Cheok list cum ConfidentialReport by RPL

RPLI salesperson/Agents proeuring RPLI policy will carefully check & verify the following
documents before completing the Confidential Report in respect of each RPLI proposal:
Age proof (self-attested/thumb impressed copy of any of the following documents
I.
a.
Standard Age proof (any of the following documents)
Birth Certificate
b.
School Certificate/Mark sheet
C. PAN Card
d. Passport
e. Driving License
Il.
Non-Standard Age Proof (any of the following documenls)
a.b. Aadhar Card
Elders declaration
C. Medical Examiner's approximate age certificate
d. Declaration by insurant counter signed by Panchayat Member
ii.
e. Voter ID
Address/Identity Proof (any of the following documents)
a. Aadhar Card
b. Passport
C. Driving License
Ration Card
e. Electricity Bill/Water Bill

Confidential Reportito be completed by the RPLu Agent/Salesperson)

(This will consist of information not revealed in the proposal form.
Agent procuring policy after proposal form is completed by proposer. Content ofcompleted
This will be by
RPLI
the record shouldd
not be discussed with the
proposer or divulged to him.)

1. Are you reated to the proposer?

2. Are you
aware of any financial/physical/mental situation concerning
proposer which makes him unsuitable for consideration of his Insurance
proposal?
3.In case of any doubt. please visit the concerned police station/village
sarpanchand verifyifthe proponent was ever arrested/convicted in the
criminal case. 1fyes, give details.
4. Has he signed/impressed the proposal/Declaration form?
5. Ay other matter you would like to bring to the notice of Proposa
accepting authority.
6. Do you recommend the acoeptance of the propasal?

7.fnot recommended, gve reasons.

8.produced
Haveyoubycorrectlyverified
proposer &dhecked Age proof(Non-standard)
9.Have you inquiredabout general health condition of the proposer and
conlirm that he/sbe is not suffering from any serkous/terminal ilnes.

10.Has the required medical tests/ examinationof the proposer been

carried out by authorised medical examiner and is found fir/unfit Yes No

11. Please confirm that:

0 Confidential report has becn written by you after completion of

by proposer.
Conrmed
proposal torm
Confidetial
with him.
report has not been divalged to proposer/ or discussed
Contmed

Signaturo of RPLI Agent:

Full Name with Agont

code N