DECLARATION FOR CHANGE OF NOMINATION UNDER AN INSURANCE POLICY
TO: Sarvodaya Life Insurance Company Limited, SCO 145-146, Sector 34-A, Chandigarh 160022
IN THE MATTER OF Policy No. LIFE/2019/0038812, and of the nomination registered upon it under section 39 of the Insurance Act, 1938
I, Simran Kaur Bajwa, daughter of Sardar Baldev Singh Bajwa, aged about 39 years, Service by occupation, resident of House No. 3162, Sector 47-D, Chandigarh 160047, PAN AFZPB6543M, being the holder of the Policy described below, held jointly with X, do solemnly declare and affirm as follows.
- 1. THE POLICY
1.1 I hold Policy No. LIFE/2019/0038812 ("the Policy"), being a policy of life insurance, issued by Sarvodaya Life Insurance Company Limited, commencing on 1 April 2026.
- 2. THE EXISTING NOMINATION
2.1 No nomination has previously been registered on this Policy.
- 3. REASON FOR THIS CHANGE
3.1 The previously registered nominee has died. The previously registered nominee died on 2 April 2026.
- 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:
- 1. Arjun Singh Bajwa, son of the Policyholder, aged 14 years, resident of House No. 3162, Sector 47-D, Chandigarh, share one-half.
- 2. Naina Kaur Bajwa, daughter of the Policyholder, aged 11 years, resident of House No. 3162, Sector 47-D, Chandigarh, share one-half.
4.2 The person or persons named in paragraph 4.1 are a parent, spouse or child of mine, or some combination of them, and the money secured by the Policy will accordingly be payable to them in their own right and for their own benefit, as section 39 of the Insurance Act, 1938 provides for such a nominee.
4.3 The following nominee or nominees named in paragraph 4.1 are minors: Arjun Singh Bajwa, aged 14 years; Naina Kaur Bajwa, aged 11 years. I appoint Harpreet Singh Bajwa, brother of the Policyholder to receive the money secured by the Policy on my death, for so long as that nominee remains a minor, under section 39(2) of the Insurance Act, 1938.
- 5. ASSIGNMENT OF THE POLICY
5.1 This Policy is not currently assigned to any person. I am aware that, where the Policy is currently assigned to any person other than Sarvodaya Life Insurance Company Limited itself by way of security for a loan, this change of nomination does not affect the rights of that assignee for as long as the assignment subsists.
- 6. WHEN THIS CHANGE TAKES EFFECT
6.1 This declaration cancels every nomination I have previously made on the Policy. The nomination in paragraph 4 takes effect from the date Sarvodaya Life Insurance Company Limited records it in its own register relating to the Policy, and not from the date of this declaration.