Insurance profiling

We need some details & documents to process your Investment/Insurance/Pension proposal. Please provide the same.

Requirement of document/s (soft copies):
1. Photo 2. Pan 3. Aadhar 4. Cheque
For any help - Call: 9891210950

Personal Information

Full Name *

Date of Birth *

Phone *

Email *

Father Name

Mother Name

Spouse Name

Mailing Address

Educational Qualification

PAN Number

Aadhar Number

Smoking

Alcohol

Professional Information

Nature of Work

Organization Name

Designation

Annual Income

Company Address

Physical Information

Height (in cm)

Weight (in kg)

Nominee Information

Nominee Name

Nominee Date of Birth

Nominee's Relationship with Applicant

Medical & Insurance Information

Any Other Insurance *

Medical History If Any

Family History *

Premium Information

Premium Payment Term (Optional)

Payment Term (Optional)

Premium Amount

Document Uploads (Required Documents)

Maximum file size: 2MB per file. Allowed formats: JPG, PNG, PDF

Upload Photo *

Click to select photo

Recent passport size photograph

Upload PAN Card *

Click to select PAN

Clear copy of PAN card

Upload Aadhar Card *

Click to select Aadhar

Both sides of Aadhar card (can be combined in one file)

Upload Bank Cheque *

Click to select cheque

Cancelled cheque or bank passbook front page

Thank You! Please upload the docs now...

For any help - Call: 9891210950