IndusInd Nippon Life Insurance

Enter Details

Salutation

Life Stage

Financial, Family Goal

Annual Family Income (Rs.)

Name of the Insurance Advisor

Advisor/Employee Code

Name of Life Assured *

Gender of Life Assured

Male

Female

Date of Quotation

Date of Birth of Life Assured*

Age *

Proposer Details

Same as Above

Yes No

Salutation

Name of Prospect / Policyholder

DOB of Prospect / Policyholder

Age

Gender of Prospect / Policyholder

Male

Female

Age Proof

Policy Term

Premium Paying Term

Premium Mode

Method of Payment

ECS

Non-ECS

Modal Premium

Annual Premium

Monthly Income

Sum Assured

SAMF

Group Employee Flag

Preferred Language

Branch location (State/UT)

Customer's Communication Address (State/UT)

Distribution Channel

Employee Code (Optional)

Mobile Number

Investment Option chosen

EMR

Flat Extra

Child Information

Children		% Sum Assured
		Total : 0%

Fund Allocation in %

Life Equity Fund 3

Life Pure Equity Fund 2

Make in India Fund

Life Balanced Fund 1

Life Corporate Bond Fund 1

Life Money Market Fund 1

Life Large Cap Equity Fund

Do you want to add Riders to this plan?

Yes No

Disclaimer

If any policy is medically Declined or postponed with INLIC then client can apply for Pension / Annuity plan only.

Partial Withdrawal

Summary

Plan Type
Investment Option
Age
Policy Term / Premium Paying Term

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Joint Life Details

Life-2

Name

Date of Birth

Age

Gender

Life-3

Name

Date of Birth

Age

Gender

Life-4

Name

Date of Birth

Age

Gender

Life-5

Name

Date of Birth

Age

Gender

Life-6

Name

Date of Birth

Age

Gender

Life-7

Name

Date of Birth

Age

Gender

Life-8

Name

Date of Birth

Age

Gender

Summary

Name	Annual Premium	Installment Premium	Goods And Services Tax	Inst. Premium with GST
No Record Found

Basic Information

Name :

Gender :

Male

Date of Birth :

Proposer Details

Same As Above

Product Information

PT :

PPT :

Modal Premium :

Annual Premium :

Monthly Income :

Sum Assured :

Annuity Products

Product	Age	PT	PPT	Premium	Option
	Label			Label

Partial Withdrawal

Rate in %

Year

Withdraw 4%

Withdraw 8%

From Year

To Year

Percentage %

Product Name

1

Enter Details

Proposer Details

Other Details

Fund (applicable for Self-Managed Investment Option)

Withdrawal

Child Information

Fund Allocation in %

Rider Details

Disclaimer

Medical Underwriting

Joint Life Details

Summary

Generate BI

Product Name

1

Enter Details

Proposer Details

Other Details

Fund (applicable for Self-Managed Investment Option)

Withdrawal

Child Information

Fund Allocation in %

Rider Details

Disclaimer

Select Preferred Goals

Validation Errors

Send Mail

Send SMS

Send WhatsApp SMS

Medical Underwriting

Joint Life Details

Summary

Generate BI