Life insurance is a contract between you and the life insurance company (the insurer), which provides you (the assured) or your beneficiary for whose benefit the policy is taken with a pre-determined amount on the happening of a particular event contingent on the duration of human life
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.
Life insurance is a contract between you and the life insurance company (the insurer), which provides you (the assured) or your beneficiary for whose benefit the policy is taken with a pre-determined amount on the happening of a particular event contingent on the duration of human life
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.
ICC NCND Publication No. 769 E, 2015 Edition OpuFund
Mandatory for all Providers, Clients & Business Associates to sign and submit for working with OpuFund.
Your Human Resources may get prone to Accidents during working premise or working hours resulting Death, Disability or other bodily damages arising Legal Liabilities to you. Get yourself covered with Workment Compensation Insurance Policy. Click https://squareinsurance.in/contact
Contoh Draft Perjanjian Pengalihan Piutang – Pada dasarnya Perjanjian Pengalihan Piutang adalah perjanjian dimana beralihnya piutang antara pengalih piutang dengan penerima piutang dengan pembayaran sejumlah uang tertentu, selanjutnya akan dibayarkan kembali oleh Penerima kepada Pengalih berdasarkan syarat dan ketentuan dalam Akta Pengakuan Utang. (Beli Perjanjian, Hub: 08118887270 (WA))
El modelo de contrato de renta de Lamudi ha sido creado para ayudar a los usuarios a acelerar el proceso a la hora de rentar o comprar una propiedad, ya sea una casa, un departamento o un local comercial. El modelo sigue las pautas generales de este tipo de acuerdos, por lo que solo es necesario imprimir el documento y rellenarlo con la información necesaria.
ICC NCND Publication No. 769 E, 2015 Edition OpuFund
Mandatory for all Providers, Clients & Business Associates to sign and submit for working with OpuFund.
Your Human Resources may get prone to Accidents during working premise or working hours resulting Death, Disability or other bodily damages arising Legal Liabilities to you. Get yourself covered with Workment Compensation Insurance Policy. Click https://squareinsurance.in/contact
Contoh Draft Perjanjian Pengalihan Piutang – Pada dasarnya Perjanjian Pengalihan Piutang adalah perjanjian dimana beralihnya piutang antara pengalih piutang dengan penerima piutang dengan pembayaran sejumlah uang tertentu, selanjutnya akan dibayarkan kembali oleh Penerima kepada Pengalih berdasarkan syarat dan ketentuan dalam Akta Pengakuan Utang. (Beli Perjanjian, Hub: 08118887270 (WA))
El modelo de contrato de renta de Lamudi ha sido creado para ayudar a los usuarios a acelerar el proceso a la hora de rentar o comprar una propiedad, ya sea una casa, un departamento o un local comercial. El modelo sigue las pautas generales de este tipo de acuerdos, por lo que solo es necesario imprimir el documento y rellenarlo con la información necesaria.
Notice of change of nomination form 3750sm123services
With a vision of becoming Delhi’s most admired INSURANCE Company, SM Services offers you to Buy Insurance Online. Insurance is a contract (insurance coverage) where the insurance provider (insurance policy company) concurs for a cost (insurance coverage premiums) to pay the insured event all or a part of any loss endured by accident or death.
Body Piercing & Tattoo Liability Insurance Applicationevaj171
APP offers PL & GL insurance coverage for Allied Healthcare professionals & business entities through AM Best “A” rated Insurance Companies. Here is the Application for Body Piercing & Tattoo Liability Insurance.
Health plus claim is a part of life insurance. Issuance of this form does not amount to admission of any liability under the claim on the part of the insurers.
Life insurance is a contract between you and the life insurance company (the insurer), which provides you (the assured) or your beneficiary for whose benefit the policy is taken with a pre-determined amount on the happening of a particular event contingent on the duration of human life
Life insurance is a contract between you and the life insurance company (the insurer), which provides you (the assured) or your beneficiary for whose benefit the policy is taken with a pre-determined amount on the happening of a particular event contingent on the duration of human life
Professional Liability insurance application for Counselorevaj171
We can meet the needs of Healthcare Professionals by tailoring insurance needs to include Professional Liability, General Liability and many more. We can provide professional liability insurance for counselor as well.
Pre- Authorization form is to be filled in case of hospitalization. It is basically a declaration by the patient to make claim for the expenses incurred during the hospitalization. While seeking health insurance coverage under Optima Restore, the Pre- Authorization form must be filled to avail the policy support. Through this Apollo Munich seek information about the patient or the insured person like name of the patient, contact details, age, policy number and card ID number, name of the hospital, nature of illness and other related details. All columns must be closely examined to provide genuine information to the insurer. The form must be duly filled and then must be attached with all the necessary documents absence of which can lead to complication.
Page 2Financial Planning Disclosure and AgreementPart I .docxkarlhennesey
Page 2
Financial Planning Disclosure and Agreement
Part I: Contact Information for Parties to the Agreement
A. John’s Name and Contact Information
i. John Butterfield
ii. Wife of John Butterfield, Haley Butterfield
Part II: Services to be provided
A. Describe the services to be provided under this Agreement with the John
For the purposes of this Agreement, there are three classes of services. John shall select the class of service by initialing each service requested. The nature and scope of each class are:
i. Comprehensive Financial Planning:
After a thorough review of all pertinent John provided data and objectives and mutually agreed upon assumptions, the Company will analyze the Johns financial situation including, but not limited to: net worth (assets and liabilities), corporate benefits, current and projected, retirement planning, risk management, investment portfolio, specific financial needs as determined by the John, and tax and estate planning considerations. Upon completion of the analysis, the Company will make recommendations including suggested strategies to achieve John’s stated objectives. The Company will provide John with a written report of all analysis and recommendations. In the event John wishes to engage the Company to provide additional services John and Company will establish mutually agreed upon terms for the continuation of services. The John will be required to sign a new John agreement and additional fees may apply for additional reviews.
ii. Specific Financial Planning:
John will review all pertinent data provided by the Company, objectives, and mutually agreed upon assumptions and will prepare analysis limited to the topics selected by the John. The Company will provide John with the written report of all the relevant analysis and recommendations to assist John’s specific financial planning needs.
iii. Hourly Financial Consultation:
Company will provide financial consulting services on an hourly basis. The Company Fee is $75.00 per hour for Financial Planning. Under no circumstances will the Company require prepayment of a fee more than six months in advance and in excess of $500.00.
B. Describe the obligations and responsibilities of each party with respect to:
i. John agrees to provide, on a timely basis, information regarding income and expenses, investments, income tax situations, estate plans, and other pertinent matters as requested by Company from time to time, John also agrees to discuss needs and goals and projected future needs candidly with Company and to keep Company informed, in writing, of changes in John’s situation, needs, and goals.
ii. John acknowledges that Company cannot adequately perform its services on the John’s behalf unless John performs such responsibilities on his/her part and that Company’s analysis and recommendations are based on the information provided by John.
iii. John agrees to permit Company to consult with and obtain information about John from John’s accou ...
Similar to Revival of Lapsed Policy Forms Fno 700 (20)
1. Revival of Lapsed Policy (Form 700) Page 1 of 4
(Established by the Life Insurance Corporation Act, 1956)
PERSONAL STATEMENT REGARDING HEALTH
For a policy on another life except for C.D.A. Plan with deferment period 10 years
or more on the date of proposal or revival of a Policy. Do not use this form if the
policy has vested in the life assured or has been assigned to the life assured.
Divl. Office: Branch Office: Prop./Policy No Agent’s Name Agent’s Code No.
Following questions to be answered by the Proposer
1. Name in Full of the Proposer
( IN BLOCK LETTERS )
Address1
Address2
Full
Address
Address3
Email Address Phone/Mobile No
2.Name in Full of the Life to be Assured/Life
Assured (IN BLOCK LETTERS )
Occupation Name of Employer Length of Service with
him
3. Is this application for
If the answer is ‘YES’ please give the Proposal
Number or the Policy Number
(a) Issue of a new Policy? (a) Proposal No.
(b) Revival of lapsed Policy? (b) Policy No.
Following questions to be answered by the Life to be assured / Life Assured
4. Since the date of your above mentioned
Proposal / since the date of proposal for the above
mentioned policy :
Answer
'Yes' or 'No'
If ‘Yes’ give details of ailment date and
duration, doctors consulted.
(a) Have you suffered from any illness/disease
requiring treatment for a week or more?
a)
(b) Did you ever have any operation, accident or
injury?
b)
(c) Did you ever undergo ECG, X-Ray, Screening,
Blood, Urine or Stool examination?
c)
F. NO. 700
Office use only
Date of Receipt _____________
Inward No. _____________
2. Revival of Lapsed Policy (Form 700) Page 2 of 4
5.(a) Has a proposal or an application for revival of a policy on your life made to this or any other Office of
the Corporation or any Insurer ever been:
(a) Withdrawn or dropped?
(b) Deferred or declined?
(c) Accepted with an extra premium or lien?
(d Accepted on terms otherwise than those proposed?
If so, give details:
5. (b) Is any proposal or an application for revival of a. lapsed
policy on your life under consideration of this or any other Office
of the Corporation?
(i) Proposal No.
If answer is 'Yes' give the following details:
(ii) Policy No.
N.B. Q Nos. 6 & 7 to be replied in case of revival under Non Medical Scheme :
6.(i) State your height (without shoes) cm.
(ii) Your weight (with thin clothes.) kgs
7. State below, details of all your policies issued and/or revived under any of the Non-Medical Schemes of the
Corporation:
Name of the Divl. Office/Unit
Br. Office Servicing the
Policy
Policy Number Sum Assured
Status of the
Policy
8.Are you at present in sound health?
9. Are you a student? If so give particulars such as name of
the institution and course.
10. For females only :
a. Since the date of your above mentioned proposal or policy:
(i) Have you been menstruating regularly?
(ii) Have you had any miscarriage/s?
(iii) Are you pregnant now?
(b) State the date of last menstruation:
(c) State the date of last delivery:
DECLARATION BY THE LIFE TO BE ASSURED/LIFE ASSURED
I
do hereby declare that the statements and answers under heading 4 to 10 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.
Dated at on the day of (month) 20
3. Revival of Lapsed Policy (Form 700) Page 3 of 4
Signature of Witness
Name
Occupation & Address
Signature or thumb impression of the Life to be
Assured/Life Assured
Signature of Witness
Name
Occupation & Address
I do hereby declare that the foregoing statements and
answers are true and complete in every particulars
Signature of the Proposer
(if the life to be assured/life assured is under 18 years)
DECLARATION BY THE PROPOSER
I, ( name of Proposer )
do hereby declare that the statements and answers under heading 1 to 3 are true and
complete in every particular and I do hereby agree and declare that these statements and this
declaration together with statements and answers under heading 4 to 10 made by the *life
assured/ life to be assured and relative declaration thereto shall be the basis of contract of
*assurance/revival of the policy, between me and Life Insurance Corporation of India, and
that if any untrue averment be contained therein, the said contract shall be null and void and
all moneys which shall have been paid in respect thereof, shall stand forfeited to the
Corporation.
( *Delete words not applicable )
** And I further declare that if between the date of this declaration and date of revival of this
policy, (i) any change in the occupation of the life assured or any adverse circumstances
connected with my financial position or general health of the life assured or that of any
member of his family occurs or (ii) a Proposal for assurance or any application for revival of a
policy on the life of the life assured made to any Office of the Corporation has been
withdrawn or dropped, deferred or declined or accepted with 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 . 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.
(** Not Applicable in case of an application for issue of a new policy.)
Dated at on the day of (month) 20
4. Revival of Lapsed Policy (Form 700) Page 4 of 4
Signature of Witness
Name
Occupation & Address
Signature or thumb impression of the Life to
be Assured/ Life Assured
N.B.
If in this form, the answers to the questions and/or signature(s) of the Proposer/Life
Assured/Life to be assured are/is in vernacular then the Proposer/Life Assured/Life to
be assured should declare in their/ his/her own handwriting above his/her own signature
that all questions were explained to him/her and that his/her replies were given after fully
understanding the same.
In case the proposer/Life assured/Life to be assured is illiterate:
(1)This declaration should be made by the
person filling in the form
Name
& Address
Of the
declarant
(1) I hereby declare that I have fully explained
the above questions to the proposer/Life
Assured/Life to be assured and I have
truthfully recorded the answers given by the
Proposer / Life Assured/ Life to be assured.
Signature
(2) This thumb impression of the
Proposer/Life Assured/Life to be assured
should be attested by a person of standing,
whose identity can easily be established, but
unconnected with, the Corporation and this
declaration should be made by him:
Name
& Address
Of the
declarant
(2) I hereby declare that I have explained the
contents of this form to the Proposer/ Life
Assured/ Life to be assured in ……………..
(language) and that I have read out to the
Proposer / Life Assured/ Life to be assured ,
the answers to the questions dictated by the
Proposer/Life Assured / Life to be assured and
that the Proposer / Life Assured / Life to be
assured has affixed his thumb impression to
this form after fully understanding' the contents
thereof.
Signature
