN GOVERNMENT LIFE INSURANCE Important Notice About Information Collection: We need this information to determine,
Form preview Travel insurance policy docume... Aviva Single trip and Annual Multitrip Travel Insurance PolicyTravel checklist3Do you need visas? Make sure you have all the visas, passports and documentation you need before going on your trip.
Form preview Request for verification of li... REQUEST FOR VERIFICATION OF LIFE INSURANCE POLICY INFORMATION NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES ECONOMIC ASSISTANCE DIVISION Clear Fields SFN 363 (6-2015) TO BE COMPLETED BY THE CLIENT Name
Form preview This is to certify that the in... Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road North St. Paul, MN 55155Certificate of Insurance Covering General Liability and Property DamageMailing
Form preview Long term care insurance polic... Next Print... Long-Term Care Insurance Application, Forms and Outline of Coverage For the Commonwealth of Massachusetts (This booklet contains the forms necessary to apply for New York Life s Long-Term
Form preview Exide life insurance policy bo... Maturity Payout Form Note Please complete the form in CAPITAL LETTERS. All fields with are mandatory I request Exide Life Insurance Company Limited to process my maturity proceeds and refund the eligible maturity value after deducting all dues under this policy. Maturity Date D D Policy Number M M Y Y Y Y POLICY DETAILS Policy Holder s Name To enable us to get in touch with you and facilitate quick processing kindly update your latest contact information In case of change in communication address a valid address proof of the new address is mandatory - Refer below for list of valid address proof Current Address Pin Code Landline Mobile Email ID SETTLEMENT OPTIONS Fund Transfer Yes No New PDA / Policy No* Settlement Options 3 5 installments option is applicable for products eligible as per Terms Conditions Full Settlement BANK DETAILS Payment Method Direct credit NEFT/RTGS A/c Payee Special Crossing Cheque Bank Name Bank Branch Account Number IFSC Code Please tick any one Bank Account Type Savings Current Account Over Draft / Cash Credit NRO TAX DEDUCTIONS Note In case IFSC code is not provided the payout will be made by A/c payee special crossing cheque. Direct Credit is not possible for NRE account 1. Do you have a PAN card If Yes kindly provide your Permanent Account Number PAN Attach a self-attested photocopy of PAN Card. As per Finance Act 2014 payments made under Life Insurance policies which are not exempt under the Income Tax Act are subject to tax deduction at source 2 Under Section 194DA. In case the payee does not furnish valid PAN details the rate of tax deduction will be 20. 2. Are you currently a Resident of India If No please specify country of Residence. Note In case you are not a Resident of India then tax deductions will be applicable as per beneficial provisions of treaty with the respective Country of Residence. I take full responsibility for the genuineness and correctness of the details filled herein* Date D D M M Witness Signature Name Address of the Witness ACKNOWLEDGMENT SLIP FOR OFFICE USE ONLY Should be someone other than the advisor/agent/employee of the company and who has also explained the contents of this form if signature is in vernacular or a thumb impression* Name of the Customer Service Representative Branch Code D Y Y Signature Employee No* This is to acknowledge the receipt of application for Maturity Payout. D D M M Y POS/MPA/Version 2. 1 DECLARATION Signature / Thumb Impression of the Policy Owner / Assignee Policy No* Sign Documents received Original Policy Document Valid Address Proof Identity Proof Bank account proof Seal Others Turn over leaf for more details. Call 1800 419 8228 TOLL FREE 91 80 4134 5444 Email customer. service exidelife. in Visit exidelife. in Registered Office Exide Life Insurance Company Limited 3rd Floor JP Techno Park No*3/1 Millers Road Bengaluru - 560 001. Formerly ING Vysya Life Insurance Company Limited IRDAI Registration No* 114 CIN U66010KA2000PLC028273 TERMS CONDITIONS DOCUMENTS REQUIRED Please submit any one of the following listed documents along with the mandatory requirements.
Form preview Portable equipment insurance p... THE NEW INDIA ASSURANCE COMPANY LIMITED Registered & Head Office 87, M. G. Road, Fort, Mumbai400001. PROPOSAL FORM FOR PORTABLE EQUIPMENTS SPECIAL CONTINGENCY INSURANCE POLICY 1. (a) Name of proposer
Form preview I am your life insurance polic... I am your life insurance policy. You and I have similar purposes in this world. It is your job to provide food, clothing, shelter, schooling, medicine, and other things for your loved ones. You do

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