Benefit Illustration Input
Product Name : DHFL Pramerica U-Protect  

Policy Particulars
  Name of Life Assured : Gender* :
  Email : Mobile Number :
  Date of Birth*
Age :
  Proposal Number : Are you resident of J & K?* :

Base Policy Information
  Payment Mode : Policy Term :
  Premium Paying Term : Sum Assured* :
  Tobacco User :    

  Rider Sum Assured
SA Option SA Value
CI Rider
ADB Rider