Voluntary Employee Top Up Cover 2024 -25

This form collects essential information about employee Top-Up Cover. Accurate details will ensure coverage and enhance financial security for you and your immediate family members (Spouse and 2 children).

Please complete the form carefully to expedite your application.

Instructions:

1. Fill in the Name and Date of Birth exactly as per the Aadhaar card to avoid issues with future claims.
2. Provide all required details for each dependent to ensure comprehensive coverage.
3. Double-check your entries for accuracy before submitting the form.
4. The premium for the top-up medical insurance coverage will be paid by the employee. The amount of premium is appended below with preferred sum insured.