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Proposal forms

Proposal Form for LIC’s Jeevan Shanti

LIC Form No. 300

MHR Form

FORM FOR SUITABILITY ANALYSIS

LIC Form No. 340

LIC Form No. 360

Health Insurance Forms

Claim Form

Claim Intimation Form

DTB Claim Form

DTB Discharge Form

Hospital treatment Form

Annexure of Documents

NEFT Mandate Form

(A) GENERAL FORMS

POLICY EXTRACT FROM PREVIOUS /PROPOSAL PAPERS

CONSENT FORM FOR CORRECTIONS/EXTRA

RE-CHECK OF MEASUREMENTS

PERSONAL FINANCIAL QUESTIONNAIRE

CERTIFICATE OF AGRICULTURAL INCOME

CHARTERED ACCOUNTANT'S CERTIFICATE

SPL MHR - ANNEXURE A

SPL MHR - ANNEXURE B

SPECIAL MHR FOR WIDOWS

APPLICATION FOR FINANCING POLICY FROM EPF

EPF ASSIGNMENT FORM

(B) ADDENDUMS

ADDENDUM FOR MULTIPLE PROPOSALS

ADDENDUM FOR MULTIPLE PREVIOUS POLICIES

ADDENDUM FOR DAB IF SA IS MORE THAN 25 LACS

ADDENDUM TO MINOR/MAJOR STUDENTS PROPOSALS

ADDENDUM TO PROPOSAL FOR CONGENITAL DISABILITY BENEFIT RIDER

ADDENDUM TO Proposal -CAT-I FEMALE LIFE

ADDENDUM – HUF POLICIES

ADDENDUM FOR SSS

SSS Clause 22 consent

(C) AGE DECLARATION

SELF DECLARATION OF AGE

ANNEXURE-A

(D) MEDICAL QUESTIONNAIRES

ADDITIONAL FORM FOR ASTHMA/BRONCHITIS

ULCER QUESTIONNAIRE- WITH OPERATION

ULCER QUESTIONNAIRE - WITHOUT OPERATION

KIDNEY DISEASE, COLIC OR STONE ETC

GALL-BLADDER DISEASE

GOITRE QUESTIONNAIRE (WITH OPERATION)

GOITRE QUESTIONNAIRE (W/O OPERATION)

FILARIASIS QUESTIONNAIRE

CHEST PAIN QUESTIONNAIRE

CNS QUESTIONNAIRE

TUBERCULOSIS QUESTIONNAIRE

PLEURISY QUESTIONNAIRE

EPILEPSY QUESTIONNAIRE

DEFORMITY QUESTIONNAIRE

HERNIA QUESTIONNAIRE

HEARING/ENT QUESTIONNAIRE

HIGH BP QUESTIONNAIRE

Diabetes Questionnaire

(E) OCCUPATIONAL QUESTIONNAIRES

GENERAL OCCUPATION QUESTIONNAIRE

ARMY PERSONNEL QUESTIONNAIRE

AVIATION (ARMED SERVICES) QUESTIONNAIRE

AVIATION (CIVIL) QUESTIONNAIRE

CIVIL GLIDING QUESTIONNAIRE

NAVY PERSONNEL QUESTIONNAIRE

DIVING (ARMED/COMML) QUESTIONNAIRE

MERCHANT MARINE QUESTIONNAIRE

(F) BUSINESS/NRI QUESTIONNAIRES

EMPLOYER-EMPLOYEE QUESTIONNAIRE

ANX-A-KEYMAN( RESOLUTION)

ANX-B - KEYMAN QUESTIONNAIRE

ANX-C – KEYMAN Declaration for Assignment

SUPPLEMENTARY DEED OF PARTNERSHIP

MAIL ORDER PROCEDURE

MAIL ORDER BUSINESS - ACR / MHR

ANNEXURE FOR MAIL ORDER

NRI - QUESTIONNAIRE

NRI - CONDITIONS

(G) MEDICAL REPORTS FORMS

Data Sheet for TPA Medical

FLUOROSCOPIC EXAMINATION

GLUCOSE TOLERENCE TEST (GTT) OF URINE

X-RAY OF GENITO URINARY TRACT (G U T) KUB AREA

STOMACH & DUODENUM (BARIUM MEAL)

X-RAY - CAECUM AND COLON (BARIUM ENEMA)

INTRAVENOUS PYELOGRAPHY

CHOLECYSTOGRAPHY

SPUTUM EXAMINATION

STOOL EXAMINATION

SPECIAL BLOOD SUGAR TEST (BST)

GYNAECOLOGIST REPORT

ELECTROCARDIOGRAM

TREADMILL TEST- CTMT

HAEMOGRAM

LIPIDOGRAM

BLOOD SUGAR TEST (BST)

ROUTINE URINE ANALYSIS (RUA)

CHEST X-RAY

ELISA FOR HIV

PHYSICIAN‟S REPORT

SBT-13

OPHTHALMIC REPORT

JUVENILE FMR

Format for Identification by TPA with Computerized Reports

(H) GENERAL

SSS INTRODUCTION - EMPLOYER'S LETTER

SSS INTRODUCTION - QUESTIONNAIRE BY EMPLOYER

SSS INTRODUCTION - REPORT BY SBM/ABM(S)

DGH – Major lives – New Proposal

DGH- Major lives - Revival

DGH – Minor lives- Age 10 and above – New/Revival

DGH – Minor lives- Up to age 9 – New/Revival

Direct Debit Form for ICICI and Corporation Bank

NEFT Form for direct credit to bank account

Declaration to be given by Nepali Proposers

AUTHORISATION LETTER TO RECEIVE POLICY BOND