@extends('layouts.secondHeader') @section('content')
Life Insurance Form
@csrf
Insurance Co. Details
Insurance Company Name
Select an Option
Plan Name
Select an Option
Sub Plan Name
Select an Option
Proposer Details
Proposer Name
Proposer DOB
Proposer Gender
Select an Option
Male
Female
Others
Aadhaar No
Is Pan Card available ?
Select an Option
Yes
No
PAN NO
Height
Weight
Education
Email
Mobile No
Alternate Mobile No
Permanent Address
Same as Permanent Address
Communication Address
Occupation
Annual Income
Life Assured Details
Same as Proposer
Life Assured Name
Life Assured DOB
Life Assured Gender
Select an Option
Male
Female
Others
Nominee Details
Nominee Name
Nominee DOB
Nominee Relationship
Select an Option
@foreach ($relationship as $data)
{{ $data->relationship_name }}
@endforeach
Appointee?
Appointee Name
Appointee DOB
Appointee Relationship
Select an Option
@foreach ($relationship as $data)
{{ $data->relationship_name }}
@endforeach
Father Name
Mother Name
Spouse Name
Attachments
Add Attchment
Pan / Form 60
Select an Option
Pan / Form 60
File
Remarks
Aadhaar Front Side
Select an Option
Aadhaar Front Side
File
Remarks
Aadhaar Back Side
Select an Option
Aadhaar Back Side
File
Remarks
Recent Photo
Select an Option
Recent Photo
File
Remarks
Remarks
Add Remarks
Remarks
Remarks Filled by
Submit
@stop