Check list before submitting Proposal Form:
(1) Proposal Form
For Insurance on own life: Form No. 300.
For insurance on life of other person and for minor lives “(Age 10 yrs & above): From No. 340 medical of minor life is compulsory.
For Insurance on life of minor (Age less than 10 yrs): form No.360 Without medical for any sum assured
For Jeevan Dhara & Jeevan Suraksha :
F. No. 440(J.D./J.S-1)
For Jeevan Akshay: F. No .440(J.A-1.),
For Varishtha Pension: F .No. 470(VPBY),
For Jeevan Balya: Form No.440 J.B,
For New Jana Raksha / up to 50,000/-s.a.:Form No.320 J.P.
(All the answer must be given in words, stroke of Pen/Dots/ Dashes will not be accepted)
(2) a) Vernacular Declaration over proposer’s signature in proposers own handwriting is required and declaration is to be signed by the person filling in the form, and in case of thumb impression in addition to declaration by the person filling in the form, declaration from 3rd person unconnected with corporation should be obtained. Below the thumb impression the identity i.e. the right hand/ left hand impression of Mr./Mrs. …………………………. Should be mentioned.
b) In case of married ladies maiden name declaration shall be given above Proposers signature or by separate letter.
(3) Agents confidential Report: Form No.380 along with each proposal. Under Non. Medical cases Physical Measurements should be given by the agent, duly mentioning the club membership or MHR authority.
(4) MHR should be obtained by the competent authority.
(5) Copy of Age proof duly signed by proposer as required under specific plans. and. for Non-standard age proof submit Annexure- A and consent for extra premium.
(6) a) FMR, and special reports as per SUC wherever required along with introduction to medical examiner by the competent authority.
b) Confirm Doctors and proposer’s signature on proposal form and special reports including ECG tracings.
c) Doctor is having the required limit as per SUC
d) Medical Report is valid for 6 months; additional proposal within 6 months from Date of medical is considered up to basis S.A. of Rs. 1/- Lac, subject to limit of medical examiner for substandard lives Medical is valid for 3 Months only.
e) Special report is valid for 1-Year, for proposal accepted at OR, otherwise for 6-months only. HIV report is valid for 6 months only in both cases.
(7) Date of proposal should not be after the date of Medical or any special report and date of medical should not be after date of ACR.
(8) Relevant query forms and Addendums:
(i) Occupational querry form is required in case of persons engaged in Army/ Navy/Air Force/ marine/any hazardous occupation.
(ii) In case of handicapped person personal History of accident: Deformity questionnaire is required.
(iii) In case of personal History of Asthma/ Bronchitis/ Ulcer/ Kidney disease/ Tuberculosis/ Gall bladder disease/ Hernia-or Hearing impartment etc : Additional questionnaire and reports are required along with treatment / operation records.
(iv) Habit of Smoking or Alcohol: Physician Report- Part-I.
(v) History of Diabetics/ Hypertension/ Heart Ailment: Physician report part I & II.
(vi) In case of NRI: NRI Questionnaire is required.
(viii) In case of Jeevan Sathi Plan: Joint Life Declaration required.
(ix) For policy under MWP ACT/HUF: Relevant Addendums are necessary.
(x) For Asha Deep/ Plans / Jeevan Bharti / jeevan Andhar/ Jeevan Vishwas Plans: Relevant Addendums are required.
(xi) For SSS Policies: Relevant authority letter in duplicate along with prior certification from employer wherever necessary is to be obtained.
Annexure for SSS policy in Triplicate are also required along with each proposal.
(xii) In case of minor lives with age 5 years & above, school going declaration is to be obtained duly singed by both parents or Bonafide certificate from school is required.
(9) Evidence of income in form of C.A. Certificate or I.T. returns are to be collected where ever necessary duly attested by the proposer and authorized person.
(10) Remit correct installment premium.
(1) Proposal Form
For Insurance on own life: Form No. 300.
For insurance on life of other person and for minor lives “(Age 10 yrs & above): From No. 340 medical of minor life is compulsory.
For Insurance on life of minor (Age less than 10 yrs): form No.360 Without medical for any sum assured
For Jeevan Dhara & Jeevan Suraksha :
F. No. 440(J.D./J.S-1)
For Jeevan Akshay: F. No .440(J.A-1.),
For Varishtha Pension: F .No. 470(VPBY),
For Jeevan Balya: Form No.440 J.B,
For New Jana Raksha / up to 50,000/-s.a.:Form No.320 J.P.
(All the answer must be given in words, stroke of Pen/Dots/ Dashes will not be accepted)
(2) a) Vernacular Declaration over proposer’s signature in proposers own handwriting is required and declaration is to be signed by the person filling in the form, and in case of thumb impression in addition to declaration by the person filling in the form, declaration from 3rd person unconnected with corporation should be obtained. Below the thumb impression the identity i.e. the right hand/ left hand impression of Mr./Mrs. …………………………. Should be mentioned.
b) In case of married ladies maiden name declaration shall be given above Proposers signature or by separate letter.
(3) Agents confidential Report: Form No.380 along with each proposal. Under Non. Medical cases Physical Measurements should be given by the agent, duly mentioning the club membership or MHR authority.
(4) MHR should be obtained by the competent authority.
(5) Copy of Age proof duly signed by proposer as required under specific plans. and. for Non-standard age proof submit Annexure- A and consent for extra premium.
(6) a) FMR, and special reports as per SUC wherever required along with introduction to medical examiner by the competent authority.
b) Confirm Doctors and proposer’s signature on proposal form and special reports including ECG tracings.
c) Doctor is having the required limit as per SUC
d) Medical Report is valid for 6 months; additional proposal within 6 months from Date of medical is considered up to basis S.A. of Rs. 1/- Lac, subject to limit of medical examiner for substandard lives Medical is valid for 3 Months only.
e) Special report is valid for 1-Year, for proposal accepted at OR, otherwise for 6-months only. HIV report is valid for 6 months only in both cases.
(7) Date of proposal should not be after the date of Medical or any special report and date of medical should not be after date of ACR.
(8) Relevant query forms and Addendums:
(i) Occupational querry form is required in case of persons engaged in Army/ Navy/Air Force/ marine/any hazardous occupation.
(ii) In case of handicapped person personal History of accident: Deformity questionnaire is required.
(iii) In case of personal History of Asthma/ Bronchitis/ Ulcer/ Kidney disease/ Tuberculosis/ Gall bladder disease/ Hernia-or Hearing impartment etc : Additional questionnaire and reports are required along with treatment / operation records.
(iv) Habit of Smoking or Alcohol: Physician Report- Part-I.
(v) History of Diabetics/ Hypertension/ Heart Ailment: Physician report part I & II.
(vi) In case of NRI: NRI Questionnaire is required.
(viii) In case of Jeevan Sathi Plan: Joint Life Declaration required.
(ix) For policy under MWP ACT/HUF: Relevant Addendums are necessary.
(x) For Asha Deep/ Plans / Jeevan Bharti / jeevan Andhar/ Jeevan Vishwas Plans: Relevant Addendums are required.
(xi) For SSS Policies: Relevant authority letter in duplicate along with prior certification from employer wherever necessary is to be obtained.
Annexure for SSS policy in Triplicate are also required along with each proposal.
(xii) In case of minor lives with age 5 years & above, school going declaration is to be obtained duly singed by both parents or Bonafide certificate from school is required.
(9) Evidence of income in form of C.A. Certificate or I.T. returns are to be collected where ever necessary duly attested by the proposer and authorized person.
(10) Remit correct installment premium.