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ICICI LOMBARD FAMILY

 

Title

Name *

Name of your company

Location *

Pincode *

Email ID *

Mobile Number *

Employee Count *

Dependent Count

Insurance Amount per Employee/ Employee Family. in Rs.

Employee Count *

Dependent Count

Insurance Amt per Employee / Employee Family. in Rs.

No. of workers *

Monthly Salary / Wages

Total Annual Turnover of transit (in Lacs) *

Transit Location : From

To

Total value of Machinery (in lacs) *

Total Value of Building (in lacs) *

Total Value of Stock (in lacs) *

Type of Machinery

Value of the Machinery (in lacs) *

Name of Insurance Product desired


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