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You are in Personal Solutions > Needs Review   Title : Mr. Ms. Mrs. Rev. Dr. Prof. Name * : Occupation / Title   Address * : Date of Birth *   (dd/mm/yyyy) Sex * : Male  Female Marital Status * : Married   Single No of children : No of dependents : Telephone Number * : Email * :       • What financial need is most important to you ? Please Prioritise Financially protecting your family against death Extremely Important Important Not Important Providing funding for your childrens' education Extremely Important Important Not Important Providing for/ or increasing your retirement Income Extremely Important Important Not Important Building a fund for a specific need (starting a business etc) Extremely Important Important Not Important     • What type of financial assistance, which covers the burden of sickness / disability, would be important to you? Please Prioritise   Cash lump sum in the event of a critical illness Extremely Important Important Not Important Income support during hospitalisation Extremely Important Important Not Important Compensation for permanent disablement Extremely Important Important Not Important Continuation of premium payments in the event of permanent disability Extremely Important Important Not Important     • Do you wish to extend protection to your spouse as well ? If so...   Your Spouse's date of birth : (dd/mm/yyyy)   Your Spouse's Occupation / Title :     • If you wish to take a child plan or if you wish to take the hospitalisation benefit for your children, please provide the information requested below ; (Age limit : between 2 -15 yrs) No. of Children to be included : 0 1 2 3 4 5 Name Date of Birth Sex (dd/mm/yyyy) Male Female (dd/mm/yyyy) Male Female (dd/mm/yyyy) Male Female (dd/mm/yyyy) Male Female (dd/mm/yyyy) Male Female     • What is the fund you wish to build for the future (eg. at retirement)? *   Rs.     • What " once off" capital (Life cover) would be required to provide financial security to your family in the event of death. *   Rs.     • Income commitment guide This is a just a guide for you to evaluate your financial ability     Monthly Annually What is your total income ? Rs. Rs. What are your expenses ? Inclusive of loan repayments etc Rs. Rs. Surplus Rs. Rs. The entered amount must be in SLR and rounded off to the nearest 1000.     • How much do you think you can set aside for a financial protection plan from this surplus? *   Rs.   Monthly Quarterly Annually     • Income commitment period? Please Select * 10yrs 15yrs 20yrs 25yrs             * Required Information

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