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Policy Surrender or Free-Look Request

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You and the policy
Your request
Where to pay

Step 1 of 3

You and the policy

Your full name (the policyholder)Needed

For example: Harjinder Singh Gill

Your addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

Your phone numberNeeded

A number somebody can be reached on. Ten digits is the usual Indian form, and a country code in front of it is fine if you want it there.

For example: 98765 43210

Insurance company's nameNeeded

For example: ABC General Insurance Company Limited

Address of the office you are writing toNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

Policy numberNeeded

For example: P/141234/01/2026/003318

What kind of policy is it?Needed

a life insurance policya health insurance policya motor or other general insurance policy

Date the policy was issued or beganNeeded

A calendar date — the day, the month and the year. Dates in a document like this are read against one another, so a date typed here can change what another date is allowed to be.

Total premium you have paid so farNeeded

An amount in rupees. Commas and a ₹ sign are both fine — write it the way you would write it anywhere else, and the document is given the tidy form of it.

For example: 50000

More details — you may leave these

Your email addressYou may leave this

An email address somebody actually reads. Notices under a document like this can be sent to it, so a working one matters more than a tidy one.

For example: harjinder.gill@example.com

Read the whole draft

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The live draft

The draft, as it stands

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POLICY SURRENDER OR FREE-LOOK CANCELLATION REQUEST

A policyholder's request to cancel a new policy in its free-look period, or to surrender a policy for its value.

TO:
The Manager, Policy Servicing
__________
__________

FROM:
__________
__________
Phone: __________

SUBJECT: Request about policy no. __________

Sir / Madam,

1. THE POLICY

1.1 I hold __________, number __________, issued by you on __________. I have paid premiums of __________ in all.

2. MY REQUEST

2.5 I understand that you may deduct only what the policy and the rules allow, and I ask you to show each deduction in writing with the clause of the policy for it.

3. WHAT I ASK YOU TO DO

3.1 Please act on this request, register it from the day you receive it, and confirm in writing the date on which the policy ends.

3.2 Please tell me the amount payable and how it is made up, and send me no further premium notice.

4. WHAT I CONFIRM

4.1 I am the policyholder and I sign this request myself. What I have written is true to the best of my knowledge.

5. PAPERS ENCLOSED

Yours faithfully,

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