POLICY ENROLLMENT FORM FOR LIC's WEB-SITE "www.licindia.

com"

To
The Chief Manager/Sr./Branch Manager,
Life Insurance Corporation of India,

.............................................................

.............................................................

.............................................................

I have registered at Life Insurance Corporation of India's web-site 'www.licindia.com' and request you to validate the
following enrolled policy/ies.

Name of Policy Holder Login User Id

Singh RN R_N_SINGH

Email-id Date of Birth

ramesh.singh781@gmail.com 01/01/1969

Landline 1 Landline 2
+91 +91
Country STD Code Phone Number Country STD Code Phone Number
Code Code

Mobile 1 Mobile 2
+91 +91
STD Code [compulsory if not a 10 digit STD Code [compulsory if not a 10 digit
mobile number] mobile number]

Sr. Policy No Ser Brn Premium (Rs.) Name of Life Assured

1 190868588 19J 6557.0 Singh RN
2 194327250 19J 11817.0 Singh RN
3 197761841 15000.0 Singh RN

I have read the provisions contained in the "Terms of Service: Registration for LIC's web-site:www.licindia.com" and
accept them. I agree that all transactions executed over "LIC's web-site: www.licindia.com" under my User-id and
Password will be binding on me.

Date : Policyholder's Signature

Place: (Life Assured / Proposer)
 Terms of Service:Enrolment of Policies on LIC's web-site "www.licindia.com"

General Information:

1. Login User-id and password can be obtained by registering on LIC's web-site as new users. The existing users
can continue with the same user-id and password.
2. You should submit the duly completed enrolment form at any LIC branch where your policy is being presently
serviced. The Branch will verify the detail and then enrol the policies under your user-id for your access to the
policy details on the web site.
3. Access to the enrolled policies will be available to you only after the enrolment form is validated by the Branch.
You can enrol only those policies for which you are an authorised signatory/claimant. A confirmatory email will be
sent for the enrolled policy/ies to the email-id mentioned in this enrolment form.
4. If you believe that any information relating to your account has a discrepancy, please bring it to the notice of the
branch by e-mail or letter.
5. Registration/Policy enrolment cannot be claimed as a right. LIC reserves the right to reject/disqualify any
registration / enrolment at its own discretion.
6. LIC reserves the right to modify the services offered or the Terms of service of LIC's web-site. The changes will
be notified to the customers through a notification on the Site.

Services Offered:

1. You can view/download & print the policy status of the policies numbers you have registered.
2. You can view/download & print revival and loan quotations.
3. You can submit online request for address change, without having to personally visit the servicing branch.
4. You can pay premiums of validated policies online through your net-banking accounts.
5. If you opt, LIC will send alerts either through Email or/and SMS about the Premium payment dates, and other
information about products and services.

Policyholder's Obligations:

1. The policyholder has an obligation to maintain secrecy in regard to the user-id and password allotted by LIC. And
LIC presupposes that login using the user-id and password is a valid session initiated by none other than the
policyholder.
2. Transaction executed through a valid session will be construed by LIC to have emanated from the registered
policyholder and will be binding on him / her.
3. The policyholder will not attempt or permit others to attempt accessing the LIC's web-site through any unlawful
means.