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Proposer Details (Person who will pay premium for this policy)

Please enter Proposer's Birth date

Date of Birth*

Gender*

Please enter Proposer's First Name

First Name*

Please enter Proposer's Last Name

Last Name*

Please enter Proposer's Mobile No

Mobile No*

Plan Details

Please enter Annual Investment Amount

Annual Investment Amount*

Please select Premium Payment Term

Premium Payment Term*

Please select Policy Term

Policy Term*

Please select Premium Mode

Payment Frequency

Pleease enter Modal Premium

Sum Assured*

Please select Maturity Payout Option

Maturity Payout Option

For more details on risk factors, terms and conditions please read the sales brochure carefully before concluding a sale.

Insurance is a contract of utmost good faith and the Life to be Insured/Proposer (If different from Life to be Insured) is required to disclose all material facts to the insurer. All answers to the questions stipulated in this Proposal form are the basic of and are an inseparable part of the policy of insurance. In case of doubt as to whether a fact is material or not, the fact should be disclosed. Please answer all questions. For more details on risk factors, terms and conditions please read the sales brochure carefully before concluding a sale.