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Specimen Signature Format We thank you for applying for an HDFC Life Insurance Policy. To enable us to assess your

application, kindly complete this form and send it to us duly signed by Life to be Assured.

Application No. / Proposal No. Name of Life to be Assured

Declaration of Life to be assured: I hereby declare that my specimen signatures in short, full, vernacular language and in all different styles

are as under.

English (Full):

1. ____________

English (Short):

1. ____________

Vernacular language:

1. ________________

Other Styles:

1. _________________ 2. _________________

3. _________________

Yours faithfully,

Declaration of the FC/ BDM/ CAM: I Mr./Ms. ___________________________, Agency code _________________ hereby attest and

declare that the Life to be Assured has signed in my presence.

Name in full: Date:

Designation: Place: Signature Employee No:

Specimen Sign -4.4

Signature (Life to be Assured)

Date:……………………………. Place:……………………………

HDFC Life Insurance Company Limited [Formerly HDFC Standard Life Insurance Company Limited] (HDFC Life).CIN: L65110MH2000PLC128245. IRDAI Registration No. 101. Regd. Off: 13th Floor, Lodha Excelus, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai - 400 011. For queries or more information, call us on 1860-267-9999 (Local charges apply). DO NOT prefix any country code e.g. +91 or 00. Available Mon-Sat from 10 am to 7 pm | Email - service@hdfclife.com | nriservice@hdfclife.com (For NRI customers only) | Visit - www.hdfclife.com