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Facts Findings
 
(Fields marked with * are mandatory)
*Name :
* Miss.        Mrs.        Mr.
*Address :
Company Name :
Telephone Office :
Telephone Residence :
Contact Time & Venue :
Mobile :
*Email :
Website :
Date & Place of Birth :
Date : Place :
Business / Occupation :
Designation :
Qualification :
Outstanding Claim / Service Expected :
Annual Income :
Date of Joining :
Identification Marks :
Family Size :
Health History :
Alcohol : / Smoking :
Any Sickness : / Accident : / Injury : / Operation : / Hospitalisation :
Spouse Details :
Name :
Height :
Weight :
Child 1 : Name: Date of Birth :
Child 2 : Name: Date of Birth :
PERSONAL PLANNING FOR YOU AND YOUR LOVED ONE
Sr. No Have You Adequately Provided For Yes / No Amount Required For Year 200_
1. Current & Future Medical Expenses
2. Higher Education of Elder Son / Daughter
3. Higher Education of Younger Son / Daughter
4. Hospitalization Reimbursement
5. Household Insurance
6. Marriage of Elder Son / Daughter
7. Marriage of Younger Son / Daughter
8. Mortgage / Loan / Liabilities
9. Personal Accident Benefit
10. Purchase of New House
11. Vehicle Insurance
12. Yearly Retirement Provision you & your Spouse
13. Yearly Retirement Provision for your Spouse only
BUSINESS INSURANCE DETAILS
Sr. No. Have You Adequately Provided For Yes / No Amount Required For Year 200_
1. Mediclaim
2. Personal Accident
3. Burglary
4. Business Indemnity
5. Cash in Safe / Fidality / Insurance
6. Cash in Transit
7. Company Insurance
8. Employer - Employee
9. Factory Insurance
10. Fire Insurance
11. Group Gratuity
12. Group Insurance
13. House - Holders Insurance
14. Key - Man Insurance
15. Loss of Profit
16. Machinery Breakdown
17. Motor Vehicle
18. Partnership Insurance
19. Shopkeeper Insurance
20. Third Party Liability
21. Workmen Components
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