Reduction In Premium - Unit Linked Plan

RIPF20009081109

For O cial Use Only

For HDFC Life Unit Linked Plans Only

Branch Name:

Reduction in Premium-

Branch Stamp

Receipt Date & Time:

Unit Linked Plans

Received by:

(Please use a separate request form for each Policy)

Interaction ID:

(First Name)

(Middle Name)

(Last Name)

Name of the Policyholder :___________________________________________________________________________________________________ _

Policy No.: _________________________________ _ E-Insurance Account No.:

Email ID*:________________________________________________________________________________________________________________

Contact * No.: (O )_______________________/(Res)_____________________________/(Mob)______________________

(Mobile number is preferable)

* Contact details provided herein will be updated for all future communications. For the customers registered under National Do Not Call R e g i s ter, this response will be treated as valid discharge.

Declarations

1. I would like to reduce the Regular Premium amount from ` ______________(Mode _________________ to ______________ (Mode) _____________

`

_______________ for the above mentioned Policy.

2. I agree that,

a. The reduction in premium will reduce the premium as per the regulatory limits. b. Premium reduction charges may be applicable.

1) I con rm having read all the relevant Policy provisions before making this application and having understood them and its consequences.

2) If you have partially withdrawn your amount or you have reduced your premium, you are requested to stay invested in your Policy by paying

your premium, failing which the Policy can be paid up cancelled. A Policy would be paid up cancelled if the fund value falls below its minimum threshold limit.

Policyholder's / Assignee Name: ______________________________________________________________________________________________

SIGN HERE

Date: ____________Place:_________________________________________

Policyholder's Signature

Note:

1)

For assigned Policies, assignees signature is required.

2) Policy servicing charges may be levied as applicable. Please refer to your Policy document for details.

Declaration to be made by a third person where:

The life assured has a xed his/her thumb impression / has signed in vernacular / has not lled the application. I hereby declare that I have explained the

contents of this application form to the life to be assured in ___________________language and have truthfully recorded the answers provided to me. I

further declare that the life to be assured has signed/a xed his/her thumb impression in my presence.

Declarant Name: ______________________________________Signature: __________________Date: ______________ Place:___________________

Declarant Address: __________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

IRDAI Registration No. 101.

In partnership with Standard Life Plc.

CIN:U99999MH2000PLC128245.

HDFC Standard Life Insurance Company Limited.

th

Regd. Off: Lodha Excelus, 13 Floor, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai - 400 011.

Customer Acknowledgement Copy (Reduction in Premium form)

Policy No: _________________ Interaction ID No:__________________Policyholder name:_________________________________________________

Documents accepted (specify):______________________________

Customer Relations O cer:

Branch Stamp

Date:

Time:

Note : If you have partially withdrawn your amount or you have reduced your premium, you are requested to stay invested in your Policy by paying your

premium, failing which the Policy can be paid up cancelled. A Policy would be paid up cancelled if the fund value falls below its minimum threshold limit.

View Premium Calendar, Pay Premium Online, Track

Call 1860-267-9999 (local charges apply). DO NOT prefix any

fluctuations in the fund value, Print your Annual

country code e.g. +91 or 00. Available all days from 9am to 9pm |

P r e m i u m S t a t e m e n t & l o t s m o r e ! Vi s i t

Email –

and register for My Account today!

(For NRI customers only) Visit –