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  • Premier Services Registration: Ram Pratap Verma 15/09/1990 84 45

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    Ramv
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    This document is a form for registering for Premier Services with an insurance company. It contains fields for the customer's name, date of birth, mobile number, email, PAN, and passport number. It also lists an eligible life insurance policy for the customer, including the policy number, customer's date of birth, and annual premium amount. At the bottom, the customer agrees that they have read and accept the Terms of Service for Premier Services registration and that all online transactions under their user ID and password will be binding.

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    222300421302_

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    This document is a form for registering for Premier Services with an insurance company. It contains fields for the customer's name, date of birth, mobile number, email, PAN, and passport number. It also lists an eligible life insurance policy for the customer, including the policy number, customer's date of birth, and annual premium amount. At the bottom, the customer agrees that they have read and accept the Terms of Service for Premier Services registration and that all online transactions under their user ID and password will be binding.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    4 views1 page

    Premier Services Registration: Ram Pratap Verma 15/09/1990 84 45

    Uploaded by

    Ramv
    This document is a form for registering for Premier Services with an insurance company. It contains fields for the customer's name, date of birth, mobile number, email, PAN, and passport number. It also lists an eligible life insurance policy for the customer, including the policy number, customer's date of birth, and annual premium amount. At the bottom, the customer agrees that they have read and accept the Terms of Service for Premier Services registration and that all online transactions under their user ID and password will be binding.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    *This form is to be printed, signed and uploaded back to submit the Premier Service Registration

    request.

    Premier Services Registration

    Name Date of Birth Mobile Number

    Ram Pratap Verma 15/09/1990 84******45

    EmailID PAN Passport Number


    pr********21@gmail.com ANXXXXXX3A

    Eligible Policies for Premier Services

    Name Policy Number Date of Birth Premium (`)

    Ram Pratap Verma 276518822 15/09/1990 15,788.00

    * I have read the provisions contained in the "Terms of Service: Registration for LIC's Premier Services"and accept
    them. I agree that all transactions executed over LIC's web-site: www.licindia.in under my User-ID and Password
    will be binding on me.

    Signature

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