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To The Head Group Operations SBI Life Insurance Company Limited Central Processing Centre Kapas Bhavan Plot No. 3A Sector No. 10 CBD Belapur Navi Mumbai 400 614. Date Dear Sir Re Surrender of Swarna Ganga Staff Group Insurance Scheme Bank Name COI Sr. No. Employee Name. Date Dear Sir Re Surrender of Swarna Ganga Staff Group Insurance Scheme Bank Name COI Sr. No. Employee Name. PF Index No.. I member of the above mentioned Group Policy Issued by SBI Life wish to pre close my membership reason I request you to settle the eligible surrender value of my contribution as per the scheme. To The Head Group Operations SBI Life Insurance Company Limited Central Processing Centre Kapas Bhavan Plot No* 3A Sector No* 10 CBD Belapur Navi Mumbai 400 614. Date Dear Sir Re Surrender of Swarna Ganga Staff Group Insurance Scheme Bank Name COI Sr. No* Employee Name. PF Index No*. I member of the above mentioned Group Policy Issued by SBI Life wish to pre close my membership reason I request you to settle the eligible surrender value of my contribution as per the scheme. I understand that upon surrender the life cover will be terminated and I will not be eligible for any benefits from the said policy. Reason for Surrender DOB - VRS Retirement Age 60 Not Interested Bank Name State Bank of Branch Name Bank A/cNo Branch Code IFSC Code Copy of cheque With Name Printed on it / Bank Pass Book / Bankers Certificate is Necessary. Current Address Contact No* Yours faithfully Signature of Witness Name. Address. Signature of Member Place Enclosure Original COI Advance Discharge Voucher moneys in respect of the above claim as detailed below. PF Index No*. I member of the above mentioned Group Policy Issued by SBI Life wish to pre close my membership reason I request you to settle the eligible surrender value of my contribution as per the scheme. I understand that upon surrender the life cover will be terminated and I will not be eligible for any benefits from the said policy. I understand that upon surrender the life cover will be terminated and I will not be eligible for any benefits from the said policy. Reason for Surrender DOB - VRS Retirement Age 60 Not Interested Bank Name State Bank of Branch Name Bank A/cNo Branch Code IFSC Code Copy of cheque With Name Printed on it / Bank Pass Book / Bankers Certificate is Necessary. Reason for Surrender DOB - VRS Retirement Age 60 Not Interested Bank Name State Bank of Branch Name Bank A/cNo Branch Code IFSC Code Copy of cheque With Name Printed on it / Bank Pass Book / Bankers Certificate is Necessary. Current Address Contact No* Yours faithfully Signature of Witness Name. Address. Signature of Member Place Enclosure Original COI Advance Discharge Voucher moneys in respect of the above claim as detailed below. PF Index No*. I member of the above mentioned Group Policy Issued by SBI Life wish to pre close my membership reason I request you to settle the eligible surrender value of my contribution as per the scheme. I understand that upon surrender the life cover will be terminated and I will not be eligible for any benefits from the said policy. Reason for Surrender DOB - VRS Retirement Age 60 Not Interested Bank Name State Bank of Branch Name Bank A/cNo Branch Code IFSC Code Copy of cheque With Name Printed on it / Bank Pass Book / Bankers Certificate is Necessary.

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