EFT Cashiering

Proposal Number*

Proposal Details

Policy Holder Name

Proposal Date

Is Proposal Same as Life Assured

Total Premium Amount

Basic Sum Assured

Policy Holder DOB

Policy Term

Premium Payment Term

Frequency

Plan Name

Policy Holder's Bank Account Number

IFSC Code*

Channel Type

SP Bank Code

SP Bank Name

Selling Branch Code

Branch Name

SP Code

SP Name

Payment Mode

Payment Paid By

Third Party Payor Name

Relationship For Third Party

Third Party Account Number

Third Party Bank Name

Bank Name(as per IFSC Code)

Branch Name(as per IFSC Code)

EFT Details

Transaction Reference Number*

Re-enter Transaction Reference Number*

Transaction Date*

Transaction Amount*

Re-enter Transaction Amount*

Pay Mode*

Journal Number*

Debit Account Number*

Re-Enter Debit Account Number*

Is account holder name Same as Proposer?*