Personal Accident Policy

Primary Insured Details
Email *
First name *
Middle name
Last name *
Mobile *
Date of birth *
Gender *
Please select your risk type *help
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Medical Extension *
Diseases suffered fromhelp
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Monthly income *help
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Occupation *
Address type *
Address for communication *
State *
City *
Pincode *
Table of cover *help
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Sum Insured *
Start date
End date
Assignee Name* *help
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Assignee relation *
Do you wish to insure your spouse?
Do you wish to insure your dependent children?
Do you wish to insure your father?
Do you wish to insure your mother?
Do you wish to insure your father-in-law?
Do you wish to insure your mother-in-law?
Have you insured your entire family?
Tip: You get discount if your entire family is insured
Select your branch office
OICL Office State *
City/Town *
Branch/Office *
Please select a role to continue
Whether any agent is involved for this proposal?
* If 'NO' is selected, the policy will be issued under code of Development Officer without an Agent.
Monthly income
Income declared should be according to the IT returns