Form No 300 – Fill Out and Use This PDF

The Form No. 300 is a comprehensive proposal document utilized by the Life Insurance Corporation of India for those seeking to insure their own lives, excluding minors. This document, detailed and established by the Life Insurance Corporation Act of 1956, captures essential information from the proposer, including personal, occupational, and medical history, to assess and provide the necessary insurance coverage effectively. Interested applicants are encouraged to thoroughly review and fill out the Form No. 300 to ensure a smooth and streamlined insurance application process.

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Form No 300 PDF Details

Embarking on the journey of securing life insurance is a pivotal step in safeguarding one's future, and the No. 300 form from the Life Insurance Corporation of India is at the heart of this process for many. Established under the Life Insurance Corporation Act of 1956, this form is designed for individuals seeking to insure their own lives, with a clear directive not to use it for minors. It meticulously gathers personal details right from the basic—like name and address—to the more intricate aspects of one's life such as health history, family medical background, and existing insurance policies. The form also delves into one's occupation, financial standing, and the specifics of the insurance sought, including types of benefits and coverage amounts. Additionally, it touches on the proposer's personal history concerning medical conditions, hospitalizations, or any lifestyle habits that could impact their health. The declaration at the conclusion serves as a covenant of honesty between the proposer and the insurance provider, emphasizing the importance of transparency in this mutual agreement. Not only does the No. 300 form facilitate a smooth application process, but it also plays a crucial role in determining the terms of the insurance policy, making it a cornerstone document for prospective policyholders.

Question	Answer
Form Name	Form No 300
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	lic form fill up, lic form 300, lic proposal form 300 pdf new 2021, lic form no 300

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Life Insurance Corporation of India

IPR-F300-V1.0

FORM NO. 300 (Rev. 98 )

PROPOSAL FOR INSURANCE ON OWN

Recent

LIFE

(Not to be used on the lives of Minors)

Passport

Inward Number:

Date.

Size Photo

(Established by the Life Insurance Corporation Act, 1956)

To be filled in by Agent: Division Code:

Branch Office Code:

FOR OFFICE USE ONLY :

Agent’s Name:

Satl Branch Code:

Proposal no :

Agent’s Code :

Dev. Officer Code:

Amt of Deposit :

Ag .License No.

Date of Expiry

B.O.C No.

Date :

Proposal. Dt :

Medical Code

(All answers to be filled in legibly. Answers must be given in Words. Stroke of the pen or dot or dashes will not be accepted as replies. )

Title:

Surname:

Initial:

Object of Insurance :

Full name (Surname first) and address to which communication are to be sent.

Addr1:

Place of Birth :

Addr2:

Addr3:

Nationality :

Sex :

Pin:

Tel Nos (with:STD Code):Res:

Off:

2A Residential address, if different from above :

Nature of Age-Proof submitted:

Addr1:

Addr2:

Addr3:

Age (nearer

Date of Birth

birthday)

Pin:

Yrs.

e-mail:

Short Name :

Father’s Full name

(Surname First )

2B. Nominee’s Full name(Surname first)

and address

Age

Relationship to

Title Code

Name :

yourself

Addr1:

Addr2:

Addr3:

Yrs.

If Nominee is a minor, appointee’s full name and address

Age

Relationship to

Signature of

Name :

nominee

Appointee as

token of consent

Addr1:

Addr2:

Addr3:

Yrs.

Note: It is in the interest of the Proposer to avail the facility of nomination

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Page 1 of 6

Life Insurance Corporation of India

IPR-F300-V1.0

Plan

Policy

Prem-

Sum Proposed

Term rider sum

Is accident Benefit

Date of

Total Amount

Term

ium

(Rs.)

proposed (if required)

required?

Commencement. If

Deposited

policy is to be dated

Term

(Rs. )

back indicate that

Critical illness sum

Sum Assured For

date .

proposed (if

the A B(Rs.)

required ) Rs.

Boc1- No.

Boc1-Date

Boc2-No

Boc2-Date

Mode(Yly, Half-

Paying Authority Code

Deptt. No.

Badge or S.R. No.

Yly,Qtrly,Mly, SSS

,Single )

PA:

Sub PA:

4A. Present Occupation

Exact nature of duties

4B. Name of Present Employer

Length of Service with him (years)

5 Educational Qualification

Annual Income

Source of

Are you an Income Tax

(Rs . )

Income

Assessee ?

6. If you are employed in the Armed forces, please state

Wing to which you

Rank therein

Date of last Medical

Medical Category after

Were you ever

belong

Examination

Medical Examination

below A-1

(dd/mm/yyyy)

category ? if so

when ?

7. Is your life now being proposed for another assurance or an

YES/NO

DETAILS

application for revival of a policy on your life or any other

proposal under consideration in any office of the corporation or

to any other insurer? If yes give details .

8A. Has a proposal( or an application for

Answer

If yes give details

revival of a policy) on your life made to

‘YES’ or

any office of the corporation or to any

‘NO’

other insurer ever been :

Withdrawn , Deferred , Dropped or

Declined ?

Accepted with extra Premium or Lien ?

Accepted on terms otherwise than those

proposed ?

8B. Have you during past one year

returned any policy of the corporation as

the same was not acceptable to you ? If

so give details :

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Page 2 of 6

Life Insurance Corporation of India

IPR-F300-V1.0

Please give details of your previous insurance : ( including policies surrendered/lapsed during last 3 years)

Policy number

Insurance

Companies from where previous policy/policies have been purchased with address ( if previous policy are from LIC of India, give name of Branch/DO)

Table

Term

		Sum	Term
		Assured	Assurance
		On	Rider
		On
		Main	Sum
		Main
		Plan	Assured
		Plan

Critical	Amount	Year
Illness	Of	Of
Rider	Accident	Issue
Sum	Benefit
Sum
Assured	Taken

Whether accepted as proposed at ordinary rate, if not give details

Med ical Or Non medi cal

Whether

in force for full Sum Assured

If not give due date of last premium paid or date

of surrender

N.B. : Corporation does not entertain any fresh proposal for insurance where a policy issued by the corporation has lapsed or has been converted into paid up policy within the last 3 years.

10. Family History .				Living		Dead

SL	Family Member	Living	Age		State of Health	Age	Cause of death
		/ Dead	( Living )			(Dead)
1
1


2
2


3
3


4
4

5
5


6
6


7
7


8
8


9
9


10
10

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Page 3 of 6

Life Insurance Corporation of India

IPR-F300-V1.0

11.

Personal History

Answer

If ‘yes’, Please give full details

‘Yes’ or

‘No’

(a) During the last five years did you

consult a Medical Practitioner for any

ailment requiring treatment for more

than a week ?

(b) Have you ever been admitted to any

hospital or nursing home for general

check up, observation, treatment or

operation ?

place of work on grounds of health

during the last 5 years ?

(d) Are you suffering from or have you

ever suffered from ailments pertaining

to liver, stomach, Heart, Lungs ,

Kidney, Brain or Nervous System ?

(e) Are you suffering from or have ever

suffered from Diabetes, Tuberculosis,

High Blood Pressure, Low Blood

Pressure, Cancer, Epilepsy, Hernia,

Hydrocele, Leprosy or any other

disease ?

(f) Did you ever have any bodily defect

or deformity ?

(g) Did you ever have any accident or

injury ?

(h) Do you use or have you ever used -

Alcoholic drinks

Narcotics

Any other drugs

Tobacco in any form

(i) What has been your usual state of

heath?

(j) Have you ever required or at present

availing/undergoing medical advice,

treatment or tests in connection with

hepatitis B or AIDS related condition.

12. In non-medical cases , please state

Height ( Cms )

Weight ( Kg )

exact height in Cms. And weight in Kgs

( Without shoes )

FOR FEMALE PROPONENT

13A Are you

Date of last delivery

Have you had any abortion or miscarriage or

Date of last Menstruation

pregnant now?

(dd/mm/yyyy)

Caesarian section ? if so give details

(dd/mm/yyyy)

13B. Husband’s full name

His Occupation

His annual Income

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Page 4 of 6

Life Insurance Corporation of India

IPR-F300-V1.0

13C.

Details of husband’s Insurance :

Policy No.

Insurance Companies

Sum Assured

Table & Term

Present Status of the

from where the

Policy

policy/policies have

been purchased with

address(if previous

policies are from LIC

India, give name of

Branch/D.O)

14. Have you understood fully the terms & conditions of the

plan you propose to take ?

DECLARATION BY THE PROPOSER

Ithe person whose life is herein being proposed to be assured, do hereby declare that the forgoing statements and answers have been given by me after fully understanding the questions and the same are true and complete in every particular and that I have not withheld any information and I do hereby agree and declare that these statements and this declaration shall be the basis of the contract of assurance between me and the Life Insurance Corporation of India and that if any untrue averment be contained therein the said contract shall be absolutely null and void and all moneys which shall have been paid in respect thereof shall stand forfeited to the corporation .

Not-withstanding the provision of any law, usage , custom or convention for the time being in force prohibiting any doctor, hospital and/or employer from divulging any knowledge or information about me concerning my health or employment on the grounds of secrecy, I , my heirs, executors, administrators and assignees or any other person or persons, having interest of any kind whatsoever in the policy contract issued to me, hereby agrees that such authority , having such knowledge or information, shall at any time be at liberty to divulge any such knowledge or information to the Corporation.

And I further agree that if after the date of submission of the proposal but before the issue of first Premium Receipt (i) any change in my occupation or any adverse circumstances connected with my financial position or the general health of myself or that of any members of my family occurs or (ii) if a proposal for assurance or any application for revival of a policy on my life made to any office of the Corporation has been withdrawn or dropped, deferred or accepted at an increased premium or subject to a lien or on terms other then as proposed I shall forthwith intimate the same to the Corporation in writing to reconsider the terms of acceptance of assurance . Any omission on my part to do so shall render this assurance invalid and all moneys which shall have been paid in respect thereof shall stand forfeited to the Corporation.

Dated at

on the

day of

Signature of witness …………………………		Signature or Thumb Impression of the Person whose life
Name		Is Proposed to be assured .
Occupation
Address

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Page 5 of 6

Life Insurance Corporation of India

IPR-F300-V1.0

1)Declaration by the person filing in the form ( in case form is filled up Signed in a language different from that of the Proposal form.

I hereby declare that I have fully explained the above questions to the proposer and I have truthfully recorded the answers given by the proposer .

Declarant’s Name and Address …………………………….

…………………………………………………………………Signature.

I certify that the contents of the form and documents have been fully explained to me by ( Name , Designation, Occupation Mr / Mrs …………………………………………………… and I have understood the significance of the proposed contract.

------------------------------------

Signature or thumb impression of the person Whose life is proposed to be assured.

2)In case the proposer is illiterate His/Her thumb impression should be attested by a person of standing whose identity can easily be established but unconnected with the Corporation and this declaration should be made by him.

I hereby declare that I have fully explained the above questions and contents of this form to the proposer in …………….

language and that the proposer has affixed the thumb impression above after fully understanding the contents thereof .

Name and Address of the declarant :

…………………………………………………………

…………………………………………………………SIGNATURE

SUMMARY OF SECTION 45 OF INSURANCE ACT, 1938

No policy of life insurance shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policyholder and that the policyholder knew at the time of making it that statement was false or that it suppressed facts which it was material to disclose.

Note: “Material” shall mean and include all important, essential and relevant information in the context of underwriting the risk to be covered by the Corporation.

INSURANCE ACT 1938 UNDER SECTION 41

1)No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India any rebate of the whole or part of the commission payable or any rebate of the Premium shown on the policy nor shall any person taking out renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer. Provided that acceptance by an insurance agent of commission with a policy of life insurance taken out by himself on his own life shall not be deemed to acceptance of a rebate of premium within the meaning of sub-section if at any time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bonafied insurance agent employed by the insurer.

2)Any person making default in complying with the provision of this section shall be punishable with fine which may extend to five hundred rupees.

FOR MEDICAL CASES ONLY

I certify that the Life Assured has signed / put his/her thumb impression in my presence after admitting that all the answers to Questions Nos 10 onwards of this form have been correctly recorded .

………………………………………………..	…………………………………………….
Signature or thumb impression of the Proposer.	Signature of the Medical Examiner.

NB. Signature or thumb impression should be affixed in presence of Medical Examiner.

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Page 6 of 6

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This PDF form will require particular information to be filled in, hence make sure you take the time to type in what is requested:

1. It is important to fill out the lic proposal form 300 pdf new 2021 properly, so be attentive while working with the parts that contain these fields:

Filling in section 1 of lic form 300 rev 2020 pdf download english

2. Once your current task is complete, take the next step – fill out all of these fields - A Residential address if different, Nature of AgeProof submitted, Age nearer birthday Yrs, Date of Birth, Short Name, Fathers Full name Surname First, B Nominees Full nameSurname first, If Nominee is a minor appointees, Age Relationship to, Title Code, yourself, Yrs, Age Relationship to, nominee, and Yrs with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling in segment 2 in lic form 300 rev 2020 pdf download english

3. Completing Plan, Policy Term, Prem ium Term, Sum Proposed, Term rider sum proposed if, Is accident Benefit required Sum, Date of Commencement If policy is, Total Amount Deposited Rs, Boc No, BocDate, BocNo, BocDate, ModeYly Half YlyQtrlyMly SSS, A Present Occupation, and Paying Authority Code is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Learn how to fill out lic form 300 rev 2020 pdf download english step 3

Be really careful when filling in A Present Occupation and Policy Term, as this is where many people make errors.

4. The subsequent paragraph requires your involvement in the subsequent parts: Were you ever below A category if, Is your life now being proposed, Answer YES or NO, YESNO, DETAILS, If yes give details, Accepted with extra Premium or, Accepted on terms otherwise than, and B Have you during past one year. Be sure that you provide all of the requested info to go onward.

Guidelines on how to fill in lic form 300 rev 2020 pdf download english stage 4

5. Since you near the completion of your form, you'll find just a few extra requirements that should be fulfilled. Notably, Insurance Companies from where, NB Corporation does not entertain, Family History Living Dead, Family Member Living Dead, Age Living, Cause of death, State of Health, and Age Dead should all be filled out.

Family Member Living Dead, Cause of death, and Age Living inside lic form 300 rev 2020 pdf download english

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