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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 P I N Permanent P I N - - Tel R O Mobile No* Email id Kindly attach any one of the self attested address proof Ration Card latest Electricity Billlatest Telephone BillRecent Bank A/c Statement with addressValid 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 Official 3. Change in Mode Yearly Kindly change my payment frequency to Please tick as applicable Half Yearly Quarterly Monthly Please furnish the latest payment details if any Cheque / DD No Cheque / DD Date Correction in DOB DD/MM/YYYY From to Amount Rs. attested by any Gazetted Officer or SBI Life Official Date Place Policyholder s Signature Enclosures - 1 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. /Mrs. /Ms. Kindly amend my policy details with the below changes. 1. Address Correspondence / Permanent please tick in the appropriate box P I N Permanent P I N - - Tel R O Mobile No* Email id Kindly attach any one of the self attested address proof Ration Card latest Electricity Billlatest Telephone BillRecent Bank A/c Statement with addressValid 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 Official 3. Change / Correction in Name Policy Holder / Life Assured/ Nominee/ Appointee/ Life Beneficiary Official 3. Change in Mode Yearly Kindly change my payment frequency to Please tick as applicable Half Yearly Quarterly Monthly Please furnish the latest payment details if any Cheque / DD No Cheque / DD Date Correction in DOB DD/MM/YYYY From to Amount Rs. Change in Mode Yearly Kindly change my payment frequency to Please tick as applicable Half Yearly Quarterly Monthly Please furnish the latest payment details if any Cheque / DD No Cheque / DD Date Correction in DOB DD/MM/YYYY From to Amount Rs. attested by any Gazetted Officer or SBI Life Official Date Place Policyholder s Signature Enclosures - 1 Corporate Office Natraj M. attested by any Gazetted Officer or SBI Life Official Date Place Policyholder s Signature Enclosures - 1 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. /Mrs. /Ms. Kindly amend my policy details with the below changes. 1. Address Correspondence / Permanent please tick in the appropriate box P I N Permanent P I N - - Tel R O Mobile No* Email id Kindly attach any one of the self attested address proof Ration Card latest Electricity Billlatest Telephone BillRecent Bank A/c Statement with addressValid 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 Official 3. Change in Mode Yearly Kindly change my payment frequency to Please tick as applicable Half Yearly Quarterly Monthly Please furnish the latest payment details if any Cheque / DD No Cheque / DD Date Correction in DOB DD/MM/YYYY From to Amount Rs..

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