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INSURANCE Information Sheet

Name of the Consultant (Primary policy holder)


SANJIB KR KUNDU

NOMINEE (NAME, ADDRESS AND RELATIONSHIP with consultant)

S.No Name Relationship Age Address


FLAT# 1B,1ST
RASHMI Floor,C/2,Ramgarh,Kolkata-
1 JHA WIFE 34 700047

Program / Cluster-

Permanent address of the consultant


FLAT# 1B,1ST Floor,C/2,Ramgarh,Kolkata-700047

Contact no during emergency situation. RASHMI JHA -9432674641

Signature:

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