Moneyplus - Health Insurance Data Collection
Basic Details
Medical History
Family Members
Declarations
Insurer
hdfc
niva
tata
nivadm
In this form, we will collect all important information required to issue your health insurance policy. Kindly share correct information as any mis-representation of facts may lead to rejection of claim or cancellation of policy in future.
Full name
*
Please enter your name as per your PAN / Aadhar.
Gender
*
Choose Gender
Male
Female
Date of Birth
*
Mobile no.
*
Add mobile number to get update for renewals and other services.
Alternate Mobile no.
*
Alternate or family member's mobile number.
Email
*
Your policy copy would be shared on this email id. Please enter it correctly.
Address
*
PIN Code
*
Upload Aadhar
*
Choose a file
or drag it here
Upload PAN
*
Choose a file
or drag it here
Mandatory Bank Details
Bank Name
*
Account No.
*
IFSC
*
Mandatory Information for KYC
Mother's name
*
Occupation for
*
Choose
PRIVATE SECTOR SERVICE
BUSINESS
PROFESSIONAL
GOVERNMENT SERVICE
RETIRED
HOUSEWIFE
STUDENT
AGRICULTURIST
Kindly choose your occupation.
Employer
Your Income Range
*
Choose
< 5 Lakhs
5-10 Lakhs
10-25 Lakhs
> 25 Lakhs
Kindly choose your income range.
Next
Submit
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