| Enter Your Details below |
| Dist Insurance Office | | Policy No: | |
| Sur_Name | | Full Name: | |
| Father Name | | Designation: |
|
| Gender | | Date of Birth: | |
| School Name | | Mandal: | |
| Dist | | PIN: | |
| Date of First Appointment | | Marital Status: | |
| If Maried, No.f Children | | Ages: | |
| Basic Pay | | Scale: | |
| Nominee Name | | Father: | |
| Nominee Age | | Relation: | |
| Present Premium | | Prposed Premium: | |
| Deducted from | | Cell No: | |
| Email | | Aadhaar No: | |
| Employee ID | | DDO Code: | |
| DDO Type | | DDO Office Address: | |