surrender form - takaful - adamjee life...zakat declaration form (to be made on a stamp paper of...

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Page 1 of 1 SURRENDER FORM Surrender Type Declaration Reason for Surrender / Withdrawl Certificate Surrender Adhoc Surrender Partial Certificate Withdrawal Partial Adhoc Withdrawal Amount PKR ___________________ Amount in words ________________ ______________________________ Financial Reasons Unsatisfactory Returns Unsatisfactory Service Others ___________________ Pay Out Confirmation Documents Required Do you want your Pay Out through; Direct Transfer in IBFT Account Cheque Account Title / : ____________________________________________________________________________________________ Account Number / : __________________________________________________________________________________________ Bank Name / : ______________________________________________________________________________________________ I ________________________________________ holding Certificate #_______________________________with Adamjee Life - W.T.O hereby put forward the request of surrender /Withdrawal of/from my certificate and demand for payment of the resulting value (If any) after adjusting for all applicable charges*.I am aware of any financial loss that I might incur as a result.I declare that the information above is true to the best of my knowledge and belief. Complete Original Certificate Documents (For Complete Surrender Cases) Zakat Declaration Form (To be made on a stamp paper of PKR.20/- duly notarized) دارى � د��� دارى � د� د�دارىك د�دارى ا� د�دارى وى د�دارىك�وى ا� ا�ب ن� ا�و� ن� ا� ادا� ر� ادا�ا�ؤ� ا� ا� آ�رت �دارى � د� ا� ر� زررت � �ن ادا� وى د�دارى*Surrender Fees of Rs.350/- applicable ؤ� ا�ؤ� ا� م ار � ا� ا�ر�(�ا) � ادا� ر�ں�� / ں . اور � / ر� ر� دا�ا� در�دارى / وا� د�� _________ �_______________________ اور �ت�م�رہ � ى�ں�� / ار � ا�ں اور � دار � ذ�/ا� ا�ا� ا�رہ �م�� ._________________________ Signature/Thumb impression of Certificate Holder _________________________ Bank Appoval _________________________ Adamjee Life Appoval �رى آد� �رى ن/ا� د� رو�-/350 دارى � د�* اتو� د��( د�دارىّ �) اتو� د� ا�ّ ہ�ى� اور �ر� ا� رو�-/ 20 �) �رم ا�ة ڈ� ز�دارى �رم د�ں�ر�) ں�ر�) ان د�- - - ( ( ( Incase of Partial Certificate withdrawal (Single Premium Plans) the sum covered will be reduced by the same amount as that of partial withdrawal amount. ) ( - If No (Please provide Zakat Declaration Form) Zakat Deduction ة�ٰ� زDo you want Zakat to be deducted from your surrender proceeds? وا�ة�ٰ� � آپ زYes No �ں ا�رم �ۃ ا�ز� ا� ؟Adamjee Life - WIndow Takaful Operations 3rd Floor, Adamjee House, I.I. Chundrigar Road, Karachi - 74000 PAKISTAN ADAMJEE LIFE WINDOW TAKAFUL OPERATIONS ر� م �ر من�رڈ � را� ر� ا� اىDate / : ____________ Plan / : ____________ Email Address / : ______________________________________________________________________________________ CNIC / : _____________________________ Contact Number / : __________________ Certificate Number / : ___________ Name of Participant / : _____________________

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Page 1 of 1

SURRENDER FORM

Surrender Type

Declaration

Reason for Surrender / Withdrawl

Certificate SurrenderAdhoc SurrenderPartial Certificate WithdrawalPartial Adhoc WithdrawalAmount PKR ___________________Amount in words ______________________________________________

Financial ReasonsUnsatisfactory Returns Unsatisfactory ServiceOthers ___________________

Pay Out Confirmation

Documents Required

Do you want your Pay Out through;

Direct Transfer in IBFT Account Cheque

Account Title / : ____________________________________________________________________________________________Account Number / : __________________________________________________________________________________________Bank Name / : ______________________________________________________________________________________________

I ________________________________________ holding Certificate #_______________________________with Adamjee Life - W.T.O hereby put forward the request of surrender /Withdrawal of/from my certificate and demand for payment of the resulting value (If any) after adjusting for all applicable charges*.I am aware of any financial loss that I might incur as a result.I declare that the information above is true to the best of my knowledge and belief.

Complete Original Certificate Documents (For Complete Surrender Cases)Zakat Declaration Form (To be made on a stamp paper of PKR.20/- duly notarized)

��� ���  � د�دارى  � ��  � د�دارى 

د�دارى  �   ��� ���� �� ��

د�دارى ��ك  � ا��

د�دارى   ��� ���� �� �� ��وى  ��

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�ادا�   ��

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*Surrender Fees of Rs.350/- applicable

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ادا� ر� �   � �ں   �� / � ���  �� �ں . اور  ر� / ر�   � دا�    در�ا��  � د�دارى / وا�   � _________ �   ��� ���� �� ��  ������  ��_______________________ ��

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ا�   �� اور  �ں  دار  ذ�  ا�/ا�    ��  � �ا    ��   � �� �

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_________________________Signature/Thumb impression of Certificate Holder

_________________________Bank Appoval

_________________________Adamjee Life Appoval

�رى  �  � �

�� �رىآد�   �   � � �ن�� ��

�  � د�/ا��   �  ��  �   ��� ���� �� ��

�  �� � 350/- رو�    ��

�  � * د�دارى 

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�د�دارى)�� �ات (�ّ 

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�رم د�دارى 

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(

((

Incase of Partial Certificate withdrawal (Single Premium Plans) the sum covered will be reduced by the same amount as that of partial withdrawal amount. )(

-

If No (Please provide Zakat Declaration Form)

Zakat Deduction �� ز�ٰة 

Do you want Zakat to be deducted from your surrender proceeds? � ��  ��  � �وا��  ��  � ز�ٰة  آپ   � ��

Yes Noں� ��

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�� �رم    ا��� �ز�ۃ    �

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؟

Adamjee Life - WIndow Takaful Operations3rd Floor, Adamjee House,I.I. Chundrigar Road, Karachi - 74000 PAKISTAN

ADAMJEE LIFE WINDOW TAKAFUL OPERATIONS

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���ر���م ��  � �ن  � �رڈ   �� � را� 

�ر�� � ا��  ���� اى 

Date / : ____________

Plan / : ____________

Email Address / : ______________________________________________________________________________________

CNIC / : _____________________________ Contact Number / : __________________

Certificate Number / : ___________ Name of Participant / : _____________________

Page 3 of 3

Adamjee Life Assurance Co. Ltd.The Forum, Suite No. 323, 3rd Floor, Plot G-20,Block 9, Clifton, Karachi - 75600 PAKISTAN

PENALTY CHARGES - BANCCA

*Surrender Charges vary from product to product and the year in which the policy is surrendered / withdrawn. Year wise Surrender Charges for each product are as under:�

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Future Assure - Old

Wealth Assure

Waseela Zindagi

Invest Assure

Save & Assure - Old

Future Assure - New

Save & Assure - New

Shelter for Life - Plus

Shelter for Life - New

Invest for Life

Shelter for Life - Maximizer

Shelter for Life - Old

Wealth Optimizer

Tameer Education & Marriage Plan

Tahaafuz

Khushali Mustaqbil

100% 50% 25% 15% NIL NIL

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100% 50% 25% 15% NIL NIL

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Page 2 of 3

Adamjee Life Assurance Co. Ltd.The Forum, Suite No. 323, 3rd Floor, Plot G-20,Block 9, Clifton, Karachi - 75600 PAKISTAN

PENALTY CHARGES - AGENCY / OTHERS

*Surrender Charges vary from product to product and the year in which the policy is surrendered / withdrawn. Year wise Surrender Charges for each product are as under:��� ��وڈ�  �� .� �ں   �(� ر�   �  ��   ��  � د�ارى   �   �����   ��  �) �  � �ل   � اور  �وڈ�  دو�ى   � �وڈ�    ا��  � � �ر��  � ��: د�دارى  �ر��  � د�دارى 

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Secure Munafa

Secure Mustaqbil

Super Sarmaya

Cover for Life

Invest and Secure

100% 50% NIL NIL NIL NIL

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100% 50% 25% NIL NIL NIL

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