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  • Medical Insurance Form.

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    Teck Engineer
    6 views1 page
    This document is a medical insurance form that provides coverage for self, spouse, and two children. It lists premium rates per year based on age and sum insured amounts of either 3 lakh or 5 lakh Indian rupees. The form includes fields for names, dates of birth, gender, and relation of covered individuals but does not yet have any entries.

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    This document is a medical insurance form that provides coverage for self, spouse, and two children. It lists premium rates per year based on age and sum insured amounts of either 3 lakh or 5 lakh Indian rupees. The form includes fields for names, dates of birth, gender, and relation of covered individuals but does not yet have any entries.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views1 page

    Medical Insurance Form.

    Uploaded by

    Teck Engineer
    This document is a medical insurance form that provides coverage for self, spouse, and two children. It lists premium rates per year based on age and sum insured amounts of either 3 lakh or 5 lakh Indian rupees. The form includes fields for names, dates of birth, gender, and relation of covered individuals but does not yet have any entries.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Medical Insurance Form

    Coverage is Self + Spouse + 2 Children

    DOB
    Sr No Name Gender Relation
    DD-MM-YYYY
    1
    2
    3
    4

    Age/SI <18 18-35 36-45 46-55 56-65 66-70 71-75 Amount

    3 Lac 3330 4582 5268 7888 13444 17615 21228 Per Year

    5 Lac 4880 6724 7893 13381 22184 29310 35309 Per Year

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