POLICY CORRECTION FORM
To,
The Manager - Operations,
SBI Life Insurance Co. Ltd.
_________________________
_________________________
Policy No: Customer ID:
Name of the Policyholder: Mr./Mrs./Ms.
Kindly amend my policy details with the below changes.
1. Address ( Correspondence / Permanent – please tick in the appropriate box)
Correspondence
P I N -
Permanent
P I N -
Tel: (R) - Mobile No.
(O) - Email – id: ___________________________________
(Kindly attach any one of the self attested address proof *Ration Card *latest Electricity Bill*latest Telephone Bill*Recent Bank A/c Statement
with address*Valid Lease Agreement not more than 3 months old* Employer Certificate* Letter from recognized Public Authority)
2. Change / Correction in Name ( Policy Holder / Life Assured/ Nominee/ Appointee/ Life Beneficiary)
(Kindly attach any one of the self attested proof such as*Marriage certificate*Gazette copy attested by Gazetted Officer or SBI Life
Official )
3. Change in Mode (Kindly change my payment frequency to : (Please tick as applicable)
Yearly Half Yearly Quarterly Monthly
Please furnish the latest payment details (if any)
Cheque / DD No Cheque / DD Date Amount (Rs.)
4. Correction in DOB (DD/MM/YYYY): ( Policy Holder / Life Assured/ Nominee/ Appointee/ Life Beneficiary)
From - - to - -
(Kindly attach any one of the self attested age proof such as *School Leaving Certificate* PAN card*Driving License*Passport etc duly
attested by any Gazetted Officer or SBI Life Official)
Date: Policyholder’s Signature :
Place:
Enclosures:- 1)
2)
SBI Life Insurance Co. Ltd
Corporate Office: "Natraj", M.V Road & Western Express Highway Junction, Andheri (East), Mumbai‐400069
Central Processing Center: Kapas Bhavan, Plot No.3A, Sector No.10, CBD Belapur, Navi Mumbai‐400614
PS‐29/Ver1.3/4/1/2012 Page 1 of 1
