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Here’s a detailed, step-by-step guide to filling out LIC Form No. 3857 – which is the Proposal for Life Assurance – With Profit (Money Back Policy) . This form is primarily used for LIC’s Money Back Plan (e.g., Plan No. 920, 921, 922, etc.).
1. Before You Start
Use black or blue pen and block capitals . Do not overwrite or use whitener. Cross out errors, initial next to them. All sections must be filled truthfully – concealment can lead to policy repudiation. Keep ready: PAN card , Address proof , Age proof , Income proof (if high sum assured), Medical reports (if required).
2. Section-by-Section Filling Instructions Section A – Type of Proposal
Box 1: Tick “Individual Life” (or “Joint Life” if applicable). Box 2: Tick “With Profit” (Money Back policies are With Profit). Box 3: Tick “Money Back” (do not tick Endowment, Term, etc.). Plan & Term: Write Plan No. (e.g., 921) and Policy Term (e.g., 25 years). Sum Assured (SA): Write in words & figures. Minimum usually ₹1,00,000.
Section B – Proposer’s Details (Life to be Assured) | Field | Instruction | |-------|-------------| | Name | As per PAN/Aadhaar (no initials) | | Date of Birth | DD/MM/YYYY (attach age proof) | | Sex | Male/Female/Transgender | | Marital status | Married/Unmarried | | Occupation | Specific (e.g., Software Engineer, not just “Service”) | | Annual Income | From all sources (justified with ITR if high SA) | | PAN / Form 60 | Mandatory – fill PAN, else Form 60 with reason | Section C – Nomination (Section 39)
Nominee name (not same as proposer unless self-nomination) Relationship (spouse, child, parent – “friend” not allowed) Age of nominee Share % if multiple nominees (total 100%). If nominee is minor: mention Appointee (major person).
Section D – Previous Insurance Details
Yes/No – Have you/has the life to be assured held any LIC/other insurance? If yes: Policy Nos., sum assured, status (in force/lapsed/claimed). Any claims declined, extra premium, or policy modified ? – If yes, attach details.
Section E – Other Insurance/Proposals
Any other pending proposals with LIC or other insurers? Give details.
Section F – Health & Lifestyle Declaration (Critical) This is detailed – answer each:
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Try it on this pageHere’s a detailed, step-by-step guide to filling out LIC Form No. 3857 – which is the Proposal for Life Assurance – With Profit (Money Back Policy) . This form is primarily used for LIC’s Money Back Plan (e.g., Plan No. 920, 921, 922, etc.).
1. Before You Start
Use black or blue pen and block capitals . Do not overwrite or use whitener. Cross out errors, initial next to them. All sections must be filled truthfully – concealment can lead to policy repudiation. Keep ready: PAN card , Address proof , Age proof , Income proof (if high sum assured), Medical reports (if required). how to fill lic form no 3857
2. Section-by-Section Filling Instructions Section A – Type of Proposal
Box 1: Tick “Individual Life” (or “Joint Life” if applicable). Box 2: Tick “With Profit” (Money Back policies are With Profit). Box 3: Tick “Money Back” (do not tick Endowment, Term, etc.). Plan & Term: Write Plan No. (e.g., 921) and Policy Term (e.g., 25 years). Sum Assured (SA): Write in words & figures. Minimum usually ₹1,00,000.
Section B – Proposer’s Details (Life to be Assured) | Field | Instruction | |-------|-------------| | Name | As per PAN/Aadhaar (no initials) | | Date of Birth | DD/MM/YYYY (attach age proof) | | Sex | Male/Female/Transgender | | Marital status | Married/Unmarried | | Occupation | Specific (e.g., Software Engineer, not just “Service”) | | Annual Income | From all sources (justified with ITR if high SA) | | PAN / Form 60 | Mandatory – fill PAN, else Form 60 with reason | Section C – Nomination (Section 39) Here’s a detailed, step-by-step guide to filling out
Nominee name (not same as proposer unless self-nomination) Relationship (spouse, child, parent – “friend” not allowed) Age of nominee Share % if multiple nominees (total 100%). If nominee is minor: mention Appointee (major person).
Section D – Previous Insurance Details
Yes/No – Have you/has the life to be assured held any LIC/other insurance? If yes: Policy Nos., sum assured, status (in force/lapsed/claimed). Any claims declined, extra premium, or policy modified ? – If yes, attach details. 920, 921, 922, etc
Section E – Other Insurance/Proposals
Any other pending proposals with LIC or other insurers? Give details.
Section F – Health & Lifestyle Declaration (Critical) This is detailed – answer each:
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