{"id":2322,"title":"FORM OF NOTICE OF CANCELLATION OF NOMINATION (Form No. 3751)","purpose":"service","insurer":{"slug":"lic","name":"Life Insurance Corporation of India"},"source_pdf":"https://licindia.in/documents/d/guest/3751e-1","sha256":"8ac15f10db750aa1b3087fb2ea748d7a28051c6b70e76c6ae213343b7cfdbcab","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is used by the life assured to notify the insurance company of the cancellation of a previously made nomination on a life insurance policy.","notes":["Strike out words not applicable where indicated.","Cancellation can be done by endorsement on the policy or by a Will.","If signature is not in English, a witness certificate is required.","The cancellation notice must be sent to the servicing office for registration.","Use the form provided or copy it exactly when making an endorsement on the policy."],"title":"FORM OF NOTICE OF CANCELLATION OF NOMINATION (Form No. 3751)","submit":{"to":"Servicing Office of the Corporation through which the Policy was issued","how":"preferably in writing, by post or in person","address":""},"purpose":"service","sections":[{"title":"Notice of Cancellation of Nomination","fields":[{"help":"Write your current address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter the date of filling this form","type":"date","label":"Date :","options":[],"required":null,"pdf_field":""},{"help":"Enter your life insurance policy number","type":"text","label":"Re: Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Name of the nominee whose nomination is being cancelled","type":"text","label":"I hereby give you notice that I have revoked the Nomination of","options":[],"required":true,"pdf_field":""},{"help":"Date of the endorsement on the policy if applicable","type":"date","label":"made in the text of the above Policy/ * by the endorsement dated","options":[],"required":null,"pdf_field":""},{"help":"Strike out the words not applicable","type":"choice","label":"vide endorsement on the enclosed Policy / *enclosed Will.","options":["Policy","Will"],"required":null,"pdf_field":""},{"help":"Sign here to confirm cancellation","type":"signature","label":"Signature of Life Assured","options":[],"required":true,"pdf_field":""}],"filled_by":"life assured"},{"title":"Cancellation of Nominee Declaration","fields":[{"help":"Enter your full name","type":"text","label":"I,","options":[],"required":true,"pdf_field":""},{"help":"Name of the nominee to be cancelled","type":"text","label":"hereby revoke and make Null and void the Nomination of","options":[],"required":true,"pdf_field":""},{"help":"Strike out the words not applicable; enter place and date of endorsement","type":"text","label":"made in the Text of the within Policy / * by the endorsement on the within Policy dated at","options":[],"required":null,"pdf_field":""},{"help":"Enter the day and month of endorsement","type":"date","label":"the day of","options":[],"required":null,"pdf_field":""},{"help":"Enter place where form is signed","type":"text","label":"Dated at","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing this form","type":"date","label":"the day of","options":[],"required":true,"pdf_field":""},{"help":"Witness must sign here","type":"signature","label":"Signature of Witness in English","options":[],"required":true,"pdf_field":""},{"help":"Life assured must sign here","type":"signature","label":"Signature of Life Assured","options":[],"required":true,"pdf_field":""},{"help":"Witness to certify that contents were explained and signature/thumb impression was affixed in their presence","type":"signature","label":"Signature of Witness & Seal","options":[],"required":null,"pdf_field":""}],"filled_by":"life assured and witness"}],"deadlines":["Submit notice immediately after cancellation by endorsement or Will"],"applies_to":"life insurance policies where the policyholder wishes to cancel a nomination","attachments":["Policy or Will as applicable"],"declarations":["The life assured declares revocation of the nomination made in the policy or by endorsement or Will.","If the life assured is not conversant with English, the cancellation must be signed before an English-knowing witness.","If illiterate, the life assured must affix thumb impression before an authorized officer and the witness must certify the same.","The Corporation is not liable for payments made to the previously nominated person if no cancellation notice is received."],"dropped_labels":3},"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/2322-form-of-notice-of-cancellation-of-nomination-form-no-3751"}