Beruflich Dokumente
Kultur Dokumente
To Date: DD / MM / YYYY
Max Life Insurance Company Limited
I hereby declare that the name on the application form < Name on application form >and the name on
supporting document < Name of the document >, < Name on supporting document > are correct
and can be used interchangeably. For your records and my Max Life Policy, please use
I hereby declare my Date of Birth is <Date of Birth as per supporting document provided> as per
Customer Sign:
Date: .