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Premium Info
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Referrer
Payment Info
Let's start with your Personal Information
Document ID/Proposal No.
Applicant Name (Bangla) || আবেদনকারীর নাম(বাংলায়)
Applicant Name (English) || আবেদনকারীর নাম(ইংরেজিতে)
Applicant's Father Name || আবেদনকারীর পিতার নাম
Applicant's Mother Name || আবেদনকারীর মাতার নাম
Gender || লিঙ্গ
Male
Female
Profession || পেশা
Marital Status || বৈবাহিক অবস্থা
Single
Married
Divorced
Widow
Spouse Name || স্বামী/স্ত্রীর নাম
Date of Birth || জন্মতারিখ
Place of Birth || জন্মস্থান
Country || দেশ
Select Country
Afghanistan
Albania
Algeria
Andorra
Angola
Antarctica
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia, Plurinational State Of
Bosnia And Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Myanmar
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Timor-leste
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (malvinas)
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle Of Man
Israel
Italy
Côte D'ivoire
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States Of
Moldova, Republic Of
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Korea, Democratic People's Republic Of
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Barthélemy
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Korea, Republic Of
Spain
Sri Lanka
Saint Helena, Ascension And Tristan Da Cunha
Saint Pierre And Miquelon
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province Of China
Tajikistan
Tanzania, United Republic Of
Thailand
Togo
Tokelau
Tonga
Tunisia
Turkey
Turkmenistan
Tuvalu
United Arab Emirates
Uganda
United Kingdom
Ukraine
Uruguay
United States
Uzbekistan
Vanuatu
Holy See (vatican City State)
Venezuela, Bolivarian Republic Of
Viet Nam
Wallis And Futuna
Yemen
Zambia
Zimbabwe
Wales
Nationality || জাতীয়তা
Select Country Name
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladeshi
Belarus
Belgium
Belize
Bolivarian Republic of Venezuela
Bolivia
Bosnia and Herzegovina
Brazil
Brunei Darussalam
Bulgaria
Cambodia
Canada
Caribbean
Chile
Colombia
Costa Rica
Croatia
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Greenland
Guatemala
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Islamic Republic of Pakistan
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Lao P.D.R.
Latvia
Lebanon
Libya
Liechtenstein
Lithuania
Luxembourg
Macao S.A.R.
Macedonia (FYROM)
Malaysia
Maldives
Malta
Mexico
Mongolia
Montenegro
Morocco
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Panama
Paraguay
People's Republic of China
Peru
Philippines
Poland
Portugal
Principality of Monaco
Puerto Rico
Qatar
Republic of the Philippines
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro (Former)
Singapore
Slovakia
Slovenia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
U.A.E.
Ukraine
United Kingdom
United States
Uruguay
Uzbekistan
Vietnam
Yemen
Zimbabwe
Mobile No.|| মোবাইল নং
Email Address || ইমেইল
Present Address || বর্তমান ঠিকানা
Permanent Address || স্থায়ী ঠিকানা
Present Village || বর্তমান গ্রাম
Permanent Village || স্থায়ী গ্রাম
Present Post Office || বর্তমান ডাকঘর
Permanent Post Office || স্থায়ী ডাকঘর
Present Post Code || বর্তমান পোস্ট কোড
Permanent Post Code || স্থায়ী পোস্ট কোড
Present Police Station || বর্তমান থানা
Permanent Police Station || স্থায়ী থানা
Present District || বর্তমান জেলা
Permanent District || স্থায়ী জেলা
ID Type || আইডির ধরণ
Voter ID
Birth Certificate
Passport
SSC Certificate
Driving License
ID No. || আইডি নং
Educational Qualification || শিক্ষাগত যোগ্যতা
PSC
JSC
SSC/Equivalent
HSC/Equivalent
BSc/Equivalent
MSc/Equivalent
PhD/Equivalent
Bank Name || ব্যাংকের নাম
Bank Branch || ব্যাংকের ব্রাঞ্চ
Bank Account No. || ব্যাংক হিসাব নং
Upload Attachment || সংযুক্তি আপলোড
Upload Photo || ছবি আপলোড
Let's get straight to your Premium Info
Proposal Date || প্রস্তাবপত্রের তারিখ
Commencement Date || বীমা শুরুর তারিখ
Entry Age || বীমা শুরুতে বয়স
Select Your Plan || প্ল্যান বাছাই করুন
--Select a plan--
FIVE STAGE PAYMENT ANTICIPATED ENDOWMENT INSURANCE PLAN WITH PROFIT
FOUR STAGE PAYMENT ANTICIPATED ENDOWMENT INSURANCE PLAN WITH PROFIT
BIENNIAL PAYMENT PLAN WITH PROFIT
ORDIRANRY ENDOWMENT INSURANCE PLAN WITH PROFIT
THREE STAGE PAYMENT ANTICIPATED ENDOWMENT INSURANCE WITH PROFIT
SINGLE PREMIUM INSURANCE PLAN
THREE STAGE MONTHLY DEPOSIT PENSION SCHEME (MDPS)
CHILD PROTECTION ASSURANCE PLAN (WITH PROFIT)
ASSURANCE CUM PENSION PLAN
HAJJ BIMA (WITH PROFIT)
DENMOHOR BIMA (WITH PROFIT)
MONEY BACK TERM INSURANCE PLAN WITH GUARANTEED PROFIT
MONTHLY SAVING INSURANCE PLAN (WITH PROFITS)
TWO STAGE MONTHLY SAVING INSURANCE PLAN (WITH PROFITS)
MONTHLY DPS SUPER PLAN (WITH PROFIT)
Term || মেয়াদকাল
Mode of Payment || পেমেন্ট পদ্ধতি
Yearly
Half Yearly
Quarterly
Sum Assured || বীমা অঙ্ক
Life Premium || প্রিমিয়াম মূল্য
Supplementary Option || সম্পূরক বাছাই
Nill
DIAB
PDAB
Supplementary Class || সম্পূরক শ্রেনী
0
Supplementary Term || সম্পূরক মেয়াদ
Supplementary Sum Assured || সম্পূরক বীমা অঙ্ক
Supplementary Premium || সম্পূরক প্রিমিয়াম
Total Premium || মোট প্রিমিয়াম
Next Due Date || পরবর্তী প্রদেয় তারিখ
Last Due Date || পূর্ববর্তী দেয় তারিখ
Maturity Date || বীমা শেষের তারিখ
Sum at Risk || ঝুঁকি মূল্যের পরিমান
Tell us who'll get the Advantages
Nominee Name || নমিনির নাম
Nominee Age
Relation with Nominee
FATHER
MOTHER
WIFE
HUSBAND
SON
DAUGHTER
BROTHER
SISTER
NEPHEW
NIECE
UNCLE
AUNT
GRAND FATHER
GRAND MOTHER
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Agent/FA Name
Agent/FA Office Code
Agent/FA Office Name
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