INSURANCE Life Insurance TERM POLICY SUPER TERM POLICY MONEY BACK POLICY Income Policy PENSION POLICY CHILD POLICY WHOLE LIFE POLICY Health Insurance Individual Family Floter Multi Individual Top-up / Super Top-up Travel Policy Critical Illness Policy Overseas Mediclaim Group Policy General Insurance TWO WHEELER POLICY Taxi / Riksha Private Car PCCV GCCV School Bus miscellaneous policy Marine Policy Personal Accident Policy workman compensation Policy Group Insurance Policy Associate ID Master ID LIFE INSURANCE TERM POLICYSUPER TERM POLICYMONEY BACK POLICYINCOME POLICYPENSION POLICYCHILD POLICYWHOLE LIFE POLICY HEALTH INSURANCE INDIVIDUALFAMILY FLOTERMULTI INDIVIDUALTOP-UP / SUPER TOP-UPTRAVEL POLICYCRITICAL ILLNESS POLICYOVERSEAS MEDI-CLAIMGROUP POLICY GENERAL INSURANCE TWO WHEELER POLICYTAXI / RIKSHAPRIVATE CARPCCVGCCVSCHOOL BUSMISCELLANEOUS POLICYMARINE POLICYPERSONAL ACCIDENTWORKMAN COMPENSATIONGROUP INSURANCE Name of Proposer Gender MaleFemaleOther Proposer Date of Birth Name of Life to be Insured Gender of Life Insured MaleFemaleOther Education of Life Insured Life Insured Date of Birth Address City City Code Contact Number Email ID Name of Nominee Nominee Date of Birth Relationship with nominee Contact Number of nominee Name of Appointee Appointee Date of Birth Relationship with Appointee Contact Number of Appointee Current Occupation Select OneService in MNCService in Private LimitedService in GovernmentSelf EmployedPartnershipSmall Scale BusinessRetired Firm Name Designation Monthly Take Home Pan Number Upload Pan Aadhar card Upload Adhar card Upload Photo Other Documents Purpose of Proposal Proposed Sum Assured Premium Payment Type Select OneSingleLimitedRegular Premium Payment Mode Select OneMonthlyQuarterlyHalf YearlyAnnually Premium Payment Way Select OneOnline PaymentCheque PaymentCard PaymentUPI Payment Need Health Policy Select OneYesNo Need Motor Policy Select OneYesNo Dear subscriber, this is the system generated service application form for collecting basic and initial information of proposer and service information use for internal record of Coverdeed Group, there will be more other process if proposal accepted. Agreed Dear subscriber, you are choosing and applying for services through Coverdeed Group and for discussion of concern service, we are appointing an advisor by Coverdeed Group for you. It is our assurance that you will be satisfied meeting with our associate for your all requirement-related concerned service, we will not take the final step for closing the deal, till you understand the process and system-related service. Our associate will clear you the whole pattern, system, terms & conditions of the base company and mediator company, also our associate will understand the product features, supportive plan and related policies, properly. Agreed
