"Full repayment of loan amount" or "Nil" (if done for love/affection) Rajesh Kumar (Your Full Name) Policy Number Sum Assured ₹5,00,000 Date of Original Policy 15th January 2018 Place & Date Mumbai, 10th May 2026 Witness Signature Must be signed by a third party (not a relative) Step-by-Step Instructions for Filling
: This is where the reassignment endorsement is made. Form No. 3857/3858 : Signed and stamped by the assignee. lic reassignment form sample filled
Signature & Code of D.O.
Below is a walkthrough of how to fill out the standard reassignment form after a loan is closed. Field Name Sample Data to Enter State Bank of India, Mumbai Branch (or name of the lender) Sum of Consideration "Full repayment of loan amount" or "Nil" (if
Assignment of Life Insurance Policy (Form No. 3150 – commonly known as the Deed of Assignment) Signature & Code of D
(If the D.O. agrees to release the agent)