Form No.
3837
FORM OF CONDITIONAL ASSIGNMENT OF
POLICY TO WIFE OR CLOSE RELATIVE
(Policies under Endowment and Double Endowment Assurance Plans)
Note: THIS FORM SHOULD NOT BE FILLED IN. The wording of the form, if found suitable,
should be copied out either on the back of the Policy itself, or in the alternative, on a proper
stamp paper of the requisite value.
(FOR INSTRUCTIONS RE: EXECUTION OF AN ASSIGNMENT SEE REVERSE)
I, in consideration of natural love and affection
do hereby assign the benefit of all moneys to become payable under the within policy of
Assurance No. of the Life Insurance Corporation of India, on my life Assuring the sum
of Rupees
to my
Aged (relationship and name)
years and declare that her/his receipt shall be a sufficient discharge to the Corporation for
the same PROVIDED however that in the event of my saidpredeceasing me, or my
surviving the date on which the said Policy if so expressed would mature, the benefit of
the Policy and the right to receive moneys there under shall revert to me as if this
assignment had not been made.
Dated at this day of 20
WITNESS:
Signature......................................................
Full Name
Designation
Address add1
Add2
(Signature of Life Assured)
The Sr. /Branch Manager,
LIFE INSURANCE CORPORATION OF INDIA
Branch
Dear Sir,
Place
Date 20
Policy No,
I hereby give you notice * that I have assigned the above policy
to :
(Here mention the name and address of the assignee.)
On Please acknowledge receipt of this notice and forward the enclosed Policy /Deed of
Assignment to after registering the assignment thereon in your books.
** Certified thumb impression here is
that of
who admits having affixed the same
after understanding the contents hereof. Yours faithfully,
Signature of Witness (Signature/Thumb impression of Assignor)
* Notice should be given by the assignor or his/her duly authorised agent.
** The assignor's thumb impression to the form should be attested by a Magistrate, Justice of
the Peace or a Gazetted Officer, An Officer or Development Officer of at least 3 years standing or
confirmed Development Officer recruited from the Agents, who were DM or BM club members before
joining or Development Officer recruited from agents who were ZM or Chairman's club members
before joining provided he/she is fully satisfied about the identity of the person. The attesting witness
should certify as above,
INSTRUCTIONS
(1) After making such alteration, if any, as may be deemed necessary in the case under
consideration, the form printed on the reverse should be copied either on the back
of the Policy, in which case no stamp duty will be payable or on a separate (special
adhesive or non -judicial) Stamp paper of the appropriate value. Parties to the
Assignment should satisfy themselves before forwarding the Policy or the deed of
Assignment, as the case may be, as regards proper Stamp duty having been paid
thereon.
(2) The full name and age of the Assignee must be stated.
(3) The Assignor must affix his signature to the Assignment in the presence of a
witness other than the Assignee. If the Assignor is not conversant with English, he
must sign the Assignment before an English knowing person and if he be illiterate,
he must affix his thumb impression to the Assignment before a Magistrate, a
Justice of the Peace, a Gazetted Officer, An Officer or Development Officer of at least
3 years standing or confirmed Development Officer recruited from the Agents, who
were DM or BM club members before joining or Development Officer recruited from
agents who were ZM or Chairman's club members before joining provided he/she is
fully satisfied about the identity of the person executing the assignment. The
witness in such cases should certify as follows :
Certified that the contents of the above Assignment were explained by me to the
Assignor in Vernacular and that he affixed his signature/left thumb
Impression thereto in my presence after thoroughly understanding the same.
(4) Signatures or any other matter written in Vernacular should have the English
translation thereof written beneath the same.
(5) Immediately after an Assignment has been executed, the policy or the deed of
Assignment must be sent to the Servicing Office of the Corporation for registration
of the Assignment accompanied by a notice of the Assignment preferably in the form
printed on the reverse. Except as otherwise provided by any law in force at the place
where the policy moneys are payable in terms of the policy contract, an Assignment
will not be operative as against the Corporation and will not confer upon the
Assignee or his legal representatives any right to sue for the Policy moneys unless a
notice in writing of the Assignment and the policy bearing the Assignment or the
Assignment Deed in original or a copy of the Assignment eer/Wed to be correct by
both the Assignor and the Assignee or by their duly authorised Agents are delivered
to the Corporation and priority of claims under Assignment will be governed strictly
by the order in which notices of Assignments have been received at the Servicing
Office of the Corporation through which the policy is serviced and not by the dates
ot execution of Assignments.
(6) If the Assignee be a minor, it is advisable to appoint a testamentary guardian in
respect of his property. Such an appointment can only be made by the Assignee's
father whom failing by a Court of Law. Appointment of a guardian in respect of the
property of a minor married girl can only be made by a Court of Law. A form of
Appointment of guardian with instructions can be had from the Corporation on
application.
