INFORMATION SHEET


GENERAL DETAIL (IS-001)

Name of First Applicant:
Date of Birth:dd/mm/yy Age: Sex:
Anuual Income (Rs.) PAN: Nationality :
Father/ Guardian Name:        
Address (Postal): PIN Code:
Address (Permanent/Overseas): PIN Code:
Telephone: Office:   Fax :    
  Res. :    Mobile :    
Email :        
Occupation : Business   Retired   Student
  Service (Pvt/ Govt)   Agriculture   Professional
  Housewife   Others (Specify)  
Nominee's Name : Age:   Relation:
Nominee's Address :  
           
           

MUTUAL FUND DETAIL (IS-002)

Name of Mutual Fund : Name of Scheme :
       
Type of Plan : Growth Dividend-Payout Dividend-Reinvestment
       
Status of First Applicant : Resident Individual Minor Partnership Firm
  HUF Proprietorship Firm Company
  Society/ Club Others(Specify):   
       
Mode of Holding Single Joint Anyone/ Survivor
       
Bank Details (Mandatory as per SEBI Regulations)    
Bank Account No.: Bank Name : 
Bank Address :  
MICR Code :  PIN Code:
           


LIC DETAIL (IS-003)

Sum Assured :
Plan Name :
  Table/Term:
 
Premium Amount :
Mode of Payment (Qtrly/ Half-Yearly/ Yearly):

     
Height :
  Weight :

Mark of Identification :
Place of Birth :
  Qualification :
  Period of Service :
 
Employer's Name
    Nature of Duty
 
   
  Age
OR
Age at Death  Cause of Death
Father  
Mother  
Wife/Husband  
Brother's  
Sister's  
Children  

 
ONLY FOR FEMALE :
Date of Last Delivery :  
Husband's Name: Occupation:  
Income :        
Husband's Insurance Details :
           
Previous LIC Policy Details of Applicant:
Policy No.:  Year of Issue :  
Branch/Code : Sum Assured :  
Name of Plan : Table/Term :  
         
    

DOCUMENTS REQUIRED

For Mutual Fund

1. Cheque
2. PAN (Permanent Account Number) Card Copy
3. KYC (Know Your Customer) Copy (if amount invested is rs. 50,000 or more)

For LIC
1. Age Proof (Copy of any one document):
              - Class 10th Passing Certificate
              - Passport, Issued by Govt. of India
              - Date of Birth Certificate issued by Municipal Body (for age upto 5 yrs.)
                   OR        Date of Birth Certificate by School (for above 5 yrs age)
              - Driving License
              - PAN (Permanent Account Number) Card

2. Residential Proof (Copy of any one document):
              - Telephone Bill
              - Electricity Bill
              - Voter Identity Card
              - Driving License
              - Rent Agreement
3. Colour Photograph (Passport Size)

NOTE
1. Please fill IS-001 & IS-002 for Investment in Mutual Funds.
2. Please fill IS-001 & IS-003 for Life Insurance Policies.
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