{"id":1911,"title":"POLICY ASSIGNMENT FORM","purpose":"service","insurer":{"slug":"star-union-dai-ichi-life-insurance","name":"Star Union Dai-Ichi Life Insurance Company Limited"},"source_pdf":"https://dxwkpt4djlxwl.cloudfront.net/Assignment_Form_3f86daceee_e0ee30d6d2.pdf","sha256":"ae076e635c0e2855fbfda80b7127fe6519010efc917c915bbb25c2824c0b1ebd","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is used by a policyholder to request the assignment of their life insurance policy to another party (assignee). The policyholder fills this form to transfer rights under the policy.","notes":["All fields are mandatory; separate forms must be filled for each policy.","Attach the original policy document with the form for registration of assignment.","Assignment may be rejected as per Section 38 of the Insurance Act 1938; reasons will be given.","Assignment cancels existing nomination except when assigned to Bank/Financial Institution where nomination is suspended temporarily.","If parties to assignment are legal persons other than individuals, additional documents may be required.","Use block letters and provide accurate information.","Witness must be above 18 years of age.","If resident or tax resident outside India, submit FATCA CRS self certification.","For assignment in consideration of loan, attach loan sanction letter.","Premium payment responsibility post assignment must be indicated."],"title":"POLICY ASSIGNMENT FORM","submit":{"to":"Star Union Dai-ichi Life Insurance Company Limited","how":"post or submit in person","address":"Registered Office: Unit No. 1101, 11th Floor, Building No. 1, Raheja Mindspace Juinagar, Plot No. GEN 2/1/E, TTC Industrial Area, MIDC Juinagar, Navi Mumbai – 400 706"},"purpose":"service","sections":[{"title":"Policyholder and Assignment Details","fields":[{"help":"","type":"text","label":"Application No","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Policy No","options":[],"required":true,"pdf_field":""},{"help":"Full name of the policyholder","type":"text","label":"Name of Policyholder","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Phone number with country/area code","type":"phone","label":"Contact No","options":[],"required":true,"pdf_field":""},{"help":"Valid email address","type":"email","label":"Email ID","options":[],"required":true,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select reason for assignment; if 'Any other', specify details","type":"choice","label":"Reason for Assignment: (mandatory) Financial Consideration of (  )   Natural Love & Affection Any other (provide details)","options":["Financial Consideration","Natural Love & Affection","Any other (provide details)"],"required":true,"pdf_field":""},{"help":"Specify relationship if assignee is an individual","type":"text","label":"Relationship with the Assignee  (In case of Individual)","options":[],"required":false,"pdf_field":""},{"help":"Indicate if the life assured is a minor","type":"yes-no","label":"Life Assured is a Minor:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer if you reside outside India","type":"yes-no","label":"Are you resident of jurisdiction outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer if you are tax resident outside India","type":"yes-no","label":"Are you tax resident of jurisdiction outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify country of residence or tax residence","type":"text","label":"Country of residence/ tax residence","options":[],"required":true,"pdf_field":""},{"help":"Full name of the assignee","type":"text","label":"Name of Assignee","options":[],"required":true,"pdf_field":""},{"help":"Select the type of assignee","type":"choice","label":"Assignee is (please tick one): Non Regulated Institution Trust NGO Others(specify)","options":["Regulated Institution (by RBI/ SEBI/ IRDAI/ Other)","Non Regulated Institution","Trust","NGO","Others(specify)"],"required":true,"pdf_field":""},{"help":"Full address of the assignee","type":"text","label":"Address:","options":[],"required":true,"pdf_field":""},{"help":"Phone number of the assignee","type":"phone","label":"Contact No:","options":[],"required":true,"pdf_field":""},{"help":"Email address of the assignee","type":"email","label":"Email ID:","options":[],"required":true,"pdf_field":""},{"help":"Indicate if assignee is a PEP","type":"yes-no","label":"Is the Assignee a  Politically Exposed Person (PEP)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if assignee is a relative of a PEP","type":"yes-no","label":"Relative of a PEP","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if assignee is an associate of a PEP","type":"yes-no","label":"Associate of a PEP","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide name and relationship if applicable","type":"text","label":"If the assignee is the relative or Associate of a PEP , mention the name of the PEP and the relationship with him","options":[],"required":false,"pdf_field":""},{"help":"Answer if you are resident or tax resident outside India","type":"yes-no","label":"Are you resident/ tax resident of any country other than India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify country","type":"text","label":"Country of Residence/ Tax Residence","options":[],"required":true,"pdf_field":""},{"help":"Answer if you are an Indian Financial Institution","type":"yes-no","label":"Are you an Indian Financial Institution","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer about tax residency of owners or controlling persons","type":"yes-no","label":"Are the Substantial owners or controlling persons in the Entity or chain of ownership resident for tax purpose in any country outside India or not","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"FATCA/CRS Declaration","fields":[{"help":"Date of signing declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / assignor"},{"title":"Third Party Declaration","fields":[{"help":"Address of declarant","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Language used to record answers","type":"text","label":"Language","options":[],"required":true,"pdf_field":""},{"help":"Declarant signs to confirm policyholder signed in presence","type":"signature","label":"Signature of Declarant","options":[],"required":true,"pdf_field":""},{"help":"Occupation of declarant","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"PAN of declarant","type":"text","label":"PAN No.","options":[],"required":false,"pdf_field":""}],"filled_by":"third party (if policyholder signed with thumb impression, vernacular language, or did not fill form)"},{"title":"Type of Assignment and Assignment Details","fields":[{"help":"Select type of assignment","type":"choice","label":"Type of Assignment (Please tick whichever is applicable)","options":["Absolute Assignment","Out of Natural Love and Affection","Conditional Assignment (out of Natural Love and Affection)"],"required":true,"pdf_field":""},{"help":"Full name of assignor","type":"text","label":"Name of the Assignor (First Name, Middle Name, Last Name)","options":[],"required":true,"pdf_field":""},{"help":"Policy number being assigned","type":"text","label":"Policy number","options":[],"required":true,"pdf_field":""},{"help":"Sum assured under the policy","type":"amount","label":"Sum Assured","options":[],"required":true,"pdf_field":""},{"help":"DOB of assignee","type":"date","label":"Date of Birth of the Assignee","options":[],"required":false,"pdf_field":""},{"help":"Relationship if assignee is individual","type":"text","label":"Relationship of the Assignee with the Policyholder (In case of Individual)","options":[],"required":false,"pdf_field":""},{"help":"Complete address of assignee","type":"text","label":"Full Address of the Assignee","options":[],"required":true,"pdf_field":""},{"help":"If assignee is a company, date of incorporation","type":"date","label":"Date of Incorporation","options":[],"required":false,"pdf_field":""},{"help":"If assignment is for loan consideration, provide loan account number","type":"text","label":"Loan Account Number","options":[],"required":false,"pdf_field":""},{"help":"Assignor must sign here","type":"signature","label":"Signature of the Assignor","options":[],"required":true,"pdf_field":""},{"help":"Name of witness to assignment","type":"text","label":"WITNESS DETAILS: Full Name of the Witness","options":[],"required":true,"pdf_field":""},{"help":"Address of witness","type":"text","label":"Address of the Witness","options":[],"required":true,"pdf_field":""},{"help":"Occupation of witness","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"For company use","type":"signature","label":"Signature / Stamp of SUD Life","options":[],"required":false,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / assignor"},{"title":"Notice of Assignment","fields":[{"help":"Full name of assignor","type":"text","label":"Name of the Assignor (First Name, Middle Name, Last Name)","options":[],"required":true,"pdf_field":""},{"help":"Policy number assigned","type":"text","label":"Policy number","options":[],"required":true,"pdf_field":""},{"help":"Sum assured under the policy","type":"amount","label":"Sum Assured","options":[],"required":true,"pdf_field":""},{"help":"Assignee signature or stamp","type":"signature","label":"Signature/Stamp of Assignee","options":[],"required":false,"pdf_field":""},{"help":"Acknowledgement by insurer","type":"checkbox","label":"Please do the needful and deliver the policy documents to the assignee after registering the assignment in your records.","options":["Acknowledged"],"required":false,"pdf_field":""},{"help":"Name of witness","type":"text","label":"Witness Details: Full Name of the Witness","options":[],"required":true,"pdf_field":""},{"help":"Address of witness","type":"text","label":"Address of the Witness","options":[],"required":true,"pdf_field":""},{"help":"Occupation of witness","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"For company use","type":"signature","label":"Signature / Stamp of SUD Life","options":[],"required":false,"pdf_field":""},{"help":"Date of notice","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of notice","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Select who will pay future premiums","type":"choice","label":"Post the Assignment the Premium under the policy will be paid by the Assignor / Assignee.","options":["Assignor","Assignee"],"required":true,"pdf_field":""}],"filled_by":"policyholder / assignor"}],"deadlines":["Aggrieved parties may approach IRDAI within 30 days of rejection of assignment request"],"applies_to":"life insurance policies issued by Star Union Dai-ichi Life Insurance Co.","attachments":["original policy document","copy of loan sanction letter (if assignment is for loan consideration)","FATCA CRS self certification (if applicable)","FATCA CRS Entity Self Certification (if applicable)"],"declarations":["The policyholder confirms the FATCA/CRS information provided is true and correct and agrees to provide updates if information changes.","The company may share the information with domestic and overseas regulators and tax authorities as legally required.","The company does not provide tax advice on FATCA/CRS and policyholder should seek independent advice.","The witness to the assignment must be a major and competent to enter into a contract."],"dropped_labels":8},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/star-union-dai-ichi-life-insurance/1911-policy-assignment-form"}