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LIC of India
413, B-Wing, Kamla City Park, Lower Parel (W), 1) Mumbai No 013 400 I need Questionnaire: Which Policy do You already Yes have ?Endowment Policy 1 3) Are You satisfied with Money-Back Policy LIC ? 2 Yes / No Retirement / Pension Policy 3 Child Education / Marriage 4 Policy Term 4) Are You satisfied with 5 Plan Your LIC Agent ULIP 6 Policy ? Whole Life Policy 8 Yes / No Mediclaim Policy 9 Policy from Private Company 10 5) Your suggestions and expectations from LIC ?
2) Which Service do You need from LIC ? (At no cost) (Please Tick) Change in Address Change in LIC Branch Change in Nomination (after Marriage) 6) Change in Payment Mode (Yly, Hly, Qly, Mly, ECS) Premium Reminder Service by 'SMS' / e-mail Premium Collection Service from Your Home / New Office Family Insurance Portfolio (FIP) LifeTime Your own 'Online Account' on www.licindia.in Personal Loan on LIC Policy / LIC Home Loan Renew Lapsed Policy (Revival) Information / Purchase of New Policy 8) Maturity Claim Money Back Policy Claim (Survival Benefit) Death Claim 9) Family Details: Nam e Relatio n Self Date of Birth
Do You believe in saving for Children's Education & Marriage?
Yes / No
7) Would You like to get Pension from LIC ? Yes / No Would You like our Representative to help / guide You for Your saving Plans ? Yes / No Has LIC Policy ? Old Policy Yes No I need Numbers, in case any 'Service' is opted
1 2 3 4 5
10) Resi. Address
Address 12) Contact No. Address Work Profile 14) Two References: (Kindly give Names of Friends for filling the same Feedback Form) 1 2 Nam e .PIN: 11) Off.s 13) Email Address : PIN: : : Signature:→ Mobile No.