1 Basic Detail

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Date Of Birth*

Education Qualification*

Occupation Type*

Annual Income*

Pin Code *

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2 Quotation Change Basic Detail

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Policy Term

Coverage Amount - Sum Insured

Death Benifit Payout Option

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3 Proposer Detail Back to Quotation

Proposer Detail

Policy Tenure : 1 Year

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Salutation*

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First Name *

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Last Name *

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Mobile No.*

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Email *

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Proposer Communication Details

Contact Address *

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Marital Status *

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PAN No.

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4 Preview & Payment Change Proposal Detail

Insurer Detail

Proposer Name
Date of Birth
Mobile No.
Email Id
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Contact Address
Pincode
PANNo
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