Group Health Insurance by AIGETOA CTD
Year 2023-24
Email *
Insurance required *
Note:
1. Please read the premium & charges  document very carefully before proceeding further.
2. Filled Up data shall be used to calculate final amount to be paid.
3. Data filled in this form will be used for final payment and it will be intimated in due course of time.
4. No deletion / alteration is possible at any point of time. Be very careful while filling up data.
5. Please do not make duplicate entry. Duplicate entry may leads to removal of data.
6. This form is designed to collect baseline data and does not guarantee issuance of health policy which is subject to final agreement and payment with the insurer.
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BSNL Executive Per No (8 Digit)
 *
Circle *
Name of Employee *
Gender *
Date of birth *
MM
/
DD
/
YYYY
Mobile No *
Email  *
PAN Number *
Adhaar No *
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