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  • Proposal Form Personal Accident Insurance

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    Kamal Singh
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    Yograj, aged 41, is applying for a personal accident insurance policy with a sum insured of Rs. 200,000 from Vrinda Publications Pvt. Ltd. The policy would cover him for 12 months and provide medical benefits. He works as a service employee earning Rs. 96,000 annually and is entitled to cumulative bonuses. Yograj does not engage in any high-risk activities and has nominated his wife Veena as the policy beneficiary.

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    Yograj, aged 41, is applying for a personal accident insurance policy with a sum insured of Rs. 200,000 from Vrinda Publications Pvt. Ltd. The policy would cover him for 12 months and provide medical benefits. He works as a service employee earning Rs. 96,000 annually and is entitled to cumulative bonuses. Yograj does not engage in any high-risk activities and has nominated his wife Veena as the policy beneficiary.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    20 views2 pages

    Proposal Form Personal Accident Insurance

    Uploaded by

    Kamal Singh
    Yograj, aged 41, is applying for a personal accident insurance policy with a sum insured of Rs. 200,000 from Vrinda Publications Pvt. Ltd. The policy would cover him for 12 months and provide medical benefits. He works as a service employee earning Rs. 96,000 annually and is entitled to cumulative bonuses. Yograj does not engage in any high-risk activities and has nominated his wife Veena as the policy beneficiary.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    PROPOSAL FORM PERSONAL ACCIDENT INSURANCE

    1. NAME & ADDRESS OF INSURED

    Yograj R/O.31/293 TRILOK PUR,Delhi,110091


    ------------------------------------------------------------------------------------------------------------ --------2. OCCUPATION (YEARLY INCOME) SERVICE (RS.96000/-)
    ------------------------------------------------------------------------------------------------------------ --------3. C.S.I RS.2,00,000/------------------------------------------------------------------------------------------------------------ --------4. ENTITLEMENT OF CUMM. BONUS YES
    ------------------------------------------------------------------------------------------------------------ --------5. AGE (COMPLETED IN YEARS) 41 YEARS / H- 510/ W- 65 KG/ DOB 19/06/1970
    ------------------------------------------------------------------------------------------------------------ --------6. PERIOD OF INSURANCE 12MONTHS HOURS
    TO
    ------------------------------------------------------------------------------------------------------------ --------7. TABLE OPTED
    3
    ------------------------------------------------------------------------------------------------------------ --------8. MEDICAL BENEFIT EXT YES
    YES/ NO
    ------------------------------------------------------------------------------------------------------------ --------9. PHYSICAL DISABILITY IF ANY NO
    ------------------------------------------------------------------------------------------------------------ --------10. DO YOU ENGAGE IN : NO
    RACING ON WHEELS OR HORSEBACK/BIG/
    GAME HUNTING/ MOUNTAINEERING/
    WINTER SPORTS SKATING/ ICE HOCKEY/
    BALLOONING /POLO
    ------------------------------------------------------------------------------------------------------------ --------11. NOMINEE NAME & RELATION VEENA ( WIFE )
    ------------------------------------------------------------------------------------------------------------ --------12. PRO POSERS NAME VRINDA PUBLICATIONS P LTD.
    ------------------------------------------------------------------------------------------------------------ ---------

    PLACE DELHI

    DATED 01/05/2012

    SIGN. OF PROPOSER

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