PROPOSAL FORM FOR HOUSE HOLDERS COMPREHENSIVE INSURANCE
 
Name of Proposer
Business/Occupation
Address of Residence
 
Current Address:  
Contact Phone
Email Address
Address
(a) External Wall built of
(b) External Root built of
(c) No. of storeys including basement/ attic/ loft
(d) Is building completely detached with own compound
(e) Occupation of entire Building: By Proposer/others if any ?
  Description Sum Insured Rs.
i) Building of Residence 
ii)

Furniture, Fixture and Fittings

iii)

 Contents there in belonging to Insured & members of this family residing permanently with him.
iv) TV Model and Manufacturer's Name
v) Others (Please submit the separate sheet to the company or email us if contents exceed the value of Rs. 2000/-)
vi) Nominee for Personal Accident insurance benefit to Insured  for Capital Sum Insured Rs. 10,000 against Death & Permanent Total Disablement benefits in age group 16 to 70 only.
Place Date
 
 
 
 
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