Applicant – somai Insurance Group

Registration & Grab It !

Applicant Name*

Gender *

Address*

DOB In BS (YY-M-D)*

Contact No*

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नागरिकता-FS*

नागरिकता-BS

Qualification *

Father's Name*

Grand Father's Name*

Email*

District & Postal code

PAN NO

Nominee/Spouse-Relation

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