[pdf] Download LIC Questionnaire Form Pdf

LIC Questionnaire form pdf– In this post you will get LIC Questionnaire form pdf, you can download it from this post. The downloadable link is given bottom of the article-

LIC Questionnaire form pdf

What is LIC Questionnaire form pdf ?

Proposal No_____________________ Form No. LIC03 – 507
Name of the Proposer______________________________________________

  1. On what type of vessel do you normally
    Cargo, passenger, container, etc
  2. In what country is the vessel registered?
  3. What is the gross tonnage of the vessel?
  4. What type of cargo does the vessel carry?
  5. What is your specific job title?
  6. What are your precise duties?
  7. In what areas does the vessel operate?
    If this includes the Middle East area, Please
    give full details
    I _______________________________ do hereby declare that the foregoing
    statements and answers are true in every particular and agree and declare that these
    statements and this declaration along with my Proposal for Insurance and the Declaration
    relative thereto shall form the basis of the contract between me and the Life Insurance
    Corporation of India and that if any untrue averment be contained therein the said contract
    Page 2 of 2
    shall be absolutely null and void and moneys which shall have been paid in respect thereof
    shall stand forfeited to the Corporation.
    Dated at _______on the _________day of _____________200 Signature of Witness____________
    Address Signature of the Life to be assured
    In case the Proposer is illiterate:
  8. This declaration should be made by the person filling in the form:
    I hereby declare that I have fully explained the above questions to the proposer & I have
    truthfully recorded the answers given by the proposer.
    Address of the Declarant Signature
  1. The thumb impression of the proposer should be attested by a person of standing whose
    identity can be easily established, but unconnected with the Corporation and this declaration
    should be made by him:
    I hereby declare that I have explained the contents of this form to the proposer in
    __(language) and that I have read out to the proposer the answers to the questions
    dictated by the proposer and that the proposer has affixed his thumb impression to this form
    after fully understanding the contents thereof.
    Address of the Declarant Signature

Also Read- LIC loan form pdf Download

Download LIC Questionnaire Form pdf

Here you can download LIC Questionnaire Form pdf below-

Name of the formLIC Questionnaire Form pdf
Total No. of Page2
File TypePDF
AuthorityLIC, India
Official WebsiteVisit
Download link


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