LIFE INSURANCE CORPORATION OF INDIA - POLICYHOLDER INFORMATION FORM

Name DoB Age Proof

Nominee
Age
Address Relation
Mobile Appointee *
E Mail Age
Relation
*Get the Sign of Appointee
Plan Policy Number
Sum Assured Term Premium { Very Important - Note down Carefully }
Term DoC
Father
Occupation Education Income Mother
Brother
Prev Policy No. DOC Sum Assured Sister
Carefully note down policies taken in the last two years Height Spouse
Children
Treatment
Weight Particulars
If Any
Lady / Minor Life Husband / Parent Policies Sum Assured Bank Account No.
Husband / Proposer Name:
DoB / Age IFSC
Bank
His Occupation Branch
Med Examiner Deduction Date: 07 / 15 / 22 / 28
Education Date Limit
Height Weight Remarks
Income
Documents Required
Photo Last Three Years Income Tax Return Copy with Statements
Aadhar Copy Please get sign in all the photocopies
PAN Copy