STEP 1:
(PA)Premium Calculator
STEP 2
STEP 3
STEP 4
Earning family member other than spouse is not a dependent. Take separate policy for such members.
Physically Challenged/Differently Abled persons are requested to contact nearest office for cover.
Basic Information Required For Rating
Enter your Gross Monthly Income
*
(From Gainful Employment)
Required Amount of Insurance
*
Maximum 72 months Gross Pay Or 15,00000 whichever is less.
Insurance Proposed
*
Amount should be minimum Rs.25000/-
Select Occupation
*
Select
Shop owner
Service
Clerical
Professional
Student
House Wife
Retired Person
Senior Executive
Accountants
Doctors
Lawyers
Architects
Consulting Engineers
Teachers
Bankers
Administrative Functions
Software engineers
Insurers
Traders & Business men
Scientist
Others
Email ID Of Self:
Mobile No Of Self:
*
Choose your Marital Status
*
Married
Unmarried
Add Spouse For Insurance
*
Yes
No
Earning
*
Yes
No
Gross Monthly Income
*
Required Amount of Insurance
*
Insurance Proposed
*
Select Occupation
*
Select
Shop owner
Service
Clerical
Professional
Student
House Wife
Retired Person
Senior Executive
Accountants
Doctors
Lawyers
Architects
Consulting Engineers
Teachers
Bankers
Administrative Functions
Software engineers
Insurers
Traders & Business men
Scientist
Others
Number of Family Members proposed for insurance
Insured Information
Date Of Birth
Disability
(Physically,Visually,Orthopedically Challenged)
Self
*
NO
Yes
Spouse
*
NO
Yes
No. Of Dependent Family Members to be Insured
*
Number Of Dependent family Members to be Insured
Additional Cover
Medical Expenses Cover Required
*
Yes
No
10% of capital sum insured or 25% or 20% of capital sum insured or 50% of admissible claim amount or actual expenses whichever is lower ? if charge @ 10% or 20% on premium
Nominee Name:
*
Date Of Birth:
Nominee Relation:
*
-Select-
Spouse
Son
Daughter
Son Studying
Daughter-Non Earning
Daughter-Unmarried
Father
Mother
Others
2010 United India Insurance Company Ltd.
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