Lic Form 3260 – Fill Out and Use This PDF

Form No. 3260

Life Insurance Corporation of India

(Established under Life Insurance Corporation Act, 1956)

____________________Division

BRANCH________________________

Statement to be submitted by the Proposer / Agent / Dev. Officer

When a standard age proof viz, School/University/Birth certificate

Is not submitted along with the proposal.

1.	Name of proponent	:
2.	Place and date of birth	:
3.	Proponent’s educational qualification and year of	:
	Leaving School or College
4.	Proponent’s occupation	:
5.	His employer’s name and address	:

6. Nature of age proof submitted		:
7. Reasons for not submitting a standard proof of age		:
[ I ) If the proponent is educated, state why a school/		:
	University Certificate is not submitted	:
(ii)	The reason why birth certificate cannot be	:
	submitted.
(iii)	If the proponent is in service, state why an extract	:
	from service register cannot be produced.
(iv)	If the submitted age proof is horoscope state	:
	reason for the same.
(v)	If the submitted age proof is either an elder’s	:

declaration or self declaration state reasons for the same.

I hereby agree that the foregoing questions and answers shall form part of the proposal

for Insurance made by me to the Life Insurance Corporation of India on ……………….. and they shall be

of the same effect as if contained in the original proposal.

Dated at	on the	day of	200 .
Signature of the Agent.		Signature of the proposer.

I have discussed the question of standard proof of age with the proposer, I am satisfied that he cannot submit a standard proof of age for the following reasons:

I further certify that according to my estimation his apparent age is ……………………

(Signature of the Agent)

I have discussed the question of standard proof of age with the proposer and I am satisfied that be cannot submit a standard proof of age for the following reasons:

I further certify that according to my estimation, his apparent age is ……………………..

(Signature of Dev. Officer)