Niramaya Health Insurance

Beneficiary Type

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New Beneficiary Existing Beneficiary (Renewal)

Personal Details

UDID / Enrolment Number *

Date of Birth *

Photo from UDID *

Name *

Father's Name *

Disability Type *

Disability % *

Gender *

Aadhaar Number *

Correspondence Details

Address *

Email *

State *

District *

PIN Code *

Mobile Number *

Bank Details (Only joint account or beneficiary own account accepted)

Bank Name *

Account Number *

IFSC Code *

Fee Details

Payment Category *

Fee Amount (₹)

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Please verify all details before submitting.