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Harish Chand

Delhi LIC Agent


577, GH-9, PASCHIM VIHAR
NEW DELHI- 110087
INDIA, 9811896425, 9212201725
www.delhiLICagent.com

Data Sheet of Shri Harish


Date : 12/07/2011
Group Code : Harish

Personal Code : 1

Group Head : Shri Harish

Pin:

Resident
Address

Pin:

Office
Address

Tel No.(R)

Tel No. (O)

Fax No.

E-mail

Mobile

Location

Personal Information
Birth Date (Rec) : 28/02/1982

Birth Date (Greeting) : 28/02/1982

Birth Place :

Age Proof : Others

Nationality :

Father's Name :

PAN :

Marriage Date :

Spouse Name :

Qualification :

Income Sources :

Occupation : Others

Annual Income : 0

Duties :

Employer :

Length of Service :
Remarks :

Medical Detail
Medical Date :

Medical History Date :

Height

Limit :

Weight

Doctors Name :
Identification :

Chest

Major Illness :

Abdomen

Operation :

Blood Group
Pulse

Special Reports :

Spectacles
Dental
B.P.

Family History
Family History Date :

Policy No

Com.
Date

Present Age

Relation

Pl/Tm/Pt

Sum

Premium

Md.

Ag
Cd

Brn.

Health

Nominee

Age at Death Cause of Death

Rel.

F.U.P.
Date

Med/
NM

DAB

Extra
Prem.

SA Duly
Rated Tax Ben.
125000

332971212

12/04/10

165/25/25

125000

510.00

Mly.

11W

12/07/11

332971547

19/04/10

165/20/20

125000

1531.00

Qly.

11W

19/01/12

125000

332973422

18/05/10

165/25/25

125000

1531.00

Qly.

11W

18/02/11

125000

332975032

26/06/10

165/25/25

625000

2552.00

Mly.

11W

26/07/11

625000

332976767

22/07/10

165/25/25

250000

1021.00

Mly.

11W

22/05/11

250000

332977838

13/08/10

165/20/20

500000

6125.00

Qly.

11W

13/08/11

500000

332977843

13/08/10

149/69/69

300000

1363.00

Mly.

11W

13/06/11

300000

332978700

28/08/10

165/25/25

125000

6005.00

Yly.

11W

28/08/11

125000

332979062

31/08/10

191/15/15

5000.00

Qly.

11W

31/08/11

332979769

15/09/10

165/21/21

250000

1021.00

Mly.

11W

15/06/11

Insure And Be Secure

250000

Harish Chand
Delhi LIC Agent
577, GH-9, PASCHIM VIHAR
NEW DELHI- 110087
INDIA, 9811896425, 9212201725
www.delhiLICagent.com
Mly.

11W

20/04/11

250000

8975.00

Qly.

11W

20/06/11

500000

1021.00

Mly.

11W

20/04/11

250000

250000

12010.00

Yly.

11W

20/09/11

250000

165/16/16

2500000

30625.00

Qly.

11W

20/06/11

2500000

06/10/10

165/26/26

2050000

98482.00

Yly.

11W

06/10/11

2050000

13/12/10

149/50/50

200000

17431.00

Yly.

11W

13/12/11

200000

332979878

20/09/10

165/21/21

250000

1021.00

332979880

20/09/10

149/75/75

500000

332979881

20/09/10

165/21/21

250000

332979885

20/09/10

165/16/16

333221397

20/09/10

333222003
333223541
333223986

23/12/10

165/21/21

250000

1021.00

Mly.

11W

23/06/11

250000

333224348

27/12/10

165/30/30

500000

12130.00

Hly.

11W

27/12/11

500000

333225657

07/01/11

149/79/79

150000

2700.00

Qly.

11W

07/07/11

150000

333225671

07/01/11

149/73/73

450000

5968.00

Qly.

11W

07/07/11

450000

333225869

28/04/10

165/25/25

500000

6125.00

Qly.

11W

28/01/11

500000

333225875

28/04/10

149/75/75

200000

3665.00

Qly.

11W

28/07/11

200000

333226107

14/01/11

149/71/71

300000

15632.00

Yly.

11W

14/01/12

300000

333226108

14/01/11

149/73/73

200000

10486.00

Yly.

11W

14/01/12

200000

333226386

25/12/10

165/25/25

500000

24020.00

Yly.

11W

25/12/11

500000

333226389

19/01/11

75/20/20

200000

6406.00

Hly.

11W

19/07/11

200000

333226498

28/04/10

165/25/25

250000

3062.00

Qly.

11W

28/01/11

250000

333226601

22/01/11

165/25/25

125000

3032.00

Hly.

11W

22/07/11

125000

333226672

24/01/11

165/20/20

250000

3062.00

Qly.

11W

24/04/11

250000

333227600

08/02/11

75/20/20

400000

6525.00

Qly.

11W

08/08/11

400000

333228162

15/02/11

165/25/25

500000

24020.00

Yly.

11W

15/02/12

500000

333228208

17/02/11

165/35/35

1250000

5104.00

Mly.

11W

17/07/11

1250000

333228628

24/02/11

165/25/25

500000

24020.00

Yly.

11W

24/02/12

500000

333228629

24/02/11

75/20/20

200000

6509.00

Hly.

11W

24/08/11

200000

333229695

09/03/11

165/25/25

62500

255.00

Mly.

11W

09/07/11

62500

333229696

09/03/11

165/25/25

62500

255.00

Mly.

11W

09/07/11

62500

333229697

09/03/11

165/25/25

100000

408.00

Mly.

11W

09/07/11

100000

333229699

09/03/11

165/25/25

100000

408.00

Mly.

11W

09/07/11

100000

333229802

01/02/11

165/25/25

625000

7656.00

Qly.

11W

01/08/11

625000

333229837

11/03/11

165/25/25

375000

4594.00

Qly.

11W

11/03/12

375000

333230817

25/03/11

165/35/35

250000

12010.00

Yly.

11W

25/03/12

250000

333231679

28/03/11

165/35/35

125000

6005.00

Yly.

11W

28/03/12

125000

333232536

28/03/11

165/21/21

62500

255.00

Mly.

11W

28/07/11

62500

333232537

28/03/11

165/22/22

62500

255.00

Mly.

11W

28/07/11

62500

333232539

28/03/11

165/23/23

62500

255.00

Mly.

11W

28/07/11

62500

333232540

28/03/11

165/24/24

62500

255.00

Mly.

11W

28/07/11

62500

333233251

18/04/11

165/25/25

250000

1021.00

Mly.

11W

18/05/11

250000

333233252

18/04/11

165/25/25

250000

1021.00

Mly.

11W

18/05/11

250000

333233738

27/04/11

165/35/35

250000

12010.00

Yly.

11W

27/04/12

250000

333233739

27/04/11

165/35/35

250000

12010.00

Yly.

11W

27/04/12

250000

333234833

24/05/11

165/25/25

125000

510.00

Mly.

11W

24/06/11

125000

333234956

25/05/11

165/35/35

250000

1021.00

Mly.

11W

25/06/11

250000

333235908

14/06/11

165/25/25

250000

1021.00

Mly.

11W

14/07/11

250000

333236961

28/06/11

165/21/21

500000

2042.00

Mly.

11W

28/07/11

500000

333236985

28/06/11

165/21/21

500000

12130.00

Hly.

11W

28/12/11

500000

333237482

05/07/11

149/73/73

300000

15429.00

Yly.

11W

05/07/12

300000

333237672

11/07/11

165/21/21

250000

3062.00

Qly.

11W

11/10/11

250000

Total :

20275000

1054200.00 p.a.

20275000

Insure And Be Secure

Harish Chand
Delhi LIC Agent
577, GH-9, PASCHIM VIHAR
NEW DELHI- 110087
INDIA, 9811896425, 9212201725
www.delhiLICagent.com

Insure And Be Secure

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