Policy Update — International Quality

Policy Holder Information

1. Proposal No

2. Policy No

3. Name

4. Father Name

5. Mother Name

6. Spouse Name

7. Address

8. Upazilla / Thana

9. District

10. Division

11. Mobile

12. Email

13. Date of Birth

14. Age

15. Age Proof

16. Education

17. Religion

18. Sex

19. National ID

Only 10, 13, or 17 digits are allowed.

20. Occupation

21. Nationality

22. Entry Date

Nominee & Guardian Information

24. Nominee 1 Name

25. Nominee 1 Age

26. Nominee 1 Relation

27. Nominee 1 %

36. Guardian Name (Optional)

37. Guardian Age (Optional)

38. Guardian Relation (Optional)

39. Entry Date (Nominee)

Policy Information

41. Sum Assured

42. Plan No

43. Term

44. Mode of Payment

50. Sum at Risk

51. Premium Rate

52. 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)

54. Supp Age Limit

55. Medical

56. Total Premium (Modal)

57. Entry Date (Policy)

Policy Setup / FA Chain / Agency

59. FA Code

60. FA Name

61. UM Code

62. UM Name

63. BM Code

64. BM Name

65. DC Code

66. DC Name

67. RC Code

68. RC Name

Agency/Office Setup

70. Agency Code

71. Agency Name

72. Zone Code

73. Zone Name

74. Division Code

75. Division Name

76. Project Code

77. Entry Date (Setup)

Document Upload

Proposal Update Form