Query No:
Query Status
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Branch Code Select
Policy No:
Name:
Plan Name:
Premium Ammount:
Sum Assured:
DOC:
Policy Status:
IP/PH Name:
Policy Term:
Premium Frequency:
Basic SA:
Nominee Name :
Nominee Relation:
Renewal Premium Due:
Renewal Due Date:
Alternate No:
Land Line No:
Mobile No:
Email id:
Alternate Mobile No:
Alternate Email id:
Address:
Type : Request
Category POLICY SERVICING
Sub Category
Application Number: *
Cheque No :
Mode of Query : Walkin
Request Received From : Policy Holder Relative
IC/SM/EMP Code
IC/SM/EMP Name
Contact No.
BM/DM EMP Code
BM/DM EMP Name
Relative Name
Relative Contact No.
Surender/Fund value:
Endorsement_type:
Pan Number:
Email:
New Mobile:
Nominee Name:
Nominee DOB:
marital status: Select Single Maried Widow
Address1:
Address2:
Pin Code:
Place: City: Distict: State:
communication mode: Select Email Letter Call
Go-green: Select Enable Disable
Rider Type: Select Addition Deletion
Reciept No:
Financial Year:
---Select--- PH Address is shifted/ Door Locked Met other than PH Met with PH Appointment Re-schduled Address Incorrect
Re-Schedules Date:
Lead Potentiality: --select-- HOT WARM COLD
Customer Agreed to meet RM? Select YES NO
Appointment Fixed by Ops? --select-- YES NO
Document: --select-- To Be Collected From Customer To Be Handover To Customer NA
Remark:
Appointment Date:
Appointment Time:
New Mobile Number :
New Email Id :
PAN Number
PAN Holder Name
Payee Name
Resident Consent
Aadhar Number:
Aadhaar No
DOB
Resident Name
Gender
Phone
Email Id
Care Of
Landmark
Locality
Vtc
District
House Number
Street
PostOffice
SubDistrict
State
PinCode
Language