{"id":1921,"title":"REFUND REQUEST FORM","purpose":"claim","insurer":{"slug":"star-union-dai-ichi-life-insurance","name":"Star Union Dai-Ichi Life Insurance Company Limited"},"source_pdf":"https://dxwkpt4djlxwl.cloudfront.net/Refund_Request_Forms_Multilingual_cade3b921c_b9d4e1f4a4.pdf","sha256":"9216e87ff8ff8d320215714a5a7e03930a62200ca65efc9d3e1407a60c51fe32","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is used by policyholders or nominees to request a refund related to their insurance policy, such as excess premium refund, unclaimed amount, or proposal not received.","notes":["Use self attested documents for KYC and proofs","Cancelled cheque must have pre-printed name of account holder or submit self attested bank statement/passbook copy attested by bank","In case of Death-Unclaimed amount, proofs should be attested by the Nominee","Account must be active and at least 6 months to 1 year old","For residents outside India, FATCA/CRS form must be filled","Check the 'Whats New?' section on www.sudlife.in for unclaimed amount document requirements","Original policy document and discharge vouchers are required for maturity claims","For maturity claims with fund value >= Rs. 5 lacs, additional documents like proposal form and age proof are required"],"title":"REFUND REQUEST FORM","submit":{"to":"Star Union Dai-ichi Life Insurance Company Limited","how":"post or 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":"claim","sections":[{"title":"Policyholder Details and Refund Request","fields":[{"help":"","type":"text","label":"Application No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"COi No. (Group Policy)","options":[],"required":false,"pdf_field":""},{"help":"Enter full name as per policy","type":"text","label":"Name of Policyholder","options":[],"required":true,"pdf_field":""},{"help":"Mandatory if refund request is for 'Proposal not received'","type":"text","label":"Transaction ID","options":[],"required":false,"pdf_field":""},{"help":"Mandatory if refund request is for 'Proposal not received'","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""},{"help":"Mandatory if refund request is for 'Proposal not received'","type":"amount","label":"Amount","options":[],"required":false,"pdf_field":""},{"help":"Enter your residence address","type":"text","label":"Flat/Plot No.","options":[],"required":true,"pdf_field":""},{"help":"Enter your residence address","type":"text","label":"Road","options":[],"required":true,"pdf_field":""},{"help":"Enter your city or district","type":"text","label":"City/District","options":[],"required":true,"pdf_field":""},{"help":"Enter your postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"Email ID","options":[],"required":true,"pdf_field":""},{"help":"Enter your PAN number","type":"text","label":"PAN","options":[],"required":true,"pdf_field":""},{"help":"Enter your building name if applicable","type":"text","label":"Building Name","options":[],"required":false,"pdf_field":""},{"help":"Enter your state","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter your phone number","type":"phone","label":"Contact No.","options":[],"required":true,"pdf_field":""},{"help":"If Yes, fill FATCA/CRS Form","type":"yes-no","label":"Are you a resident of jurisdiction outside India","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Fill only if resident outside India","type":"text","label":"Country of Residence","options":[],"required":false,"pdf_field":""},{"help":"Enter bank account holder's name","type":"text","label":"Account Holder's Name","options":[],"required":true,"pdf_field":""},{"help":"Enter your bank's name","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Enter bank NC number","type":"text","label":"Bank NC No.","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code of your bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Enter MICR code if available","type":"text","label":"MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Mandatory for payment of Assigned policy","type":"text","label":"Loan NC No.","options":[],"required":false,"pdf_field":""},{"help":"Mandatory for payment to Union Bank of India NRE and Union Bank of India Assigned policy","type":"text","label":"Digital NC No.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or nominee"},{"title":"Declaration by Policyholder / Nominee","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing the declaration","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign to confirm declaration","type":"signature","label":"Policyholder's/ Nominee's signature","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder or nominee"},{"title":"Declaration if Signature is Thumb Impression or Vernacular","fields":[{"help":"Date of declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of declaration","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Declarant's signature","type":"signature","label":"Signature of Declarant","options":[],"required":true,"pdf_field":""}],"filled_by":"declarant (person who knows the policyholder/nominee)"}],"deadlines":["Submit a new form within 30 days if any information or certification on this form becomes incorrect","Refund request will be processed in 10 days subject to documents being complete"],"applies_to":"Refund requests for Proposal not received, Excess Premium Refund, Unclaimed Amount (Individual / Group)","attachments":["Self attested Photo ID & Address Proof","PAN","Customised cancelled cheque/ Pass-book","Policy document/Indemnity bond (as applicable)","Cancelled cheque with pre-printed name of the account holder / Self attested Bank Statement / Pass Book attested by bank","Nominee's Death Certificate (for death claims)","Succession Certificate from Court of Law (for death claims)","Bank details of the Beneficiary mentioned in Succession Certificate (for death claims)","KYC of Life Assured (for Group Surrender claims)","Bank details of the Life Assured - Cancelled Cheque with pre printed name/ Bank Pass book copy (for Group Surrender claims)","KYC of Nominee (for Individual/Group Death Claims EFT rejects)","Bank details of the Nominee - Cancelled Cheque with pre printed name/ Bank Pass book copy (for Individual/Group Death Claims EFT rejects)","Original Policy Document (for Maturity Claims)","Maturity Discharge Voucher duly filled and signed (for Maturity Claims)","Annuity Option Sheet duly filled and signed (for Pension Maturity Claims)","Proposal Form duly filled and signed (where Fund Value is equal to or more than Rs. 5 lacs)","Age Proof (where Fund Value is equal to or more than Rs. 5 lacs)"],"declarations":["I am the rightful policyholder/nominee and understand the payout is due as per policy terms","I provide complete KYC details and agree to abide by policy terms and conditions","The company may reject the request if policy conditions are not fulfilled","The company does not provide tax advice on CRS/FATCA and I will seek professional advice","I agree to submit a new form within 30 days if any information becomes incorrect","The company may report details to tax authorities or close/suspend my account as required"],"dropped_labels":4},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customercare@sudlife.in","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/GEBP+Master+Pol+doc_2020-21.pdf/a5b92dec-159b-de50-83f9-52e6f268a1fc?version=1.1&t=1667460674786&download=true","quote":"ly check the Master Policy details and the terms & conditions carefully. If you have any queries, please write to us at customercare@sudlife.in.\nIn case You are not satisfied with the terms and conditions of the Master policy, then you may return the Master polic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18002668833","label":"Toll Free No","level":null,"hours":null,"applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/GEBP+Master+Pol+doc_2020-21.pdf/a5b92dec-159b-de50-83f9-52e6f268a1fc?version=1.1&t=1667460674786&download=true","quote":"or any assistance relating to your Master Policy or claim related query, you may get in touch with us via Toll Free No: 18002668833 or email Us at: customercare@sudlife.in\nThanking you once again for your patronage and looking forward to your continue","fetched_at":"2026-10-20"}],"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/1921-refund-request-form"}