Vanguard Life - Surrender Claim

SURRENDER CLAIM FORM

FILL FORMS IN BLOCK LETTERS
Date

MonthDayYear
Date
Policy Number:
Name

First NameLast Name
Address
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Premium Payment Bank/Paypoint
Staff Id
Pay me through

BankChequeMobile
Kindly terminate premium deduction

Tick if you wish to
Name of Bank / Momo Account Name
Branch
Account Number / Momo Number
Reason for Surrender

Loss of jobFinancial difficultyTravellingPay school feesPay medical billsPay rentPoor serviceUnattractive yieldOthers
Upload Necessary Documents Here

Cancelof
Signature of Policyholder (Claimant)

Clear
Should be Empty:

SURRENDER CLAIM FORM