@extends('layouts.default') @section('content')
Nationa Pension Scheme Form
@csrf
Insurance Co. Details
Insurance Company Name
Select an Option
Plan Name
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Sub Plan Name
Select an Option
Personal Details
Name
DOB
Are You Senior Citizen ?
Select an Option
Yes
No
Gender
Select an Option
Male
Female
Others
Marital Status
Select an Option
Married
Unmarried
Others
Aadhaar No
Is Pan Card available ?
Select an Option
Yes
No
PAN NO
Nationality
Select an Option
Indian
NRI
Others
Height
Weight
Education
Email
Mobile No
Alternate Mobile No
Employee Type
Please Select Employee Type
Salaried
Self Employed
Self Employed Professional
Business Owner
Yearly Income
Please Select Income
Up to 3 lacs
3 to 4 lacs
4 to 5 lacs
5 to 10 lacs
10+ lacs
Company Name
Permanent Address
Same as Permanent Address
Communication Address
Occupation
Annual Income
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)
{{ $data->relationship_name }}
@endforeach
Father Name
Mother Name
Spouse Name
Team Details
TEAM DETAILS
Employee
Partner
Caller
Select an Option
@foreach ($caller_list as $data)
{{ $data->firstname }} {{ $data->lastname }}-{{$data->employee_code }}
@endforeach
Team Leader
Assistant Manager
Manager
Center Head
Regional Head / AVP
Zonal Head
Vice President
SM / RM
Select an Option
@foreach ($leads->ResponseObject as $data)
{{ $data->firstname }} {{ $data->lastname }}-{{$data->employee_code }}
@endforeach
Branch - Center Location Name
Select an Option
@foreach ($branchlist->ResponseObject as $branch)
{{ $branch->branch_name }}
@endforeach
Partner Details
Choose an option
Manager Details
Relationship Manager
Choose an option
Payout Cycle
Location
CBRE
Is Cashback offered ?
Select an Option
Yes
No
CBRE %
Employee who offered CBRE to Client
Select an Option
@foreach ($leads->ResponseObject as $data)
{{ $data->firstname }} {{ $data->lastname }} -{{$data->employee_code }}
@endforeach
Remarks
Premium Details
PPT
PT
Frequency
Select an Option
Monthly
Quartely
Half Yearly
Yearly
Loan Amount
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
Select an Option
GST AMOUNT
Premium Without Tax
Annualised Net Premium
Total Sum Assured
NPS Details
Investment Amount
Investment Frequency
Please Select Payout
Monthly
Quaterly
Half Yearly
Yearly
Pay for
Please Select Payout
@for($i=5;$i<=15;$i++)
{{$i}} Years
@endfor
Payout Frequency
Please Select Payout
Monthly
Quaterly
Half Yearly
Yearly
Get Pension When & Turn
Please Select Payout
@for($i=20;$i<=100;)
{{$i}} Years
{{$i = $i + 5}}; @endfor
Loan Amount
Please Select Amount
Up to 3 lacs
3 to 4 lacs
4 to 5 lacs
5 to 10 lacs
10+ lacs
Loan Status
Select an Option
Issued
Query
Rejected / Cancelled
Under Process
Quote Id
Payment Url
Ekyc Status
Please Select Amount
Failed
Pending
Approved
Banking Details
Bank Name
Account Number
IFSC Code
Bank Address
Bank Branch
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
Bank Passbook
Select an Option
Bank Passbook
File
Remarks
Bank Statement
Select an Option
Bank Statement
File
Remarks
Bank Cheque
Select an Option
Bank Cheque
File
Remarks
Remarks
Add Remarks
Remarks
Remarks Filled by
Declaration
I am not politically exposed
I pay tax only in india
I hereby give my consent fo vizzafintech to feith my details from ckyc and share the same to credit card companies
I agree to the terms & condition of vizza fintech and credit card companies terms and conditions and FATCA/CRS declaration
Submit
@stop