Witness: ( Signature of the Proposer). The document is an application form for a cancer insurance policy.It requests basic personal details like name, date of birth, contact information. Full Name (Max 40. Char). LIC's Cancer Cover (Plan No. 905, UIN : 512N314V02). This document is a proposal form for a LIC health insurance policy. No special form is required; a handwritten letter will do. CLAIM FORM FOR LIC's Cancer Cover policy​​ Name of the Life Assured: ………………………………………………………. Date of Birth: …………………………….. For expenses necessary for the legal activities of the Depart- ment of Justice, not otherwise provided for, including not to exceed.