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Lic Data Sheet Male PDF

This document is an application for a male life insurance policy. It requests personal information such as name, address, date of birth, occupation, income, family history, health details, and documents required for the application such as age, ID, and address proofs, photos, pay slips, tax returns, previous policy details, and discharge summaries for any hospitalizations. The applicant is also asked to provide nominee details, policy term and premium information, and provide a signature.

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4K views1 page

Lic Data Sheet Male PDF

This document is an application for a male life insurance policy. It requests personal information such as name, address, date of birth, occupation, income, family history, health details, and documents required for the application such as age, ID, and address proofs, photos, pay slips, tax returns, previous policy details, and discharge summaries for any hospitalizations. The applicant is also asked to provide nominee details, policy term and premium information, and provide a signature.

Uploaded by

Anonymous UfOB6i6V
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • LIC Data Sheet / Male Life: Collector data for male life insurance, including personal information, family history, and required document list.

LIC DATA SHEET / MALE LIFE

Please fill in Capital letters only.


Track Id. No. :- ___________ Mob. No. :- ________________________ Phone No ______________________
Name in full :- ___________________________________Fathers full name :- _________________________
Present address :- ___________________________________________________________________________
__________________________________________________________________________________________
Occupation :- ______________________________ Nature of work :-__________________________________
Name of Employer :- __________________________ Length of service :- ____ Yrs. PAN :-_______________
Date of birth :- ___________ Place of birth :-____________________ Age. :-______Education :- ___________
Table / Term _____________ Sum Assured______________ Premium______________ Mode_____________
Income :- ______________ Tax Payer :- Yes / No Name of Nominee :-________________________________
Relationship :-_________________________________ Nominee DOB :-__________________ Age :-_______
FAMILY HISTORY

Relationship Age State of Health Age at Death Cause of Death

Father
Mother
Brothers
Sisters
Husband/Wife
Children

Height :-____ Weight :- ______ Specs Power :- _____________Identification :-_________________________


Surgery if any ______________________________________________________________________________
Hospitalisations if any _______________________________________________________________________
Documents Required :-
1) Age Proof,
2) ID Proof,
3) Address Proof,
4) Passport size photo,
5) Latest pay slip,
6) Professionl certificates
7) Previous Policy Details
8) Last 3years IT Returns or Form 16
9) Discharge Summary in case of Hospitalizations
10) Cheque in favorer of LIC OF INDIA A/C payee.
11) Annexure A&B with proposer assets and liabilitys details (If sum assured exceeding Rs.20lakhs and above)

Date :- ________________ Specimen Signature :- ___________________

LIC DATA SHEET / MALE LIFE Please fill in Capital letters only. Track Id. No. :- ___________ Mob. No. :- __________________

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