Family Floater Health Insurance Application
Proposer Details
Full Name
Gender
Male
Female
Other
Date of Birth
Email
Mobile Number
Address
Family Members to be Insured
Member 1 Name
Gender
Male
Female
Other
Date of Birth
Relationship
Self
Spouse
Son
Daughter
Father
Mother
Other
Member 2 Name
Gender
Male
Female
Other
Date of Birth
Relationship
Self
Spouse
Son
Daughter
Father
Mother
Other
Policy Details
Sum Insured
Policy Term (years)
1
2
3