7/17/2019 Bank Account Updation Form

http://slidepdf.com/reader/full/bank-account-updation-form 1/2

Bank Account UpdationForm for Payouts

I request Exide Life Insurance Company Limited to update the below bank account details for any future payout of the below mentioned policy/s.

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BranchSeal

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Sign:

This is to acknowledge the receipt of application for Bank Account Updation for future payouts  Date

Documents received: Policy No.

  Original Policy Document Valid Address Proof Identity Proof Bank Account Proof

Others______________________________________________________________________________ 

Please tick (ü) any one Bank Account Type*: Savings Current Account Over Draft / Cash Credit NRO

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Payment Method*: Direct Credit (NEFT/RTGS) A/c Payee Special Crossing Cheque

Note: 1) In case the IFSC code is not provided or if the same is not enabled for NEFT, then the payout will be made by A/c payee special crossedcheque. Direct credit is not possible for NRE accounts.

  2) Personalised cancelled cheque OR Personalised Bank statement is mandatory  3) If the information provided is incomplete or if there is a mis-match of details with our records, the same will not be updated.  4) Please note that the amount would be credited to the bank account number provided by you and the same will be considered as final.

Bank Name*: Bank Branch*:

 Account Number*: IFSC Code*:

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Signature / Thumb Impression of the Policy Owner / Assignee*: WitnessSignature*:

Date

Name & Address of the Witness*:

*(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 invernacular or a thumb impression.)

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I take full responsibility for the genuineness and correctness of the details filled herein.

 All fields with (*) are mandatoryNote: Please complete the form in CAPITAL LETTERS.

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Code:

Employee No.:D D M M Y Y Y Y  Date:

Name of the CustomerService Representative:  Signature:

 Address*:

City*: State*: PIN*:

Landline*: Mobile*:

E-mail*:

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Policy Number*: Policy Holder’s Name*:

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 Additional Policy Nos. :

1. Do you have a PAN card

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 Yes No

If Yes, kindly provide your Permanent Account Number (PAN): along with self-attested photo copy 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  Yes No

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.

Email : customer.service@exidelife.inCall : 1800 419 8228 (TOLL FREE); +91 80 4134 5444 Visit : exidelife.in

(Formerly ING Vysya Life Insurance Company Limited)

Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001.

IRDAI Registration No. 114 CIN: U66010KA2000PLC028273

7/17/2019 Bank Account Updation Form

http://slidepdf.com/reader/full/bank-account-updation-form 2/2

Bank Account UpdationForm for Payouts

 All fields with (*) are mandatoryNote: Please complete the form in CAPITAL LETTERS.

Please submit any one of the following listed documents along with the mandatory requirements (*).

  1) Self-attested valid photo ID proof * 2) Self-attested valid address proof 3) Original Policy Documents

  4) Original cancelled cheque with your name and account number pre-printed* OR 

  5) Self-attested copy of bank statement / pass book copy with bank seal, if personalised cheque is not attached*.

List of valid address proofs: Telephone Bill, Bank letter/ Account Statement, Water Bill, Electricity Bill, Valid Passport, Valid Driving License, Ration Card, ESI Card,Domicile Certificate, Company Lease Agreement/Rental Agreement, Employer's Certificate. Statement/Receipt/Bill should not be more than six months old fromthe request submission date. Please attach self-attested identity proof bearing photo (e.g. Pan card, Voter’s ID, Passport, Driving License, Aadhar Card)   D

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Email : customer.service@exidelife.inCall : 1800 419 8228 (TOLL FREE); +91 80 4134 5444 Visit : exidelife.in

(Formerly ING Vysya Life Insurance Company Limited)

Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001.

IRDAI Registration No. 114 CIN: U66010KA2000PLC028273