To,

Branch Manager,
Branch No-912,
LIC of India, Mumbai.

Respected Sir,

Re: Policy No. – **********/********** own Life with Reference to above mentioned Policy.

I am enclosing herewith the certified Xerox copy of Govt. Gazette for change in my name as
under: -

Old Name – Prerana Mohan Surve.

New Name – Prerana Rupesh Vele.

Kindly record my signature as per old stage.

I request you please change my name in my policy.

Thanking You

(Prerana Rupesh Vele)