Health Declaration Form Lic

Answers must be given in words strokes of pen or dots or dashes will not be accepted as replies.

Health declaration form lic. If your declaration is more than one page long staple all pages together. Proposal for insurance under jeevan akshay ii. Lic branch offices in india lic branch offices in india with branch code branch address and branch email id.

Revival of lapsed policy form 680. Life form 32 page 1 of 3 declaration of good health personal statement regarding health all answers to be filled in legibly. Proposal for insurance under bima nivesh.

Full name of the life assured address1 address2 full. Sum assured name address. And understand that you will inform the department of any changes to the information provided in the form.

Yogakshema building jeevan bima marg p o. Lic forms download declaration of good health dgh 680. Posted by lic of india at 8 14 pm.

Instructions for filling up above form. Tell how the information in the declaration relates to the facility i am a resident of i am a neighbor of etc be sure the declaration gives the name and address of the facility and the operator s name. Use this form for the first and last pages.

Lic ecs mandate form for premium payment. Proposal details policy no. Page 1 of 3 established by the life insurance corporation act 1956 personal statement regarding health revival of lapsed policies on both medical non medical basis agent s name.