VMRF-DU GMC - Puducherry
Basic Details
College
*
-- Select College --
Aarupadai Veedu Medical College & Hospital
Vinayaka Mission College of Nursing
School of Physiotherapy
School of Rehabilitation and Behavioral Sciences
School of Allied Health Science - Pondy
School of Allied Health Science - Salem
Employee Code
*
Employee Name
*
Email ID
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Mobile No
*
Gender
*
Select Gender
Male
Female
Others
Date of Birth
*
Age
*
Department
*
Designation
*
Do you wish to include your family under this group medical insurance
*
-- Select --
Yes
No
Sum Assured
*
-- Select Sum Assured --
300000
500000
Family Member Details
Name
*
Gender
*
Select Gender
Male
Female
Others
Relationship
*
-- Select Sum Relationship --
Father
Mother
Spouse
Child
Date of Birth
*
Age
*
Action
I hereby confirm that all information provided in this registration is accurate and complete.
Submit
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