Standard Proposal Form For Life Insurance Policies - IRDA

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ANNEXURE APROPOSAL FORMName of Insurer :Agency / Broker Name and contact details :Licence No. & Validity Details :Affix latestpassport sizephotographhere1. Basic InformationA. DETAILS OF PROSPECTNameSpouse’s NameFather’s NameMother’s NameGenderDate of birthAge ProofIdentification marksAddress for CommunicationPermanent AddressAddress ProofTelephone ( Landline/Mobile)E-mail idMarital statusNationalityEducation QualificationsState of healthSmokerDo you consume alcohol regularly?Excellent/Very good/Good/Moderate/PoorYes/NoYes/NoWhy do you want to take this policy?2. PAN Number/ Aadhaar Number:4
PAN NumberAadhaar Number3. Family detailsNumber of dependantsDetails of dependants 1 2 3 4 5NameMale/FemaleRelationshipAgeDate of BirthState of health ( Excellent/Verygood/Good/Moderate/Poor)OccupationWhether financially dependentAny scope for expansion of familyYes/No4. Employment detailsOccupationNature of WorkLength of serviceAnnual incomeDetails of Income proof submittedWhether covered under pensionschemeNormal retirement age5. Pension detailsEmployer's Scheme/<strong>Insurance</strong>Personal contribution/PremiumRetirement age5
Page 6 and 7: Anticipated value6. How do you proj
Page 8 and 9: Have you ever consulted a doctor be
Page 10: 5. Details of commitment for thecur

Standard Proposal Form For Life Insurance Policies - IRDA

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