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Buy Insurance TATA-AIG


Buy Health Insurance: Submit Form

Select Insurance Option, fill up & submit form below. We will issue and email your insurance policy within 2 to 4 hours of receipt of payment. Note: Fill up your Surname, Given Name EXACTLY as per Passport.

Our Bank Details for Payment.    

Buy Health Insurance

  • Select Insurance Option
  • SD Ref No. (optional)
  • Mr / Ms
          
  • Given Name as per Passport *
  • Surname as per Passport *
  • Mobile Number*
  • Email *
  • Assignee Name* (Father or Mother)
  • Joining US Univ*
  • Insurance Start Date * (Same as Travel Date)
    / / Pick a date
  •  
  • Passport No. *
  • Passport Expiry Date *
    / / Pick a date
  •  
  • Date of Birth *
    / / Pick a date
  • Postal Address Line 1 *
  • Postal Address Line 2 *
  • City *
  • State *
  • PIN *
SUBMIT