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DETAILS OF DEPENDANTS
Relationship		Age Years
Relationship		Age Years
Relationship		Age Years
Relationship		Age Years
FINANCIAL NEEDS/GOALS		Please Tick
Life protection
Child’s education/marriage
Save for a specific goal (E.g. car/home/international trip/your own startup etc.)
Retirement planning / Corpus creation
Protection for Illness related expenses
Wealth creation/Market linked returns
Regular Income / Money Back at important milestone
WHAT WOULD YOU NEED FROM A FINANCIAL SOLUTION?		Please Tick
High returns with high risk
Moderate returns at moderate risk
Conservative returns at low risk
Guaranteed returns
NA
For How long do you want to Pay Premium		Please Tick
Single Pay
Limited Pay
Regular Pay
Investment Horizon		Please Tick
Short Term
Medium Term
Long Term
SELECTED PRODUCT
Plan Name	Guaranteed Lifetime Income Plan	Buy Now
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