Type of Insurance*Individual/DependentGroup MedicalEducation PlanMarriage/Education PlanInvestment Plan with Life CoverInvestment Plan without Life Cover
Name*
Email*
Mobile Number*
Company Name*
Please download this form and fill the details Group Medical Census List Form
Please upload the Filled Census List Form provide above ( Forms to be uploaded in .xlsx format only )
No. of Applicant's 123
Applicant's Name*
Email
Mobile Number
Date of Birth*
Gender MaleFemale
Maritial Status ---Not MarriedMarried
Nationality *
Insurance Category*
Domestic workersParents & Parents In LawMarried Females aged 18-45 years under sponsorshipAll Others, 0-65 yrs under sponsorship (Children, Employees salaried below AED 4,000)
Applicant's Relation to Sponsor* ---ParentsParent in LawWifeChildrenEmployeeDomestic WorkerOthers
Visa Issue* ---DubaiAbu DhabiSharjahRas al KhaimahAjmanFujairahUmm Al Quwain
Residence Location* ---DubaiAbu DhabiSharjahRas al KhaimahAjmanFujairahUmm Al Quwain
Insurance Category* Domestic workersParents & Parents In LawMarried Females aged 18-45 years under sponsorshipAll Others, 0-65 yrs under sponsorship (Children, Employees salaried below AED 4,000)
Gender
MaleFemale