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Personal Code : 1
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Resident
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Pin:
Office
Address
Tel No.(R)
Fax No.
Mobile
Location
Personal Information
Birth Date (Rec) : 28/02/1982
Birth Place :
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 :
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
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
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
Harish Chand
Delhi LIC Agent
577, GH-9, PASCHIM VIHAR
NEW DELHI- 110087
INDIA, 9811896425, 9212201725
www.delhiLICagent.com