This document contains a proposal form for life insurance on an individual's own life. It requests information such as the proposed insured's name, address, age, occupation, income, family medical history, personal medical history, existing insurance policies and beneficiary details. The proposed insured is required to declare that their statements are true and complete, and consent to the insurer obtaining medical information if required. Witness signatures are also required.
This document is an application for a deferred annuity from Farm Bureau Life Insurance Company. It collects information such as the proposed annuitant's name, date of birth, social security number, and contact details. It also requests details about the type of annuity and plan being applied for, including premium payment amounts and frequencies. The application is signed by the proposed annuitant, owner if different, and agent to certify that all statements are true.
This document is a consumer credit application that collects personal and financial information from an applicant. It requests information such as name, social insurance number, address, contact details, employment details including income and length of employment, bank account details, credit history, existing debts and debt ratios. It also includes optional protections that can be purchased, such as credit life protection that pays off the loan if the applicant passes away, sickness and injury protection that makes payments if the applicant cannot work due to illness or injury, critical illness protection that pays the loan if the applicant suffers certain critical illnesses, and loss of employment protection that makes payments if the applicant loses their job involuntarily. The applicant signs to authorize the use of their information to evaluate creditworthiness
This document appears to be an intake form for a law office collecting information about potential clients seeking a divorce. It requests detailed personal and financial information from both the client and their spouse, including names, addresses, employment details, assets like real estate, vehicles, bank accounts, debts, and insurance. It also asks about the client's demands regarding issues like child custody, support, property division in a potential divorce case.
The document discusses several key Indian labor laws:
1. The Employees' State Insurance Act provides medical benefits and cash benefits for lost wages to eligible employees of factories and establishments.
2. The Employees' Provident Fund & Miscellaneous Provisions Act requires contributions to a provident fund for eligible employees. This is payable on retirement, death, or withdrawal.
3. The Employees' Pension Scheme provides pension benefits for survivors, retired, and disabled eligible employees based on years of service and salary.
This document contains a property claim form for Calliden insurance. It requests information to process a claim for loss or damage to insured property. The three-page form requests details of the policy, loss event, repair costs, previous claims history, and a declaration authorizing Calliden to process the claim. It also contains brief sections on Calliden's privacy policy and disputes resolution process.
This document provides forms and instructions for a hardship assistance package to help borrowers who are behind on their mortgage payments or in danger of default. It requests copies of recent pay stubs, tax returns, and bank statements. It includes forms to provide borrower information, property details, income and expense details, assets, general hardship questions, and an authorization to release information. Borrowers are instructed to complete as many questions as possible and that additional information may be needed to thoroughly review the situation.
This document is a machinery claim report form from CGU Insurance Limited. It requests information from the policyholder to process a machinery insurance claim, including the policy number, contact details, description of the damaged or lost machinery, and purchase details. The form advises that CGU will contact the policyholder about the claim and requests the repair quote or account be attached when submitting the completed form.
This document is an application for a deferred annuity from Farm Bureau Life Insurance Company. It collects information such as the proposed annuitant's name, date of birth, social security number, and contact details. It also requests details about the type of annuity and plan being applied for, including premium payment amounts and frequencies. The application is signed by the proposed annuitant, owner if different, and agent to certify that all statements are true.
This document is a consumer credit application that collects personal and financial information from an applicant. It requests information such as name, social insurance number, address, contact details, employment details including income and length of employment, bank account details, credit history, existing debts and debt ratios. It also includes optional protections that can be purchased, such as credit life protection that pays off the loan if the applicant passes away, sickness and injury protection that makes payments if the applicant cannot work due to illness or injury, critical illness protection that pays the loan if the applicant suffers certain critical illnesses, and loss of employment protection that makes payments if the applicant loses their job involuntarily. The applicant signs to authorize the use of their information to evaluate creditworthiness
This document appears to be an intake form for a law office collecting information about potential clients seeking a divorce. It requests detailed personal and financial information from both the client and their spouse, including names, addresses, employment details, assets like real estate, vehicles, bank accounts, debts, and insurance. It also asks about the client's demands regarding issues like child custody, support, property division in a potential divorce case.
The document discusses several key Indian labor laws:
1. The Employees' State Insurance Act provides medical benefits and cash benefits for lost wages to eligible employees of factories and establishments.
2. The Employees' Provident Fund & Miscellaneous Provisions Act requires contributions to a provident fund for eligible employees. This is payable on retirement, death, or withdrawal.
3. The Employees' Pension Scheme provides pension benefits for survivors, retired, and disabled eligible employees based on years of service and salary.
This document contains a property claim form for Calliden insurance. It requests information to process a claim for loss or damage to insured property. The three-page form requests details of the policy, loss event, repair costs, previous claims history, and a declaration authorizing Calliden to process the claim. It also contains brief sections on Calliden's privacy policy and disputes resolution process.
This document provides forms and instructions for a hardship assistance package to help borrowers who are behind on their mortgage payments or in danger of default. It requests copies of recent pay stubs, tax returns, and bank statements. It includes forms to provide borrower information, property details, income and expense details, assets, general hardship questions, and an authorization to release information. Borrowers are instructed to complete as many questions as possible and that additional information may be needed to thoroughly review the situation.
This document is a machinery claim report form from CGU Insurance Limited. It requests information from the policyholder to process a machinery insurance claim, including the policy number, contact details, description of the damaged or lost machinery, and purchase details. The form advises that CGU will contact the policyholder about the claim and requests the repair quote or account be attached when submitting the completed form.
This document is a product disclosure statement and policy wording for First Option Business Insurance. It contains important information about the General Insurance Code of Practice, underinsurance/average clauses, duty of disclosure requirements, privacy policy, and details to be provided in the application form such as business/premises details, interests of other parties, and security measures in place.
1) The document is a general claim form from an insurance company.
2) It requests information about the claimant, their policy, and details of the incident to lodge a claim.
3) The form notes that submitting a claim does not mean the company admits liability, and requires signatures to authorize the company to collect information in assessing the claim.
Use this worksheet when starting the process of filing for personal bankruptcy or a personal proposal to provide to the Trustee information about your financial situation.
It can be printed, filled out, and faxed to us or you can type directly on it and email it to us.
Contact us at: 888-504-1511
or visit: http://www.djallen.ca
The document is a confidential questionnaire for gathering a client's basic financial situation. It requests information about family status, occupation/income, mortgages, real estate, savings, investments, and other assets. Providing this information and accompanying documents will help ensure the best use of time during a financial interview and allow for a discussion of appropriate options given the client's specific circumstances.
The document outlines various VA and military benefits and indicates whether veterans who received different types of discharges are eligible for each benefit. It shows that veterans with an honorable discharge are eligible for all benefits, while those with a dishonorable discharge or bad-conduct discharge are generally not eligible unless approved by the administering agency. Veterans with other than honorable or general discharges under honorable conditions may be eligible for some benefits.
This document is a global health insurance application form. It requests personal details of the applicant and any family members to be covered, including name, address, contact information, date of birth, nationality, occupation, and country of residence. It also asks about previous and current insurance coverage. The applicant selects the type of health insurance plan and coverage area desired. Additional optional plans like travel and personal accident insurance can be included. The applicant provides medical history details and declares their health and any pre-existing conditions. Contact information is requested for the applicant and family members' primary treating physicians. The applicant selects the payment currency, method, and frequency for insurance premiums.
Sample 5 page loan modifcation proposal with before and after budgets, cash flow, payments based on HAMP NPV model version 3. Excellant way to begin rapport with lender. Organization, calculation, presentation & negotiation. Used alongside lenders papaerwork.
This document provides a Good Faith Estimate (GFE) of settlement charges and loan terms for a $294,566 loan with a 30-year term and 5% interest rate. The total estimated settlement charges are $13,501.44, including adjusted origination charges of $3,750 and charges for other settlement services totaling $9,751.44. The monthly principal and interest payment would be $1,713.98, not including amounts for taxes and insurance held in an escrow account. The interest rate can increase over the life of the loan but the loan does not have prepayment penalties or balloon payments.
This document provides an overview of health and welfare benefits as well as retirement and savings plans offered by Lincoln. The benefits include medical, dental, vision, life and disability insurance, as well as 401k, pension, and deferred compensation plans. Premiums, contributions and eligibility requirements vary depending on factors such as income level and years of service. The plans are subject to amendment by Lincoln and the official plan documents will govern in all cases.
This document is an application agreement to become an independent consultant for Nikken UK Limited. Key details:
- The applicant agrees to the terms and conditions of being a Nikken consultant as outlined in this agreement and related documents.
- As a consultant, the applicant will purchase products only from Nikken and promote the products and business opportunity lawfully and ethically.
- Nikken agrees to pay commissions to the consultant according to their compensation plan and supply products for orders placed according to their procedures.
- The agreement can be terminated by either party with 14 days notice, or immediately by Nikken for breaches of the agreement. The applicant has 14 days to cancel the agreement for a full refund.
This document is a Canadian income tax return form for the year 2010. It requests personal information such as name, address, social insurance number, date of birth, marital status, and residence. It also has sections to provide information about a spouse or common-law partner. There are questions regarding citizenship, authorization to share information with Elections Canada, and application for GST/HST credit. The document is multi-page and requests additional financial information to complete the income tax filing.
This document is a proposal form for a family floater health insurance policy from Bajaj Allianz General Insurance Company. It collects personal and medical information about the proposer and family members to be insured. The proposer must provide full and accurate information in the proposal form which will form the basis of the insurance policy if issued.
Proposal form is the most important and basic document required for life insurance contract between the insured and insurance company. It includes the insured's basic information like address, age, name, education, occupation etc. It also includes the person's medical history.
The document is a declaration of good health form completed by a life assured individual seeking to revive their life insurance policy. It contains questions regarding the individual's medical history since the policy was issued, including any illnesses, operations, accidents, examinations, as well as changes in health, occupation, residence, or pregnancy status (for females). The individual declares that their answers are true and complete. A witness signature is required to verify the individual's statements. The individual requests revival of their policy and encloses payment.
The document is a declaration of good health form completed by a life assured individual seeking to revive their life insurance policy. It contains questions regarding the individual's medical history since the policy was issued, including any illnesses, operations, accidents, examinations, as well as changes in health, occupation, residence, or pregnancy status (for females). The individual declares that their answers are true and complete. A witness signature is required to verify the individual's statements. The individual requests revival of their policy and encloses payment.
This document is an application form for a position with Sutton Coldfield Dairies. It requests personal details, education and employment history, references, and availability for an interview. It also notes that a background check including criminal record check will be conducted as part of the hiring process due to the nature of the dairy business. The applicant is asked to provide thorough details to account for the past 10 years. Debts, bankruptcies, and legal judgments are also addressed. The final page includes interview notes fields.
This document is an insurance claim form from BCS Insurance Company. It requests information from the insured to process a claim, including the insured's details, patient information if different, description of the accident or sickness, prior treatment history, employment details, other insurance coverage, and an authorization to obtain medical records. The insured signs to authorize payment of benefits and to allow their medical information to be disclosed for processing the claim.
Revival of Lapsed Policy Forms Fno 680Indialic .in
This 3 page document is a personal statement form regarding health for the revival of a lapsed life insurance policy. It collects information about the policy holder's health and medical history since the original application. It asks if the policy holder has suffered any illnesses, had any operations or medical tests, or previously had any insurance applications declined or modified. It collects current health and biometric details and pregnancy information for females. The policy holder must declare that all information provided is true and complete, and agrees to notify the insurer of any health changes before the policy is revived. Witness signatures are required.
This document is a request form for innocent spouse relief from the Utah State Tax Commission. It collects information about the taxpayer seeking relief such as their name, address, social security number, filing status, and relationship details. The form asks if the taxpayer filed a joint return, is legally separated or divorced from their spouse, and if the underpayment or understatement of tax is due to erroneous items from or attributable to their spouse. It concludes by having the taxpayer and preparer sign under penalty of perjury.
This document is a request form for innocent spouse relief from the Utah State Tax Commission. It collects information about the taxpayer filing for relief such as their name, address, social security number, filing status, and relationship status with their spouse. The form asks if the taxpayer filed a joint return, is legally separated or divorced from their spouse, lived apart from their spouse for the last 12 months, or if their spouse is deceased. It also inquires about understatements or underpayments of tax on joint returns and whether the taxpayer has already filed for innocent spouse relief with the IRS.
1) Isaac Vimal Raj is applying for a position in utility operation and maintenance with BGR Energy Systems Limited. He has over 35 days notice required if selected.
2) Vimal is 28 years old and currently resides in Dubai, UAE but is originally from Ukkirankottai, Tamil Nadu, India.
3) He has a bachelor's degree in electrical engineering and speaks Tamil, English, and has basic knowledge of Hindi. He is interested in areas related to power plant equipment maintenance and troubleshooting.
This document is a product disclosure statement and policy wording for First Option Business Insurance. It contains important information about the General Insurance Code of Practice, underinsurance/average clauses, duty of disclosure requirements, privacy policy, and details to be provided in the application form such as business/premises details, interests of other parties, and security measures in place.
1) The document is a general claim form from an insurance company.
2) It requests information about the claimant, their policy, and details of the incident to lodge a claim.
3) The form notes that submitting a claim does not mean the company admits liability, and requires signatures to authorize the company to collect information in assessing the claim.
Use this worksheet when starting the process of filing for personal bankruptcy or a personal proposal to provide to the Trustee information about your financial situation.
It can be printed, filled out, and faxed to us or you can type directly on it and email it to us.
Contact us at: 888-504-1511
or visit: http://www.djallen.ca
The document is a confidential questionnaire for gathering a client's basic financial situation. It requests information about family status, occupation/income, mortgages, real estate, savings, investments, and other assets. Providing this information and accompanying documents will help ensure the best use of time during a financial interview and allow for a discussion of appropriate options given the client's specific circumstances.
The document outlines various VA and military benefits and indicates whether veterans who received different types of discharges are eligible for each benefit. It shows that veterans with an honorable discharge are eligible for all benefits, while those with a dishonorable discharge or bad-conduct discharge are generally not eligible unless approved by the administering agency. Veterans with other than honorable or general discharges under honorable conditions may be eligible for some benefits.
This document is a global health insurance application form. It requests personal details of the applicant and any family members to be covered, including name, address, contact information, date of birth, nationality, occupation, and country of residence. It also asks about previous and current insurance coverage. The applicant selects the type of health insurance plan and coverage area desired. Additional optional plans like travel and personal accident insurance can be included. The applicant provides medical history details and declares their health and any pre-existing conditions. Contact information is requested for the applicant and family members' primary treating physicians. The applicant selects the payment currency, method, and frequency for insurance premiums.
Sample 5 page loan modifcation proposal with before and after budgets, cash flow, payments based on HAMP NPV model version 3. Excellant way to begin rapport with lender. Organization, calculation, presentation & negotiation. Used alongside lenders papaerwork.
This document provides a Good Faith Estimate (GFE) of settlement charges and loan terms for a $294,566 loan with a 30-year term and 5% interest rate. The total estimated settlement charges are $13,501.44, including adjusted origination charges of $3,750 and charges for other settlement services totaling $9,751.44. The monthly principal and interest payment would be $1,713.98, not including amounts for taxes and insurance held in an escrow account. The interest rate can increase over the life of the loan but the loan does not have prepayment penalties or balloon payments.
This document provides an overview of health and welfare benefits as well as retirement and savings plans offered by Lincoln. The benefits include medical, dental, vision, life and disability insurance, as well as 401k, pension, and deferred compensation plans. Premiums, contributions and eligibility requirements vary depending on factors such as income level and years of service. The plans are subject to amendment by Lincoln and the official plan documents will govern in all cases.
This document is an application agreement to become an independent consultant for Nikken UK Limited. Key details:
- The applicant agrees to the terms and conditions of being a Nikken consultant as outlined in this agreement and related documents.
- As a consultant, the applicant will purchase products only from Nikken and promote the products and business opportunity lawfully and ethically.
- Nikken agrees to pay commissions to the consultant according to their compensation plan and supply products for orders placed according to their procedures.
- The agreement can be terminated by either party with 14 days notice, or immediately by Nikken for breaches of the agreement. The applicant has 14 days to cancel the agreement for a full refund.
This document is a Canadian income tax return form for the year 2010. It requests personal information such as name, address, social insurance number, date of birth, marital status, and residence. It also has sections to provide information about a spouse or common-law partner. There are questions regarding citizenship, authorization to share information with Elections Canada, and application for GST/HST credit. The document is multi-page and requests additional financial information to complete the income tax filing.
This document is a proposal form for a family floater health insurance policy from Bajaj Allianz General Insurance Company. It collects personal and medical information about the proposer and family members to be insured. The proposer must provide full and accurate information in the proposal form which will form the basis of the insurance policy if issued.
Proposal form is the most important and basic document required for life insurance contract between the insured and insurance company. It includes the insured's basic information like address, age, name, education, occupation etc. It also includes the person's medical history.
The document is a declaration of good health form completed by a life assured individual seeking to revive their life insurance policy. It contains questions regarding the individual's medical history since the policy was issued, including any illnesses, operations, accidents, examinations, as well as changes in health, occupation, residence, or pregnancy status (for females). The individual declares that their answers are true and complete. A witness signature is required to verify the individual's statements. The individual requests revival of their policy and encloses payment.
The document is a declaration of good health form completed by a life assured individual seeking to revive their life insurance policy. It contains questions regarding the individual's medical history since the policy was issued, including any illnesses, operations, accidents, examinations, as well as changes in health, occupation, residence, or pregnancy status (for females). The individual declares that their answers are true and complete. A witness signature is required to verify the individual's statements. The individual requests revival of their policy and encloses payment.
This document is an application form for a position with Sutton Coldfield Dairies. It requests personal details, education and employment history, references, and availability for an interview. It also notes that a background check including criminal record check will be conducted as part of the hiring process due to the nature of the dairy business. The applicant is asked to provide thorough details to account for the past 10 years. Debts, bankruptcies, and legal judgments are also addressed. The final page includes interview notes fields.
This document is an insurance claim form from BCS Insurance Company. It requests information from the insured to process a claim, including the insured's details, patient information if different, description of the accident or sickness, prior treatment history, employment details, other insurance coverage, and an authorization to obtain medical records. The insured signs to authorize payment of benefits and to allow their medical information to be disclosed for processing the claim.
Revival of Lapsed Policy Forms Fno 680Indialic .in
This 3 page document is a personal statement form regarding health for the revival of a lapsed life insurance policy. It collects information about the policy holder's health and medical history since the original application. It asks if the policy holder has suffered any illnesses, had any operations or medical tests, or previously had any insurance applications declined or modified. It collects current health and biometric details and pregnancy information for females. The policy holder must declare that all information provided is true and complete, and agrees to notify the insurer of any health changes before the policy is revived. Witness signatures are required.
This document is a request form for innocent spouse relief from the Utah State Tax Commission. It collects information about the taxpayer seeking relief such as their name, address, social security number, filing status, and relationship details. The form asks if the taxpayer filed a joint return, is legally separated or divorced from their spouse, and if the underpayment or understatement of tax is due to erroneous items from or attributable to their spouse. It concludes by having the taxpayer and preparer sign under penalty of perjury.
This document is a request form for innocent spouse relief from the Utah State Tax Commission. It collects information about the taxpayer filing for relief such as their name, address, social security number, filing status, and relationship status with their spouse. The form asks if the taxpayer filed a joint return, is legally separated or divorced from their spouse, lived apart from their spouse for the last 12 months, or if their spouse is deceased. It also inquires about understatements or underpayments of tax on joint returns and whether the taxpayer has already filed for innocent spouse relief with the IRS.
1) Isaac Vimal Raj is applying for a position in utility operation and maintenance with BGR Energy Systems Limited. He has over 35 days notice required if selected.
2) Vimal is 28 years old and currently resides in Dubai, UAE but is originally from Ukkirankottai, Tamil Nadu, India.
3) He has a bachelor's degree in electrical engineering and speaks Tamil, English, and has basic knowledge of Hindi. He is interested in areas related to power plant equipment maintenance and troubleshooting.
1) The document is a general claim form from an insurance company.
2) It requests information about the claimant, their policy, and details of the incident to assess their claim.
3) The form notes that submitting a claim does not mean the company accepts liability, and requires signatures to authorize the use and sharing of personal information for assessing the claim.
1) The insured has submitted a claim form to Zurich Australian Insurance Limited to lodge a written statement about an insurance claim.
2) The form requests details about the insured, the incident, ownership of damaged property, costs of repairs or replacements, and a declaration authorizing Zurich to assess the claim.
3) The insured must provide evidence of ownership and value of damaged items and is warned against exaggerating the claim amount.
The document is a general claim form from an insurance company. It requests information to process an insurance claim, including details of:
- The insured and their contact information
- How the incident occurred and details of what happened
- A description of any damaged or lost property and its value
- Whether any other parties may be responsible
- Whether the incident has been reported to police
It also provides information on how personal details will be used to process the claim, and a declaration for the insured to sign.
The document is a general claim form from an insurance company. It requests information to process an insurance claim, including details of:
- The insured and their contact information
- How the incident occurred and details of what happened
- A description of any damaged or lost property and its value
- Whether any other parties may be responsible
- Whether the insured has other relevant insurance policies
- Contact with authorities like the police, if applicable
It notes the company will collect personal information as needed to assess the claim, and may share information with third parties for this purpose.
This document contains forms for applying for a micro loan through a credit union. It requests business and personal information from loan applicants, including details about the business, ownership, financial history, the loan request, and personal financial statements. If approved, the loan would be processed, underwritten and serviced by a third party on behalf of the credit union.
This document provides information and a form for individuals receiving certain benefits due to illness or disability to report any paid work they want to start or have started, including details about permitted work limits, how earnings may affect benefits, and medical testing requirements. The multi-part form gathers information about the individual, the work, support details if applicable, and requires a declaration of truthfulness to be signed and submitted to the benefits office.
This presentation provides an overview of the road map needed to avoid the land mines and traps related to Medicaid. Proper planning is needed to preserve a legacy, cover final expenses and still be eligible for all available Medicaid benefits.
Proposal form is meant to seek accurate information about the proposer and his/ her life. Proposal form for Maxima is easily accessible through the website of Apollo Munich. It requires the details like name, address, plan details, nominee details and about the life of the proposer. The form is to be filled by the proposer according to the instructions provided in the form. Make sure that the information provided is genuine.
The form is to be closely studied by the proposer and must be filled with due attention. Along with the proposal form, the proposer need to attach certain crucial documents like ID proof, residence proof, age proof, renewal notice with claim details and photocopies of other documents like previous policies and endorsements. The form is to be duly filled and attached with all necessary documents (information regarding documents to be attached is clearly mentioned in the form).
This document is a personal statement form regarding an individual's health for the purpose of reviving a lapsed life insurance policy. The form collects information about the individual's medical history and current health status. It requires details about any past or present illnesses, injuries, tests, as well as any previous life insurance applications that were declined or accepted with special conditions. The individual must declare that the information provided is complete and accurate, and agree that any false information would void the revival of the lapsed policy. The form also includes sections for additional details depending on if the revival is under a non-medical scheme or if the individual is illiterate.
Similar to Proposal For Insurance On Own Life (20)
The document outlines conditions for life insurance proposals for non-resident Indians according to exchange control regulations. Key points include: [1] The life to be assured must be an Indian national or person of Indian origin residing outside India temporarily with a valid Indian passport. [2] Policies can only be in Indian rupees and premiums must be paid through approved banking channels from the country of residence or India. [3] Claims are generally settled proportionate to premiums paid in foreign currency, with some flexibility for beneficiaries' accounts.
The document is a questionnaire for non-resident Indians seeking life insurance from LIC of India. It requests information such as nationality, country of residence, date of leaving India, employment and income abroad, passport details, bank accounts, how insurance premiums will be paid, and contact details in India and abroad. The applicant declares the information provided is true and agrees to terms restricting claims to being settled in India in Indian currency only.
This document contains a proposal form for life insurance on an individual's own life. It requests information such as the proposed insured's name, address, age, occupation, income, family medical history, personal medical history, existing insurance policies and beneficiary details. The proposed insured is required to declare that their statements are true and complete, and consent to the insurer obtaining medical information if required. Witness signatures are also required.
This document is a proposal form for life insurance on an individual's own life from the Life Insurance Corporation of India. [1] It requests basic personal information about the applicant such as name, address, age, occupation, income, family history and medical history. [2] The applicant is required to disclose details of any previous life insurance policies and must declare that all information provided is true and complete. [3] The form includes declarations that must be signed by the applicant and witness.
This document is a proposal form for life insurance on an individual's own life from the Life Insurance Corporation of India. [1] It requests basic personal information about the applicant such as name, address, age, occupation, income, family history and medical history. [2] The applicant is required to disclose details of any previous life insurance policies and sign a declaration that the information provided is true and complete. [3] The form contains various declarations and consents including consent for medical authorities to provide health information to the insurer and consent for the insurer to reconsider terms if the applicant's health changes before issuance of the first premium receipt.
In World Expo 2010 Shanghai – the most visited Expo in the World History
https://www.britannica.com/event/Expo-Shanghai-2010
China’s official organizer of the Expo, CCPIT (China Council for the Promotion of International Trade https://en.ccpit.org/) has chosen Dr. Alyce Su as the Cover Person with Cover Story, in the Expo’s official magazine distributed throughout the Expo, showcasing China’s New Generation of Leaders to the World.
Madhya Pradesh, the "Heart of India," boasts a rich tapestry of culture and heritage, from ancient dynasties to modern developments. Explore its land records, historical landmarks, and vibrant traditions. From agricultural expanses to urban growth, Madhya Pradesh offers a unique blend of the ancient and modern.
KYC Compliance: A Cornerstone of Global Crypto Regulatory FrameworksAny kyc Account
This presentation explores the pivotal role of KYC compliance in shaping and enforcing global regulations within the dynamic landscape of cryptocurrencies. Dive into the intricate connection between KYC practices and the evolving legal frameworks governing the crypto industry.
An accounting information system (AIS) refers to tools and systems designed for the collection and display of accounting information so accountants and executives can make informed decisions.
Calculation of compliance cost: Veterinary and sanitary control of aquatic bi...Alexander Belyaev
Calculation of compliance cost in the fishing industry of Russia after extended SCM model (Veterinary and sanitary control of aquatic biological resources (ABR) - Preparation of documents, passing expertise)
In World Expo 2010 Shanghai – the most visited Expo in the World History
https://www.britannica.com/event/Expo-Shanghai-2010
China’s official organizer of the Expo, CCPIT (China Council for the Promotion of International Trade https://en.ccpit.org/) has chosen Dr. Alyce Su as the Cover Person with Cover Story, in the Expo’s official magazine distributed throughout the Expo, showcasing China’s New Generation of Leaders to the World.
1. F.No. 300 (Rev.98)
Proposal No.: Branch
Agents Code Number D.O Code
(Established by the Life Insurance Corporation Act, 1956)
PROPOSAL FOR INSURANCE ON OWN LIFE
Inward Number Date
(Not to be used for Insurance on the Lives of minors)
DIVISIONAL OFFICE______________________
(All Answers to be filled in legibly. Answers must be given in words. Stroke of the pen or dots or dashes will not be accepted as replies.)
Full Name (Surname first) and Address to which communications are to be sent. Object of Insurance
Place of Birth
Nationality Sex
PIN
Residential address, if different from above. Nature of Age-proof submitted
Age (nearer Date of Birth
birthday)
PIN
Short Name Father’s Full Name (Surname first)
2. Nominee’s Full Name (Surname first) and Address Age Relationship to yourself
If Nominee is a Minor, Appointee’s Full Name and Address Age Relationship to Nominee
Signature of Appointee as token of consent
Plan & Term Sum Proposed Is Accident Benefit required? If policy is to be dated back, Amount deposited BOC No.
indicate date
Mode (Yearly, Half-yearly, Quarterly Paying Authority Code Deptt. No. Badge or S.R. No.
Monthly or under SSS)
3. Present Occupation Exact Nature of Duties
Name of present employer Length of Service with Him.
Educational Qualification Annual Income Rs. Sources of Income Are you an Income Tax
Assessee?
If you are employed in the Armed Forces, please state:
Wing to which you belong. Rank therein Date of last Medical Medical category after Were you ever below A-1
Examination Medical examination Category? If so, when?
Is your life now being proposed for another assurance or an application for revival of a policy on your
life under consideration in any office of the corporation? If yes, give details.
Has a proposal (or an application for revival of a policy) on your life made to any office of the Ans If yes.
8 Corporation ever been wer give details.
‘Yes’
(a) Withdrawn, Deferred, Dropped or Declined or
‘No’
(b) Accepted with Extra Premium or Lien?
(c) Accepted on terms otherwise than those proposed?
4. Please give details of your previous insurance: (Including Policies Surrendered/Lapsed during last 3 years)
Policy Office of the Table Sum Year Whether With or Medical Whether in If not give
Number Corporation & Assured of accepted without or Non- Force for due date of
Term Issue as proposed Accident medical full Sum last
at ordinary Benefit Assured premium
rates paid or date
D.O. Branch
of surrender
N.B.: Corporation does not entertain any fresh proposal for insurance where a policy has lapsed or have been converted into paid up policy within
he last 3 years.
5. Family History
. Living Dead
Family History: Age State of health Age of death Cause of Death
Father
Mother
Brothers
Living ……………
Dead ……………..
Sisters
Living ……………
Dead ……………..
Wife/Husband
Children
Living …………..
Dead …………….
Personal History Answer ‘Yes’ or ‘No’ If ‘Yes’, Please give full details
.
During the last five years did you consult a Medical Practitioner for
any ailment requiring treatment for more than a week?
Have you ever been admitted to any hospital or nursing home for
general check up, observation, treatment or operation?
Have you remained absent from place of work on grounds of health
) during the last 5 years?
Are you suffering from or have you ever suffered from ailments
pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous
system?
Are you suffering from or have you ever suffered from Diabetes,
Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer,
Epilepsy, Hernia, Hydrocele, Leprosy or any other disease?
Did you ever have any bodily defect or deformity?
Did you ever have any accident or injury?
Do you use or have you ever used –
i) Alcoholic drinks
ii) Narcotics
iii) Any other drugs
Iv)Tobacco in any form
What has been your usual state of health?
Have you ever required or at present availing/undergoing medical
advice, treatment or tests in connection with Hepatitis B or AIDS
related condition.
6. In Non-medical cases, please state exact Height in Height Weight
Cms, and Weight in Kgs. (without shoes)
A
Are you pregnant now? Date of last delivery Have you had any abortion or Date of last Mensuration
miscarriage or Ceasarian Section?
If so, give details
B Husband’s Full Name His Occupation His annual income
Details of Husband’s insurance:
C Policy Office of Corporation Sum Assured Table & Term Present status of the Policy
Number
ANSWERS TO QUESTIONS ARE GIVEN AFTER READING THE QUESTIONS CAREFULLY
7. DECLARATION BY THE PROPOSER
I________________________ the person whose life is herein being proposed to be assured. Do hereby declare that the
foregoing statements and answers have been given by me after fully understanding the questions and the same are true and
complete in every particular and that I have not withheld any information and I do hereby agree and declare that these
statements and this declaration shall be the basis of the contract of assurance between me and the Life Insurance Corporation
of India and that if any untrue averment be contained therein the said contract shall be absolutely null and void and all moneys
which shall have been paid in respect thereof shall stand forfeited to the Corporation.
Notwithstanding the provision of any law, usage, custom or convention for the time being in force prohibiting any doctor,
hospital and / or employer from divulging any knowledge or information about me concerning my health or employment on the
grounds of secrecy. I, my heirs, executors, administrators and assignees or any other person or person having interest of any
kind whatsoever in the policy contract issued to me, hereby agree that such authority having such knowledge or information,
shall at any time be at liberty to divulge any such knowledge or information to the Corporation.
And I further agree that if after the date of submission of the proposal but before the issue of the first Premium Receipt (i) any
change in my occupation or any adverse circumstance connected with my financial position or the general health of myself or
that of any members of my family occurs or (ii) if a proposal for assurance or an application for revival of a policy on my life
made to any office of the Corporation has been withdrawn or dropped, deferred or accepted at an increased premium or
subject to a lien or on terms other than as proposed I shall forthwith intimate the same to the Corporation in writing to
reconsider the terms of acceptance of assurance. Any omission on my part to do so shall render this assurance invalid and all
moneys which shall have been paid in respect thereof shall stand forfeited to the corporation.
19 ___________
Dated at _____________ on the _________ day of _______________ 19____________
Day of 19
Signature of witness _______________________________
Signature or thumb impression of the
Name: ______________________ Person whose life is proposed to be
assured
Occupation: ________________________
Address: ___________________________
___________________________
8. (1) Declaration by the person filling in the form: I hereby declare that I have fully explained
Declarant’s Name & Address:___________ the above questions to the Proposer and I
_____________________________________ have truthfully recorded the answers given
_______________________PIN___________ by the Proposer.
____________________
IN CASE THE PROPOSER IS ILLITERATE:
Signature
(2)His/Her thumb impression should be attested I hereby declare that I have explained the
by a person of standing whose identity can contents of this Form to the Proposers in
easily be established, but unconnectedwith __________language and that the Proposers
the Corporation and this declaration impression have affixed their thumb above
should be made by him. after fully understanding the contents thereof.
Name & Address of the declarant:
___________________________________
___________________________________
___________________________________ _____________________
PIN_____________ Signature
Insurance Act 1938 1938 Under Section 41 (Summary)
N.B.: Rebate of premiums shall be allowed only in accordance with the details given in the prospectus or premium rates or, as
the case may be, the relevant document, and that an offer or acceptance of any other rebates shall be an offence under
Section 41 of the Insurance Act, 1938.
For Medical Cases Only
I certify that the Life Assured has signed/put his/her thumb impression in my presence after admiting that all the answers to
Question Nos. 10 onwards of this form have been correctly recorded.
_________________________________________
Signature or Thumb impression of the proposed.
_____________________________
N.B. – Signature or Thumb impression should be affixed
In presence of Medical Examiner. Signature of the Medical Examiner