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Re-Assignment Form To The Manager Policy Servicing SBI Life Insurance Co. Ltd. Central Processing Center Kapas Bhavan Plot No.3A Sector No.10 CBD Belapur Navi Mumbai -400614 Date Dear Sir Notice of Re Assignment of Policy No I/We hereby give you notice that I/we have reassigned the above Policy to Mr/Ms The original Policy Document is sent herewith. Form of Re-Assignment for valuable of consideration under the Policy I/We the assignees in Consideration of the sum of Rs. repaid to us by the receipt of which we do hereby acknowledge as beneficial owners reassign to the Assured his heirs Executers Administrators and assign the policy of Assurance on his life granted to him by the SBI Life Insurance Co. Please acknowledge receipt of this Notice and return the Policy Document after registering the Re-assignment in your books. Yours truly Signature of the Assignee With his/their designation/s and seal Name. Address. Encl Original Policy Document. Form of Re-Assignment for valuable of consideration under the Policy I/We the assignees in Consideration of the sum of Rs. repaid to us by the receipt of which we do hereby acknowledge as beneficial owners reassign to the Assured his heirs Executers Administrators and assign the policy of Assurance on his life granted to him by the SBI Life Insurance Co. Ltd. assuring the sum of Rs and numbered Policy No and bearing date the DOC date day of 20. and the sum assured thereby and all other moneys benefits and advantages to be received there under. Please acknowledge receipt of this Notice and return the Policy Document after registering the Re-assignment in your books. Yours truly Signature of the Assignee With his/their designation/s and seal Name. Address. Encl Original Policy Document. Yours truly Signature of the Assignee With his/their designation/s and seal Name. Address. Encl Original Policy Document. Form of Re-Assignment for valuable of consideration under the Policy I/We the assignees in Consideration of the sum of Rs. repaid to us by the receipt of which we do hereby acknowledge as beneficial owners reassign to the Assured his heirs Executers Administrators and assign the policy of Assurance on his life granted to him by the SBI Life Insurance Co. Ltd. assuring the sum of Rs and numbered Policy No and bearing date the DOC date day of 20. Ltd. assuring the sum of Rs and numbered Policy No and bearing date the DOC date day of 20. and the sum assured thereby and all other moneys benefits and advantages to be received there under. Please acknowledge receipt of this Notice and return the Policy Document after registering the Re-assignment in your books. Yours truly Signature of the Assignee With his/their designation/s and seal Name. Address. Encl Original Policy Document. Form of Re-Assignment for valuable of consideration under the Policy I/We the assignees in Consideration of the sum of Rs. repaid to us by the receipt of which we do hereby acknowledge as beneficial owners reassign to the Assured his heirs Executers Administrators and assign the policy of Assurance on his life granted to him by the SBI Life Insurance Co. Ltd. assuring the sum of Rs and numbered Policy No and bearing date the DOC date day of 20. and the sum assured thereby and all other moneys benefits and advantages to be received there under.

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