Email: info@alphalife.com.bd Hot line: 01787683517 (Policy Service Department), 01787683520 (Group Insurance) IP Phone : 09612 400 200

Policy Holder Information

1

Policy Holder Information

2

Policy Information

3

Chain Setup

Policy Holder Information

Proposal No

Comm. Date

Type

Business Month

Proposal Date

Name

Image[JPEG,JPG,PNG]

Father's Name

Mother's Name

Spouse Name

Occupation

Nationality

Locality

Mobile

Email ID

DOB

Age

Age Proof

Education

Religion

Sex

NID

Address

Division

District

Upazilla/PS

Address

Nominee(s)

Image	Name	Age	%	Relation	Action

Guardian

Guardian Name

Guardian Age

Relation

Child

Child Name

DOB

Age

Age Proof

Image

Class

Relation With Payee

Policy Information

Sum Assured

Plan

Term

Payment Method

Pension Amount

Pension Age

Stipend Term

Stipend Unit

Stipend Amount

Sum At Risk

Premium Rate

Supplementary Services

Supple. Name	Supp Pre Rate	Supp Age	Sum Assured	Limit

Health Insurance

Clause Name

Clause Code

Extra Name

Extra Code

Extra Pre Rate

Lien Year

Lien Percent

Lien Type

Basic Premium

Supp. Premium

FE Premium

OE Premium

H. Extra/Loading

Total Premium

Chain Setup

Agency Code

Agency Name

Organization Code

Organization Name

Service Cell Code

Service Cell Name

Financial Associate

FA Code and Name

UM Code and Name

BM Code and Name

ASM Code and Name

SM Code and Name