Current Session :
June - 2010 Proposal Receiving Date :  
  Case No : Monthwise:   Proposal No :  
                             Yearwise:   Insured Name Life Assured) :  
  Plan  :   Date of Birth :  
  Terms :   Age :  
  PC:   Sex :  
  Mini PC :   City :  
  Branch Office:   Insured Phone No :  
       

Insured mobile Phone No

( ForSMS):

 
        Insured Address :  
        Sum insured Consideration :  
        Sum insured/Age Slab Code :  
             
   
  Agent Code :   Type Of Business  :

New Business Renewal

 
  Agent name :   Test Case :  
  Agent Phone No :   TPA Fees :  
  Unit Manager :   Courier Charges :  
        Total Collection :  
        Payment Collection :

Payment to be Collected

Payment not to be Collected

 
             
 

Type A.

     
   
 
A - CBC ESR  + HBA1C + Lipid Profile Category - A  
 
B - RFT(s.Creatinine,BUN,S.Uric Acid) + LFT(GGTP,SGOT,SGPT,Alkaline) Category - A  
 
C - FBS + RUA Category - A  
 
D - HIV Category - A  
 
FMR Category - A  
 
 

Type B.

     
   
 
A - CBC ESR  + HBA1C + Lipid Profile Category - B  
 
B - RFT(s.Creatinine,BUN,S.Uric Acid) + LFT(GGTP,SGOT,SGPT,Alkaline) Category - B  
 
C - FBS + RUA Category - B  
 
D - HIV Category - B  
 
FMR Category - B  
 
  Remarks :