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Form No. 300 Agent

The document appears to be an application form for a life insurance policy, as it requests personal details of the proposed policy holder such as name, date of birth, occupation, income, family history, bank account details, and medical information. It also asks for details of the proposed insurance plan such as the sum assured, term, payment mode, and nominee details. The form requires signatures of the proposer, witness, and nominee to complete the application.

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Tarun Goyal
Copyright
© © All Rights Reserved
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75 views

Form No. 300 Agent

The document appears to be an application form for a life insurance policy, as it requests personal details of the proposed policy holder such as name, date of birth, occupation, income, family history, bank account details, and medical information. It also asks for details of the proposed insurance plan such as the sum assured, term, payment mode, and nominee details. The form requires signatures of the proposer, witness, and nominee to complete the application.

Uploaded by

Tarun Goyal
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
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OF THE LIFE TO BE
LIFE INSURANCE CORPORATION OF INDIA ASSURED
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FORM NO. QkeZ la[;k 300 (vfHkdrkZ mi;ksx gsrq izi= )
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Agent Name & Agency Code-

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Documents Detail (Policy Holder)

School Certificate
Aadhar Card
Driving License
Voter ID Card
PAN Card
Passport
3 F.Y. IT Return Certificate
GS TIN
C KYC

Bank Account Detail (Policy Holder For NEFT Feeding)


Name of Account Holder
Account Number
Type of Account
Bank Name
Bank IFSC Number
Bank MICR Number

Bank Full Address

Nominee Photo & Address Proof-

Aadhar Card
Driving License
Voter ID Card
PAN Card
Passport
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Full Name -
Fathers Name- Mothers Name-
Date of Birth- Age-
Spouse’s Full Name-
Education Qualification-
Present Occupation- Source of Income-
Name of the Present Employer-
Length of Service- Annual Income-
Mobile Number- WhatsApp Number-
E-mail-
Customer Portal ID-
Hight (CMS)- Weight (KG)-
Birth Mark-

Correspondence Address Permanent Address

Pin Code- Pin Code-

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Table Number- Plan Term-


Sum Assured- Mode of Payment-
Term Rider S.A.- Critical illness Rider-
Accident Benefit Rider (AB)
Accidental Death and Disability Benefit Rider (AD&DB)-
Paying Authority Code and Dep No (For SSS Policies)-
Back Dating-

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Appointee Relation
Name Share Age Relation Appointee
With Nominee
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Policy Number Company Name Plan Term Sum Assured DOC

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Death
Relationship Age
Age at Death Cause of Death
FATHER
MOTHER

BROTHER

SISTER

SPOUSE

SON

DAUGHTER

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Spouse Name- Spouse Occupation-


Spouse Annual Income-
Total Income (Self + Spouse)-
Secured Loan- Non-Secured Loan-
FOR FEMALE PROPONENTS ONLY
Date of Last Delivery-
Abortion or Miscarriage Cesarean Section-

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Policy Number Company Name Plan Term Sum Assured DOC

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