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Bankers Verification Form20170619 084455

This document is a banker's verification form for an insurance policyholder. It contains fields for the policyholder's name, bank account number, Aadhar and PAN details. It is to be signed by the branch manager of the policyholder's bank, along with the manager's name, signature, and bank seal. There is also space for a third party declaration if the policyholder signs in a language other than English.

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Venkatesh
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2K views1 page

Bankers Verification Form20170619 084455

This document is a banker's verification form for an insurance policyholder. It contains fields for the policyholder's name, bank account number, Aadhar and PAN details. It is to be signed by the branch manager of the policyholder's bank, along with the manager's name, signature, and bank seal. There is also space for a third party declaration if the policyholder signs in a language other than English.

Uploaded by

Venkatesh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PSRF727217021750 | Comp/Feb/Int/4748

For office use only:


Banker’s Verification Form Branch:
Received at branch on:
Applicable to all policies Received by:
Policy No.:

Name of the policyholder


I/We confirm that: ____________________________________________________________________________________________

operates the Savings Current NRE NRO

Bank Account No. : and the below signature matches


with our records.
Aadhar No.:

PAN:

Name of the Bank: ____________________________________________________________________________________________

Branch Name: ________________________________________________________________________________________________

Name Of The Branch Manager:___________________________________________________________________________________

Signature of Branch manager


SIGN HERE and Banks seal.
DD/MM/YYYY
Date: __________________ Latest
Customer
Place: __________________
Signature of the Account Holder Photograph.

Declaration made by third party where the Account Holder has signed in vernacular:

I hereby declare that the content of this application form has been explained to the account holder in ___________________________
language and have truthfully recorded the answers provided to me. I further declare that the account holder has signed/affixed his/her
thumb impression in my presence.

Name ___________________________________________________________________ SIGN HERE

Address: _________________________________________________________________

DD/MM/YYYY
Date: __________________ Place: _________________ Signature of third party

HDFC Standard Life Insurance Company Limited (HDFC Life). In partnership with Standard Life Plc. CIN:U99999MH2000PLC128245. IRDAI Registration No. 101.
Regd. Off: Lodha Excelus, 13th Floor, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai - 400 011

Customer Acknowledgement Copy (Banker's Verification Format)

Policy No.:______________________________ Policyholder Name:______________________________


Branch Stamp
Customer Relations Officer:________________________________ Date: __________
DD/MM/YYYY Time: ___________

For queries or more information, call us on 1860-267-9999 (Local charges apply). DO NOT prefix any country code e.g. +91 or 00. Available Mon-Sat from 10 am to 7 pm |
Email - [email protected] | [email protected] (For NRI customers only) | Visit - www.hdfclife.com

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