Beema e Hayat — Life Insurance Advisory | Authorized Agent, State Life Insurance

Setup needed: the submission endpoint isn't configured yet — set APPS_SCRIPT_URL in public/proposal-form.js. Until then the form still generates both PDFs for download.

1 Choose plan type

This selects the correct official State Life form and adjusts the questions below.

2 Personal details

As they appear on your CNIC. Please use CAPITAL LETTERS for names.

Full name *

CNIC number *

Father's / Husband's name *

Date of birth *

Gender *

Marital status

Nationality

Place of birth

Religion

Number of dependents

Other nationality (if any)

Resident in Pakistan?

Mother's maiden name

Name of proposer (if other than life proposed)

Name of child (if child policy)

3 Contact & address

Mobile number *

Landline / phone

Email address

Fax number

Address for correspondence *

Permanent residential address (if different)

Office / business address

4 Occupation & income

Occupation *

Nature of work (full details)

Employer's name & address (if salaried)

If businessman — nature of business

Business name & address

Average monthly income (Rs)

Yearly income (Rs)

NTN number

Agricultural land (size / location / Nehri or Barani)

Qualification

5 Plan details

Plan *

Policy term (years)

Payment mode

Sum assured (Rs) *

Premium / contribution (Rs)

Automatic non-forfeiture option

Indexation option

6 Investment fund allocation

How your net contribution is split across funds (should total 100%).

Conservative Fund (%)

Balanced Fund (%)

Aggressive Fund (%)

8 Nominee / beneficiary

Beneficiary 1

Full name

Relationship

CNIC / B-Form

Date of birth

Share (%)

Beneficiary 2 (optional)

Full name

Relationship

CNIC / B-Form

Date of birth

Share (%)

Guardian / appointee (if any beneficiary is a minor)

Guardian name

Relationship with nominee

Guardian CNIC

9 Family history

Brief health/family background (used in the statement of health).

Status

Age

Health / cause of death

Father

Mother

Spouse

No. of brothers

No. of sisters

No. of sons

No. of daughters

10 Personal statement of health

Height

Weight (kg)

Blood pressure (if known)

Cigarettes per day

Pan / Niswar / Tobacco

Alcohol

1. Are you currently able to work?

2. In the past 5 years, unable to work for more than 30 consecutive days?

3. Ever treated for / under treatment for high BP, heart disease, diabetes, cancer, kidney, liver, or other serious illness?

4. Have you ever been seriously injured?

5. Had or been advised to have a surgical operation?

6. Currently taking medication for any disease or disorder?

7. Do you intend to seek medical advice, treatment, or tests?

8. Tested positive for HIV/AIDS or Hepatitis B or C?

9. Smoked cigarettes within the past 12 months?

10. Any defect of vision or hearing?

11. Have parents/siblings died or suffered heart disease, cancer, or diabetes before age 65?

12. Intend hazardous activity (e.g. scuba diving) or to fly other than as a passenger?

13. Are you in good health?

If you answered "Yes" to any health question, please give details (illness, dates, treatment)

11 For female applicants

Date of last delivery

Are you pregnant?

Date(s) of any miscarriage

Date(s) of any caesarean (reason)

Date of L.M.P

Any history of female disease?

12 Existing insurance / Takaful

Any current or past policies (declined, lapsed, paid-up, in-force).

Company / Zone

Policy / proposal no.

Sum assured / covered

Status

13 Declaration

I declare that the information provided is true and complete to the best of my knowledge, and I authorize Beema e Hayat / State Life to use it to prepare my proposal. I understand this is not a contract and no policy is in force until issued and confirmed.Required to submit.

On submit, a complete filled application form (PDF) is generated and downloaded to your device, and your proposal is sent securely to our advisor, who will contact you on WhatsApp to verify and finalize it.

Proposal received

Your filled form has been generated and your proposal sent to our advisor.

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