Note

Without vaccination not allowed for policy generation.

1 Basic Detail

Gender*

Male Female

Gender required

Do you smoke or chew tobacco?*

Yes No

tobacco required

Date Of Birth*

Education Qualification*

Occupation Type*

Annual Income*

Pin Code *

Note: Please type slowly to view Pin Code and select from list.

2 Quotation Change Basic Detail

Pay Frequency

Policy Term

Coverage Amount - Sum Insured

Death Benifit Payout Option

Pay Premium For

Best Plans For You 5 Plans Found For You

Quotation number :

3 Proposer Detail Back to Quotation

Proposer Detail

Policy Tenure : 1 Year

Premium :

Payment Frequency :

Salutation*

Salutation required

First Name *

First Name required Please enter valid First Name

Last Name *

Last Name required Please enter valid Last Name

Mobile No.*

Mobile No. is required Please enter valid Mobile No.

Email *

Email required Please enter valid Email

Proposer Communication Details

Contact Address *

Address is required Please enter valid Address

Marital Status *

Select Marital Status

PAN No.

PAN No. required Please enter valid PAN No.

4 Preview & Payment Change Proposal Detail

Insurer Detail

Proposer Name
Date of Birth
Mobile No.
Email Id
State
City
Contact Address
Pincode
PANNo
Download Benefit Illustration	Generate EBI Download Note: Please click to generate EBI and downloand to go head.

I hereby confirm that I have mandated Vittachaya Insurance Brokers Pvt Ltd. to place my insurance cover and have read and agreed on the Terms and Conditions. Please select Terms & Conditions

Proposer Communication Details

Please Wait...

Contact no.

Address

Email ID

1 Basic Detail

2 Quotation Change Basic Detail

No Plans Found.

3 Proposer Detail Back to Quotation

Proposer Detail

Proposer Communication Details

4 Preview & Payment Change Proposal Detail

Insurer Detail

Please Wait...