Information Required for Term Insurance Process
Please fill your details in English and capital letters. You may feel free to call us on 9373907560 if you come across any query.
Your Full Name *
Please type your full name.
Your Father's Name *
Please type the full name
Your Mother's Name *
Please type the full name
Your Address as per AADHAAR *
Please type address, Landmark, City, and PIN Code
Your Place of Birth *
Your Date of Birth *
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DD
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YYYY
Your Contact No. *
Your E-mail Address *
Your PAN *
What is your Annual Income? *
Your Marital Status *
What is your Highest Education? *
Your Occupation details *
Select which is applicable
Name of the Company *
Company Address *
Please write the complete address along with the PIN Code
Total Number of Years in this service or Business *
Your Designation *
What is the nature of work your organization has? *
Name of the Nominee *
Date of birth of the Nominee
MM
/
DD
/
YYYY
Relationship with Nominee *
Existing Life Insurance Cover *
Total Life Insurance cover you have with all insurance policies
Your Height *
Your Weight *
Your Bank and Branch Name *
Your Bank Account Number *
Your Bank's MICR and IFSC *
Have you gain or lost weight in last 6 months *
Do you have an addiction of Tobacco or Alcohol? *
Please provide age details of the family members *
Age of Parents, brothers, sisters, spouse and kids
Do you need help for any of these following? *
Required
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