DECLARATION FOR CHANGE OF NOMINATION UNDER AN INSURANCE POLICY
I, __________, __________, aged about __________ years, resident of __________, being the holder of the Policy described below, do solemnly declare and affirm as follows.
- 1. THE POLICY
- 2. THE EXISTING NOMINATION
- 3. REASON FOR THIS CHANGE
- 4. THE NEW NOMINATION
4.1 Under section 39 of the Insurance Act, 1938, I nominate the following person or persons to receive the money secured by the Policy in the event of my death, cancelling every nomination I have previously made on the Policy:
- 6. WHEN THIS CHANGE TAKES EFFECT
- 7. REQUEST
- 8. UNDERTAKING
VERIFICATION
JURAT (where this declaration is sworn or affirmed)
_______________________________
NOTARY PUBLIC / OATH COMMISSIONER (only where this declaration is sworn)
(Signature, seal, registration number, and serial number in the notarial register, if applicable)
This notice is given under the Digital Personal Data Protection Act, 2023.
Personal data in this document is collected only to record and communicate the stated change of nomination, identify the Policyholder and every nominee named, verify the facts stated in this declaration, and retain an evidentiary record of the change.
If the change is not registered, personal data will be retained for 90 days and then erased. If it is registered, the record will be retained for the term of the Policy plus 12 months, except where a named statutory or regulatory record-retention period requires longer retention.
Data minimisation: this document does not collect a full Aadhaar number, an Aadhaar-card copy, a password, or bank credentials, and none should be written into it. Use masked account or identity references where an identifying reference is genuinely necessary.