Vanguard Life - Maturity Claim

MATURITY CLAIM FORM

FILL FORMS IN BLOCK LETTERS
Date

MonthDayYear
Date
Policy Number
Name

First NameLast Name
Premium Payment Bank/Pay point
Staff ID.
Phone Number
Please enter a valid phone number.
Policy Start Date

MonthDayYear
Date
Policy Maturity Date

MonthDayYear
Date
Do you desire to start a new policy?

YesNo
Kindly terminate policy

Thick if you wish to
Email
example@example.com
Pay me through

BankChequeMobile Money
Name of Bank /Momo Account Name
Provide Mobile money account name if you choose Mobile money
Branch
Bank Branch
Account Number /Momo Number
Enter Momo Number if you choose Mobile money
I the undersigned hereby claim payment for the Net Cash Value under my policy with number stated above in full and final settlement of my maturity benefit as a result of which I have enclosed my original policy document including the policy schedule and all other endorsements thereto. I the assured, give Vanguard Life Ass. Co. Ltd. full and complete discharge of its liabilities under this policy and thereby relieve the company of any future claim under the policy. I hereby request my maturity benefit payment to be made as per my application
.
Signature

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MATURITY CLAIM FORM