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DISCLAIMER () Name of (Proposed) Insured() Name of (Proposed) Policyholder/ Application/Policy No. Insurance Intermediary s Name Insurance Intermediaries Registration Code/ Branch/ Intermediaries
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The name of the proposed policyholder is the individual or entity who is proposed to be the holder of the insurance policy.
The insurance company or broker is required to file the name of the proposed policyholder.
The name of the proposed policyholder should be filled out by providing the full legal name of the individual or entity.
The purpose of providing the name of proposed policyholder is to accurately identify who the insurance policy will be issued to.
The information that must be reported includes the full legal name of the proposed policyholder.
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