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Life N Legacy Financials

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Thank you for your patronage and giving us the privilege to be your advisor for your investments and insurance needs. We have been constantly upgrading our infrastructure by adopting various technology tools from time to time. It gives us immense pleasure and pride in introducing to you our new state-of-the-art Android Application. By filling up the below form with 100% accuracy will help us load your details in the App. I can assure you that No Financial Advisor Would Be Providing You With Such An App. Do help us have accurate data of yours.

Select your current family status

Individual

Only Married

Married with 1 child

Married with 2 child

Married with 3 child

Married with 4 child

Fill as per your Criteria

Self Info

Full Name*

Date of Birth as per Pan Card*

Actual Date of Birth If different from Pan Card

Pan Card No*

Adhaar Card No*

Email id*

Mobile No(+91)*

Alternate Mobile No(+91)

Employer Name*

Designation*

Annual Income (Rs.)*

Father Name*

Mother Name*

Communication Address*

Permanent Address*

Spouse Info (If Married)

Full Name*

Date of Birth as per Pan Card

Actual Date of Birth If different from Pan Card*

Marriage Anniversary Date*

Pan Card No*

Adhaar Card No*

Email id*

Mobile No(+91)*

Alternate Mobile No(+91)

Employement*
Working Housewife

Designation

Annual Income

Children Info

Child 1 Name

Child 1 Gender
Male Female

Child-1 Date of Birth

Child 2 Name

Child 2 Gender
Male Female

Child 2 Date of Birth

Child 3 Name

Child 3 Gender
Male Female

Child 3 Date of Birth

Child 4 Name

Child 4 Gender
Male Female

Child 4 Date of Birth

General Info

Do You Have Health Insurance?*
Yes No

Do You Have Life Insurance?*
Yes No

Do You Have Four Wheeler?*
Yes No

Do You Have Two Wheeler?*
Yes No

Do You Have Mutual Funds?*
Yes No

Are You Smoke?*
Yes No

Do You consumed alcohol?*
Yes No

Do You have retairment plan with 1 lakh monthly pension?*
Yes No

Any Comment

Document upload [optional]

Upload Pan Card

Uploade Adhaar Card

Upload your Health/Life/ Four Wheeler/Two Wheeler Insurance copy

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Address:
Office No. 122,
1st Floor, Sky Lark Building,
Plot No. 63, Sector 11,
CBD Belapur, Navi Mumbai, Pin: 400614.
Phone: +91 7208810886
Email: [email protected]

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