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APPLICATION FOR LOAN AGAINST POLICY
Contact details mentioned above will be updated in all future communication.
Signature of Assignor/ Policholder
Signature of Witness
Name of Policyholder (Proposer)
Dear Sir / Madam,
I, _______________________________________________________________________, the holder of the above mentioned policy, agree to the Terms &
Conditions mentioned in this form and hereby apply for a loan against this policy.
Request you to advance me a loan of amount as selected below:
Maximum amount available as loan against policy
(amount in figures)
(amount in words)
Notice is hereby given that I, the holder of the policy, have assigned the above policy to ICICI Prudential Life Insurance Company Ltd., whose Registered
Office is at ICICI PruLife Towers,1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400 025.
I, the holder of the above mentioned Policy issued by ICICI Prudential Life Insurance Company Limited (‘the Company’), do hereby absolutely transfer
and assign the rights and benefits of the said Policy in favour of the Company for a valuable consideration. I acknowledge that the assignment shall be
complete and effectual only upon the execution of this endorsement. I also acknowledge that the assignment shall not be operative as against the
Company until a notice in writing of this assignment and either the said endorsement or the instrument itself or a copy thereof certified to be correct by
both the assignor and the assignee or their duly authorised agent has been delivered to the specified office of the Company. I hereby declare that receipt
of benefits arising under the policy by the Assignee/ Company, shall be valid and sufficient discharg