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0% found this document useful (0 votes)
96 views3 pagesReliance Insurance
Uploaded by
sharathkumarreddy2021Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
GENERAL [Link]
Bee URANCE Tol ree) 1800 3009
[A RELIANCE CAPITAL COMPANY (022) 4890 3009 (Paid)
Combo Proposal Form Proposal FoomNo=
Please note:
1. Tobefiledandsignedby Proposer
2. ThisProposalform shalbe the basi ofcntractfor Cover
(nen een)
Intermediary Name LYE: B:AIN Ki Lil Mit Ty EyD J Code 4,718 3,7, 7,0, 6]
IMD Employee Code
IMO Branch Code
ECan en nore)
4, Proposer’s FulName (MriMrsuMs,) Lo tibus vty yy yy ey ody ey Vy a sy
2. Proposer'sAddross J
city L J Pin Code L J statel J
Phone L J emai L J
3. Gender O Male Female 4. Date of sith Lad Lm a y
5. PANNo. Ll J 6. UID Aadhaar No. L J
7. Do youhave a GST Registration Number Oo Yes 1 No
IWY¥es, please specify L J
8. Status of Proposer] Main Proposer [] Co-Proposer 9. Loan Account Holder 1 Single CI Joint
10. Source of Funds —-«}._ Business] Profession C1 Salary C] Agricultural Income] Savings [1 others
41. Monthly Income upto ® 20,000 FI ¥ 20.00% to 50,000 C1 £50,001 to 1,00,000 CI © 1,00,00tand above
12, Profession, Trade, Business or Occupation ofthe Proposer
1. Lean Account No, (LAN) Customer 1D
2. Loan Tenure: 3. Sanction DatelAmount Ld
4 Disbursal Date! Amount 1 5. Type otLoan
6.
Le
Please specity if currently you aro ropaying any alr Toan ‘Loan EMT
(ene)
1. Nominee Name Le
2. Gender []Male []Female 3. Date of Birth rym
4. Relationship with Proposer
roduct opted
1 Home LoanProtect Policy Group Mesicaim
1 ersonal Loan Care insurance TF Atotoan Care nsirance
Financial Protection Personal Accent Poly
‘An [80 9001:2015 Cerifed Company
IRDAI Registration No, 103, Rellance General insurance Company Limited. Registered Office: H Block, 1 Flor, Dhrubhal Ambani Knowledge Cty, Navi
Mumbai- 400710. Corporate Office: Reliance Contre, South Wing, 4” Flor, Of. Wostem Express Highway, Santacruz (Eas), Mumbai~400 055. Corporato
Identity Number US6603MH2000PLC128300. This advertisement fs designed for combination of Benes af wo or more individual and separate products
names. 1) Reliance Home LoanProtect Policy (UIN: IRDVNL-HLT/RGUP-HNV.U525/13-14), 2) Rene Personal Loan Care Insurance (UIN: RDN:
HUTIRGUP-HVLI326/15-"4), 3) Relance AutoLoan Care Insurance (UIN: IRDANL-HLTIRGUP-HIVII327/13-14).4) Group Medielim (UIN
RELHLGP0200"¥010102 }, 5) Financial Protecton Personal Accident Poy (UIN: RELPAGP18103V011718 ) Trade Logo esplayed above belongs to An
Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGIMCOMICOICOMBO-PROPOSALVer. 1.107119, 1. Sum insured (Sum Insured cannat exceed Sanctioned Amount)
2 PEDDetais —Yes_—=No_ (Yes, then please mention)
3, Make & Model (Only for Auto Loan).
4 Product: Pian
Home LoanProtect Policy Secton:a-p 1
Home LoanProtect Policy secton:a-F OI
‘AutoLoan Care insurance Section :A-0 E]
Personal Loan Care insurance Section :A-D EF]
‘overage Suminsured Basis Coverage ‘Suminsured Basis
‘Secfon-Rasintal Death
Permanent otal isabilty oor
