{"id":2414,"title":"POLICY SERVICING REQUEST FORM","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/Policy_Request_Form_Ver_02_0dde9517ed_f58817a969.pdf","sha256":"6ceca07138d2d47d83ca5d905235ef7892b013921f6a1cf26472edfcb2f42bd8","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is used by policyholders to request various changes or updates to their insurance policy details such as name correction, address change, legal entity change, appointee change, mode change, personal details update, date of birth correction, proposer change, and rider addition.","notes":["All supporting documents should be self attested by the Policyholder (mandatory)","For name change of married woman, marriage certificate copy is required","For other name changes, Gazette notification is required","NACH / Direct Debit mandate mandatory for monthly premium mode","5th, 10th, 15th draw date options not applicable for monthly mode","Use self attested copies of documents","Third party declaration required if policyholder signed in vernacular or affixed thumb impression or did not fill application"],"title":"POLICY SERVICING REQUEST FORM","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Policy Details and FATCA/CRS Declaration","fields":[{"help":"","type":"text","label":"Policy No. 1:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No. 2:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No. 3:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Policyholder:","options":[],"required":null,"pdf_field":""},{"help":"Submit self attested copy of PAN Card","type":"text","label":"PAN No.:","options":[],"required":null,"pdf_field":""},{"help":"Submit self attested copy of Aadhaar Card","type":"text","label":"Aadhaar No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you resident of jurisdiction outside India?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you tax resident of jurisdiction outside India?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes or country other than India, submit FATCA / CRS self certification","type":"text","label":"Country of residence / tax residence","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Correction / Updation in Name","fields":[{"help":"Submit copy of self attested Photo ID proof","type":"text","label":"Name to be changed to","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reason for change","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Change in Correspondence Address / E-mail ID / Contact No.","fields":[{"help":"","type":"text","label":"Reason for change","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Flat/Plot No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Building Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Road:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Landmark:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City/District:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Landline No:","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-mail ID:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Addition / Correction in PAN / Aadhaar","fields":[{"help":"Submit self attested copy of PAN Card","type":"text","label":"PAN No.:","options":[],"required":null,"pdf_field":""},{"help":"Submit self attested copy of Aadhaar Card","type":"text","label":"Aadhaar No.:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Acknowledgment Slip - Policy Servicing Request","fields":[{"help":"","type":"text","label":"Request type:","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Policyholder:","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Change in Legal Entity","fields":[{"help":"Submit attested copy of KYC documents of the Entity","type":"text","label":"Name of New Entity:","options":[],"required":null,"pdf_field":""},{"help":"Change is subject to underwriting decision","type":"choice","label":"Nature of New Entity:","options":["Partnership Firm","Private Company","Public Company","Trust","HUF"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Change / Add of Appointee","fields":[{"help":"","type":"text","label":"Appointee Name: (Mr./Mrs./Ms.)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the Nominee:","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Appointee’s Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Fill full address including Flat/Plot No., Building Name, Road, Landmark, City/District, State, Pin Code","type":"text","label":"Appointee’s Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Landline No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-mail ID:","options":[],"required":false,"pdf_field":""},{"help":"Submit self attested copy of PAN Card","type":"text","label":"PAN No.:","options":[],"required":null,"pdf_field":""},{"help":"Submit self attested copy of Aadhaar Card","type":"text","label":"Aadhaar No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you resident of jurisdiction outside India?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you tax resident of jurisdiction outside India?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes or country other than India, submit FATCA / CRS self certification","type":"text","label":"Country of residence/tax residence","options":[],"required":null,"pdf_field":""},{"help":"Fill policy number","type":"text","label":"I/We Mr./Ms. (Name of the Appointee), has / have agreed to act as appointee, under the Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder and appointee"},{"title":"Mode Change","fields":[{"help":"5, 10 & 15 options not applicable for monthly mode","type":"choice","label":"Preferred draw date for auto debit of renewal premium","options":["5th","10th","15th"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Change / Updation in Personal Details","fields":[{"help":"If Residential/Tax status other than India, submit FATCA / CRS questionnaire","type":"checkbox","label":"Nature of Change / Updation","options":["Residential Status / Tax Residential Status*","Gender / Salutation Correction","Height / Weight","Bank account details updation","Signature","Occupation","Others","Family History"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Required updation:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Correction in Date of Birth","fields":[{"help":"Submit supporting proof such as Birth Certificate / Passport / Aadhaar","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reason for change:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Change of Proposer","fields":[{"help":"","type":"text","label":"New Proposer’s Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Life Assured:","options":[],"required":null,"pdf_field":""},{"help":"Submit self attested copy of PAN Card","type":"text","label":"PAN No. of New Proposer:","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Proposer’s Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Submit self attested copy of Aadhaar Card","type":"text","label":"Aadhaar No. of New Proposer:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Reason for change:","options":["Death of previous Policyholder","Others (please specify)"],"required":null,"pdf_field":""},{"help":"Fill full address including Flat/Plot No., Building Name, Road, Landmark, City/District, State, Pin Code","type":"text","label":"Proposer’s Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Landline No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-mail ID:","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you resident of jurisdiction outside India?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you tax resident of jurisdiction outside India?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes or country other than India, submit FATCA / CRS self certification","type":"text","label":"Country of residence/tax residence","options":[],"required":null,"pdf_field":""},{"help":"PEP means individuals with prominent public functions or their immediate family","type":"yes-no","label":"Is the new Proposer a Politically Exposed Person (PEP)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Rider Addition","fields":[{"help":"If yes, provide details and attach reports if applicable","type":"checkbox","label":"Change in Health & Lifestyle details","options":["Change in occupation from date of proposal","Currently in good health","Change in health status (Diabetes / Hypertension / Kidney Disorder / Liver Disorder / Nervous Disorder / HIV, etc.)","Visited doctor / treatment for more than 1 week since proposal","Change in habits like smoking / alcohol intake"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Policyholder Declaration","fields":[{"help":"","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Third Party Declaration","fields":[{"help":"","type":"signature","label":"Signature of Declarant","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""}],"filled_by":"third party"}],"deadlines":["Submit a new form within 30 days if any information or certification on this form becomes incorrect"],"applies_to":"","attachments":["Copy of marriage certificate for change in surname of married woman","Gazette notification for other name changes","Self attested Photo ID proof for name and address changes","Self attested Address Proof / Telephone Bill / Mobile Bill for address changes","Self attested copy of PAN Card","Self attested copy of Aadhaar Card","Attested copy of KYC documents of new legal entity","Supporting proof for date of birth correction (Birth Certificate / Passport / Aadhaar)","Reports for health changes if applicable","FATCA / CRS self certification if applicable","FATCA / CRS questionnaire if residential/tax status changes"],"declarations":["Policyholder consents to use Aadhaar for e-KYC authentication and storing data as per law without storing biometric","Policyholder declares information provided is true and correct and understands impact of changes","Policyholder agrees company may report details to tax authorities or close/suspend account as required","Third party declares having explained form contents to policyholder and witnessed signature/thumb impression"],"dropped_labels":20},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"18002668833","label":"Toll Free No","level":null,"hours":null,"applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/Saral+Jeevan+Bima+PD+V_1_5+%28final%29_2020-21.pdf/dc4af66a-d7ca-94d8-62a4-432805c9f5ed?version=1.1&t=1667460523120&download=true","quote":"PAID.\nFor any assistance relating to your Policy or claim related query, you may get in touch with us via Toll Free No: 18002668833 or Land line No: 022 71966300 (charges apply) or email Us at: customercare@sudlife.in.\nThanking you once again for your","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"022 71966300","label":"Land line No","level":null,"hours":"charges apply","applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/Saral+Jeevan+Bima+PD+V_1_5+%28final%29_2020-21.pdf/dc4af66a-d7ca-94d8-62a4-432805c9f5ed?version=1.1&t=1667460523120&download=true","quote":"ting to your Policy or claim related query, you may get in touch with us via Toll Free No: 18002668833 or Land line No: 022 71966300 (charges apply) or email Us at: customercare@sudlife.in.\nThanking you once again for your patronage and looking forward","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"022 39546300","label":"Land line No","level":null,"hours":"charges apply","applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/142N056V01_2017-18.pdf/53e63035-8872-7f44-0263-63016740a6c8?version=1.1&t=1667469582333&download=true","quote":"ting to your Policy or claim related query, you may get in touch with us via Toll Free No: 18002668833 or Land line No: 022 39546300 (charges apply) or email Us at: customercare@sudlife.in.\nThanking you once again for your patronage and looking forward","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Grievance Redressal Officer, Star Union Dai-ichi Life Insurance Company Ltd., 11th Floor, Vishwaroop IT Park, Plot No. 34, 35 & 38, Sector 30A of IIP, Vashi, Navi Mumbai – 400 703","label":"Grievance Redressal Officer","level":1,"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":"our website\nIf You are not satisfied with the response provided by any of the above touch points, You may write to the Grievance Redressal Officer at grievanceredressal@sudlife.in or send a communication at Grievance Redressal Officer, Star Union Dai-ichi Life Insurance Company Ltd., 11th Floor, Vishwaroop IT Park, Plot No. 34, 35 & 38, Sector 30A of IIP, Vashi, Navi Mumbai – 400 703.\nTo further escalate the matter","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievanceredressal@sudlife.in","label":"Grievance Redressal Officer","level":1,"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":"isfied with the response provided by any of the above touch points, You may write to the Grievance Redressal Officer at grievanceredressal@sudlife.in or send a communication at Grievance Redressal Officer, Star Union Dai-ichi Life Insurance Company Ltd., 11th Floor, Vi","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/2414-policy-servicing-request-form"}