1Form No. HI/PPL/1 Annexure III PROPOSAL FORM FOR LIC’s HEALTH PLUS POLICY – PLAN 901 · IN UNIT-LINKED POLICIES, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO.

 

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HEALTH INSURANCE CLAIM FORM Please attach this form in Original to the hospital b ill and other claim documents. Separate claim form.

 

Allianz Insurance Lanka Limited 92, Glennie Street, Colombo02 Tel: 2300400 Fax: 2 304404 E- mail : info allianz. lk It is important that.

 

Page 1of 5 Date Home Telephone Business Telephone _______________ Email address This form is extremely important. Your accuracy and completeness.

 

Page 1of 5 Date Home Telephone Business Telephone _______________ Email address This form is extremely important. Your accuracy and completeness.

 

NATIONAL INSURANCE TRUST FUND No. 97, Maradana Road, Maradana. Tel : 011 4 873900 –5 Hotline 071 4 553941, Fax : 0112 431145 E- mail mail nitf. lk , Web www. nitf.

 

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002 Easy Health ProposalForm24. In the event of the death of an Insured Person.

 

Corporate Health Providers Proposal Form Page 1 Corporate Health Providers Proposal Form Page 1 Please read the following questions.

 

PLEASEANSWER ALLQUESTION S This insur ance does not commence until the proposal is accepted and premium paid. Proposer Details1. Name of the Proposer.

 

1. ±±±±SECTION2 INSURANCE Illness benefit applied for Rs. Do you have other current or pending critical illness Insurance with BAGICL YESNOIf yes Policy.

 

±±±± 1. Name of the proposer: Mr/Ms Surname First Name MiddleName2. Address: Res: PinCity State Telephone Mobile E mail Income.

 

When your application is completed, simply cut off form, moisten, fold and seal where indicated and post. FREEMAN L.

 

PERSONAL GUARD PERSONAL GUARD Proposal Form PLEASE ANSWER ALL QUESTIONS This Insurance does not commence until the proposal is accepted.

 

Ê ‡1 Ê- 7HEN4HYROID ISAFFECTED /…ÞÀœˆ ̅ ˜ÊޜÕÊ̅ˆ˜ŽÊ ÞÊ ÀiÃÌ Ê Ü ˜ 9OU !BOUT ILLNESS 7OMENAREFIVETO MPROVEDPUBLIC THYROID 1 ENDOCRINESYSTEM.

 

PERSONAL GUARD PERSONAL GUARD Proposal Form PLEASE ANSWER ALL QUESTIONS This Insurance does not commence until the proposal is accepted.

 

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PERSONAL GUARD PERSONAL GUARD Proposal Form PLEASE ANSWER ALL QUESTIONS This Insurance does not commence until the proposal is accepted.

 

1. ±±±±SECTION2 INSURANCE Illness benefit applied for Rs. Do you have other current or pending critical illness Insurance with BAGICL YESNOIf yes Policy.

 

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! ! PROPOSAL FORM FOR HEALTH INSURANCE POLICY Branch ……………. Divisional. R/U/F/S…… ………………………. Agent’s Name ………………………………… ……… Code No. ……… ……. Licence No……………….