Policy Update — International Quality

Proposal Update Form

New

Policy Holder

Nominee & Guardian

Policy & Riders

FA & Documents

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

20. Occupation

21. Nationality

22. Entry Date

23. User ID

Nominee & Guardian Information

Policy No

Sum Assured

Plan No

Term

Occupation

Nationality

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)

40. User ID (Nominee)

Child Information (If Applicable)

Child Name

Child DOB

Age

Age Proof

Class

Relation

Policy Information

41. Sum Assured

42. Plan No

43. Term

44. Mode of Payment

45. Pension Amount

46. Pension Age

47. Stipend Term

48. Stipend Unit

49. Stipend Amount

50. Sum at Risk

51. Premium Rate

52. Basic Premium (Modal)

Supplementary Riders

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)

58. User ID (Policy)