LIFE INSURANCE CORPORATION OF INDIA – DIGITAL INTERMEDIATE, VISUAL EFFECTS & GAMING ASSOCIATION

LIFE INSURANCE CORPORATION OF INDIA .

FLAT COVER OF Rs 1,00,000

1.No medical examination is required.

2.Cover is offered only to citizens of India.

3.This Group Insurance Scheme covers Death due to any reason and any time for one year from date of receiving the premium.

4.Claim payable for both natural and accidental death.

5.Cover offered is worldwide. The Claim amount shall be paid in Indian Rupees.

6.Maximum age allowed is 60 yrs only.

DIVA ID NUMBER *

NAME *

DATE OF BIRTH *//

PAN NUMBER *

DESIGNATION *

MOBILE NUMBER *

NOMINEE NAME *

NOMINEE DATE OF BIRTH *//

RELATIONSHIP *

Address *