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Customer Care IndiaFirst Life
Insurance Company Ltd.301, 'B' Wing, The Qube,Infinity Park,
Dindoshi - Film City Road,Malad (East), Mumbai - 400 097
FORM NO. 60
proviso to rule 114B]
Form for declaration to be filed by an
individual or a person (not being a company or firm) who does
not have a permanent account number and who enters into any
transaction specified in rule 114B .
Please agree to Terms and Conditions to
I hereby provide my Aadhaar number and PAN to IndiaFirst Life Insurance Company Ltd and give my consent to link Aadhaar and PAN to all my policies. I give my consent to obtain Aadhaar number and identify information like name, date of birth, etc, for authentication with UIDAI. I also give my consent for verification of PAN with the Income tax authorities. The company has informed me that the data will be used for validation and e-KYC purpose.
I, do hereby declare that what is stated above is true to the best of my knowledge and belief. I further declare that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in which the above transaction is held will be less than maximum amount not chargeable to tax. Signature authentication(Single factor authentication): An OTP authentication number has been sent on your registered mobile number. By feeding in the said number in the system, you hereby unconditionally and absolutely acknowledge and accept the information furnished in this form is true and correct in all respects. Note: 1. Before confirming OTP, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on conviction be punishable, - (i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine (ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine. 2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.
Mobile Number Verification
Mobile No: XXXXXX
Reg. Off: 12th and 13th Floor, North [C] wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregaon (East), Mumbai – 400063.
IRDAI Regd. No. 143 | CIN: U66010MH2008PLC183679
For more details on risk factors, associated terms and conditions and exclusions please read the product brochure before concluding a sale.
©2016 IndiaFirst Life Insurance Company Limited. All rights reserved.
IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public receiving such phone calls are requested to lodge a police complaint.
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