Personal Accident Insurance

Details of the persons to be insured are provided below:-
If insurance is required for specific amounts, complete the following:-

(1) Specific benefits indicate the amount of insurance required for each item

(2) Specific benefits indicate the amount of insurance required for each item

(3) Specific benefits indicate the amount of insurance required for each item

(4) Specific benefits indicate the amount of insurance required for each item

(5) Specific benefits indicate the amount of insurance required for each item

(6) Specific benefits indicate the amount of insurance required for each item

If the insurance amounts required are the multiples or parts of the annual base salary / salary, complete the following:-

(1) Select the fold or parts of the annual basic salary / pay required insurance under each item

(-) Persons to be insured

(2) Select the fold or parts of the annual basic salary / pay required insurance under each item

(-) Persons to be insured

(3) Select the fold or parts of the annual basic salary / pay required insurance under each item

(-) Persons to be insured

(4) Select the fold or parts of the annual basic salary / pay required insurance under each item

(-) Persons to be insured

(5) Select the fold or parts of the annual basic salary / pay required insurance under each item

(-) Persons to be insured