Apne liye. Ap no ke liye.
SBI LIFE INSURANCE COMPANY LIMITED
Passport Size
CENTRAL PROCESSING CENTRE CLAIMS DEPARTMENT Photograph
of Surety
SURETY LETTER
(To be completed and signed by any person, not related to the Claimant having Assets more than the Claim Amount)
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 pay
Shri/Smt_________________________________________________________________________the death claim proceeds under
Policy No without insisting on legal evidence of life.
I have filled in the details as given below:
QUESTIONS ANSWERS
(1) Name and Address ______________________________________________________________
______________________________________________________________
______________________________________________________________
(2) Telephone No.
(3) Present occupation ______________________________________________________________
(4) Approximate monthly income
(5) Are you related to the party in respect of which ______________________________________________________________
this surety is given? If so, state the relationship. ______________________________________________________________
(6) Property, movable or immovable, ______________________________________________________________
possessed and its present value? ______________________________________________________________
(7) Is the property free from encumbrance? ______________________________________________________________
(8) Attached copy of Pan Card YES NO
(9) Attached proof of Income / Property. YES NO
(10) Whether, has stood as 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.
Witness:
Signature Signature (Surety)
Name of Witness:
Address of Witness:
Tel. No. of Witness
Date: D D M M Y Y Y Y Place:
N.B.: This form must be completed before (1) and Advocate, (2) a Bank Manager, (3) a Block Development Officer, (4) a Commissioner of
Oaths, (5) a Doctor, (6) a Gazetted Officer, (7) a Head Master of a High School (8) a Head Postmaster or Departmental Sub-Postmaster,
(9) a Magistrate, (10) An Officer of SBI Life (11) President of a Village Panchayat of Local Board.
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/SL/Ver 1.06/01-24
