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20.+surety Form

The document is a Surety Form to be completed when the Net Claim Amount exceeds Rs 5 Lacs, requiring details from a surety who is not related to the claimant. It includes sections for the surety's personal information, property details, and income verification. The surety must sign the form, assuring the insurance company of the accuracy of the provided information.

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Amit Devrat
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37 views1 page

20.+surety Form

The document is a Surety Form to be completed when the Net Claim Amount exceeds Rs 5 Lacs, requiring details from a surety who is not related to the claimant. It includes sections for the surety's personal information, property details, and income verification. The surety must sign the form, assuring the insurance company of the accuracy of the provided information.

Uploaded by

Amit Devrat
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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Apne liye. Ap no ke liye.

SURETY FORM Photograph


of Surety
(To be completed only when the Net Claim Amount exceeds Rs 5 Lacs)

(To be completed and signed by any person, not related to the Policyholder/Claimant having Assets more than Net Claim Amount)

Dear Sir/Madam,

I wish to inform you that I am prepared to execute an Indemnity Bond in favor of SBI Life Insurance Co. Ltd to enable it to payclaim
amount without insisting on original policy document to shri/Smt._____________________________________________________
(Name of the Policy Holder/Claimant) under Policy No.

I have filled in the details as given below:


QUESTIONS ANSWERS

(1) Surety’s Name and Address ______________________________________________________________


(Please provide address proof with self attestation)
______________________________________________________________

______________________________________________________________

(2) Telephone No./Mobile No.

(3) Present occupation ______________________________________________________________

(4) Approximate monthly income `

(5) Are you related to the Claimant/Policy Holder


in respect of which this surety is given?
If so, state the relationship

(6) Property, movable or immovable


Possessed and its present value, the details thereof?

(7) Is the property free from encumbrance?

(8) Attached copy of Pan Card/KYC Documents YES NO

(9) Attached proof of Income / Property. YES NO

(10) Are you a guarantor in any other cases,


if so the total amount of guarantee undertaken so far
In all the cases put together. (Excluding the present case)

I do hereby solemnly assure the Company that I have thoroughly understood and correctly provided the above details.

Signature of Witness Signature of Surety

Name of Witness: Name of Surety:

Designation: Designation:
Address of Witness: Address of Surety:

Tel. No. of Witness: Tel No. of Surety:

Date: D D M M Y Y Y Y Place:
Note: If the space not sufficient for question no.6, please use additional sheet.
SBI Life Insurance Company Limited: Registered and Corporate Office: Natraj, M.V. Road & Western Express Highway Junction, Andheri(East), Mumbai- 400 069. Tel.: (022) 61910000.
Central Processing Center: 7th Level (D-Wing) & 8th Level, Seawoods Grand Central, Tower 2, Plot No. R-1, Sector-40, Seawoods, Nerul Node, Navi Mumbai- 400 706. Tel.: (022) 66456000.
IRDAI Registration No. 111. CIN: L99999MH2000PLC129113. Toll Free No. 1800 267 9090 ( (Customer Service timing: 24X7). Visit: www.sbilife.co.in E-mail: info@sbilife.co.in

Page 1 of 1 CLM/SF/Ver 1.06/01-24

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