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LIC ECS Annuity Payment Form

Yogesh Kulkarni is providing his bank account details to Life Insurance Corporation of India (LIC) in order to receive annuity payments through their ECS (Electronic Clearing System) option. He is providing his annuity number, bank name (ICICI), branch address, 9-digit MICR code, account number, account type (savings), residential address, contact number, and signature. He acknowledges that any delays or failures in payment due to incorrect information provided would not be the responsibility of LIC. Confirmation of the start of ECS payments will be sent once the first payment is credited.

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101 views1 page

LIC ECS Annuity Payment Form

Yogesh Kulkarni is providing his bank account details to Life Insurance Corporation of India (LIC) in order to receive annuity payments through their ECS (Electronic Clearing System) option. He is providing his annuity number, bank name (ICICI), branch address, 9-digit MICR code, account number, account type (savings), residential address, contact number, and signature. He acknowledges that any delays or failures in payment due to incorrect information provided would not be the responsibility of LIC. Confirmation of the start of ECS payments will be sent once the first payment is credited.

Uploaded by

ydee28
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Life Insurance Corporation Of India

P & GS UNIT
FORM OF ECS OPTION ( ANNUITY PAYMENT

To,
DIVISIONAL MANAGER(P&GS),
LIC OF INDIA,
PUNE [Link],
JEEVAN PRAKASH, UNIVERSITY ROAD,
SHIVAJINAGAR, PUNE 411005
DEAR SIR,

1. NAME OF ANNUITANT
(BLOCK LETTERS)

YOGESH KULKARNI

2. ANNUITY NUMBER
3. PARTICULARS OF BANK ACCOUNT
A) BANK NAME
ICICI
A
B)BRANCH NAME & ADDRESS_ICICI Kondhwa Pune
4. 9-DIGIT CODE NO OF THE BABK & BRANCH
APPEARING ON THE MICR CHEQUE ISSUED
BY THE BANK
_________________________________
(PLEASE ATTACH THE XEROX COPY OF A
CHEQUE / A BLANK CANCELLED CHEQUE
ISSUED BY YOUR BANK FOR VERIFYING
THE ACCURACY OF CODE NUMBER______________________________
[Link] NUMBER

007401008802

(APPEARING ON THE CHEQUE BOOK)__________________________


[Link] TYPE(S.B. / CURRENT A/C, Savings
CASH CREDIT ACCOUNT)
7. RESIDENTIAL ADDRESS WITH PIN CODE Plot 1Survey No 669 Next to Pooja
Park,,Ninad,Sanjwat Hsg Society Bibewadi Pune 411037_
8 CONTACT NUMBER
_9881060287_
I HEREBY DECLARE THAT THE PARTICULARS GIVEN ABOVE ARE CORRECT AND
COMPLETE,IF THE TRANCTION IS DELAYED OR NOT EFFECTED AT ALL FOR
REASONS OF INCOMPLETE OR INCORRECT INFORMATION ,IWOULD NOT HOLD THE
LIC RESPONSIBLE I HAVE READ THE OPTION INVITATION LETTER AND AGREE TO
DISCHARGE THE
RESPONSIBILITY EXPECTED OF ME AS A PARTICIPANT UNDER THE SCHEME.
PLACE:
DATE:

SIGNATURE OF THE ANNUITANT

P.S CONFIRMATION HAVING STARTED PAYMENTS BY THE ECS SYSTEM WILL BE


SENT TO [Link] DETAILS AT THE TIME OF CREDITING FIRST PAYMENT.

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