Form 3265
Form 3265
Form 3265
Witness :
______________________________ _______________________________
( Signature ) ( Signature of Life Assured )
Full Name : “Certified that the contents of the above
Appointment of Appointee have been
Occupation : explained by me to the Life Assured
………………………………………….. in
Address : Vernacular and that he affixed his signature/
thumb impression thereto in my presence,
after thoroughly understanding the same”.
_______________________________
( Signature of Witness )
( Seal )
Witness : Signature :
Full Name :
Occupation: _______________________________
Address : ( Signature of the Appointee )
( See Instructions)
(1) An appointment of Appointee can be made only by the holder of a Policy on his own
life, i.e. only by the life Assured.
(2) After filling up the blanks as may be necessary in the Form of the Appointment of
Appointee, the Life Assured should copy it out on the back of the Policy. The
certificate of the witness should also be copied out if the signature of the life assured
is not in English ( see 3 below ) .
(3) The Life Assured must affix his signature to the endorsement of Appointment of
Appointee in the presence of a witness. If the Assured be not conversant with
English, he/she should sign the endorsement before an English knowing witness and
if he/she be illiterate he/she must affix his/her thumb impression(s) to the
endorsement before a Magistrate, a Special Executive Magistrate, a Gazetted Officer,
an Officer or Development Officer of atleast 3 years standing or confirmed
Development officer recruited from the Agents, who were DM or BM club members
before joining or Development Officers recruited from agents who were ZM or
Chairman’s club members provided he/she is fully satisfied about the identity of the
person(s) executing the endorsement. In such cases the witness should sign the
certificate in the endorsement.
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