Primary Insured Details
Date of birth *
Gender *
Please select your risk type *help
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Do you wish to have medical extension? *help
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Diseases suffered fromhelp
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Monthly income *help
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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 *
Monthly income
Income declared should be according to the IT returns