Group Insurance - Registration

Fill in your details and continue to secure your enrollment under the group insurance plan.

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Type

Roll Number (1 to 4 digits)

Primary Details

Applied on

Name

Username / Email

Mobile No

School No

DOB

House

Policy Selection

Coverage

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With Parents / In-Laws

Without Parents / In-Laws

Payment Mode

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Single Payment

Instalments

Family / Dependents

Family Scope

Self, Spouse & Children

Self, Spouse & Children + Single Parent or Single In-laws

Self, Spouse & Children + Both Parent or Both In-laws

Spouse

Spouse Name

Spouse DOB

Child 1

Child 1 Name

Child 1 DOB

Child 1 Gender

Child 2

Child 2 Name

Child 2 DOB

Child 2 Gender

Child 3

Child 3 Name

Child 3 DOB

Child 3 Gender

Parent / In-Laws 1

Relative 1 Name

Relative 1 Relation

Relative 1 DOB

Parent / In-Laws 2

Relative 2 Name

Relative 2 Relation

Relative 2 DOB

Captcha: 2 + 8 = ?

We will send OTP to your email before final submission.