Primary insured details
Date of birth *
Gender *
PAN number
Please specify illnesses/conditions *
Suffering since
Upload a photograph of the person to be insured *
Please upload the passport size (preferred) photograph while proceeding to buy policy.
Plan details
Plan *
Sum insured *
Do you want to extend the coverage for Personal Accident? *
TIP: You can extend the coverage for Personal Accident also with an additional premium of Rs 60 only(per lakh/ per member)
Name of the nominee for primary insured *
Relationship with the nominee *
Start date *
End date
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?
Name and address of family physician  help
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Name of family physician
Address of family physician
TPA / NON - TPA
Do you wish to opt for TPA services?
Tip: You get 5% discount if you opt out of TPA(Third Party Administrator) Service
Select your branch office  help
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OICL Office State *
City/Town *
Branch/Office *
OTP Validation
Mobile :
Email :
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.