Takaful - Surrender Form

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ADAMJEE LIFE WINDOW TAKAFUL OPERATIONS Page 1 of 1

SURRENDER FORM
Adamjee Life - WIndow Takaful Operations
‫د�دارى  �رم‬
3rd Floor, Adamjee House,
I.I. Chundrigar Road, Karachi - 74000 PAKISTAN
� � �
� � � � ���� ����� �
Date / �‫ ��ر‬: ____________ Certificate Number / �  �� ������� : ___________ Name of Participant / ‫�  �  ���م‬ � ‫ ��ر‬: _____________________

Plan /‫ �ن  �  ��م‬: ____________ CNIC / �  ‫ ��  �رڈ‬: _____________________________ Contact Number / �  �‫ را‬: __________________
� ���
� �‫ا‬
Email Address / �‫�ر‬ �  �  ‫ اى‬: ______________________________________________________________________________________


Surrender Type �� ���  �  ‫د�دارى‬ Reason for Surrender / Withdrawl � �  �  ‫د�دارى‬

� �
Certificate Surrender ‫������� ��  �  د�دارى‬ Financial Reasons ‫���� ��  ا�ب‬
�� �

‫�ا���ك  د�دارى‬ ��  �  ‫ا��ن‬  ��
� � ��
Adhoc Surrender Unsatisfactory Returns
� � �‫ا�ن  �  �و‬
�  ��
‫���وى  ������� ��  د�دارى‬
Partial Certificate Withdrawal � Unsatisfactory Service
Partial Adhoc Withdrawal � Others ___________________ �
‫د��ان‬
‫�وى  �ا���ك  �  د�دارى‬
Amount PKR ___________________ (� �  ‫)ر�  ��ں‬
Amount in words ________________ (� �  ‫)ر�  �ں‬
______________________________

� �
Pay Out Confirmation ��� �
 �  �‫ادا‬
� �
Do you want your Pay Out through; �‫�ر‬ �
� ��  �‫ادا‬

� �  �
�  �‫ا�ؤ‬ �� �
�  �  �  �‫آ�  �  �ا‬ ��
Direct Transfer in IBFT Account �‫�  �ا‬ Cheque �

� �
Account Title / ����  �‫ا�ؤ‬ : ____________________________________________________________________________________________
Account Number / �  �‫ا�ؤ‬ � � : __________________________________________________________________________________________
� ��
Bank Name / ‫�  �  ��م‬ � : ______________________________________________________________________________________________
Incase of Partial Certificate withdrawal (Single Premium Plans) the sum � covered will be reduced by the same� amount as that of partial
withdrawal amount. ��   ��  ‫��  �  �������� ���  �  د�دارى  �  �رت‬
�   �   �   �   � ‫ا‬   ��  �‫�  زر  � �����  ر‬�  ‫ادا�  �  �ن �  �رت‬
�  
� � ���
� � ) ‫د�دارى‬
� � �
 ‫������� ��  �  ���وى‬
- (
- � �
Declaration ���  ‫ا��ار‬
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.
� �� � � � � ��
���‫�ر�  �ا‬
� �  � �‫ ��  �ں  �  ر‬/ ��
 �� (��  ��  �‫ادا� )ا‬ �  ��  ‫ اور‬. ‫ ر�  �ں‬/ �‫ وا�  �  در�ا�  دا�  �  ر‬/ ‫_________ �  د�دارى‬ � �  �� �������  ����  ��_______________________ � �
� � � �
� � �  �  ‫ ��  �ں‬/ ��
- �� �  ‫�ى  ��رہ  ���  �م  ��ت  ���  �  اور‬ � � � � �  �‫ �  �م  �  �  ��  �  ��� ��  �رہ  �  ا‬.��  �  �  �  ��
�  ‫ا�  ذ�  دار  �ں  اور  �  ا��ار‬/�‫�  �  �ا  �  �  ا‬

Zakat Deduction ��  ‫ز�ٰة‬



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

Yes ‫�ں‬ � No
� � �

�  �‫ا��  �رم  ��ا‬
�� �  �‫ا‬
 ‫�  �ز�ۃ‬
If No (Please provide Zakat Declaration Form)

_________________________ _________________________ _________________________


Signature/Thumb impression of Bank Appoval Adamjee Life Appoval
� Certificate Holder
� �
� �� ��
‫ا��  �  ��ن‬/�‫������� ��  �  ��  �  د‬ ‫�  �  �رى‬� ‫آد�  ��  �  �رى‬

*Surrender Fees of Rs.350/- applicable



- �  ��  �‫ رو‬-/350 �  ��  �  ‫* د�دارى‬

Documents Required �
‫د�و��ات‬  ��

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
ّ
 �) ‫�ات‬ �
�‫د�و‬   �� �  �‫�  ّ ا‬
( �  ‫��  �ہ‬� � � �  ��‫ا‬
 �  ‫��  �  ��ر  ��  ��  اور  ��ى‬ �  �  �‫ رو‬-/ 20 �����  �  �) ‫ڈ��ا�  �رم‬ � �  ‫ز�ة‬
ADAMJEE LIFE ASSURANCE CO.LTD Page 3 of 3

PENALTY CHARGES
� � - BANCCA
� � � �
Adamjee Life Assurance Co. Ltd. �������� - �  �‫�ر‬
�  ‫د�دارى‬
The Forum, Suite No. 323, 3rd Floor, Plot G-20,
Block 9, Clifton, Karachi - 75600 PAKISTAN

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

�� �  �‫ز‬ �  �  ‫د�ارى‬
�  ‫�ر��  درج‬

Plan Year 1 Year 2 Year 3 � Year 4 Year 5 Year 6


‫�ن‬ ‫�  �ل‬ ‫دو�ا  �ل‬ �
‫��ا  �ل‬ ‫��  �ل‬ ‫����اں  �ل‬ ‫�  �ل‬

Future Assure - Old


� �� � 100% 50% 25% 15% � NIL � NIL
��‫ �ا‬-‫آ��ر‬ ��
 �� �
�  �� �
�  ��

Wealth Assure � � � ��� 100% 50% 25% 15% � NIL � NIL


‫آ��ر‬  � � ‫و‬ �
�  �� �
�  ��

Waseela Zindagi 100% 50% 25% � NIL � NIL � NIL


�  ��
� �  ��
� �  ��

��‫و�����  ز‬

Invest Assure 100% 50% 25% � NIL � NIL � NIL


�� � �  �� �  �� �  ��
‫آ��ر‬ �
 ��‫ا‬ � � �

Save & Assure - Old


� �� 100% 50% 25% � NIL � NIL � NIL
�� -‫آ��ر‬ �
 �� �
�  �� �
�  �� �
�  ��

Future Assure - New


� �� � 100% 50% � NIL � NIL � NIL � NIL
�� -‫آ��ر‬ ��
 �� �  ��
� �  ��
� �  ��
� �  ��

Save & Assure - New 100% 50% � NIL � NIL � NIL � NIL
� �� � � � � � �
�� -‫آ��ر‬ � �  ��
 �‫ا‬ � �  �� �  �� �  �� �  ��

Shelter for Life� - Plus�


� � 25% 15% � NIL � NIL � NIL � NIL
� - ��  ‫��������  �ر‬ �
�  �� �
�  �� �
�  �� �
�  ��

� Life� � - New�
Shelter for � 100% � NIL � NIL � NIL � NIL � NIL
�� - ��  ‫��������  �ر‬ �  ��
� �  ��
� �  ��
� �  ��
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Invest for Life�


� � � � in first six months only. Nil Afterwards
0.5%

��  ‫ا��  �ر‬ �  ��  �  �  ‫ اس‬- 0.5% ‫�  � �ہ  ��  �ف‬

Shelter for Life - Maximizer � NIL � NIL � NIL � NIL � NIL � NIL
� ��� � � � � � � � � � �
‫ ������ر‬- ��  ‫��������  �ر‬ �  �� �  �� �  �� �  �� �  �� �  ��

� � � NIL � NIL � NIL � NIL


Shelter for Life� - Old 100% 100%
� �
� - ��  ‫��������  �ر‬
�‫�ا‬ �  ��
� �  ��
� �  ��
� �  ��

Wealth Optimizer
� � �
Initial 11 Months 3%

12 - 23 Months 2% � NIL � NIL � NIL
�  �����‫و‬
‫آ���ر‬ 3% ������ 11 �‫ا�ا‬ 2% ������ 12 - 23 �  ��
� �
�  �� �
�  ��

� & Marriage
Tameer Education Plan 100% 50% � NIL � NIL � NIL � NIL
� � �� � �  �� �  �� �  �� �  ��
‫��  اور  ���ج  �ن‬ �‫��  ا‬ � � � �
Tahaafuz 50% 25% � NIL � NIL � NIL � NIL
� �
�  �� �
�  �� �
�  �� �
�  ��
Khushali Mustaqbil
100% � NIL � NIL � NIL � NIL � NIL
�  ��� �
�  �� �
�  �� �
�  �� �
�  �� �
�  ��
ADAMJEE LIFE ASSURANCE CO.LTD Page 2 of 3

� �
PENALTY CHARGES� - AGENCY / OTHERS
� � ��
� -�
� /�‫ا‬
Adamjee Life Assurance Co. Ltd.
The Forum, Suite No. 323, 3rd Floor, Plot G-20,
��‫د‬  �‫�ر‬
�  ‫د�دارى‬
Block 9, Clifton, Karachi - 75600 PAKISTAN

*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.�  ‫�  ��  �  ر�  �(�  �ں‬�  �  ‫�  �� ���  �  د�ارى‬�  �) �  �  ‫�ر��  �ا�  �وڈ�  �  دو�ى  �وڈ�  اور  �  �ل‬  �  ‫ د�دارى‬:��‫�ر‬  �  ‫*د�دارى‬

�� �  �‫ز‬ �  �  ‫د�ارى‬
�  ‫�ر��  درج‬

� �
�‫ا‬� / AGENCY
Plan Year 1 Year 2 Year 3 � Year 4 Year 5 Year 6
‫�ن‬ ‫�  �ل‬ ‫دو�ا  �ل‬ �
‫��ا  �ل‬ ‫��  �ل‬ ‫����اں  �ل‬ ‫�  �ل‬

Secure Munafa 100% 50% � NIL � NIL � NIL � NIL


��‫�������ر‬ �  ��
� �  ��
� �  ��
� �  ��

Secure Mustaqbil 100% 50% 25% � NIL � NIL � NIL
� � �
�‫�������ر‬ �  �� �  �� �  ��

Super Sarmaya

Initial 11 Months 3%

12 - 23 Months 2%

24 - 30 Moths 1% � Nil Afterwords
����  � 3% ������ 11�‫ا�ا‬ 2% ������ 12 - 23 1% ������ 24 - 30 �  ��  �  �  �‫ا‬

� / OTHERS
��‫د‬

Cover for Life 100% 50% 25% � NIL � NIL � NIL


�� �  �� �  �� �  ��
��  ‫�ور  �ر‬ � � �

Invest and Secure 100% 50% 25% 15% 10% � NIL


�� � �  ��
‫ا�  �������ر‬ �
� �  ��‫ا‬ �

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