1. Contact details provided herein will be updated for all future communication.

munication. For the customer registered under National Do Not Call

Registry, this response will be treated as valid discharge.
2. The change will be eected in all the policies where client exists.






Policy Holder Life Assured Nominee/Beneciary Appointee
Change in Correspondence Address(Multiple selections allowed in case of common address)


Declarations

Correction in Name
General Rules
For Married women with change in surname, marriage certicate is mandatory. For the other request involving signicant name change a
Gazette Copy is required.
Name to be change to* : _________________________________________________________________________
Policy Holder Life Assured Nominee/Beneciary Appointee
General Rules
The change will be eected in all the policies where the client code exists. Self attested documentary proof of the new address is
mandatory. Contact us at any of our touch points to know the list of acceptable address proofs.
Address*: __________________________________________________________________________
___________________________________________________________________________________
Email ID: _________________________________________, Contact No * : _______________________
Declaration of the Policyholder:
I have understood the meaning and scope of the change request form and take complete responsibility of the change submitted by me.
Any changes in the policy or personal details are subjected to the policy terms & conditions and relevant underwriting guideline.
Signature of Life Assured 1 : * Signature of Life Assured 2 (In case Joint Life) : *
Date : * Place : *
In case policy is assigned Signature of Assignee with seal : *
Date * : Place : *
Declaration to be made by third party where the policy holder has axed his/her thumb impression/ has signed in vernacular:
I hereby declare that I have explained the contents of this application form to the Policy Holder in _________________________________
language and have truthfully recorded the answers provided to me. I further declare that the policy holder has signed/ axed his/ her *
thumb impression in my presence.
Name *: ________________________________ Date *: _____________ Place :______________________________ *
Signature : *
Address : ____________________________________________________________________________________________________ *

Policy Service Request
Form 1A

(Change in Name and Address)
(* Indicates Required Fields)

For Ocial Use Only
Branch Name:
Date & Time:
Received by








Version No. | Comp/Dec/Int/3069

Policy Number *: ______________________________ Email ID: ___________________________________________
Policy Holder's Name * : ____________________________________________________________________________
Contact Nos. Mobile* : _____________________ O: _____________________ Res: _____________________ (Mobile No is preferable)
E-Insurance Account No.:

Employee Code:.
Signature:
Branch Stamp:
Accepted
Rejected

Customer Acknowledgement Copy (Policy Servicing Form)


Policy No.: ____________ Policyholder Name _______________________________________________
PS Request: __________________________________________________ Interaction ID No.: __________
Documents accepted: ___________________________________________________________________




Customer Relations Ocer: Date: Time: Branch Stamp
HDFC Standard Life Insurance Company Limited. Regd. Off: Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi, Mumbai-400 011.
E-Insurance Account No.:

Addition/ Change of Appointee

Policy Service Request Form 1B
(Change in Nominee & Nominee
DoB)
(* Indicates Required Fields)
For Ocial Use Only
Branch Name:
Date & Time:
Received by
Addition or change in Nominee / Beneciary
Change in Nominee/ Beneciary Date of Birth

In case, the nominee/ beneciary is a minor, please
ll up the appointee details below.

1. Nominee/ Beneciary Name : *
____________________________________________
Address :____________________________________ *
____________________________________________
Relationship to Life Assured : _____________________ *
Percentage of entitlement : _______________________ *
In case of change in date of birth of nominee/ beneciary
Old DOB: __/__/____ (dd/mm/yyyy) *
New DOB: __/__/____ (dd/mm/yyyy) *
1. Nominee/ Beneciary Name : *
____________________________________________
Address :______________________________________ *
____________________________________________
Relationship to Life Assured : _____________________ *
Percentage of entitlement : _______________________ *
In case of change in date of birth of nominee/ beneciary
Old DOB: __/__/____ (dd/mm/yyyy) *
New DOB: __/__/____ (dd/mm/yyyy) *
Change of Appointee Date of Birth
Appointee Name : Mr/Mrs/Ms:__________________________________________________________ *
Address : __________________________________________________________________________ *
_____________________________________________________________________
Email ID : _____________________________________________________________ *
Appointee Relation to Nominee/Beneciary :_______________________________________________________ *
In case of change of DOB of Appointee, Old DOB ____/____/____ (dd/mm/yyyy) New DOB ____/____/____ (dd/mm/yyyy) * *
Declaration of Appointee:
I hereby accept my appointment as an appointee to receive the proceeds under the policy on behalf of Beneciary/Nominee who is minor.
Appointee Signature : Date : Place : * * *
Declaration of the Policyholder:
I have understood the meaning and scope of the change request form and take complete responsibility of the change submitted by me.
Any changes in the policy or personal details are subjected to the policy terms & conditions and relevant underwriting guideline.
Signature of Life Assured 1 : Signature of Life Assured 2 ( In case Joint Life) : * *
Date : Place : * *
In case policy is assigned Signature of Assignee with seal:
Date : Place : * *
Declaration to be made by third party where the policy holder has axed his/her thumb impression/ has signed in vernacular:
I hereby declare that I have explained the contents of this application form to the Policy Holder in ___________________ language and
have truthfully recorded the answers provided to me. I further declare that the policy holder has signed/ axed his/ her thumb impression
in my presence.
*
Name : ________________________________ Date : _____________ Place :______________________________ * * *
Signature : *
Address : _____________________________________________________________________________________________________ *
Declaration
Version No. | Comp/Dec/Int/3070
Policy Number : ______________________________ Email ID: _________________________________________ *
Policy Holder's Name : ___________________________________________________________________________ *
Contact Nos. Mobile : _______________________ O: _____________________ Res: ____________________ (Mobile No is preferable) *
1. Contact details provided herein will be updated for all future communication. For the customer registered under National Do Not Call
Registry, this response will be treated as valid discharge.
2. The change will be eected in all the policies where client exists.


Employee Code:.
Signature:
Branch Stamp:
Accepted
Rejected

Customer Acknowledgement Copy (Policy Servicing Form)


Policy No.: ____________ Policyholder Name _______________________________________________
PS Request: __________________________________________________ Interaction ID No.: __________
Documents accepted: ___________________________________________________________________




Customer Relations Ocer: Date: Time: Branch Stamp
HDFC Standard Life Insurance Company Limited. Regd. Off: Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi, Mumbai-400 011.

Reduction in Sum Assured
Increase in Premium
Decrease in Term
Deletion of Rider

Please reduce the Sum Assured of my policy from Rs. ______________________ to Rs. _____________________


Please increase the premium of my policy from Rs. ______________________ to Rs. _______________________


Please decrease the term of my policy from __________ years to ___________ years.


I would like to cancel the below riders from my policy
1. _____________________ 2. __________________ 3.______________________ 4. _____________________



Change in frequency
Please change the frequency of premium payment of my policy to

Annual

Half Yearly

Quarterly*

Monthly*
* Auto debit is mandatory for monthly mode (all plans) and quarterly mode (specied plans).

Loan or Surrender Quote

(tick the one applicable)

I would like to avail of a loan against the policy. Kindly provide me a loan quote.
I would like to know the surrender value of my policy. Kindly provide me the surrender quote.



Declarations

Declaration of the Policyholder:
I have understood the meaning and scope of the change request form and take complete responsibility of the change submitted by me.
Any changes in the policy or personal details are subjected to the policy terms & conditions and relevant underwriting guideline.
Signature of Life Assured 1 *: Signature of Life Assured 2 (In case Joint Life) *:
Date *: Place *:
In case policy is assigned Signature of Assignee with seal *:
Date *: Place *:
Declaration to be made by third party where the policy holder has axed his/her thumb impression/ has signed in
vernacular:
I hereby declare that I have explained the contents of this application form to the Policy Holder in __________________language and
have truthfully recorded the answers provided to me. I further declare that the policy holder has signed/ axed his/ her thumb impression
in my presence.
*
Name : ________________________________ Date : _____________ Place : _____________________________ * * *
Signature : *
Address : _____________________________________________________________________________________________________ *


Request for changes in policy benets is allowed only after completion of Six months from the date of commencement of policy
The request should be submitted at least 15 days prior to the next premium due date.
For policy alterations where auto debit method of payment is active, the current mandate will be de-activated post policy alteration. A fresh auto Debit Mandate will be required if
you wish to opt for or continue with auto debit facility for your policy. This should be submitted at any HDFC Life branch at least 30 days prior to the next premium due date.
Request for change in certain policy benets must be accompanied by the original policy document.
Policy servicing charges may be levied as applicable. Please refer to your policy document for details.
Declarations for Suvidha and Conventional plans:
I/We understand the reduction in premium will reduce the Sum Assured as per the regulatory limits. I/We agree that reducing the Sum Assured will change the future benets.
Reduction in premium for SUVIDHA plan is permissible only if the Policy Commencement date is less than or equal to 31-10-2007.
Reduction in premium for SAP plan is not allowed if the policy is converted after 01-08-2009.
E-Insurance Account No.:

Version No. | Comp/Dec/Int/3071

For Ocial Use Only
Branch Name:
Date & Time:
Received by
(Major Alteration)

(* Indicates Required Fields)
Policy Service Request
Form 1C


Policy Number : ______________________________ Email ID: _________________________________________ *
Policy Holder's Name : ___________________________________________________________________________ *
Contact Nos. Mobile : ___________________ O: _____________________Res: ______________________(Mobile No is preferable) *
1. Contact details provided herein will be updated for all future communication. For the customer registered under National Do Not Call
Registry, this response will be treated as valid discharge.
2. The change will be eected in all the policies where client exists.

Employee Code:.
Signature:
Branch Stamp:
Accepted
Rejected

Customer Acknowledgement Copy (Policy Servicing Form)


Policy No.: ____________ Policyholder Name _______________________________________________
PS Request: __________________________________________________ Interaction ID No.: __________
Documents accepted: ___________________________________________________________________




Customer Relations Ocer: Date: Time: Branch Stamp
HDFC Standard Life Insurance Company Limited. Regd. Off: Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi, Mumbai-400 011.