Takaful - Surrender Form
Takaful - Surrender Form
Takaful - Surrender Form
SURRENDER FORM
Adamjee Life - WIndow Takaful Operations
د�دارى �رم
3rd Floor, Adamjee House,
I.I. Chundrigar Road, Karachi - 74000 PAKISTAN
� � �
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Date / � ��ر: ____________ Certificate Number / � �� ������� : ___________ Name of Participant / � � ���م � ��ر: _____________________
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Plan / �ن � ��م: ____________ CNIC / � �� �رڈ: _____________________________ Contact Number / � � را: __________________
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Email Address / ��ر � � اى: ______________________________________________________________________________________
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Surrender Type �� ��� � د�دارى Reason for Surrender / Withdrawl � � � د�دارى
�
� �
Certificate Surrender ������� �� � د�دارى Financial Reasons ���� �� ا�ب
�� �
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�ا���ك د�دارى �� � ا��ن ��
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Adhoc Surrender Unsatisfactory Returns
� � �ا�ن � �و
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���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
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������� �� � ���وى
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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 � � �� ������� ���� ��_______________________ � �
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� � � � �� �ں/ ��
- �� � �ى ��رہ ��� �م ��ت ��� � اور � � � � � � � �م � � �� � ��� �� �رہ � ا.�� � � � ��
� ا� ذ� دار �ں اور � ا��ار/�� � �ا � � ا
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
Save & Assure - New 100% 50% � NIL � NIL � NIL � NIL
� �� � � � � � �
�� -آ��ر � � ��
�ا � � �� � �� � �� � ��
� Life� � - New�
Shelter for � 100% � NIL � NIL � NIL � NIL � NIL
�� - �� �������� �ر � ��
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Shelter for Life - Maximizer � NIL � NIL � NIL � NIL � NIL � NIL
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������ر- �� �������� �ر � �� � �� � �� � �� � �� � ��
Wealth Optimizer
� � �
Initial 11 Months 3%
�
12 - 23 Months 2% � NIL � NIL � NIL
� �����و
آ���ر 3% ������ 11 �ا�ا 2% ������ 12 - 23 � ��
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� & Marriage
Tameer Education Plan 100% 50% � NIL � NIL � NIL � NIL
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�� اور ���ج �ن ��� ا � � � �
Tahaafuz 50% 25% � NIL � NIL � NIL � NIL
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Khushali Mustaqbil
100% � NIL � NIL � NIL � NIL � NIL
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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
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