Standard Proposal Form For Life Insurance Policies - IRDA

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Have you ever consulted a doctor because of an irregularity at the breast, vagina, uterus,ovary, fallopian tubes, menstruation, birth delivery, complications during pregnancy orchild delivery or a sexually transmitted disease?YES/NOSections 41 and 45 to be reproducedDeclaration of Proposer regarding correctness of the information provided.Signature of ProposerC. NEEDS OF PROSPECT1. Affordable contribution—Current and projectedYEARYearlyLastYearCurrentYear5-10Years10-15Years15-20Years20-25Years25-30YearsMonthly2. Identified insurance needsLife Insurance ( Death/Maturity)Desirable Sum AssuredHealth InsuranceDesirable limit of coverage per annumSavings and Investment PlanningDesirable returns per annumPension planningDesirable pension per annum3. Insurance Plan Details ( Traditional/ULIP/Pension/Health)Plan NamePremium TypePayment Mode8
Payment MethodPremium TermCoverage TermSum AssuredBenefits/Riders/Fund Allocation4. Identified Life needs Projections per annumITEM/YEARFood, shelter, clothing and other livingexpenses such as transportationexpenses, utilities etcLastYearCurrentYear5-10Years10-15Years15-20Years20-25Years25-30YearsEducation expensesHealth expensesMarriage expensesVacations and other travel expensesOther commitments such as insurancepremium, various contributions etcTOTALD. RECOMMENDATION1. Recommendation:1. Life stage Childhood/Young unmarried/Young married/ Young married withchildren/married with older children/post-family or preretirement/retirement2. Protection needs Life & Health/Savings and Investment/Pension3. Appetite for risk Low/Medium/High4. Policy recommended, includingname of insurer9
Page 4 and 5: ANNEXURE APROPOSAL FORMName of Insu
Page 6 and 7: Anticipated value6. How do you proj
Page 10: 5. Details of commitment for thecur

Standard Proposal Form For Life Insurance Policies - IRDA

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