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Online Premium Calculator for Insurance Plans - Kotak Life Insurance
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Other Details
Insured Name
Mr.
Ms.
Master
Name of Proposer
Mr.
Ms.
Master
Name of Spouse
Mr.
Ms.
If you are a NPS Subscriber, then will you prefer Family Pension
*
No
Yes
Existing Policy Number
*
Organization Name
*
Organization Name
*
Is the Life Insured same as the Proposer?
Yes
No
Proposer Gender
Male
Female
Date of Birth of Premium Payer
*
/
/
Do you want to backdate the policy?
Yes
No
If yes, kindly specify the backdation date
*
/
/
Gender
Male
Female
Date Of Birth Of Insured
*
/
/
Spouse Gender
Male
Female
Date of Birth of Spouse
*
/
/
Channel Type
*
Email
Mobile No
Are you a Tobacco user ?
Yes
No
Are you a Non-Resident Indian?
*
Yes
No
Will you be able to furnish the Bank Certificate?
Yes
No
Agent’s Branch Location
*
Select
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chattisgarh
Daman Diu Dadra Nagar Haveli
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep Islands
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
State located in
Proposer’s Current Location
*
Select
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chattisgarh
Daman Diu Dadra Nagar Haveli
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep Islands
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Foreign Country
Correspondence Address / State
Occupation Of Proposer
Select
Employed
House Wife
Dummy Code for OTC
Retired/ Pensioner
Self Employed
Self employed /Professional
Student
Occupation Of Insured
Select
Employed
House Wife
Dummy Code for OTC
Retired/ Pensioner
Self Employed
Self employed /Professional
Student
Income Of Proposer
Category
Select
Electronic Cl. System
Employer Employee
Hindu undivided family
Married Women Property
Rural/Urban Not Known
Non Rural
Non Resident Indian
Partnership
Rural Policy
Trust cases
Mode of Premium Payment
*
Select
Cash
Cheque
Demand Draft
Credit Card
Net banking
Future Type of Premium Payment
Additional Details required for Addendum Form:
Plan:
Kotak Life Time Income
Portion of the proceeds you want to purchase Annuity* with:
%
Annuity
Option:
*
Frequency of Annuity Payment:
*
Monthly
Quarterly
Half-Yearly
Yearly
Spouse Details (*Applicable only for ‘Last survivor Lifetime Income options’ Spouse):
Name of Spouse
Mr.
Ms.
Gender
Male
Female
Date of Birth
*
/
/