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ADMISSION OF LIABILITY) BRANCH / DIVISIONAL OFFICE : Polocy No. 1 2 3 4 Name and address of the insured (financier / Bank) Address of the Insured Name of the Insured person / borrower a) Permanent Address of the Insured person / borrower b) Address of the house property. 5 a) Occupation of the Insured person / borrower b) Age / Date of birth 6 7 Period Insurance Total Amount of Loan Disbursed to this borrower Sum Insured : A) House B) Person 8 9 10 Amount of Loan outstanding as on date o.

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