MoneyChanakya

Your Guide to Financial Wisdom

Kapil Chopra

Your Money Chanakya™

NISM Certified · ARN – 282253

Term Insurance Proposal Form

A promise that stands strong when life takes unexpected turns

Congratulations! You've taken an important step towards strengthening your family's long-term financial security. Term insurance is a core pillar of a solid protection plan and ensures that your loved ones are financially protected even if your income stops unexpectedly.

This form captures the key details needed for your term insurance proposal. Please provide accurate and complete information for error free proposal submission.

Quick instructions

Prefer using a Laptop or a Desktop for a seamless and hassle-free process.
Use exact name, date of birth and address as per Aadhaar / PAN.
Keep these documents ready for upload:
Insured: Aadhaar, PAN, cancelled cheque / bank proof, last 6-months salary account statement, and last 3 months payslips (if SALARIED) / OR Latest 3 Years ITR copy (If SELF EMPLOYED or BUSINESS) (either separate PDFs or consolidated) & Photo.
Nominee: Aadhaar, PAN and cancelled cheque / bank proof of active account.
If you have existing life insurance policies, please provide details of each policy (company, sum assured, issuance date).
Clearly disclose any past or existing critical illnesses (self / parents / siblings) to avoid issues at underwriting or claim stage.
Use a mobile number and email ID that you actively use for communication and OTPs.

Insured Name *

Insured Date of Birth (DD-MM-YYYY) *

Format: DD-MM-YYYY

Age (completed years)

Height (cm) *

Weight (kg) *

Father's Name *

Mother's Name *

Marital Status *

Spouse name required for Married / Divorced / Widow.

Spouse Name

Place of Birth — State / UT *

Place of Birth — City / Town / Village *

Mobile No. *

Email ID *

Permanent Address (As per Aadhaar) * Correspondence Address *

Same as Permanent Address

PAN Card No *

Aadhaar Card No (12-digit) *

Even if you upload single Aadhaar PDF (front+back), Aadhaar number is required here.

Gender *

Highest Educational Qualification *

Occupation *

Firm Name / Employer Name *

Company Address *

Designation *

Annual Income (INR) *

Duration of Current Employment *

Nature of Work *

Nominee Details

Nominee details help ensure the claim is processed smoothly and the benefit reaches the right person without delays.

Nominee Name *

Nominee DOB (DD-MM-YYYY) *

Nominee Mobile No. *

Nominee Email ID *

Nominee Relation *

Existing Insurance Cover (Life)? *

Past & Existing Health Status (Any critical illness before age 60?)

Please disclose only major or critical illnesses such as cancer, heart ailments, kidney ailments, liver ailments, major organ disease, major surgery or the like. Common lifestyle conditions like hypertension, diabetes, hypothyroidism, or obesity should not be included here.

Self *

Parents *

Siblings *

Whether diagnosed with COVID-19? *

COVID Vaccination Done? *

If you do not remember the exact dates, please check the Aarogya Setu app or your email inbox/SMS records for COVID vaccination updates.

Tobacco & Alcohol

Tobacco and alcohol usage has a major impact on underwriting and premium calculation for term insurance, so please disclose it accurately.

Smoker *

Alcohol *

Bank Details

Account Holder Name *

Bank Account Number *

Account Type *

IFSC Code *

Documents — Insured

Allowed: jpg, jpeg, png, pdf. Max size per file: 1 MB. Aadhaar PDF accepted as front+back — if you upload Aadhaar as a single PDF (front+back), Aadhaar back upload is not required; the system will use the same PDF for both sides.

Bank Statement(s)

Minimum 1 file is mandatory. If you are uploading month-wise statement, upload up to last 6 months (max 6 files).

Salary Slips / ITR Copies

Minimum 1 file is mandatory. If consolidated not available, upload last 3 months salary slips separately (max 3 files) If Self Employed / Business Owner, please upload latest 3 years ITR Copies (SHOULD NOT BE PASSWORD PROTECTED).

Documents — Nominee

Allowed: jpg, jpeg, png, pdf. Max size per file: 1 MB. If nominee Aadhaar is uploaded as a single PDF (front+back), nominee Aadhaar back upload is not required.

I agree that my details will be shared with the insurance company to submit the proposal for term insurance.