{"id":2321,"title":"POLICYHOLDERS’ MANDATE FORM FOR PAYING PREMIUM THROUGH ELECTONIC CLEARANCE SERVICE (DEBIT CLEARING) OR DIRECT DEBIT","purpose":"service","insurer":{"slug":"lic","name":"Life Insurance Corporation of India"},"source_pdf":"https://licindia.in/documents/d/guest/ecs-direct_debit_mandate_form_eng","sha256":"6fe7d8fa8b762879d13854d6411d5350fa72524fa16ff6347c1c024cafd436ba","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by policyholders to authorize payment of their LIC premium through Electronic Clearance Service (ECS) or Direct Debit from their bank account.","notes":["Direct Debit facility is only for ICICI & SBI bank account holders","ECS mandate form must be attested by the bank","Debit dates allowed are only 7th, 15th, and 28th of the month based on date of commencement","Premium for ECS mode policies cannot be paid at branch cash counters except for dishonoured cases or after grace period","Maintain sufficient balance on debit date to avoid dishonour","If account number is less than 15 digits, confirm the correct CBS compatible account number with the bank","Acknowledgement letter from branch must be verified and discrepancies reported immediately","Direct Debit facility is available Pan India for SBI & ICICI Bank account holders","ECS facility can be opted if bank account is in a city where LIC ECS facility is enabled"],"title":"POLICYHOLDERS’ MANDATE FORM FOR PAYING PREMIUM THROUGH ELECTONIC CLEARANCE SERVICE (DEBIT CLEARING) OR DIRECT DEBIT","submit":{"to":"Bank and a copy to LIC Branch Office","how":"Submit to bank and provide a copy to LIC branch office","address":""},"purpose":"service","sections":[{"title":"Application Type and Policyholder Details","fields":[{"help":"Tick the applicable option and strike off the others","type":"choice","label":"NEW APPLICATION\nCHANGE IN BANK DETAILS\nCANCELLATION\n(Tick which is applicable and strike off the others)","options":["NEW APPLICATION","CHANGE IN BANK DETAILS","CANCELLATION"],"required":true,"pdf_field":""},{"help":"Enter full name of the policyholder(s)","type":"text","label":"Name of the policyholder/s","options":[],"required":true,"pdf_field":""},{"help":"Fill details for each policy or proposal including policy number, insured name, mode, and premium amount","type":"table","label":"Policy Details:\nSr. No.\nNew proposal/* Policy No.\nName of the Insured Self &/spouse/children\nMode\nPremium Amount\nOr Not over than","options":[],"required":true,"pdf_field":""},{"help":"Enter residential and office telephone numbers","type":"phone","label":"Tel. No. Res :\nOff :","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail ID","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Bank Account Details","fields":[{"help":"Enter the name of your bank","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Enter full bank branch address","type":"text","label":"Bank Address","options":[],"required":true,"pdf_field":""},{"help":"Enter the name(s) as per bank account","type":"text","label":"Name of the Account Holder/s","options":[],"required":true,"pdf_field":""},{"help":"Select the account type code","type":"choice","label":"Account Type (Savings Bank Account -10 /Current A/c-11 or Cash/Credit - 11)","options":["Savings Bank Account -10","Current A/c-11","Cash/Credit - 11"],"required":true,"pdf_field":""},{"help":"Enter your bank account number exactly as on cheque book","type":"text","label":"Account Number (as appearing on the Cheque Book)","options":[],"required":true,"pdf_field":""},{"help":"Enter 9 digit MICR code from your cheque leaf","type":"text","label":"9 Digit MICR CODE NUMBER of the Bank and Branch\n(Should not begin or end with “000”)","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Authorization and Declaration","fields":[{"help":"Enter the premium amount to be debited","type":"amount","label":"I / We hereby instruct the bank to debit my/our above Account No. and pay LIC Premium of Rs.","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature/s of the Policyholder/s","options":[],"required":true,"pdf_field":""},{"help":"Specify relation if account holder differs from policyholder","type":"text","label":"Relation of A/C holder to the policy holder (Ist Policy)","options":[],"required":false,"pdf_field":""},{"help":"Signature of account holder if different from policyholder","type":"signature","label":"Signature of the A/c holder\n(in case the policyholder differs from that of the A/c holder)","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Bank Certification","fields":[{"help":"Bank official to certify account details","type":"checkbox","label":"We certify that the Bank particulars furnished above are correct as per our records and the account is active.","options":["Certified"],"required":true,"pdf_field":""},{"help":"Bank official to acknowledge receipt","type":"checkbox","label":"We acknowledge the receipt of the mandate and note to carry out the customer’ instructions as per mandate given.","options":["Acknowledged"],"required":true,"pdf_field":""},{"help":"Date of certification","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Bank official to affix seal","type":"signature","label":"Bank Seal","options":[],"required":true,"pdf_field":""},{"help":"Bank official to sign","type":"signature","label":"Signature of the Bank Official","options":[],"required":true,"pdf_field":""}],"filled_by":"bank official"}],"deadlines":["Request to discontinue ECS facility should be given at least 20 days in advance of the debit date for MLY mode policies and 30 days in advance for other modes"],"applies_to":"payment of LIC premiums through ECS or Direct Debit for ICICI & SBI bank account holders","attachments":["Copy of the mandate form attested by the bank"],"declarations":["The particulars given are correct and complete","The policyholder authorizes LIC to debit the bank account for premium payments","LIC or the user institution is not responsible for delayed or failed transactions due to incomplete or incorrect information, insufficient funds, or account closure","The first transaction after authorization may take one month to commence","Premium can only be paid on behalf of near relatives as prescribed by the Income-Tax Act, 1961","The policyholder agrees to the terms and conditions stated"],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"+91-22-68276827","label":"Customer Care Phone Number","level":null,"hours":"24*7","applies_to":"all","source_url":"https://licindia.in/web/guest/grievances","quote":"Corporation \r\n   of India.\nNavigation\nSkip to Content\nMenu Display\nVoice Search\nSearch\nSkip to main content\n8976862090\n+91-22-68276827\nBranch Locator\nLanguage Selector\nenglish\nहिन्दी [beta]\nमराठी\nA+\nA\nA-\nA\nA\nAbout Us\nHistory\nObjectives Of LIC\nMission/Vis","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"8976862090","label":"Customer Care Phone Number","level":null,"hours":"24*7","applies_to":"all","source_url":"https://licindia.in/web/guest/grievances","quote":"e Insurance Corporation \r\n   of India.\nNavigation\nSkip to Content\nMenu Display\nVoice Search\nSearch\nSkip to main content\n8976862090\n+91-22-68276827\nBranch Locator\nLanguage Selector\nenglish\nहिन्दी [beta]\nमराठी\nA+\nA\nA-\nA\nA\nAbout Us\nHistory\nObjectives Of","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"'Yogakshema' , Jeevan Bima Marg, P.O. Box No19953, Mumbai – 400 021.","label":"Corporate Office Address","level":null,"hours":null,"applies_to":"all","source_url":"https://licindia.in/web/guest/grievances","quote":"any grievances, email at\nco_complaints[at]licindia[dot]com\nCorporate Office\n: Life Insurance Corporation of India \r\n\t\t\t\t'Yogakshema' , Jeevan Bima Marg, P.O. Box No19953, \r\n\t\t\t\tMumbai – 400 021. IRDAI Reg No- 512\nFor any query regarding this website, please contact the Web Information Manager\nSmt. Himali As","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"co_healthsc@licindia.com","label":"Senior Citizens Health Grievance Email","level":null,"hours":null,"applies_to":"health","source_url":"https://licindia.in/documents/20121/124155/Sample_Policy_Document_LIC-s-Arogya-Rakshak.pdf/ed974eaa-4330-7732-6a85-43cfd7980a67?t=1669266625981","quote":"District Court Judge is member of each of the Claims Dispute Redressal Committees. For Senior Citizens:\nEmail address: co_healthsc@licindia.com Health Toll free Number: 18004259876\nOf IRDAI:\nIn case the customer is not satisfied with the response or do not receiv","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91-22-68276827","label":"LIC Call Center","level":null,"hours":"24*7","applies_to":"all","source_url":"https://licindia.in/phone-help-line","quote":"Corporation \r\n   of India.\nNavigation\nSkip to Content\nMenu Display\nVoice Search\nSearch\nSkip to main content\n8976862090\n+91-22-68276827\nBranch Locator\nLanguage Selector\nenglish\nहिन्दी [beta]\nमराठी\nA+\nA\nA-\nA\nA\nAbout Us\nHistory\nObjectives Of LIC\nMission/Vis","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"8976862090","label":"LIC Call Center","level":null,"hours":"24*7","applies_to":"all","source_url":"https://licindia.in/phone-help-line","quote":"e Insurance Corporation \r\n   of India.\nNavigation\nSkip to Content\nMenu Display\nVoice Search\nSearch\nSkip to main content\n8976862090\n+91-22-68276827\nBranch Locator\nLanguage Selector\nenglish\nहिन्दी [beta]\nमराठी\nA+\nA\nA-\nA\nA\nAbout Us\nHistory\nObjectives Of","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"sms","value":"SMS LICHELP <pol.no.> to 9222492224","label":"Grievance Redressal SMS","level":null,"hours":null,"applies_to":"all","source_url":"https://licindia.in/phone-help-line","quote":"Branch / Division / Zonal / Corporate Level.\n(For details click on the `Grievances' tab on the homepage).\nSMS LICHELP :\nSMS LICHELP <pol.no.> to 9222492224.\nDetails of Health Insurance TPA along with Toll Free Numbers\n(Content: English | Format: PDF | View/Download |Size: 44","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/lic/2321-policyholders-mandate-form-for-paying-premium-through-electonic-clearance-servic"}