3S CLAIMANT’S STATEMENT FORM (DEATH CLAIMS) - …
10.ELECTRONIC PAYOUT OPTION (Direct transfer of funds to your Bank Account) Please submit cancelled cheque / cheque copy along with this form Name of account holder: ... 11.ICICI BANK Account details, if any, held in the name of Life Assured* (This information will be passed onto ICICI Bank for closure formalities):
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