Life Insurance Step 03 – Tpllife

Life Insurance Step 03demo.deadhappy2024-02-16T10:29:06+05:00

Step 1 of 5

20%

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First Name(Required)

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Last Name(Required)

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YYYY-MM-DD(Required)

YYYY dash MM dash DD

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AGE(Required)

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Gender(Required)

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Mobile Number(Required)

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Email(Required)

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Current Height (not use)(Required)

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Current Weight (not use)(Required)

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Occupation (not use)(Required)

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Monthly Income (not use)(Required)

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Feet (not use)

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Whole (not use)

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Decimal (not use)

Questions

Do you intake Tobacco or Nicotine in any form?

Do not worry, it's a confidential information!

Answer No. 1(Required)

Yes

No

Questions

What's your intake of Tobacco or Nicotine in any form?

Help us identify your consumption pattern

Answer No. 2 with 4 options(Required)

0-5 times

5 to 10 times

10 to 20 times

Can't specify

Questions

Do you consume Alcohol?

Do not worry, it's a confidential information!

Answer No. 3(Required)

Yes

No

Questions

What's your routine for consuming alcohol?

Help us identify your consumption pattern

Answer No. 4 with 2 options(Required)

Social Drinking

Regular Drinking

We are just getting done, hang on!

Have you been diagnosed before or are currently suffering from any of the following diseases?

Disease

Cancer

Kidney Disease

Stroke

Deformity or Disability

Nervous Disorders (Depression, Psychiatric Disorder)

Bleeding Disorder

Anaemia

Paralysis

Musculoskeletal Disorders

Chronic Obstructive Pulmonary Disease

High Blood Pressure

Thyroid Disorder

Liver Cirrhosis/Liver Failure

Heart Failure

Ischemic Heart Disease

Heart Valvular Disease

Cardiac Arrhythmia

Hepatitis B

Hepatitis C

Diabetes

Coronary Artery Disease

Heart Attack

Other options

I am unaware

I am healthy

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Qusetion No.5 answer(Required)

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Term 1 Ratio

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Term 2 Ratio

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Term 3 Ratio

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Term 4 Ratio

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Term 5 Ratio

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Term 6 Ratio

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Term 7 Ratio

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Term 8 Ratio

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Term 9 Ratio

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Term 10 Ratio

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Term 11 Ratio

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Term 12 Ratio

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Term 13 Ratio

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Term 14 Ratio

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Term 15 Ratio

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Term 16 Ratio

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Term 17 Ratio

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Term 18 Ratio

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Term 19 Ratio

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Term 20 Ratio

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Term 21 Ratio

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Term 22 Ratio

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Term 23 Ratio

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Term 24 Ratio

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Term 25 Ratio

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Tax Amount

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form or continue onward with Inshu Charity.

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