Group Mediclaim Template for Premium Quote

Corporate Details

Full Name of the Organisation

Business (What is the organization into ?)

Address

S. NO Employee Id First Name Relationship Gender Date Of Birth

Self Male dd-mm-yyyy
Spouse Female
Kid1
Kid2
Parent1
Parent2
Age Sum Insured
 At the End of Policy
Total No. Of Employees
Total No. of Lives
Total Sum Insured
Total Premium Paid(including
Endorsement Premiums)
Claim MIS Date