{"id":1914,"title":"Surrender Form for Credit Life Policies","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/Surrender_form_for_Credit_Life_Schemes_1c30dd8b98_40b06158f9.pdf","sha256":"28bc2fc7aa13473a96eb3f931e10aa92a97f997fa0cb28bd38e5c9791e3f657c","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by insured members to apply for surrender of their credit life insurance policies under specified schemes.","notes":["All columns have to be filled up compulsorily, without which the surrender form will not be accepted.","Please affix Re. 1/- revenue stamp and sign across the stamp."],"title":"Surrender Form for Credit Life Policies","submit":{"to":"Star Union Dai-ichi Life Insurance Company Limited","how":"","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":"Policy and Insured Member Details","fields":[{"help":"Tick the box for your policy type","type":"choice","label":"Policy Type (Please tick the appropriate box):","options":["Ashiana Suraksha","Shiksha Suraksha","Ashiana Suraksha Plus"],"required":true,"pdf_field":""},{"help":"Enter the name of your policy","type":"text","label":"Name of the Policy","options":[],"required":true,"pdf_field":""},{"help":"Enter the master policy number","type":"text","label":"Master Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Enter your full name as per records","type":"text","label":"Full name of the Insured member (As in the data sent to us)","options":[],"required":true,"pdf_field":""},{"help":"Enter your COi or application number","type":"text","label":"COi Number/ Application No.","options":[],"required":true,"pdf_field":""},{"help":"Enter your loan account number","type":"text","label":"Loan Account Number","options":[],"required":true,"pdf_field":""},{"help":"State the reason for surrendering the policy","type":"text","label":"Reason for Surrender","options":[],"required":true,"pdf_field":""}],"filled_by":"insured member"},{"title":"Bank Account Details for Direct Fund Transfer","fields":[{"help":"Enter the bank name for fund transfer","type":"text","label":"Name of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of the bank account holder","type":"text","label":"Account Holder Name","options":[],"required":true,"pdf_field":""},{"help":"Enter your bank account number","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"Enter the branch name and code","type":"text","label":"Bank Branch Name & Code","options":[],"required":true,"pdf_field":""},{"help":"Enter the IFSC code of your bank branch","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""},{"help":"Enter the MICR number of your bank branch","type":"text","label":"MICR Number","options":[],"required":true,"pdf_field":""}],"filled_by":"insured member"},{"title":"Advance Discharge Voucher and Declaration","fields":[{"help":"Confirm your agreement by signing","type":"yes-no","label":"I/We hereby agree to accept the surrender value and declare that/We understand and agree to all the conditions and information given in this form.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Affix revenue stamp and sign across it","type":"signature","label":"Please affix Re. 1/ Revenue Stamp and sign across the stamp","options":[],"required":true,"pdf_field":""},{"help":"Witness must sign here","type":"signature","label":"Signature of the Witness","options":[],"required":true,"pdf_field":""},{"help":"Master policy holder to stamp and sign","type":"signature","label":"Stamp and Signature of the Master Policy Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"insured member and witness"}],"deadlines":[],"applies_to":"Credit Life Policies under Ashiana Suraksha, Shiksha Suraksha, and Ashiana Suraksha Plus schemes","attachments":["Foreclosure letter issued to member by bank branch","Original COi"],"declarations":["I/We agree to accept the surrender value and understand all conditions in this form.","The information given is correct to the best of our knowledge and belief.","We are the sole beneficiaries under the payout paid via this Discharge Form."],"dropped_labels":2},"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/1914-surrender-form-for-credit-life-policies"}