Scribd
Upload
8K views1 page

Self Declaration Form Pli

This document is a self-declaration of income form for individuals (Graduates/Diploma holders) applying for Postal Life Insurance as per POLI Rules-2011. It requires the proponent to provide personal details, educational qualifications, employment status, and monthly income. The form must be signed by both the proponent and a sales force agent to confirm the adequacy of the declared income.

Uploaded by

gauravsharmahjp
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
8K views1 page

Self Declaration Form Pli

This document is a self-declaration of income form for individuals (Graduates/Diploma holders) applying for Postal Life Insurance as per POLI Rules-2011. It requires the proponent to provide personal details, educational qualifications, employment status, and monthly income. The form must be signed by both the proponent and a sales force agent to confirm the adequacy of the declared income.

Uploaded by

gauravsharmahjp
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
You are on page 1/ 1

Self Declaration of income by proponent (Graduate/Diploma)

(Vide PLI Dte letter No. 25-01/2022-LI dated 01.12.2022)

I, Shri/Smt/Miss...........................................................................................................S/D/W
...............................................................At/Po.......................................................Dist..........................
born on ............................................., do hereby furnish the following self declaration of income

to purchase Postal Life Insurance as per POLI Rules-2011 and its amendment from time to

time:

1. I have passed Graduation from ..............................................................University

recognized by Central/State Government in the year..................................


Or

I have passed Diploma from .............................................................. Institute recognized


by Central/State Government in the year..................................
2. I am employed and working as...............................................................................in
......................................................................And my monthly income is

"························.. ·····............................
Or

I am self employed and my source of income is "·············· .. ·················.............per month


from ....................................................... (Nature of work)
I do hereby declare that the above statement is true to the best of my knowledge and
belief.

Signature of the proponent

Date.............................................

I am satisfied about the adequacy and regularity about the income of the proponent.

Signature ofSales Force

Agent Code-..................................

Date.............................................

You might also like