Date of birth *
Gender *
Yearly income *
Disability *
Sum insured *
Start date *
End date

Assignee name *Assignee relationship *Share percentage (%) *Action
Tip: At least one assignee is mandatory
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?
Select your branch officeOICL 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.
Yearly income
Your yearly income is too low to insure a Nagarik Suraksha Policy. Minimum yearly income should be 16667.