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SUPERAGENT
HOME VISIT
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Name :
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Product :
Select Product Name
Wealth Gain
New FamilyGain II
New SecureFirst
Unit Gain Pension
UnitGain
UnitGain Plus
LifeLong Gain
FamilyGain
UnitGain Premier
New UnitGain
UnitGain Guarantee SP
New UnitGain II
UnitGain Super
Family Assure II
Shield Plus
CenturyPlus III
UnitGain Protection Plus II
Smart Investment Plan II
iGain II
Max Gain
Assured Gain
Future Income Generator
Swarna Vishranti
Retirement Advantage RP
Retirement Advantage SP
Pension Guarantee
Future Secure II
InvestGain
CashGain
SaveCare Economy SP
Life Time Care
Super Saver
Invest Plus
Protector
Term Care
New Risk Care
Miss Confident Plans
Care First
Health Care
Family CareFirst
ChildGain
YoungCare II
Group Seva Plan
Group Secure Life
Invest Plus Premier
Credit Shield
Group Term Life(Non Employer Employee)
Group Term Life(Employer Employee)
New Group Gratuity Care
New Group Superannuation Care
Group Save Plus
Group Term Life in lieu of EDLI
Group Suraksha
Sarve Shakti Suraksha
Group Loan Protector
Group Leave Encashment Scheme
Group Annuity
Group Income Protection
Group Superannuation Gold
Group Gratuity Gold
Group UnitGain
Alp Nivesh Yojana
Jana Vikas Yojana
Saral Suraksha Yojana
Additional Rider Benefits
Additional Rider Benefits
UL Waiver of Premium Benefit
UL Family Income Benefit
Unit Linked Term Rider
UL Accelerated Critical Illness Rider
Life Insurance Need Calculator
Personal Information
Your age (in Years)
Age of your spouse
Some Financial Estimates on...
Expected Long Term Interest Rate (in %)
(Lower the interest rate the higher the capital)
Expected Rate of Inflation (in %)
(Higher the inflation rate higher the need for capital)
5%
6%
7%
8%
9%
Cash Needs
What are the estimated necessary expenses which will have to be met?
A) Outstanding Liabilities
Type
Existing Loan Amount
Home Loan (in Rs.)
Personal Loan (in Rs.)
Auto Loan (in Rs.)
B) Children Education Fund Requirement
Child
Age
Please select the current fee (Rs. p.a.) for the following education types:
1st Child
Select Age
No Child
New Born
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Primary (5 - 12)
Secondary (13 - 17)
Graduation (18 - 22)
Post graduation (23 - 24)
Any additional Educational Expenses expected
Child
Age
Please select the current fee (Rs. p.a.) for the following education types:
2nd Child
Select Age
No Child
New Born
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Primary (5 - 12)
Secondary (13 - 17)
Graduation (18 - 22)
Post graduation (23 - 24)
Any additional Educational Expenses expected
C) Future Expenses like children's marriage
Child
Gender
Expected age at marriage (in Years)
Expenses of marriage today (in Rs.)
1st Child
Select Gender
Male
Female
2nd Child
Select Gender
Male
Female
Income Need
What is the income that will permit the family to maintain their standard for living in case of loss of income?
Current monthly family expenses (in Rs.)
Estate Assets
What are the assets you have?
Mutual Funds (in Rs.)
Bank deposit/savings account/PF/PPF (in Rs.)
Shares/direct investment (in Rs.)
If spouse is also working
Ratio of the spouse's contribution to family income (in %)
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INSURANCE IS THE SUBJECT MATTER OF THE SOLICITATION. BAJAJ ALLIANZ LIFE INSURANCE CO. LTD., GE PLAZA, AIRPORT ROAD, YERAWADA, PUNE-411006
email:
life@bajajallianz.co.in
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