Form NoForm NameF5
3
Age Declaration by Parent 
43
Specimen Signature Form 
137A
Claim for Disability/Sickness Benefit under Nav Prabhat Plan 
137B
Claim for Disability/Sickness Benefit under Nav Prabhat Plan 
137C
Claim for Disability/Sickness Benefit under Nav Prabhat Plan 
137D
Claim for Disability/Sickness Benefit under Nav Prabhat Plan 
137E
Claim for Disability/Sickness Benefit under Nav Prabhat Plan 
137F
Disability Claims Due To Accident And Sickness Under Nav Prabhat Plan  
294
Addendum For Assurance On The Lives Of Minors & Non-earning Major Lives 
295
Addendum to Proposal for family details 
300
Proposal For Insurance on Own Life 
311
Policy Lost Questionnaire 
340
Proposal For Insurance On The Life Of Another Person 
360
Proposal For Insurance On Another Person 
440
Proposal Form For Jeevan Akshay VI 
460
Health Declaration for New Policy 
680
Health Declaration for Revival of Policies 
700
Personal Statement Regarding Health 
720
Health Declaration for Revival of Policies on Minor Life 
827
Jeevan Rakshak Own Life 
827A
Jeevan Rakshak Another Life 
835
Proposal For New Endowment Plus Plan 
904
Proposal Form For Health Insurance Policy 
3166
Previous Policy Extract 
3179
Consent For Extra 
3237
Nomination form under Joint Life 
3237A
Nomination form under Jeevan Saathi Policy 
3251A
Special Moral Hazard - Annexure A 
3251B
Special Moral Hazard - Annexure B 
3260
Declaration By Proposer / Agent / D.O. for Standard Age Proof 
3261
Stamped Age Declaration By Elder 
3264
Nomination form  
3265
Nomination form for Minor Nominee 
3310
Report of Fluoroscopic Examination (Screening) 
3311A
Report of Glucose Tolerance Test of Urine 
3313
Report on X-ray (plain) of Genito Urinary Tract KUB Area 
3314
Report on X-ray of Stomach & Duodenum (Barium meal) 
3315
Report on X-ray of Caecum and Colon (Barium enema) 
3316
Report on Intravenous – Pyelography 
3317
Report of Cholecystography 
3321
Sputum Examination 
3322
Addendum for Asthama / Bronchitis 
3324
Personal History of An Operation for Gastric or Duodenal Ulcer 
3325
Personal History of Indigestion, Dypspepsia, Gastric or Duodenal Ulcer (not operated) 
3326
Kidney / Colic / Stone History Questionnaire 
3327
Personal History of Gall-bladder Disease 
3330
Goitre (with operation) 
3331
Goitre ( without Operation ) Questionnaire 
3332
Filariasis Form 
3333
Chest Pain Questionnaire 
3334
C.N.S. Questionnaire 
3335
Stool Report 
3336
Tuberculosis Questionnaire 
3337
Pleurisy Questionnaire 
3340
Epilesy Questionnaire 
3341
Gynaelogist Report 
3344
SBT-27 
3738
Appointment of Appointee 
3740
Revocation of Appointment of Appointee 
3741
Appointment of Fresh Appointee 
3750
Change of Nomination 
3757
Indemnity Bond For Duplicate Policy - In Multiple Case 
3762
Stamped Declaration for Policy Loss - Duplicate Policy 
3772
Declaration Of Health And Risk For Accident Benefit 
3777
Queries To Be Answered By Army Personnel 
3783A
Claimants Statement 
3784B
Medical Attendants Certificate 
3785
Burial Cremation Certificate 
3787
Employers Certificate 
3788
Confidential Report By The Agent 
3801
Death Claim Discharge Form 
3805
Claim 
3805A
Claim Settlement 
3805B
Form Of Letter Of Indemnity 
3806
Form Of Application To Dispense With Legal Evidence Of Title 
3806A
Form Of Application To Dispense With Legal Evidence Of Title 
3815
Stamped Declaration for Policy Loss - Claim 
3815A
Form Of Letter Of Indemnity 
3815B
Judicial Form 
3816B1
Certificate Of Hospital Treatment 
3816B2
Certificate Of Treatment 
3825
Maturity Value Discharge Form 
3827
Certificate Of Existence 
3828
Form Of Receipt To Be Furnished Under Educational Annuity 
3848
Form of Assignment 
4104A
Statement If Std. Age Proof Not Submitted 
4104B
Age Extract 
5074
Surrender Value Discharge Form 
5096
Unstamped Self Age Declaration 
5193A
Diving Questionnaire 
5194
Successive, Alternative Nomination 
5220
Stamped Self Age Declaration 
5233
Form of Declaration for disability Benefit under a Policy 
5279
Claim for Disability Benefit 
5280
Claim for Disability Benefit 
7554
Specimen Of Authorisation Letter 
32851
Special M.H.R. 
AD(C)-1
Cancer Claim under Asha Deep 
AD(C)-2
Cancer (Malignant) Claim under Asha Deep 
AD(CABG)-2
CABG Claim under Asha Deep 
AD(CABG)-3
CABG Claim under Asha Deep 
AD(KF)-1
Kidney Failure Claim under Asha Deep 
AD(KF)-2
Kidney Failure Claim under Asha Deep 
AD(KF)-3
Kidney Failure Claim under Asha Deep 
AD(PS)-1
Paralytic Stroke Claim under Asha Deep 
AD(PS)-2
Paralytic Stroke Claim under Asha Deep 
Addendum1
Addendum to Proposal for Ceasarean History 
Addendum2
Addendum For Multiple Proposals 
Addendum3
Proposal Form For Jeevan Tarun 
AD(CABG)-1
CABG Claim under Asha Deep 
A-EC
Certificate Of Existence under Annuity 
AIC
Certificate Of Agricultural Income 
CA1
Chartered Accountants Certificate 
Cat-I
Addendum to Proposal for Cat. I Female 
Cat-III
Special MHR for Category III ladies 
CIRB1
Claimants Statement For CIRB 
CIRB2
Employers Certificate 
CIRB3
Critical Illness (Heart Attack,CABG,HVR) 
CIRB4
Claim Under Critical Illness Rider 
CIRB5
Critical Illness (Cancer) 
CIRB6
Claim Under Critical Illness Rider For Cancer 
CIRB7
Critical Illness (Stroke) 
CIRB8
Claim Under Critical Illness Rider For Stroke 
CIRB9
Critical Illness (Kidney Failure) 
CIRB11
Critical Illness (Aorta Graft Surgery) 
CIRB12
Claim Under Critical Illness Rider For Aorta Graft Surgery 
CIRB13
Critical Illness (Blindness) 
CIRB14
Claim Under Critical Illness Rider For Blindness 
CIRB15
Critical Illness (Third Degree Burns) 
CIRB16
Claim Under Critical Illness Rider For Third Degree Burns 
CIRB17
Critical Illness (Major Organ Transplant) 
CIRB18
Claim Under Critical Illness Rider For Major Organ Transplant 
CIRB19
Critical Illness (Paralysis) 
CIRB20
Claim Under Critical Illness Rider For Paralysis 
CIRB-C
Discharge Under Critical Illness Rider Benefit 
DCPB
Day Care Procedure Benefit 
Declaration1
Declaration For Splitting Of Large Sum Assured 
Direct1
Premium Collection Facility Through LIC Nomura Mutual Fund 
ECS1
IPP ECS Mandate Form 
ECS4
ECS Mandate Form 
HI-ClaimIntimation
Health Insurance Claim Intimation Form 
HIDGH1
Personal Statement Regarding Health Plus Policies 
HIDGH2
Personal Statement Regarding Health For Major Insured Member Under Health Plus Policies 
HIDGH3
Personal Statement Regarding Health For Minor Insured Under Health Plus Policies 
HOSPITAL CLAIM
Claim For HCB, MSB under Health Insurance Policy 
HUF
HUF Addendum To Proposal 
JA-1
Claim Under Survival Benefit Option II Of Jeevan Asha Plan  
JA-2
Claim For Minor/Major Surgical Procedure Covered Under Jeevan Asha 
JB(CDB)-1
Requirements Needed For Processing The Claim Under Critical Illness Rider 
JB(CDB)-2
Claim Investigation Report Of Critical Illness Rider Benefit 
JB(FCE)-3
Congenital Disability Benefit Claim Under Jeevan Bharati 
JB(FCF)-2
Female Critical Illness Benefit Claim Under Jeevan Bharati 
Juv FMR
JUVENILE FMR 
KeyMan
KEYMAN QUESTIONNAIRE 
KeyMan-A
Draft Of Resolution To Be Passed By Company Board For KeyMan Insurance 
KeyMan-B
KEYMAN QUESTIONNAIRE 
KeyMan-C
Income Declaration For Keyman Insurance 
LI-Annuity
Form Of Letter Of Indemnity 
LIC-03-002
ELECTROCARDIOGRAM 
LIC-03-003
COMPUTERISED TREADMILL TEST 
LIC-03-004
HAEMOGRAM 
LIC-03-005
LIPIDOGRAM 
LIC-03-006
BLOOD SUGAR TOLERANCE REPORT 
LIC-03-007
SPECIAL BIO-CHEMICAL TESTS – 12 (SBT-12) 
LIC-03-008
SPECIAL BIO-CHEMICAL TESTS – 18 (SBT-18) 
LIC-03-009
ROUTINE URINE ANALYSIS 
LIC-03-010
REPORT ON X-RAY OF CHEST (P.A. VIEW) 
LIC-03-011
ELISA FOR HIV 
LIC-03-012
PHYSICIAN’S REPORT 
LIC-03-013
SPECIAL BIO-CHEMICAL TESTS – 13 (SBT-13) 
LIC-03-500
GENERAL OCCUPATION QUESTIONNAIRE 
LIC-03-501
ARMY PERSONNEL QUESTIONNAIRE 
LIC-03-502
AVIATION (ARMED SERVICES) QUESTIONNAIRE 
LIC-03-503
AVIATION (CIVIL) QUESTIONNAIRE 
LIC-03-504
CIVIL GLIDING QUESTIONNAIRE 
LIC-03-505
NAVY PERSONNEL QUESTIONNAIRE 
LIC-03-506
DIVING (ARMED SERVICES AND COMMERCIAL) QUESTIONNAIRE 
LIC-03-507
MERCHANT MARINE QUESTIONNAIRE 
LICCard
Application form for Credit Card 
MHR-III
Special MHR for Category III ladies 
MI
DEATH CLAIM FORM UNDER MICRO INSURANCE POLICY 
MSB
Annexure For Major Surgical Benefit 
NB-56
MHR For Physically Handicapped Life 
NB59
DEFORMITY QUESTIONNAIRE 
NRI1
Moral Hazard Report For Mail Order Business 
NRI2
SPECIAL QUESTIONNAIRE TO BE COMPLETED IN RESPECT OF NRIs 
NRI3
QUESTIONNAIRE TO BE COMPLETED BY NON-RESIDENT INDIAN 
PN74
ADDENDUM TO PROPOSAL FOR ASSURANCE ON THE LIVES OF MINORS AND NON-EARNING MAJOR LIVES 
PPL1
Health Plus Plan Proposal Form – Addendum for Bank Details 
Q-AA
Arthritis Questionnaire 
Q-BP
High Blodd Pressure Questionnaire 
Q-DA
Diabetes Questionnaire - Applicant 
Q-DP
Diabetes Questionnaire - Physician 
Q-EE
EMPLOYER – EMPLOYEE SCHEME QUESTIONNAIRE 
Q-H
HERNIA QUERY FORM 
Q-HA
High Blood Pressure Questionnaire – Applicant 
Q-Hearing
Hearing Questionnaire 
Q-HP
Hypertension Questionnaire – Physician 
Q-MD
Musculoskeletal Disorders Questionnaire – Attending Physician 
Q-Op
Ophthalmic Report 
Q-PF
Personal Financial Questionnaire 
Q-PL
Policy Lost Questionnaire 
Q-RT
Residence and Travel Questionnaire 
Reassign
Reassignment For Valuable Consideration 
Recheck
Re-Check Of Measurements 
Rev-0814
Hospital Treatment Form 
Sup-deed
Specimen of Supplementary Deed Of Partnership 
503
Jeevan Shanti Proposal Form 
AIC
Certificate Of Agricultural Income 
5
DECLARATION TO BE MADE BY THE PARENTS 
74
ADDENDUM TO PROPOSAL FOR ASSURANCE ON THE LIVES OF MINORS AND NON-EARNING MAJOR LIVES 
Arthritis1
Arthritis questionnaire - Applicant 
Claim form MI
DEATH CLAIM FORM UNDER MICRO INSURANCE POLICY 
Claim1
Claim For HCB and MSB under Health Insurance Policy 
Claim2
Health Insurance Claim Intimation Form 
3179
Consent For Extra 
Credit1
Application form for Credit Card 
Diabetes1
Diabetes Questionnaire - Applicant 
Diabetes2
Diabetes Questionnaire - Physician 
DQ1
DEFORMITY QUESTIONNAIRE 
EC1
Certificate Of Existence under Group Annuity 
EmployerEmployee1
EMPLOYER – EMPLOYEE SCHEME QUESTIONNAIRE