@extends('layouts.secondHeader') @section('content')
Credit Card Apply Form
@csrf
Bank Details
Bank Name
Select an Option
SBI
HDFC
ICICI
Plan Name
Select an Option
Sub Plan Name
Select an Option
Personal Details
Name
DOB
Gender
Select an Option
Male
Female
Others
Father Name
Mother Name
Marital Status
Select an Option
Married
Unmarried
Divorced
Aadhaar No
Is Pan Card available ?
Select an Option
Yes
No
PAN NO
Height
Weight
Education
Email
Mobile No
Alternate Mobile No
Employee Type
Please Select Employee Type
Salaried
Self Employed
Self Employed Professional
Yearly Income
Please Select Income
Up to 3 lacs
3 to 4 lacs
4 to 5 lacs
5 to 10 lacs
10+ lacs
Salary Received In
Please Select Bank
HDFC
ICICI
SBI
AXIS
Others
Company Name
Permanent Address
Same as Permanent Address
Communication Address
Occupation
Annual Income
Nationality
Please Select Nationality
Indian
NRI
Others
Nominee Details
Nominee Name
Nominee DOB
Nominee Relationship
Select an Option
Appointee?
Appointee Name
Appointee DOB
Appointee Relationship
Select an Option
Father Name
Mother Name
Spouse Name
Premium Details
PPT
PT
Frequency
Select an Option
Monthly
Quartely
Half Yearly
Yearly
Credit Card Eligible
Please Select Amount
Up to 3 lacs
3 to 4 lacs
4 to 5 lacs
5 to 10 lacs
10+ lacs
Number Of Due Collected In Months
Select an Option
1 Month
2 Months
3 Months
Total Premium With Tax / Collected premium
GST Percentage
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GST AMOUNT
Premium Without Tax
Annualised Net Premium
Total Sum Assured
Team Details
TEAM DETAILS
Employee
Partner
Caller
Select an Option
Team Leader
Assistant Manager
Manager
Center Head
Regional Head / AVP
Zonal Head
Vice President
SM / RM
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Branch - Center Location Name
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Partner Details
Choose an option
Manager Details
Relationship Manager
Choose an option
Payout Cycle
Location
Discrepancy Team Details
DISCREPANCY TEAM DETAILS
DISCREPANCY TEAM DETAILS
Select Option
YES
NO
Caller
Choose an option
Team Leader
Choose an option
Assistant Manager
Choose an option
Manager
Choose an option
Center Head
Choose an option
Regional Head / AVP
Choose an option
Zonal Head
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Vice President
Choose an option
Relationship Manager & Relationship Manager Code
Choose an option
Branch - Center Location Name
Select an Option
Employee List Not Available
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New Joinee
Others
Partner Details
Select an Option
Manager Details
Relation Manager
Choose an option
Payout Cycle
Location
Remarks
CBRE
Is Cashback offered ?
Select an Option
Yes
No
CBRE %
Employee who offered CBRE to Client
Select an Option
Remarks
Credit Card Details
Credit Card Referance No
Credit Card No
Credit Card Limit
Please Select Amount
Up to 3 lacs
3 to 4 lacs
4 to 5 lacs
5 to 10 lacs
10+ lacs
Credit Card Status
Select an Option
Issued
Query
Rejected / Cancelled
Under Process
Attachments
Add Attchment
Pan / Form 60
Select an Option
Pan / Form 60
File
Remarks
Aadhaar Front Side
Select an Option
Policy Copy
KYC DOC
Proposal Form
Verification Call Recording
Datasheet
Aadhaar Front Side
Aadhaar Back Side
Pan / Form 60
Recent Photo
File
Remarks
Aadhaar Back Side
Select an Option
Policy Copy
KYC DOC
Proposal Form
Verification Call Recording
Datasheet
Aadhaar Front Side
Aadhaar Back Side
Pan / Form 60
Recent Photo
File
Remarks
Recent Photo
Select an Option
Policy Copy
KYC DOC
Proposal Form
Verification Call Recording
Datasheet
Aadhaar Front Side
Aadhaar Back Side
Pan / Form 60
Recent Photo
File
Remarks
Proposal From
Select an Option
Proposal From
File
Remarks
Illustration
Select an Option
Illustration
File
Remarks
Receipt Copy / Payment Paid Confirmation
Select an Option
Receipt copy
File
Remarks
Cancelled Cheque Leaf or Bank Pass Book
Select an Option
Cancelled cheque leaf
File
Remarks
Remarks
Add Remarks
Remarks
Remarks Filled by
Submit
@stop