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NRI Questionnaire

This document contains a questionnaire for non-resident Indians applying for an insurance policy. It requests information such as nationality, country of permanent residence, dates of leaving and returning to India, employment and income abroad, passport details, bank account details, premium payment details, address abroad, and contact details for an individual in India. The applicant declares that the information provided is true and acknowledges that any claims will be settled in India in Indian currency.

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111 views2 pages

NRI Questionnaire

This document contains a questionnaire for non-resident Indians applying for an insurance policy. It requests information such as nationality, country of permanent residence, dates of leaving and returning to India, employment and income abroad, passport details, bank account details, premium payment details, address abroad, and contact details for an individual in India. The applicant declares that the information provided is true and acknowledges that any claims will be settled in India in Indian currency.

Uploaded by

சரண் கணினியகம்
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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NRI - 4

Divisional Office_______________ Branch Code____________

QUESTIONNAIRE TO BE COMPLETED BY NON-RESIDENT INDIAN

Proposal No.______________ Policy No.________________

Sr. No. Particulars

1. Your Nationality

2. a. Your country of permanent residence


b. Date from which you became a permanent
resident of country mentioned in (a) above

3. a Date of leaving India for the first time


b. Details of exchange facility availed of
c. Full particulars of Reserve Bank Permit
Number
d. Visa status, if any
e. Name of Office of the Reserve Bank which
granted the above facilities

4. Duration of your stay abroad

5. a. Purpose of your stay abroad


b. Are you gainfully employed abroad?
c. Your monthly income from employment in
the foreign country (including Scholarship,
Assistantship etc for students or trainees).
Please enclose true copies of the
appointment letter received from your
employer or educational institutes.

6. a. Passport Number
b. Date of issue
c. Place of issue
d. Date of birth

7. Whether you hold any Bank account in


India and if so, whether it is a Resident
Account or Non-resident Account. Furnish
full details thereof
8. The source from which the premiums will
be paid
9. Please indicate by which of the following
manner you propose to remit the premiums
to LIC of India
a. By direct remittance from the country of
your residence to India through Banking
channels (preferably by Rupee Draft in
favour of LIC) Or by remittance through
postal channels like foreign money orders.
b. By cheques drawn on your Non-Resident
(External) or Foreign Currency (Non-
Resident Bank) Account with a Bank in
India
c. By cheques drawn on your Resident / Non-
resident Account with Bank in India
d. By cheques drawn on account maintained
by resident parent or spouse of the
policyholder in their name or joint name
with other close relatives
e. By any other manner (please specify)

10. Your full address in the country of your


residence abroad

11. State full name and address of an Indian


National permanently residing in India to
whom the policy may be despatched

12. Date of your leaving India / Date you left


India (current visit)

13. If you are a student state the nature and full


details of your studies

I hereby declare that the foregoing statements and answers are true in every respect and I am
agreeable for treating this as a part of the original Proposal Form dt._____________. I am also
aware that claims of any nature arising under the policy will be settled in Indian currency in
India only. I have taken note of the restrictions applicable as given in the enclosed annexure.

Dated at___________this____________day of_____________20 __________

__________________________
Signature of the life to be assured

Witness
Signature: __________________
Name: _____________________
Address: ___________________
Designation: ________________

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