{"id":2284,"title":"DISCHARGE OF MATURED POLICY","purpose":"claim","insurer":{"slug":"lic","name":"Life Insurance Corporation of India"},"source_pdf":"https://licindia.in/documents/d/guest/form_no_3825-1-2-","sha256":"f0e75da1182c443093cb1fd26daa894f62ba2c2baf294231c3797a66a6fef008","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is used by the life assured or assignee to claim the maturity amount of a life insurance policy from the Life Insurance Corporation of India. The claimant fills it to acknowledge receipt of the maturity proceeds and discharge the insurer from further claims.","notes":["Use specimen signature as per record","Affix one rupee revenue stamp on the form","If payment by Money Order or Demand Draft is desired, sign the request and bear the cost and risk","If the policy is under Salary Savings Scheme and premiums are shown unpaid but already deducted, submit employer's certificate","In case of dispute, the English version of the form shall prevail","Witness must be a credible person who knows the language and the claimant","If thumb impression is used, attestation by authorized persons is mandatory","If multiple claimants sign and payment is to be made to one, a notarized authority letter is required"],"title":"DISCHARGE OF MATURED POLICY","submit":{"to":"servicing Branch","how":"in person or by post","address":""},"purpose":"claim","sections":[{"title":"Policy and Claim Details","fields":[{"help":"Enter the branch number where the policy is serviced","type":"text","label":"शाखा क्र. / Branch No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the matured policy number","type":"text","label":"DISCHARGE OF MATURED POLICY No.","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of discharge","type":"date","label":"Dated","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of the life assured","type":"text","label":"on the Life of Shri/Smt.","options":[],"required":true,"pdf_field":""},{"help":"Enter the sum assured or paid-up value","type":"amount","label":"विमा रक्कम / स्थगिती मूल्य Sum Assured / Paid-up Value","options":[],"required":null,"pdf_field":""},{"help":"Enter the vested bonus amount","type":"amount","label":"निहित लागू बोनस/निहित बोनस अबंटित/Vested Bonus alloted","options":[],"required":null,"pdf_field":""},{"help":"Enter the interim bonus amount","type":"amount","label":"अन्तरिम बोनस / Interim Bonus","options":[],"required":null,"pdf_field":""},{"help":"Enter the terminal bonus amount","type":"amount","label":"अंतिम बोनस /आवधिक बोनस/Terminal Bonus","options":[],"required":null,"pdf_field":""},{"help":"Enter the final additional bonus amount","type":"amount","label":"अतिरिक्त अंतिम बोनस/Final Additional Bonus","options":[],"required":null,"pdf_field":""},{"help":"Enter premium difference due to overstatement of age","type":"amount","label":"वय जास्त नमूद झाल्यामुळे हयातील फरक Difference of premiums on account of overstatement of age","options":[],"required":null,"pdf_field":""},{"help":"Enter refund of extra premium for sex, double accident benefit, extended permanent disability benefit and occupation","type":"amount","label":"लिंग, व्यवसाय आणि दुहेरी अपघाती लाभ आणि विस्तारित निरंतर अपंगत्व लाभ ह्यासाठींच्या ज्यादा हप्त्यांचा परतावा Refund of extra Premium for sex D.A.B. & E.P.D.B. & occupation","options":[],"required":null,"pdf_field":""},{"help":"Enter amount recoverable due to understatement of age","type":"amount","label":"उम्र अधिक लिखी होने के कारण प्रीमियम की अन्तर राशि/लिंग तथा व्यवसाय हेतु अतिरिक्त प्रीमियम-दु.दू. हि. तथा वि. अस्था अ. हि/ Amount recoverable on account of under-statement of age","options":[],"required":null,"pdf_field":""},{"help":"Enter the gross claim amount","type":"amount","label":"एकूण दावा रक्कम / कुल दावा राशि/ Gross claim amount","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Deductions","fields":[{"help":"Enter unpaid premium instalments","type":"amount","label":"देय हप्त्यांची थकबाकी/बकाया देय प्रीमियम/Unpaid instalments of premiums due","options":[],"required":null,"pdf_field":""},{"help":"Enter late fees on unpaid premiums","type":"amount","label":"त्यावरील विलंब शुल्क / विलम्ब शुल्क / Late fee thereon","options":[],"required":null,"pdf_field":""},{"help":"Enter A.N.F. loan amount","type":"amount","label":"स्वाभाविक गैर जप्ती कर्ज/ए. एन. एफ. ऋण/A.N.F. Dept.","options":[],"required":null,"pdf_field":""},{"help":"Enter discount or commuted interest","type":"amount","label":"कसर/अंशराशीकृत व्याज/कटौती/कम्यूटेडब्याज/Discount/Commuted Interest","options":[],"required":null,"pdf_field":""},{"help":"Enter loan amount","type":"amount","label":"कर्ज / ऋण / Loan","options":[],"required":null,"pdf_field":""},{"help":"Enter interest amount","type":"amount","label":"व्याज / ब्याज / Interest","options":[],"required":null,"pdf_field":""},{"help":"Enter amount recoverable due to understatement of age","type":"amount","label":"वय कमी उल्लेखिल्याने वसूल करावयाची रक्कम उमर कम लिखी होने के कारण वसूली योग्य राशि Amount recoverable on account of under-statement of age","options":[],"required":null,"pdf_field":""},{"help":"Enter total deductions","type":"amount","label":"एकूण कपात / कुल कटौती / Total Deductions","options":[],"required":null,"pdf_field":""},{"help":"Enter net claim amount after deductions","type":"amount","label":"निव्वळ दावा रक्कम रु./शुध्द दावा राशिं/Net claim amount","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claimant Declaration and Signature","fields":[{"help":"Enter place of signing","type":"text","label":"दिनांकंत ठिकाण/dated at","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"दिनांक / this माहे/day of वर्ष 200","options":[],"required":true,"pdf_field":""},{"help":"Claimant(s) must sign as per specimen signature","type":"signature","label":"दावेदार/दावेदारांची संपूर्ण स्वाक्षरी Signature(s) of the claimants (s) in full (as per Specimen in the Record)","options":[],"required":true,"pdf_field":""},{"help":"Enter current address","type":"text","label":"सध्याचा पत्ता / वर्तमान पत्ता Present address","options":[],"required":true,"pdf_field":""},{"help":"Provide bank details for cheque payment","type":"text","label":"Please Send the cheque to my Banker's S. B. A/c. No. : Name of Bank : Address of Bank :","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Payment Mode Request","fields":[{"help":"Tick if payment by Money Order or Demand Draft is desired and sign below","type":"checkbox","label":"Payment will be made by a not negotiable -Account / Payee cheque. If payment is desired by M. O. or a demand draft it can be made at the claimant's cost and at his/her risk and responsibility on his/her signing the following note of request.","options":["Request payment by Money Order","Request payment by Demand Draft"],"required":false,"pdf_field":""},{"help":"Claimant(s) signature for payment mode request","type":"signature","label":"दावेदाराची/दावेदारांची स्वाक्षरी Signature(s) of the claimants (s)","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Witness and Attestation","fields":[{"help":"Witness must sign in presence of claimant","type":"signature","label":"Signed by Shri/Smt. in the presence of*","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"साक्षीदाराची स्वाक्षरी /साक्षी के हस्ताक्षर/Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Enter full name of witness","type":"text","label":"पूर्ण नांव / पूरा नाम / Full Name","options":[],"required":true,"pdf_field":""},{"help":"Enter designation of witness if applicable","type":"text","label":"हुद्दा /पद / Designation","options":[],"required":false,"pdf_field":""},{"help":"Enter address of witness","type":"text","label":"पत्ता /पता / Address","options":[],"required":false,"pdf_field":""},{"help":"Affix one rupee revenue stamp on the form","type":"attachment","label":"One Rupee Revenue Stamp","options":[],"required":true,"pdf_field":""}],"filled_by":"witness"},{"title":"Note of Authority (if applicable)","fields":[{"help":"Attesting officer must sign with official seal","type":"signature","label":"Signature of the official with Seal of his office","options":[],"required":false,"pdf_field":""},{"help":"All claimants must sign the authority letter","type":"signature","label":"Signature(s) of the claimant(s)","options":[],"required":false,"pdf_field":""},{"help":"Witness to the authority letter must sign","type":"signature","label":"Signature of the witness","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant and attesting officer"}],"deadlines":["If you have not received any intimation for your claim due in the next two months, please contact the servicing Branch immediately"],"applies_to":"Maturity claims under life insurance policies","attachments":["One Rupee Revenue Stamp","Certificate from employer if policy is under Salary Savings Scheme and premiums shown as unpaid are already deducted","Note of Authority if payment is to be made to one claimant when multiple have signed"],"declarations":["I/we acknowledge receipt of the maturity amount including bonus in full and final settlement of all claims under the policy","This discharge form must be signed by the Life Assured and witnessed by a credible person who knows the language and the life assured","If more than one person signs the discharge form, the names of all signatories must be stated","If the claimant affixes thumb impression or multiple persons sign and payment is desired to only one, a Note of Authority must be completed and attested by authorized officers","Payment will be made by a non-negotiable payee cheque unless payment by Money Order or Demand Draft is requested at claimant's risk and cost","If the final premium is shown unpaid but has been paid, inform the office or bank with details to enable refund of deducted amount"],"dropped_labels":5},"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/lic/2284-discharge-of-matured-policy"}