Plan your Policy: Create unique financial protection plan for you and your family




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For Individuals > Plan Your Policy

If you would like Janashakthi to create a unique Financial Protection Plan for you and/or your family, based on your needs please fill the following form and send it to us.

All the information provided by you will be treated as confidential and will be analysed by one of our Professional Financial Advisors. You will then be presented a tailormade solution suited to your needs.

* - Mandatory fields

1. General Information

Name: *

Address: *

Contact Number(s):

Fax:

Email:

	You	Spouse
Name:
Age:
Sex:
Occupation:
Monthly Income:
How Many Children Do You Have?:

2. Your Commitments

Average Monthly Household Expenses:

Food/Clothing:	Rs.
Travelling:	Rs.
Health:	Rs.
Child Education:	Rs.
House Rent:	Rs.
Electricity/Water/Telephone:	Rs.
Others:	Rs.

Total Monthly Household Expenses:	Rs.

If either you or your spouse die, how will your family be taken care of? Do you have a mechanism to take on that responsibility? Yes No

3. Your Liabilities

Have you or your spouse taken any loans/mortages? Yes No
(Note:-Credit Card Outstandings are considered as loan for this purpose)

Main Income Earner (MIE):

Details loans/mortages
Repayment Period(No. of Years)
Loan Amount(Rs.)
End Year(Specify the year)
Protected/ Unprotected (if protected check)

Spouse:

Details of loans/mortages
Repayment Period(No. of Years)
Loan Amount(Rs.)
End Year(Specify the year)
Protected/ Unprotected (if protected check)

4. Your Assets

Current Assets :

Shares, Debentures, Loans given, etc	Name of the Financial Instrument	You Rs.	Spouse Rs.




Total Current Asset Value

Disposable Income :

Bank Deposits,Fixed Deposits,Savings, etc	Name of the Financial Instrument	You Rs.	Spouse Rs.




Total Disposable Income Value

Fixed Assets :

Land, Buildings, Vehicles (Please state approxi - mate market values)	Name of the Financial Instrument	You Rs.	Spouse Rs.




Total Fixed Assets Value

Any Other Asset(Please specify) :

Other Assets	Name of the Financial Instrument	You Rs.	Spouse Rs.




Total Value of any other type of Assets

Existing Insurance Covers :

Term Covers For YOU Term Covers: (No maturity value, only Accidental & Death Benefits)	Sum Assured Rs.	Period Years

Term Covers For SPOUSE Term Covers: (No maturity value, only Accidental & Death Benefits)	Sum Assured Rs.	Period Years

Endowment Covers For YOU
(You receive a lump sum at maturity) Sum Assured
Rs. Period
Years

Endowment Covers For SPOUSE
(You receive a lump sum at maturity) Sum Assured
Rs. Period
Years

5. Your Future Goals

Child 1	(Press Ctrl + Click for multiple selection)	Please state Amount (in today's context)
Child 2	(Press Ctrl + Click for multiple selection)
Child 3	(Press Ctrl + Click for multiple selection)
Child 4	(Press Ctrl + Click for multiple selection)
Income you envisage at Retirement
Others

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