Declaration: I the undersigned claiming as the Assured/Named Beneficiary hereby authorize and request Heirs Life Assurance
Limited to pay the net amount above being
by cheque/transfer payable to me in full satisfaction and discharge of all claims in respect of the above life policy. I do further solemnly and sincerely declare that I am the legal holder of this Policy/Beneficiary and that my Estate has not been sequestrated, assigned or pledged this policy either by ante-nuptial contract or otherwise to anyone, is not subject to any prior or preferment claim and has not, except in favour of the Company been encumbered in any manner whatsoever.
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