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FLC Request Letter Date SBI Life Insurance Company Ltd Branch Dear Sir Re Request for Free look Cancellation for Policy Number The captioned Policy Document is received by me as on. I am not satisfied with the terms and conditions of the policy. I therefore request you to kindly cancel my policy under the Freelook Cancellation and refund the premium as per the rules. The Original Policy Document along with the First Premium Receipt is attached* Please do the needful* Yours faithfully Signature of the Policyholder Name of the Policyholder Applicable only when Policyholder has signed in vernacular language or thumb impression Name of Witness Address of Witness 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-09/Ver1. I am not satisfied with the terms and conditions of the policy. I therefore request you to kindly cancel my policy under the Freelook Cancellation and refund the premium as per the rules. The Original Policy Document along with the First Premium Receipt is attached* Please do the needful* Yours faithfully Signature of the Policyholder Name of the Policyholder Applicable only when Policyholder has signed in vernacular language or thumb impression Name of Witness Address of Witness Corporate Office Natraj M. The Original Policy Document along with the First Premium Receipt is attached* Please do the needful* Yours faithfully Signature of the Policyholder Name of the Policyholder Applicable only when Policyholder has signed in vernacular language or thumb impression Name of Witness Address of Witness 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-09/Ver1. I am not satisfied with the terms and conditions of the policy. I therefore request you to kindly cancel my policy under the Freelook Cancellation and refund the premium as per the rules. The Original Policy Document along with the First Premium Receipt is attached* Please do the needful* Yours faithfully Signature of the Policyholder Name of the Policyholder Applicable only when Policyholder has signed in vernacular language or thumb impression Name of Witness Address of Witness 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-09/Ver1.

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