First Name
Middle Name
Last Name
Email
Mobile No.
D.O.B.
Residential Status
Resident Indian
Non-Resident Indian
Present country of residence
India
Andorra
Anguilla
Antigua & Barbuda
Aruba
Australia
Austria
Bahamas
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Brazil
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Brunei
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Canada
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Chile
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Fiji
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Hong Kong
Hungary
Iceland
Ireland
Israel - Tel Aviv
Italy
Japan
Jordan
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Latvia
Leichtenstein
Lithuania
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Macau (part of China)
Madeira
Malaysia - Kuala Lumpur
Maldives
Malta
Martinique ( France)
Mauritius
Mexico
Monaco
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Netherland Antilles
Netherlands
New Caledonia
New Zealand
Norway
Oman
Poland
Portugal
Qatar
Reunion (France)
Romania
Russia-Major cities
S Korea
Saudi Arabia
Seychelles
Singapore
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Slovenia
South Africa-Bloemfontein
South Africa-Cape Town
South Africa-Durban
South Africa-Johannesburg
South Africa-Pretoria
Spain
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St Kitts and Nevis
St Lucia
St Martin (France & Holland)
St Vincent and Grenadines
Sweden
Switzerland
Taiwan
Thailand
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Turkey
Turks and Caicos
U.A.E
UK
US Virgin Islands
USA
Venezuela - Caracas
Vietnam - Ho Chi Minh City
Kenya
Angola
Whether Employed in LIC
Not Employed in LIC
Existing Employee in LIC
Retired Employee from LIC
Servicing Unit
Choose
----------------------
Bangalore
Chennai
Delhi
Gurgaon
Hyderabad
Secunderabad
Kolkata
Mumbai
Thane
Pune
----------------------
Agra
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Ajmer
Aligarh
Allahabad
Ambala
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Bareilly
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Belgaum
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Bhopal
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Ernakulam
Faizabad
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Goa
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Guwahati
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Howrah
Hubli
Indore
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Jaipur
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Lucknow
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Nadiad
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Nashik
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Noida
Patiala
Patna
Pondicherry
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Satara
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Shahdol
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Silchar
Surat
Thrissur
Tirunelveli
Trichy
Trivandrum
Tuticorin
Udaipur
Vadodara
Varanasi
Vellore
Vijayawada
Visakhapatnam
Warangal
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