SBI Life Advisor

Short MHR

Proposal Number

Proposal Name

Sum Assured

IA Name

IA Code

Region

SUC

Channel

1) Have you met the life to be assured/proposer?

Yes

Meeting Date:

Place of Meeting

Customer Photo

Please describe the manner in which you gathered information about this case.

2) Have you verified occupation, financial & social position, and personal habits of the Life to be assured as stated in the proposal form & found them to be correct?

Yes

Life Assured Details

3) Do you have any knowledge of Life to be Assured suffering from any serious illness or injury or undergone any operation or medical investigation or aware of having any apparent physical deformity or mental retardation or any other circumstances that are likely to add to the risk?

Yes

Injury , Illness or Other Details

4) Are you fully satisfied with the overall profile & identity (including KYC details) of the Life to be assured & recommend for policy issuance ?

Yes

Details

I hereby declare that I have discussed this case with the Advisor and confirm on the basis of my independent assessment and evaluation that the foregoing statements are correct.