Candidate Application Form

Applicant Details
Name as per Adhaar Card :
Salutation First Name Middle Name Last Name

Father’s Name :

Permanent Address :

State : Pin Code :

Country :

Current Address : Same as Permanent Address Yes No

State : Pin Code :

Country :

Gender : Date of Birth : D D M M Y Y Y Y

E-mail : PAN :

Contact Number :

Have you ever been interviewed in Care Health Insurance in last 6 months? : Yes No

If Yes, Where and for which role? ______________________________________ Who was the Interviewer? ___________________________________________

Employment Details
Employment Name of the Organization Last Designation Employment Employment Last CTC Emp. Reporting Reporting Employmen
Details Start Date End Date code Manager - Manager's t Type: Full/
(DD/MMM/YYY) (DD/MMM/YYY) Name & Contact Part Time/
Designation Number Contract
Current / Last
Employer
2nd Last
Employer
3rd Last
Employer

Education Details
Qualification Degree Name College/ Institute Name University Year of Joining Year of Passing Full time/ Part Grade/
Time Percentage

10th

12th

Graduation

Post-
Graduation

Do you have any family member /relative working with Care Health Insurance or any group company : Yes No

If Yes, please mention the name and department ________________________________________________________________________________________

Undertaking:
Terms and Conditions: I certify that the information furnished above is factually correct and subject to verification by the company (including Reference
Check & Background Verification). I accept that an appointment given to me on this basis can be revoked and/or terminated without any notice at any time
in future if any information has been false, misleading or deliberately omitted/suppressed. I also certify that i am at present in sound mental and physical
condition to undertake employment with the company.
Date : Signature :
Place :
Care Health Insurance Limited (Formerly Religare Health Insurance Company Limited)
Regd. Office: 5th Floor, 19 Chawla House, Nehru Place, New Delhi-110019 Corresp. Office: Unit No. 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector-39, Gurugram-122001 (Haryana)
Website: www.careinsurance.com E-mail: customerfirst@careinsurance.com Call us: 1800-102-4488
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CIN: U66000DL2007PLC161503 IRDAI Registration No. - 148