Sl.

No

Particulers
1 Name of the Life Assured
2 Proposer
3 Father's Name
4 Nominee Name and Relationship
5 Date of Birth of Life Assured
6 Date of Birth of Proposer
7 Place of Birth of Life Assured
8 Place of Birth of Proposer
9 Address for Communication
10 Permanent Address
11 Annual income
12 Occupation
13 Date of Entry into service
14 Father, Age, State of health
15 Mother, Age, State of health
16 Brothers, Age, State of health,
17 Sisters, Age, State of health,
18 Husband/Wife, Age, State of health
19 Bank Account Detail
20 Plan & Term
21 Mode
22 SA
23 Premium
24

Proposal Form detail

DATA BLANK SHEET
Deatil

Remarks