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Bajaj Allianz life insurance Co. Ltd.

To ensure your policy remains in-force and premiums are paid on time please fill up, sign, detach & submit below NACH mandate.
You can also submit the filled NACH mandate at a) any of our branches b) Or SMS RENEW (space) <policy number> on 9773500500 for a pickup c)
Or WhatsApp the mandate form to 7030105508 d) Or email a scanned copy to customercare@bajajallianz.co.in

Debit Mandate Form NACH/ DIRECT DEBIT

as & when presented

I agree for the debit of mandate processing charges by the bank whom I an authorising to debit my account as per last schedule of charges of the bank.

This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity / Corporate to debit my account, based on the instructions as agreed and signed by me.
I have understood that I am authorised to cancel / amend this mandate by approximately communicating the cancellation / amendment request to the User entity / corporate or the bank where I have authorised debit.

9. In Traditional policies please add 2% over and above premium amount to keep mandate live in case any changes made in tax structure
Bajaj Allianz Life will debit exact premium due under policy

Bajaj Allianz Life Insurance Co. Ltd. NACH Mandate Ver. 1 (052017)

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