REQUEST FOR CHANGE IN SIGNATURE 
Recent
Date . Policy No.
photograph of
d d m m y y y y
Policyholder
Name of the Policy Holder signed across

Address:

Residence Office Mobile

Contact No s t d s t d m o b i l e

Email ID
All fields are mandatory (At least one contact no is mandatory for processing your request. Contact nos mentioned above will be updated for future communication)

I hereby declare that I have changed the style of my signature and affix my new signatures in the boxes hereunder. I request you
to kindly register my new style of signature in your records. I further state that henceforth, the signature as appended below should
be considered for all future requests received under this policy.
New Signature 1
(To be done before Banker)
Old Signature
New Signature 2
(To be done before SBI Life Official)

Name of Bank
Bank Account Number
Date of Birth of the Bank Account Holder d d m m y y y y

Bank Seal & Attestation

 
I certify that the above details are correct as per bank records.
 

 
Signature
Name:
Bank Seal 
Signature Serial No:

Any one of the following documents should be produced in case of bank attestation (Tick D)
Original Cancelled Cheque Leaf with pre printed Name
Self attested Bank passbook copy updated with transactions till previous month
Any one of the following documents will be accepted as photo identity proof and should be produced in original for verification by
SBI Life official along with the form (Tick D)
Driving License Passport Pan Card PIO Card with photograph Election ID Card Aadhar Card
Armed forces ID Card with Photograph Bank Passbook with photo Employer ID Card Ration Card with photo
Any one of the following documents will be accepted as Residence proof and should be produced in original for verification by SBI
Life official along with the form (Tick D)
Driving License Passport Election ID Card Aadhar Card Ration Card Utility Bills not older than 6 months
Bank passbook/ Account Statement with transactions till previous month Rent/Lease agreement with last 3 months’ rent receipts

(For office use only. To be filled in by Branch)

I confirm that the customer has personally visited the branch. I also confirm that I have verified the originals of the above documents.

Name & Designation:___________________________________,

Date_____________ Employee Code :____________Branch: ________________
Signature
Recommendations of the Dy. PC Head & Above (Mandatory)

SBI Life Insurance Co Ltd |Corporate Office: “Natraj”,MV Road & Western Express Highway Junction, Andheri(East), Mumbai‐400069 
PS‐26/Ver. 2.1/07 Mar 2013      Page 1 of 1