Submit Insurance Proposal

Proposer Details

Primary policyholder personal information and qualification

Full Name *

Mobile Number *

Alternative Mobile

Email Address *

Date of Birth *

Gender *

Marital Status *

Tobacco Smoker? *

Consume Alcohol? *

Educational Qualification *

Occupation *

Annual Income (₹) *

Nominee Name *

Nominee Relation *

Nominee Date of Birth *

Height (cm) *

Weight (kg) *

Current residential address for official dispatch and verification

Address Line 1 *

Address Line 2

City *

State *

Pincode *

Details of the plan, sum assured, and medical background

Plan Name *

Sum Assured (₹) *

Proposer Medical History / Pre-Existing Diseases (PED)

Add other family members to be covered under this policy (optional)

Provide high-quality scanned copies (Max 10MB each, PDF/JPG/PNG)

Aadhaar Card — Front Side *

Choose Aadhaar Front File PDF, JPG, PNG up to 10MB

Selected

Aadhaar Card — Back Side *

Choose Aadhaar Back File PDF, JPG, PNG up to 10MB

Selected

PAN Card *

Choose PAN File PDF, JPG, PNG up to 10MB

Selected

Cancelled Cheque *

Choose Cheque File PDF, JPG, PNG up to 10MB

Selected