DDR LIFE

Business Form

Name

Father's Name

Date of Birth

PAN Number

Mobile

Aadhaar Number

Address

Pin Code

Bank Details

Bank Name

Account Holder Name

Account Number

IFSC Code

Policy Owner ( Only For Insurance )

Nominee Name

Nominee D.O.B

Nominee A/C No

Nominee Bank Name

PO Mother Name

PO Father Name

PO Education

PO Height

PO Weight

PO Yearly Income

PO Occupation

Policy Insured

PI Name

PI D.O.B

PI Mother Name

PI Height

PI Weight

Insurance Co. Name

PI Plan Name

PPT

First Premium Pay

Member Id

Member Name

Cheque Bank name

Cheque Number

Premium Amount

Number Quality Item Number

Receipt Upload*

I accept Term & Conditions

Terms & Conditions

I declare that I have received complete information about DDR LIFE PRIVATE LIMITED's business plan, as well as specific information about all the products offered by the Company, and have found them satisfactory. I am accepting this after careful consideration. I accept all the terms, conditions, terms and regulations of the Company. I also agree to accept any changes made by the Company from time to time. I am uploading correct KYC-related documents as required by the Company. I acknowledge that, if under any circumstances I am found to be inaccurate or acting against the Company's interests, the Company reserves the right to take appropriate action against me or cancel my license.

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Business Form

Bank Details

Policy Owner ( Only For Insurance )

Policy Insured

Terms & Conditions

Signature