SALICO (Sagarmatha Lumbini Insurance Co. Ltd.)

Basic Details Address Details Document Details/Upload Payment Option

KYC Type *

Type of Insurance *

Gender *

Occupation *

Name in Devnagari *

First Name *

Last Name *

Grandfather Name

Grandmother Name

Father Name *

Mother Name *

Spouse Name

Date of Birth (A.D) *

Province *

District *

VDC/Municipality *

Tole/Street *

Tole in Devnagari

Ward No. *

Same as Permanent Address?

Temporary Address

Province

District

VDC/Municipality

Tole/Street

Tole in Devnagari

Ward No.

Telephone No.

Mobile No. *

PAN_VAT No.

PAN Reg. Date[yyyy-mm-dd]

ID Detail Info

ID Type *

Id No *

ID Issued Place *

Id Issued Date(B.S) *

Id Issued Date(A.D) *

Citizenship No

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Debit Note Number

Premium Amount

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Sagarmatha Lumbini Insurance

Sagarmatha Lumbini Company LTD

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Temporary Address

ID Detail Info

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