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POLICY AMENDMENT REQUEST FORM (A) SECTION A 1. Change in Address Address City Please write in (BLOCK LETTERS) Pin Policy No. Home Work Mobile* Alternate/Permanent Tel* * Mandatory Email Please indicate.

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3. Fill in the empty fields; concerned parties names, places of residence and numbers etc.
4. Change the template with unique fillable areas.
5. Add the day/time and place your electronic signature.
6. Click on Done following twice-checking everything.
7. Save the ready-produced document to your gadget or print it out as a hard copy.

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