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    JITENDRA

    Uploaded by

    Asrar Khan
    This document contains a data sheet for a life insurance policy holder named Jitendra Kumar Ahari. It provides his personal details like name, date of birth, gender, occupation, income, address, contact information, nominee details, and required documents. The policy has a sum assured of Rs. 240000 and an annual premium of Rs. 7990. The data sheet collects information needed to process the insurance application and issue the policy.

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    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd

    JITENDRA

    Uploaded by

    Asrar Khan
    56 views2 pages
    This document contains a data sheet for a life insurance policy holder named Jitendra Kumar Ahari. It provides his personal details like name, date of birth, gender, occupation, income, address, contact information, nominee details, and required documents. The policy has a sum assured of Rs. 240000 and an annual premium of Rs. 7990. The data sheet collects information needed to process the insurance application and issue the policy.

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    This document contains a data sheet for a life insurance policy holder named Jitendra Kumar Ahari. It provides his personal details like name, date of birth, gender, occupation, income, address, contact information, nominee details, and required documents. The policy has a sum assured of Rs. 240000 and an annual premium of Rs. 7990. The data sheet collects information needed to process the insurance application and issue the policy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    56 views2 pages

    JITENDRA

    Uploaded by

    Asrar Khan
    This document contains a data sheet for a life insurance policy holder named Jitendra Kumar Ahari. It provides his personal details like name, date of birth, gender, occupation, income, address, contact information, nominee details, and required documents. The policy has a sum assured of Rs. 240000 and an annual premium of Rs. 7990. The data sheet collects information needed to process the insurance application and issue the policy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
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    DATA SHEET FOR Policy Holder / Proposer

    Application Number
    TRACK ID: RMPJITENDRADPR Product Name
    PREMIUM AMOUNT: Rs. 7990 SUM ASSURED : Rs. 240000
    Personal Details
    Name - Life Assured MR / MRS / MISS JITENDRA KUMAR AHARI

    Date Of Birth: 13-03-1969 Gender MALE Marital Status:MARRIED Nationality INDIAN

    Education: 1/9/1900 Occupation FARMER Annual Income 80000


    In Case of Service (mention
    Nature of Duties AGRICULTURE name & address of the
    employer)
    Do You Have Existing Policy with FGI Yes No If Yes Qoute Policy No.

    Father's NameLAL JI AHARI


    Complete Name before marriage ( In case of female)
    Is your Occupation associated with any specific hazards Yes No
    Communication Details

    Residence Address:77 , VIKASOTA , KALU GAMADA , BHOJATO KA ODA ,

    LandMark

    DUNGARPUR
    City/Town: Taluka: KALU GAMADA Dist: DUNGARPUR

    State: RAJASTHAN Pin: 314037 E-mail id:

    Telephone : Mobile:9602378917

    NOMINEE DETAILS

    Name: LAXMI AHARI Date Of Birth:21-08-1972

    Relationship to Insured Person: WIFE

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


    APPOINTEE DETAILS

    Name Date Of Birth:

    Relationship to the Nominee:

    Address :

    PROOFS DETAILS

    Age proof: Address proof: ID proof:

    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 Income:

    SIGNATURE

    Leader Name: HARI K TRIVEDI Place: UDAIPUR


    Mobile No. 9269696191
    Note :- * Demand Draft on the Name of “ FUTURE GENERALI INDIA LIFE INSURANCE CO LTD” payable at CHENNAI * Incase Insured
    is minor, Fill up the 2 data sheet forms - One for child & Another for Proposer - both Data Sheets should be Signed BY Proposer.
    Note :- * Demand Draft on the Name of “ FUTURE GENERALI INDIA LIFE INSURANCE CO LTD” payable at CHENNAI * Incase Insured
    is minor, Fill up the 2 data sheet forms - One for child & Another for Proposer - both Data Sheets should be Signed BY Proposer.

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