{"id":1981,"title":"DUAL SIGN FORMAT / दोहरे हस्ताक्षर का प्रारूप","purpose":"service","insurer":{"slug":"canara-hsbc-life-insurance","name":"Canara HSBC Life Insurance Company Limited"},"source_pdf":"https://www.canarahsbclife.com/content/dam/chli/pdf/underwriting-questionnaires/non-medical-questionnaire/a-english/dual_sign_format.pdf","sha256":"d65161f6475335bff03240dc4d09704053f06201b9d35f17c7a7c372a927754c","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the life to be assured to provide dual specimen signatures for verification purposes.","notes":["The life assured/proposed owner must sign all specimen signatures they sign.","Dual Signature Format must be witnessed by the SP.","Also counter-witnessed by the SM/AM to confirm the same.","Fill details in Hindi or English only.","In case of disagreement, English version prevails."],"title":"DUAL SIGN FORMAT / दोहरे हस्ताक्षर का प्रारूप","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Life to be assured details and declaration","fields":[{"help":"Write the full name of the life to be assured.","type":"text","label":"Name of Life to Be Assured / बीमा के लिए प्रस्तावित व्यक्तत का नाम","options":[],"required":null,"pdf_field":""},{"help":"Enter the proposal number.","type":"text","label":"Proposal No.: / प्रस्ताि संख्या.:","options":[],"required":null,"pdf_field":""},{"help":"Fill in your name and the date of signing.","type":"text","label":"Declaration: I __________________________________________________, hereby declare that both the signatures below are mine and are signed by me on _____/ _____/20____. I further declare that either of the signatures is valid.","options":[],"required":null,"pdf_field":""},{"help":"Provide first specimen signature.","type":"signature","label":"SPECIMEN 1 / नमूना 1","options":[],"required":null,"pdf_field":""},{"help":"Provide second specimen signature.","type":"signature","label":"SPECIMEN 2 / नमूना 2","options":[],"required":null,"pdf_field":""},{"help":"Sign here for signature 1.","type":"signature","label":"SIGN 1 / हस्ताक्षर 1","options":[],"required":null,"pdf_field":""},{"help":"Sign here for signature 2.","type":"signature","label":"SIGN 2 / हस्ताक्षर 2","options":[],"required":null,"pdf_field":""},{"help":"Witness 1 must sign here.","type":"signature","label":"Signature of Witness 1:/ गिाह के हस्ताक्षर 1:","options":[],"required":null,"pdf_field":""},{"help":"Name of Witness 1.","type":"text","label":"Name: / नाम:","options":[],"required":null,"pdf_field":""},{"help":"Designation of Witness 1.","type":"text","label":"Designation: / पि:","options":[],"required":null,"pdf_field":""},{"help":"Witness 2 must sign here.","type":"signature","label":"Signature of Witness 2: / गिाह के हस्ताक्षर 2:","options":[],"required":null,"pdf_field":""},{"help":"Name of Witness 2.","type":"text","label":"Name: / नाम:","options":[],"required":null,"pdf_field":""},{"help":"Designation of Witness 2.","type":"text","label":"Designation: / पि:","options":[],"required":null,"pdf_field":""},{"help":"Enter the date and place of signing.","type":"text","label":"Date & Place: / दिनांक और स्थान:","options":[],"required":null,"pdf_field":""}],"filled_by":"life to be assured"},{"title":"Declaration if signed in Vernacular/Thumb Impression","fields":[{"help":"Fill in your name, parent’s name, address, and language of explanation.","type":"text","label":"I, ___________________________ son / daughter of _______________________, an adult residing at _____________________________ hereby declare that the contents of this form have been duly explained to me in _______________ language and have been understood by me.","options":[],"required":null,"pdf_field":""},{"help":"Sign here if form is signed in vernacular or thumb impression.","type":"signature","label":"(Signature of the customer)","options":[],"required":null,"pdf_field":""},{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Provide contact number.","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""}],"filled_by":"life to be assured"}],"deadlines":[],"applies_to":"","attachments":[],"declarations":["The life assured declares both signatures are theirs and either signature is valid.","If signed in vernacular or thumb impression, the form contents have been explained and understood."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/canara-hsbc-life-insurance/1981-dual-sign-format"}