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    Personal Details Change Form

    Uploaded by

    rameshpalloli
    1) This form is for making personal details changes to insurance policies where the applicant is the policy owner. 2) It allows the policy owner to change their communication address, contact details, PAN, name, date of birth, signature, occupation, residency status, opt out of WhatsApp communications, and bank account details for claim payments. 3) The applicant must provide documentation like address proofs, ID cards, marriage certificates etc. to validate the requested changes and authorizes the insurance company to make the changes subject to policy terms.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Personal Details Change Form

    Uploaded by

    rameshpalloli
    24 views2 pages
    1) This form is for making personal details changes to insurance policies where the applicant is the policy owner. 2) It allows the policy owner to change their communication address, contact details, PAN, name, date of birth, signature, occupation, residency status, opt out of WhatsApp communications, and bank account details for claim payments. 3) The applicant must provide documentation like address proofs, ID cards, marriage certificates etc. to validate the requested changes and authorizes the insurance company to make the changes subject to policy terms.

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    1) This form is for making personal details changes to insurance policies where the applicant is the policy owner. 2) It allows the policy owner to change their communication address, contact details, PAN, name, date of birth, signature, occupation, residency status, opt out of WhatsApp communications, and bank account details for claim payments. 3) The applicant must provide documentation like address proofs, ID cards, marriage certificates etc. to validate the requested changes and authorizes the insurance company to make the changes subject to policy terms.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views2 pages

    Personal Details Change Form

    Uploaded by

    rameshpalloli
    1) This form is for making personal details changes to insurance policies where the applicant is the policy owner. 2) It allows the policy owner to change their communication address, contact details, PAN, name, date of birth, signature, occupation, residency status, opt out of WhatsApp communications, and bank account details for claim payments. 3) The applicant must provide documentation like address proofs, ID cards, marriage certificates etc. to validate the requested changes and authorizes the insurance company to make the changes subject to policy terms.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    PERSONAL DETAILS CHANGE FORM

    व्य क्तिगत जा
    न का री बद लाव फ़ॉ र्म Form No ( फ़ॉ र्मक्र मांक) : P E C 0 1
    To be filled in BLOCK letters only. ( केवल ब्लॉक प त्रों मेंभ रा जा ना )हैTick ( √ ) the applicable change type.
    Changes marked below will be amended for all policies where you are the Policy Owner.
    Policy No( पॉ लि सी क्र मांक): Date( दि नांक):
    (10-digit number starting with C or U) C U { 10 क का र
    या से शु
    रू हो ने वा ला अं नंब }

    Name of Policy Owner:


    ( पॉ लि सी र का ना )
    ओन म

    1) Change in Communication Address ( र प में व) सं चा ते बद ला

    House/Flat No.: Street/Area:


    City:
    State: Pin code:
    Country:
    Reason for Change in Address: Moved to New residence Correction in address Re-location of work place
    Other reasons specify ___________________
    Share valid self-attested copy of Aadhaar Card (Show last 4 digits only)/Driving License/Passport/Voter ID/NPR/Job card issued by NREGA duly signed by an
    officer of State Government
    2) Change in Registered Contact details: (र प जा का में व) जिस्ट र्ड सं र्क न री बद ला

    Mobile No.:
    Alternate No.: WhatsApp Opt In:
    Email ID:
    The mentioned contact number will be considered as consent to communicate with you. All communication will be sent through electronic

    medium on the email ID provided.


    3) Update PAN( न
    पै में व)
    बद ला

    Policy Owner PAN Life Assured PAN


    Submit Self Attested PAN Card Copy.

    4) Change/Correction in Name ( ना में व म बद ला / सुधा र)


    Policy Owner Life Assured

    Are you a Non-Profit Organization (NPO) No Yes


    If Yes, Please provide CIN No
    Are you registered on the Darpan Portal No YesIf yes, share registration no. _________________
    If No, I hereby declare that I will get the entity registered on Darpan Portal.
    Non-profit organization (NPO)” means any entity or organization, constituted for religious or charitable purposes referred to in clause (15) of section 2 of the Income-tax Act, 1961 (43 of 1961), that is
    registered as a trust or a society under the Societies Registration Act, 1860 (21 of 1860) or any similar State legislation or a Company registered under the section 8 of the Companies Act, 2013 (18 of 2013)
    Attach Gazette copy. For married women, Gazette copy or Marriage certificate must be submitted.
    5) Change in Date of Birth: ( में व) जन्म ति थि बद ला

    Policy Owner Life Assured


    Attach self-attested copy of age proof (PAN, Aadhaar Card (Show last 4 digits only),Passport)

    6) Change of Signature ह स्ताक्ष र में व


    बद ला

    Reason( कारण)
    Existing Signature: New Signature:
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    Customer Acknowledgement Copy Personal Details Change form) (

    Policy No.: Date: Time: Before 3 PM After 3 PM


    Service Request No: Request Type:
    Employee Name Code: &
    Date Time:

    &

    Signature: Branch Code:


    7) Change of Occupation: (व्यव साय मेंबद लाव)
    New Occupation: Salaried Business/Self Employed Agriculturist Housewife
    Others, please specify
    Exact Nature of daily duty:

    8) Residency declaration (To be filled in case of change in tax residency status):


    रे जी डेंसी घोष णा ( टैक्स रे जी डेंसी स्थि ति मेंबद लाव केसमय भ रा जा ना )है
    Are you a Non-Resident Indian? Yes No If Yes. fill the FATCA form and CRS- Self Certification form.

    9) WhatsApp Service Opt Out (Policy related communications Will discontinue)


    वाट्सऐप स र्विस और आउट ( पॉ लि सी सं बं धी सं चार दबं हो जाए गा)

    10) Bank Account Details -National Electronic Funds Transfer (NEFT)


    बैंक खा ता जान का री नैशनल इ लेक् ट्रॉ निक फंड्स ट्रांसफर (एनईएफ टी)
    Account Holder Name:
    Bank A/C No: IFSC Code
    Bank Name: Branch
    Account Type: Savings Current NRO NRE
    Please provide self-attested personalised cancelled cheque or self-attested non-personalised cheque along with Bank Statement/Passbook.

    Authorization ( प्रा धिकरण)

    1) 'l have understood the scope of the Personal Information Update Form and confirm that the above details provided by me are true and correct'
    2) If the transaction is delayed or not effected for reason of incomplete or incorrect information . l/We would not hold Tata AIA Life Insurance

    Company Limited or any of its associates/agents responsible


    3) Changes in above details are subject to policy terms and conditions and relevant underwriting guidelines

    Signature of Policy Owner: Date:

    Declaration if signature in vernacular ( घोष णा य दि ह स्ताक्षर शा ब्दिक भा षा मेंहो तो)

    Declarant to be 21 years or above and should a person, other than the beneficiary of this policy.

    I,________________________________________________________ declare that the contents of the form have been explained to the
    Policy Owner in ________________ language and form has been signed/ thumb impression affixed after fully understanding the content.

    Date:
    Signature of the Declarant: M obile No.:
    Place:
    # RakshakaranHero

    • L&C/Misc/2023/Aug/0440

    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    Contact us

    Visit www.tataala.com Chat on WhatsApp (7045669966) Chat on our website

    Call us on 18602669966

    SMS HELP to 5676799 [email protected]


    (24*7 Interactive Voice Response-IVR)

    Customer Service Department: 9 Floor, Tower B. I Think Lodha Techno Campus Off Pokharan Road Number 2, Thane (West)-400004

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