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Re-Check of Measurements: Name

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shishuranjan
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38 views1 page

Re-Check of Measurements: Name

Uploaded by

shishuranjan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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RE-CHECK OF MEASUREMENTS

Division___________________ Branch Office _______________

Date ___________

Proposal No./Policy No._______________ Date of Re-check______________

On the life of ___________________________________ Age _______ Years

Height(without shoes) Cms.

Weight(with thin clothes) Kgs.

Chest(Over Nipples Stripped) on complete expiration Cms.

On complete Inspiration Cms.

Abdomen (Over Naval) Stripped Cms.

Marks of Identification _______________________________________________________

_________________________ _____________________________________
Signature of Proposer/Life Assured Signature of Medical Examiner with seal/Branch Manager

________________________ Name :
Signature of the Introducer Designation & Qualification :
Code No. & Address
Agent / Dev Officer
Code No.

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