I am a .   My date of birth is .

I    consumed tobacco (in last 12 months) .

My marital status is   and I am

I am   and my annual income is

My residential status is  and I reside at .

I want to buy life insurance to

 with a life cover of   and a policy term of    years

and nominee for this plan is my  .

For quick issuance we need your age proof, ID proof, address proof & income proof.

Please keep it handy which filing the application form. (Issuance Time: 3 working days.4 | No Medicals.5)