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Rance Policy The Policy does not commence until the proposal is accepted and premium paid Note : Please answer every question fully Intermediary Details (To be filled in BLOCK LETTERS) Intermediary Name Code Branch Name Code Sales Manager Name Code Proposer's Details 1. Name of the Proposer 2. Customer ID 3. Address for Communication Flat Building Road/Street/Sector Area Taluka/Village/District/City Pin Code State Country Phone Mobile Email Fax 4. Profession, trade, business.

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