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    RMPNO9RAVIKUMAR191010 7990 Ravikumar Rs 5/3/1991 MEL Singal: Residence Address

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    sasirtr
    This document contains details of a life insurance policy application for Mr. Ravi Kumar including personal details, nominee details, proofs submitted, and signatures. Key details include the applicant's name, date of birth, sum assured of Rs. 240000, occupation as business, nominee as his mother Sridevamma, and proofs submitted of age and address. The document was signed by the applicant and agent Abhilash Reddy in Chinthamani.

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    RMPNO9RAVIKUMAR191010 7990 Ravikumar Rs 5/3/1991 MEL Singal: Residence Address

    Uploaded by

    sasirtr
    73 views4 pages
    This document contains details of a life insurance policy application for Mr. Ravi Kumar including personal details, nominee details, proofs submitted, and signatures. Key details include the applicant's name, date of birth, sum assured of Rs. 240000, occupation as business, nominee as his mother Sridevamma, and proofs submitted of age and address. The document was signed by the applicant and agent Abhilash Reddy in Chinthamani.

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    FGI5

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    This document contains details of a life insurance policy application for Mr. Ravi Kumar including personal details, nominee details, proofs submitted, and signatures. Key details include the applicant's name, date of birth, sum assured of Rs. 240000, occupation as business, nominee as his mother Sridevamma, and proofs submitted of age and address. The document was signed by the applicant and agent Abhilash Reddy in Chinthamani.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    73 views4 pages

    RMPNO9RAVIKUMAR191010 7990 Ravikumar Rs 5/3/1991 MEL Singal: Residence Address

    Uploaded by

    sasirtr
    This document contains details of a life insurance policy application for Mr. Ravi Kumar including personal details, nominee details, proofs submitted, and signatures. Key details include the applicant's name, date of birth, sum assured of Rs. 240000, occupation as business, nominee as his mother Sridevamma, and proofs submitted of age and address. The document was signed by the applicant and agent Abhilash Reddy in Chinthamani.

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    DATA SHEET FOR Policy Holder / Proposer

    Application Number
    TRACK ID: RMPNO9RAVIKUMAR191010 Product Name
    PREMIUM AMOUNT: Rs. 7990 SUM ASSURED : Rs.
    Personal Details
    Name - Life Assured MR / MRS / MISSRAVIKUMAR RS

    Date Of Birth:5/3/1991 Gender MEL Marital Status:SINGAL

    Education: BBM Occupation


    BUSINESS
    In Case of Service (mention
    Nature of Duties RMP name & address of the
    employer)
    Do You Have Existing Policy with FGI Yes No

    Father's NameUTTAMAREDDY
    Complete Name before marriage ( In case of female)
    Is your Occupation associated with any specific hazards Yes No
    Communication Details
    Residence Address:
    S/O UTTAMAREDDY, NAMALAPALLI[V], CHALIMAVIDI[POST], THAMB
    LandMark

    B KOTTAKOTA
    City/Town: Taluka:THAMBALAPALLI

    State: ANDRA PRADES Pin: 517370 E-mail id:

    Telephone : 9849690701 Mobile:

    NOMINEE DETAILS
    Name:SRIDEVAMMA Date Of Birth:

    Relationship to Insured Person: MOTHER

    Incase if nominee is a minor - Please provide following appointee details.


    APPOINTEE DETAILS
    Name Date Of Birth:

    Relationship to the Nominee:


    Address :

    PROOFS DETAILS

    RESHON CORD
    Age proof: AddressRESHON
    proof: CORD

    All Proofs should be Clearly SELF ATTESTED BY PROPOSER (CUSTOMER)

    Females Only

    Are you pregnant.


    yes / No If yes - Duration in Weeks
    Husband Occupation & Annual Inc

    SIGNATURE

    Leader Name: ABHILASH REDDY Place: CHINTHAMANI


    Mobile No. 9980115418
    oser
    TS3399743
    FGI
    SSURED : Rs. 240000

    SINGAL Nationality
    INDIAN

    Annual Income
    20000

    If Yes Qoute Policy No.

    MAVIDI[POST], THAMBALAPPALLI[TQ],CHITTOOR[D]
    LandMark SRIRAMA TEMPAL

    Dist: CHITTOOR

    E-mail id:

    9535126484

    Date Of Birth: 5/5/1973

    Date Of Birth:
    ID proof:
    RESHON CORD

    pation & Annual Income:

    CHINTHAMANI

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