HIKYC

Health Insurance - Data and Documents

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* Indicates required field

Proposer Name *

First

Last

Email *

Mobile # (India) *

Mobile # (Intn'l - NRIs) *

Name (Self) *

First

Last

Gender (self) *

Date of Birth (Self) *

Height (Self) (in cms) *

Weight (Self) (in Kgs) *

Name (Spouse) *

First

Last

Gender (Spouse) *

Date of Birth (Spouse) *

Height (Spouse) (in cms) *

Weight (Spouse) (in Kgs) *

Name (Child 1) *

Gender (Child 1) *

Date of Birth (Child 1) *

Height (Child 1) (in cms) *

Weight (Child 1) (in Kgs) *

Name (Child 2) *

Gender (Child 2) *

Date of Birth (Child 2) *

Height (Child 2) (in cms) *

Weigt (Child 2) (in Kgs) *

Name (Child 3) *

Gender (Child 3) *

Date of Birth (Child 3) *

Height (Child 3) (in cms) *

Weight (Child 3) (in Kgs) *

Country of Birth *

Country of Residence *

Full Address with PIN Code (India) *

Full Adress with PIN Code (Intn'l - NRIs) *

Permanent Account Number (PAN) *

Occupation *

Employer Name *

Annual Salary (Rs. L p.a) *

Are you a Cigarette Smoker / Tobacco user? *

Do you consume Liquor / Alcoholic Beverages? *

Sum Insured (Health Cover / Mediclaim) in INR) *

Are you seeking portability / transfer from an existing Health Insurer? *

Pre-Existing Diseases (Give details, if any) *

Nominee Details *

Upload KYC Documents as Single ZIP File *

Max file size: 20MB

Submit

Instructions for KYC (Read first)

Read the below instructions carefully to get all the supporting documents ready, before starting KYC Data Entry and Document Upload
The KYC form inputs and documents are to be provided by filling in the details for Self and family members for whom Family Floater Health Insurance Cover is requested.

Create a ZIP file with all the below mentioned applicable documents and then upload via "Choose File" button above

1. PAN Card (of the Proposer)
2. Address Proof (Aadhaar / Drvg Lic / Util Bill / Voter ID / Govt Letter / Property Tax / Tenancy Agreement - India and Intn'l)
3. Passport - Front & Back with Visa Stamp (NRIs only)
4. National or Resident ID (NRIs only)
4. Empty (Unsigned) Cheque (of Bank a/c to be used for making the Policy Premium payment - INR Currency Bank account Cheque only accepted - Cheque leaf should have name printed)
5. Passbook (or) Bank Statement - last 1 month (if cheque leaf does not have name printed - Passbook or Bank Statement should mandatorily display Account Holder Name, Account Number, Bank Name, Branch Name, Branch address (with Pin Code), NEFT/IFSC Code and MICR Code)
6. If you are seeking transfer / portability from an existing health insurance company, please include last TWO YEARS years health insurance policy documents issued by current Insurer.

(Files should be of JPG (or) PNG or PDF Format only - Other formats cannot be processed. Store all the above document files in a folder, select all files and upload (or) Zip the entire folder and upload via "Upload" button in left side, after entering the details in form fields, and finally press "Submit" button)

Health Insurance - Data and Documents

Enter details

Instructions for KYC (Read first)

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