APPLICATION FOR LOAN ON SECURITY OF POSTAL LIFE INSURANCE POLICY

1. Name (in block letters)

2. Occupation

3. Address

4. Reference to previous loan taken , if any

(a) No. & date of sanction

(b) Amount of previous loan

(c) Date of repayment of previous loan

5. Amount of loan now required ………………………………………………….

6. Name of the Post Office( with the name of its Head Post Office, if it is Sub Post Office)at which the payment is desired …………………………………………………..

7. Name of the Post Office at which repayment with interest will be made……………………………….

8. Particulars of Policy(ies) against which the loan is desired

(A) Policy Number : _________________________________________

(B) Value of policy : __________________________________________

9. Name of the Post Office in which and the dates on which premia for the last 12 months have been paid (in case of cash policy)

10. The purpose for which loan is applied for ……………………………………………….

Documents attached :

Policy document duly signed in favour of the President Of India.

Loan Repayment Receipt Book relating to previous loan.

Premium Receipt Book.

Date ___________________ Signature Of Insurant

Telephone no. :

Office :

Residence :