Registration Form for Primary

Sainik Ardhyasainik Seva Sangathan (SASS)

GROUP MEDICLAIM INSURANCE POLICY PROPOSAL

GROUP MEDICLAIM POLICY FOR (2026–27)

TO SERVE BEYOND SERVICE

Policy Document

Please review the complete policy document below

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I have read and agree with the above policy document and conditions

Registration form for Primary Member

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Service & Personal Details

Personal No. / Service No. (as per Service-ID)

Salutation

Name (as per Service or ex-Service ID)

Name (Aadhaar card)

Gender

Rank Category

Service

Other Service

Relation to Service Member (If applicable)

PAN Number Format: ABCDE1234F (5 letters, 4 numbers, 1 letter)

Marital Status

Rank of Service Member

Equivalent Rank (as per BSF / CAPF)

Address

Pin code

State / Union Territories

City

Date of Birth

Enter Email OTP

Mobile No. (with Country code)

Enter Mobile OTP

Do you wish to opt for Mediclaim policy?

I select the following risk cover amount as a family floater plan?

I wish to subscribe for my family

Nominee Details

Name (as per Nominee's Aadhaar)

Relationship

Date of Birth

Mobile No.

Nominee Address

Do I have Linked Associate Member (LAM) and/or Linked Associate Sponsored Member (LASM)?

Upload PDF File (max. size: 1 MB) Please upload required documents in PDF format (1 MB)

I agree to all membership conditions of SASS, SASS Bye Laws and AOP.

I agree to all the conditions of the Mediclaim plan opted by me.

All the details shared above are true and correct.

GROUP MEDICLAIM POLICY FOR (2026–27)

Policy Document

Registration form for Primary Member

Service & Personal Details

Nominee Details

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