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Discharge Voucher

This document is a discharge voucher from Heirs Life Assurance authorizing the payment of NGN 29,944.36 in surrender benefits to Isaac Owen under his Heirs Save Plan policy. It provides details of the policy such as the policy number, sum assured, amount due, and total payable amount. The policyholder is requested to provide bank account details and identification documents to receive the funds, and the document requires his signature and a witness for authorization of the payment.

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372 views1 page

Discharge Voucher

This document is a discharge voucher from Heirs Life Assurance authorizing the payment of NGN 29,944.36 in surrender benefits to Isaac Owen under his Heirs Save Plan policy. It provides details of the policy such as the policy number, sum assured, amount due, and total payable amount. The policyholder is requested to provide bank account details and identification documents to receive the funds, and the document requires his signature and a witness for authorization of the payment.

Uploaded by

nh5jybzrvb
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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0700 434 7754

[email protected]

DISCHARGE VOUCHER

POLICY TYPE: Heirs Save Plan

POLICY NO.: 31012300257

CLAIM NUMBER: C001-31012300257

NAME OF POLICYHOLDER: ISAAC OWEN

SUM ASSURED NGN 100,000.00

AMOUNT DUE: NGN 29,000.00

ADD ACCRUED INTEREST: NGN 0.00

WITHDRAWALS: (NGN 0.00)

TOTAL SUM PAYABLE: NGN 29,944.36

The undersigned of the above named scheme hereby authorize and request the company to pay the sum of
NGN 29,944.36 surrender benefit on my policy being full and final discharge of all claims and liabilities under
the policy.

BANK ACCOUNT DETAIILS:

ACCOUNT NAME:.........................................................................

NAME OF BANK:...........................................................................

ACCOUNT NO.:............................................................................

SORT CODE:.................................................................................

NOTE: KINDLY ATTACH MEANS OF IDENTIFICATION (INTERNATIONAL PASSPORT/NATIONAL ID


CARD/DRIVER’S LICENCE), PASSPORT PHOTOGRAPH, AND UTILITY BILL

Policyholder’s Signature.............................................................Date ..............................................

Name of Witness...........................................................................Signature ................................

Address of Witness.....................................................................................................................

Occupation.................................................................................................................................

N.B. The witness should be a person other than the husband or wife signatory
KINDLY AFFIX =N=50.00 POSTAGE STAMP HERE

Heirs Life Assurance Limited (RC: 1561351) Heirs Towers, Plot 107B, Ajose Adeogun Street, Victoria Island,
Lagos, Nigeria. Tel: +234 700 434 7754
www.heirslifeassurance.com
Authorised and Regulated by the National Insurance Commission.

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