Reliance Nippon Life Insurance

Enter Details

Salutation

Life Stage

Financial, Family Goal

Annual Family Income (Rs.)

Name of the Insurance Advisor

Advisor/Employee Code

Name of Life Assured *

Gender of Life Assured

Male

Female

Date of Quotation

Date of Birth of Life Assured*

Age *

Proposer Details

Same as Above

Yes No

Salutation

Name of Prospect / Policyholder

DOB of Prospect / Policyholder

Age

Gender of Prospect / Policyholder

Male

Female

Age Proof

Policy Term

Premium Paying Term

Premium Mode

Method of Payment

ECS

Non-ECS

Modal Premium

Annual Premium

Monthly Income

Sum Assured

SAMF

Reliance group employees

Preferred Language

Branch location (State/UT)

Customer's Communication Address (State/UT)

Distribution Channel

Employee Code (Optional)

Mobile Number

Investment Option chosen

EMR

Flat Extra

Child Information

Children		% Sum Assured
		Total : 0%

Fund Allocation in %

Life Equity Fund 3

Life Pure Equity Fund 2

Make in India Fund

Life Balanced Fund 1

Life Corporate Bond Fund 1

Life Money Market Fund 1

Life Large Cap Equity Fund

Do you want to add Riders to this plan?

Yes No

Partial Withdrawal

Summary

Plan Type
Investment Option
Age
Policy Term / Premium Paying Term

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Joint Life Details

Life-2

Name

Date of Birth

Age

Gender

Life-3

Name

Date of Birth

Age

Gender

Life-4

Name

Date of Birth

Age

Gender

Life-5

Name

Date of Birth

Age

Gender

Life-6

Name

Date of Birth

Age

Gender

Life-7

Name

Date of Birth

Age

Gender

Life-8

Name

Date of Birth

Age

Gender

Summary

Name	Annual Premium	Installment Premium	Goods And Services Tax	Inst. Premium with GST
No Record Found

Basic Information

Name :

Gender :

Male

Date of Birth :

Proposer Details

Same As Above

Product Information

PT :

PPT :

Modal Premium :

Annual Premium :

Monthly Income :

Sum Assured :

Product	Age	PT	PPT	Premium	Option
	Label			Label

Partial Withdrawal

Rate in %

Year

Withdraw 4%

Withdraw 8%

From Year

To Year

Percentage %

Product Name

1

Enter Details

Proposer Details

Other Details

Fund (applicable for Self-Managed Investment Option)

Withdrawal

Child Information

Fund Allocation in %

Rider Details

Medical Underwriting

Joint Life Details

Summary

Generate BI

Product Name

1

Enter Details

Proposer Details

Other Details

Fund (applicable for Self-Managed Investment Option)

Withdrawal

Child Information

Fund Allocation in %

Rider Details

Select Preferred Goals

Validation Errors

Send Mail

Send SMS

Send WhatsApp SMS

Medical Underwriting

Joint Life Details

Summary

Generate BI