Proposer Name is required.
Date of Birth is required.
Mobile number is too short. Mobile number is too long. Enter a numeric value
Email is required. Invalid email address.
ID No is required.
Annual Income is required.
Address Line 1 is required.
Address Line 2 is required.
Inward Credit For GST Number?
GST Number
GST Number is required.
No Relationship With Proposer Name Gender DOB Occupation Sum Insured Nominee Name Relationship with nominee Pre-existing disease Remove

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a. Declained to issue a policy to you or your proposed family member?
b. Declained to continue your Insurance or proposed family member?
c. Not invited renewal of your or your proposed family family member
d. Imposed any restriction or special conditions.
If so, please give name and address of each company in respect of a,b,c,d above.
12. Is this Insurance to be additional to any other Critical Illness or Medical Health insurance?
a. Name and adress of Company:
b. Number of persons covered under the Policy:
c. Benefits under the Policy:
d. Sum Insured:
e. Policy Number:

Total Premium to be paid for your complete health insurance is :
(Exclusive of GST)
No Name Sum Insured Premium
Basic Premium: (A)

Loading Details
Occupation Loading:

Total Premium on Loading: (B)

Discount Details: Discount(%)
Policy Duration Discount:

Total of Discounts: (C)

Net Premium : (A+B-C)
IGST (18%) :
CGST (9%) :
SGST (9%) :
UGST (9%) :
Final Premium :
I have read and understood the Declaration, hereby agree to agreements, terms and conditions mentioned in Declaration.