Policy Update — International Quality

Policy Holder Information

1. Name

2. Father Name

3. Mother Name

4. Spouse Name

5. Address

6. Upazilla / Thana

7. District

8. Division

9. Mobile

10. Email

11. Date of Birth

12. Age

13. Age Proof

14. Education

15. Religion

16. Sex

17. National ID

Only 10, 13, or 17 digits are allowed.

18. Occupation

19. Nationality

20. Entry Date

Nominee & Guardian Information

21. Nominee 1 Name

22. Nominee 1 Age

23. Nominee 1 Relation

24. Nominee 1 %

33. Guardian Name (Optional)

34. Guardian Age (Optional)

35. Guardian Relation (Optional)

36. Entry Date (Nominee)

Policy Information

37. Sum Assured

38. Plan No

39. Term

40. Mode of Payment

43. Sum at Risk

44. Premium Rate

45. Basic Premium (Modal)

Supplementary Riders

Designed for a cleaner look. The new HI rider fields stay in one elegant single-line layout on larger screens.

Supple Name

Supple Sum Assured

Supple Premium Rate

Supple Premium (Modal)

Supple Sum Assured (Total)

46. Supp Age Limit

48. Total Premium (Modal)

49. Entry Date (Policy)

Policy Setup / FA Chain / Agency

50. FA Code

51. FA Name

52. UM Code

53. UM Name

54. BM Code

55. BM Name

56. DC Code

57. DC Name

58. RC Code

59. RC Name

Agency/Office Setup

60. Agency Code

61. Agency Name

62. Zone Code

63. Zone Name

64. Division Code

65. Division Name

66. Project Code

67. Entry Date (Setup)

Document Upload

PH/Nominee photos are automatically prepared in passport ratio (35:45). Default background is White; Sky Blue is optional.

Online Proposal Entry Form