Policy Loan Request - Liberty Life Assurance Kenya Ltd

Policy Loan Request and Agreement
Liberty Life Assurance Kenya LImited
PO Box 30364-00100,Nairobi,Kenya
t 254 20 286 6000 f 254 20 271 8365
e cfclife@cfclife.co.ke
www.cfclife-kenya.com
Please read instruction carefully before completing your request
1.Print the full names of insured, owner and policy number.
2. Loan cheque may only be issued if this form, properly completed, is brought to the office along with the policy holders document.
3. This loan is made under and subject to the terms of the policy.
4. The policy is hereby assigned to the company as the sole security for such policy loan.
5. The total loan shall include any existing loan(s) including interest due or accrued.
6.Interest shall be at the rate specified in the policy, or at a rate determined by the company (currently being 15% compounded annually). Interest shall be charged on each anniversary date of the policy.
If interest is not paid when due, it shall be added to the principal of loan and a new memo of interest generated.
7.The loan shall be paid by crossed bankers cheque or by EFT (Electronic Funds Transfer) directly to your account. Applicants without bank accounts should make their own alternative arrangements of
cashing their cheques.
8.You could choose to repay the loan through a bankers order, salary deductions or direct cash payments. Please completed the applicable forms ad submit together with this request.
Policy number
Name of insured
Name of owner if other than insured
CfC Life Assurance Ltd is requested by: (policy owner)
Policy loan on the security of the loan value, amount sufficient to:
Kshs
The cheque to be payable to
Each of the undersigned certifies that no bankruptcy or insolvency proceedings have been filed or commenced by or against him or her.
Important (Tick one of the boxes below for the dispatch of your loan.
Pay through
EFT
Collect cheque from CfC House
MPESA
Collect from Agency Office
DISPATCH OF DOCUMENT
Collect document from CfC House
Mail to my address
Collect from Agency Office
If you prefer to have the loan amount transferred direct into your bank account (EFT), please provide us with the full details of your account in the fields provided below.
Account type
Current account
Savings account
Bank name
Branch name
Branch code
Account holder name
Account number
Policy owner’s Passport/Identity number
Telephone number
Application dated at (place)
Postal address
Postal code
E-mail address
CLAIM DETAILS
The policy loan of Kshs
shall be repayable in
Effective
DD
D
Cash
D
-
MPESA
M
M
-
Y
Y
Y
Y
To
D
-
M
M
-
Y
Y
Y
Y
D
D
-
Check-off
Policyowner’s signature
Date
Witnessed by (name)
Signature
PS 13 (PR 072)
D
months
1 of 2
M
M
-
Y
Y
Y
Y