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Data Sheet

The document is a LIC data sheet that requires personal and family information for insurance purposes. It includes sections for contact details, occupation, education, income, family history, and previous insurance details. Additionally, it requests specific health information and requires a specimen signature.

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sumitsurve308
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18 views

Data Sheet

The document is a LIC data sheet that requires personal and family information for insurance purposes. It includes sections for contact details, occupation, education, income, family history, and previous insurance details. Additionally, it requests specific health information and requires a specimen signature.

Uploaded by

sumitsurve308
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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LIC DATA SHEET

Please fill in Capital letters only.

Track Id. No. :- __________________ Mob. No. :- ________________________________________

Name in full :- __________________________________________________________________________

Father’s full name :- _____________________________________________________________________

Present address :- ________________________________________________________________________

______________________________________________________________________________________

Occupation :- ___________________ Nature of work :- _________________________________

Name of Employer :- ____________ Length of service :- ____ Yrs. PAN No. :- ___________________

Date of birth :- _________________ Place of birth :- _______________ Age. :- ____________________

Education :- _____________ Income :- _____________ Tax Payer :- Yes / No

Name of Nominee :- _______________ Relationship :- ____________ Age :- _______________

FAMILY HISTORY DETAILS OF PREVIOUS INSURANCE


Relationship Age. Age of death Cause of Policy No S.A Mode T/T D.O.C
death
Father
Mother
Brothers
Sisters
Husb/Wife
Children

Height :-_____ Weight :- _____ Abdomen :- _____ Chest :- ____ Identification : ____________

In case of Female proponent :-


Last delivery date :- Abortion / miscarriage / pregnancy desea

Maiden Name :- ___________________________________________________________________________

Husband’s full Name :- _____________________________________________________________________

His occupation :- ______________________ Yearly Income :- __________ Tax Payer :- Yes / No

Policy No. 1) __________ 2) ____________ 3) ___________ 4) 5) ____________

Date :- ___________ Specimen Signature :- ____________________

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