Rashtriya Vidyarthi Suraksha Yojana

Back to Home Page

Student Insurance Registration Form

_* Mandatory Fields

Full Name of Student _*

Student Photo _*

Full Name of Student's Mother or Father _*

Complete Address of Student _*

Taluka _*

District _*

State _*

Pin Code _*

Mobile Number _*

Student's Aadhaar Card Number _*

Date of Birth of Student _*

Is the student disabled? _*

Yes

If Yes:

Gender _*

Student's Height _*

Name of Heir _*

Student's Inheritance Relationship _*

School Name _*

Class _*

Important Disclaimer

A. Please read the sales brochure carefully before purchase for more information on risk factors, terms and conditions. B. Insurance is a matter of insistence. C. Terms and conditions apply. D. In case of dispute, the English version will be applicable, I have been given all the information and ideas in this regard, I agree to the terms and conditions, I have no objection for me and my family to take the said insurance.