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Icy Particulars Name of the Policy No. Insurance Co. Validity Period From (Date) To(Date) Claim Amount Claims history Ailment for which Claim was made. (If previous policies were taken from other Insurance companies, Xerox copies of such policies to be enclosed) 1. Name of the Branch : 2. Name of the Proposer-Customer (BLOCK LETTERS): 3. Type of Account : 4. Account Number of the proposer : 5. Postal Address: (BLOCK LETTERS) : 6. If employee/retired employee of Indian Bank : SR No E.

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