ECS FORM
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Life Insurance Corporation Of India P & GS UNIT – FORM OF ECS OPTION ( ANNUITY PAYMENT) To, DIVISIONAL MANAGER(P&GS), LIC OF INDIA, PUNE DIVL.OFFICE, JEEVAN PRAKASH, UNIVERSITY ROAD, SHIVAJINAGAR, PUNE 411005 DEAR SIR, 1. NAME OF ANNUITANT YOGESH KULKARNI (BLOCK LETTERS) 2. ANNUITY NUMBER 3. PARTICULARS OF BANK ACCOUNT A) BANK NAME ICICI B)BRANCH NAME & ADDRESS_ICICI Kondhwa Pune 4. 9-DIGIT CODE NO OF THE BABK & BRANCH APPEARING ON THE MICR CHEQUE ISSUED BY THE BANK _________________________________ (PLEASE ATTACH THE XEROX COPY OF A CHEQUE / A BLANK CANCELLED CHEQUE ISSUED BY YOUR BANK FOR VERIFYING THE ACCURACY OF CODE NUMBER______________________________ 5.ACCOUNT NUMBER 007401008802 (APPEARING ON THE CHEQUE BOOK)__________________________ 6.ACCOUNT TYPE(S.B. / CURRENT A/C, Savings CASH CREDIT ACCOUNT) 7. RESIDENTIAL ADDRESS WITH PIN CODE Plot 1Survey No 669 Next to Pooja Park,,Ninad,Sanjwat Hsg Society Bibewadi Pune 411037_ 8 CONTACT NUMBER _9881060287_
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Transcript of ECS FORM
Life Insurance Corporation Of India
Life Insurance Corporation Of India P & GS UNIT FORM OF ECS OPTION ( ANNUITY PAYMENT)
To,
DIVISIONAL MANAGER(P&GS),
LIC OF INDIA,
PUNE DIVL.OFFICE,
JEEVAN PRAKASH, UNIVERSITY ROAD,
SHIVAJINAGAR, PUNE 411005
DEAR SIR,
1. NAME OF ANNUITANT YOGESH KULKARNI
(BLOCK LETTERS)
2. ANNUITY NUMBER 3. PARTICULARS OF BANK ACCOUNT
A) BANK NAME ICICI B)BRANCH NAME & ADDRESS_ICICI Kondhwa Pune 4. 9-DIGIT CODE NO OF THE BABK & BRANCH
APPEARING ON THE MICR CHEQUE ISSUED
BY THE BANK _________________________________
(PLEASE ATTACH THE XEROX COPY OF A
CHEQUE / A BLANK CANCELLED CHEQUE
ISSUED BY YOUR BANK FOR VERIFYING
THE ACCURACY OF CODE NUMBER______________________________
5.ACCOUNT NUMBER 007401008802 (APPEARING ON THE CHEQUE BOOK)__________________________
6.ACCOUNT TYPE(S.B. / CURRENT A/C, Savings CASH CREDIT ACCOUNT)
7. RESIDENTIAL ADDRESS WITH PIN CODE Plot 1Survey No 669 Next to Pooja Park,,Ninad,Sanjwat Hsg Society Bibewadi Pune 411037_
8 CONTACT NUMBER _9881060287_ I HEREBY DECLARE THAT THE PARTICULARS GIVEN ABOVE ARE CORRECT AND COMPLETE,IF THE TRANCTION IS DELAYED OR NOT EFFECTED AT ALL FOR REASONS OF INCOMPLETE OR INCORRECT INFORMATION ,IWOULD NOT HOLD THE LIC RESPONSIBLE I HAVE READ THE OPTION INVITATION LETTER AND AGREE TO DISCHARGE THE
RESPONSIBILITY EXPECTED OF ME AS A PARTICIPANT UNDER THE SCHEME.
PLACE:
DATE: SIGNATURE OF THE ANNUITANT
P.S CONFIRMATION HAVING STARTED PAYMENTS BY THE ECS SYSTEM WILL BE SENT TO YOU.GIVING DETAILS AT THE TIME OF CREDITING FIRST PAYMENT.
