Full Name

Phone *

Email *

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How do you know your referral?

What is their approximate yearly premium budget?

What type of insurance plan are they interested in?

🛡️ Term Insurance (Pure Life Protection)

👶 Children's Plan (Education/Future)

👴 Pension Plan (Retirement Income)

📈 Investment/Money Back Plan

💼 ULIP or Mutual Fund SIP

❓ Not decided yet (Need guidance)

How serious is your referral about purchasing?

✅ Very Serious - Ready to buy within 2 weeks

🎯 Considering Seriously - Will buy within a month

🤔 Exploring Options - Might buy in 2-3 months

❓ Just Starting Research

I confirm that my referral is genuinely interested in purchasing LIC insurance and I have their permission to share their interest with your team.