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Application Form




Proposer - प्रस्तावक      Life Assured - जिसके लिये पॉलिसी लेना है
Height(cm):   Weight(Kg):
Educational Qualification :
Address: Mark of Identification: Place of Birth:
Name of nominee      Age   Relation

Occupation detail : Present Occupation Nature of duty
Organization            Length Source of income     Anual Income
Living Dead
Family Member Age Age at the time of death Cause of death
Father
Mother
Brothers
(Sapareted by ,)
Sisters
(Sapareted by ,)
Spouse
Childrens








Enter text bellow * :

Form filling Instruction

Please follow these instruction to filling the form.

  • Please Provide Required proper detail in appropreate field.
  • For child Plan Please select both date of birth 1. Age > 18 as your date of birth. 2. Age < 18 as your child date of birth.

Documents Required.

  • 2 Passport size Photograph(Proposor)
  • 2 Passport size Photograph(Child) if required
  • Your ID Proof
  • School ID Card(Child) if age > 5
  • Your Age Proof
  • Age Proof(Child) if required
  • Address Proof

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