(To be filled in by the Applicant in capital letters)
Yes, I have attached a cancelled cheque or its photocopy.
No (Please provide photocopy of latest bank statement/passbook or get this NEFT form attested by your bank)
I have verified the above mentioned particulars with supporting documents and found them complete and correct for
CSE Name________________________________________________ Emp. Code___________________________________
Name of the Policyholder: ________________________________________________________________________________
I accept to receive all future communication from Max Life Insurance vide email ID only (strike if you want to continue by hard copies).
Type of Bank Account: Savings
Bank Account No.:
NRE accounts are guided by FEMA regulations: We are not accepting NRE account for NEFT so you are requested not to provide NRE
After submission of NEFT details, if there is any change in bank details then fresh mandate form will have to be submitted.
undertake to refund any amount that is credited to my account either in excess or which is not due to me, at any time.
In case of non credit to my bank account with / without assigning any reasons thereof or if the transaction is delayed or
not effected at all for reasons of incomplete / incorrect information, I would not hold Max Life Insurance Co. Ltd.
responsible in any manner whatsoever. The Company reserves the right to use any alternative payout option,
including demand draft / payable at par cheque in spite of opting for Direct Credit option.
Max Life Insurance Co. Ltd. Plot No. 90A, Sector 18, Gurugram, 122015, Haryana.
IRDAI Registration No. 104
Ver: V1/Jun 2017