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    Data Sheet

    Uploaded by

    Dinesh Verma
    This document contains an application for a life insurance policy. It requests personal details of the applicant such as name, date of birth, occupation, income, contact information, nominee details, and proof of identity, address, and age. If the applicant is female, it also asks if she is currently pregnant and if so, how many weeks. The document is to be signed by the applicant and includes instructions on payment by demand draft.

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

    Data Sheet

    Uploaded by

    Dinesh Verma
    23 views1 page
    This document contains an application for a life insurance policy. It requests personal details of the applicant such as name, date of birth, occupation, income, contact information, nominee details, and proof of identity, address, and age. If the applicant is female, it also asks if she is currently pregnant and if so, how many weeks. The document is to be signed by the applicant and includes instructions on payment by demand draft.

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    © Attribution Non-Commercial (BY-NC)

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    This document contains an application for a life insurance policy. It requests personal details of the applicant such as name, date of birth, occupation, income, contact information, nominee details, and proof of identity, address, and age. If the applicant is female, it also asks if she is currently pregnant and if so, how many weeks. The document is to be signed by the applicant and includes instructions on payment by demand draft.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    23 views1 page

    Data Sheet

    Uploaded by

    Dinesh Verma
    This document contains an application for a life insurance policy. It requests personal details of the applicant such as name, date of birth, occupation, income, contact information, nominee details, and proof of identity, address, and age. If the applicant is female, it also asks if she is currently pregnant and if so, how many weeks. The document is to be signed by the applicant and includes instructions on payment by demand draft.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    You are on page 1of 1

    DATA SHEET FOR Policy Holder / Proposer TRACK ID: PREMIUM AMOUNT: Rs.

    Application Number Product Name SUM ASSURED : Rs. Personal Details

    Name - Life Assured Date Of Birth: Education:


    Nature of Duties

    MR / MRS / MISS

    Gender Occupation

    Marital Status:

    Nationality Annual Income

    In Case of Service (mention name & address of the employer)

    Do You Have Existing Policy with FGI Father's Name


    Complete Name before marriage ( In case of female)

    Yes

    No

    If Yes Qoute Policy No.

    Is your Occupation associated with any specific hazards Yes

    No Communication Details

    Residence Address: LandMark


    City/Town:

    Taluka: Pin:

    Dist: E-mail id: Mobile:

    State: Telephone :

    NOMINEE DETAILS

    Name: Relationship to Insured Person:

    Date Of Birth:

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

    Name Relationship to the Nominee: Address :

    Date Of Birth:

    PROOFS DETAILS Age proof:

    Address proof:

    ID proof:

    All Proofs should be Clearly SELF ATTESTED BY PROPOSER (CUSTOMER) Females Only Are you pregnant. SIGNATURE Leader Name: Place: yes / No If yes - Duration in Weeks Husband Occupation & Annual Income:

    Mobile No. 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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