Property Insurance Policy || United Ajod Insurance Company Ltd

Insurance Proposal Form

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Your Full Name *

Your Full Address *

District *

VDC/Municipality *

Tole *

Ward No. *

Phone Number *

Date of Birth(AD) *

Email address *

Father's Name *

Grand Father's Name *

PAN/VAT No. *

Citizenship No. *

Citizenship Issued Date *

Citizenship Issued Place *

PP Size Photo *

Citizenship Front *

Citizenship Back *

Property Owner Name *

Property District *

Property Address *

Location Nature *

Building Stories *

Class of Construction *

Is Pool? *

Value of Property/House *

Remarks (Kitta Number) *

Upload Images [Multiple Select upto 5]

Policy Effective From[yyyy-mm-dd]:

Note: If your payment date is after above date, policy will be effective from payment date.

Policy Expiry Date[yyyy-mm-dd]:

accept the Terms of Service. I hereby declare that the details furnished above are true and correct