Proposal form

Proposer Details

Name Of Proposer Date of Birth Part of Insurer

Add Family members

Note:- If you change family size your Premium amount will aslo change.

Insured Relationship with applicant* Full Name* Date of Birth* Height(Ft.Inches) Weight(in Kg)
Adult 1
Adult 2
Child 1
Child 2
Child 3

Proposer Details

Medical Conditions/Disease and Lifestyle Adult 1Adult 2Child 1Child 2Child 3
Pre-existing medical conditions/disease/Illness?

Personal Information

Document Details Document Details
PAN Number Name
Aadhaar No Date of Birth (dd/mm/yyyy)
Part of Insured Person Annual Income
Email ID Alternate Email
Mobile Number Alternate Mobile
Permanent Address Address  Tick if Correspondence Address is different from Permanent Address
Nominee Name: DOB of Nominee:
Relationship with Nominee:

Upload You Bank Details.

Document Details Document Details
Bank Name Branch
Account Number IFSC
Account Type
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