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Corporate Details

Name of the Company* Please enter valid company name

Contact Person* Please enter valid contact person name

Email ID* Please enter valid email id

Mobile* Please enter valid mobile number

Do you have an existing group Mediclaim policy for your employees?

Yes No

Does your company belongs to production house of media and entertainment industry?

Yes No

Dose your company fall under any of the below mentioned category?

Yes No

Diagnostic centers / Hospitals / Clinics / Nursing homes / Medical colleges etc.
Into the business of business of health / offer free medical consultation / OPD packages or Schemes / tie - ups with hospitals offering discounted treatment / free camps.
Any Association / Trust (Religious / Non-religious) / Social Club / NGO involved in charity.
Media and Entertainment other than production house.
Politicians / Lawyers / Policeman / Paramilitary, Military

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