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Proposer Details
Title
Title
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First Name
Middle Name
Last Name
Email ID
Mobile No
Gender
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Third Gender
Date of Birth
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You wish to purchase annuity for
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Single Life
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Single Life
Two Lives
Are you a resident of Jammu & Kashmir?
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No
Yes
No
State
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Select
ANDAMAN AND NICOBAR
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LADAKH
LAKSHADEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGALAYA
MIZORAM
NAGALAND
ORISSA
PONDICHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
City
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Please Provide Annuitant (s) Details As Below
You are purchasing this
immediate annuity plan for
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Self
Another individual
Self
Another individual
First Annuitant Details
Gender
*
Male
Female
Third Gender
Date of Birth
*
YYYY
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
DD
Age
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of premium on death of the annuitant?
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at intervals mentioned above
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Annuity Amount:
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and by submitting my contact details here, I override my NCPR registration and authorise SBl Life and its authorised representatives to contact me and send information/communication relating to this proposal/or the resulting policy through SMS /Email /Phone /Letter /WhatsApp /any other electronic mode of communication to my registered email id/mobile number.
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