Registration form for Linked Associate Member

Details of Primary Member (PM)

Personal No. / Service No. (of Primary Member)

SASS membership number of Primary Member

Note: Link LASM to SASS membership number of PM for the purpose of membership and payment of mediclaim plan. Admin should be allowed to delink LAM from PM.

Rank Category (of Primary Member)

Service (of Primary Member)

Other Service

Rank (of Primary Member as applicable)

Equivalent Rank (as per BSF / CAPF)

Details of Linked Associate Sponsored Member (LASM)

Salutation

Name (as per Linked Associate Member's ID)

Name (as per Linked Associate Member's Aadhaar card)

Gender

Relation to Service/Primary Member (as applicable)

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

Marital Status

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?

Note: The LASM is linked to the Primary Member and can pay the policy premium only if the Primary Member has opted for the policy, and the risk cover does not exceed that of the Primary Member.

I wish to subscribe for my family

Note: Only children under 25 years and unmarried will be considered part of the family. In case of a married child or child over 25 years, please ask them to apply for Associate Membership. No age limit for a disabled child. A valid disability certificate must be submitted with the application for the insurer's approval and declared in this form. Member, family, and nominee details shall be shared by members at the time of premium payment.

Nominee Details (as per Nominee's Aadhaar as applicable)

Name

Relationship

Date of Birth

Mobile no.

Nominee Address

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

I have opted for Risk cover lesser than or equal to my Primary Member.

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

All the details shared above are true and correct.

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GROUP MEDICLAIM POLICY FOR (2026–27)

Policy Document