Health Insurance Proposal Details

Plan details

Not sure? Choose "Advise me" and Abhishek will suggest the best fit.

Plan *

Abhishek will recommend the right plan, sum insured and cover type after understanding your family's needs.

Sum insured * Cover type * Policy tenure Premium payment

Existing cover

Any current health policy? Port it to Aditya Birla? Current insurer Policy no. / expiry date

Proposer details

The person who pays the premium. Name must match the PAN card exactly.

Full name (as on PAN) * Date of birth * Gender * Mobile * Email * PAN * Aadhaar (for KYC) Marital status Occupation * Annual income * Education

Communication address

House no., street, area * City * State * Pincode *

People to be insured

Add everyone who should be covered. Please declare health conditions honestly — it protects your claims later.

Nominee & bank details

Bank details are used only for claim settlements and refunds.

Nominee

Nominee name * Relationship * Nominee DOB *

Bank account

Account holder name Account number IFSC

Anything else?

Best time to call Referred by Notes for your advisor

I confirm the details above are true and complete, and I authorise Abhishek RJ (advisor) to use them to prepare and submit my Aditya Birla Health Insurance proposal and to contact me by call, SMS, WhatsApp or email.

Thank you. Your details have been received.

Your reference number

—

Abhishek will call you shortly. To speed things up, send photos of your PAN, Aadhaar, a cancelled cheque and any existing policy / medical reports on WhatsApp.

Send documents on WhatsApp