Servicing Related Forms
General Requisition Form for
• Surrender Value Quotation
• Policy Loan Quotation
• Revival Quotation
• Change of Mode/ Quotation
• Change of Address
• Discounted Claim
• Certificate of Premium Payment
Claims Discharge Voucher for
• Survival Benefit
• Maturity Value
• Discounted Value
Policy Loan Application Form
Change of Nomination Forms
Transfer of Policy: Form for Assignment/ Re-Assignment of a Policy
Loss of Policy - for issue of a "special policy" or duplicate policy in place of the lost policy.
Health Declaration for Revival of a Lapsed Policy.
Complaint Lodgment Form
Form for Bank Details for Direct Credit of Policy Payments
New Business Related Forms
Proposal Forms for Insurance on Own Life (Form 300)
• To be used where the proposer is above 18 years last birthday, and is having independent income.
• To be also used for Smart Life 2 where Term Rider opted (and medicial exmaination report is need)
Proposal Forms for Insurance on Another Life (Form 340) – where the age of the life proposed is above 10 years of age, but below 18years
Proposal Forms for Insurance on Another Life (Form 360) – where the age of the life proposed is less than 10 years
Proposal Forms for Insurance on Another Life (Form 340) – For Key man Insurance Policies
• Where a company is insuring its key empolyee or manager or director.
Proposal Form for Smart Life 2 Plan (Form 300BN)
• To be used only in respect of 'without term rider' cases. Can also be used where only the 'accidental death rider' is opted
Agents’ Confidential Report- must accompany every proposal submitted to LICI
Health Declaration in respect of a New Proposal
Medical Examination Form
Product Brochure Downloads
• The Money Tree Range
• Riders Range - Arm Your Policies with Extra Security Features
• The Target Range
• The Wealth Builder Range
• The Aspire Range
• Important Information to Our Policyholders and Prospective Policyholders - Part 1, Part 2
• Gold Life Single Premium Bond
• What Makes LICI Policies A Better Choice
You may send the completed forms by post or fax to our office. For postal address and fax numbers, please click here.
You will be directed to the relevant web page within this site.