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Get Health Insurance Questionnaire Sample

Website : www.nji.com.pk To be filled by the Employer: Addition of: Please tick( Employee/Family Spouse Child Benefit Plan: ) HEALTH QUESTIONNAIRE FORM (This Questionnaire is to be filled by the employee) (Please use Ball Point) NOTE : SUBMISSION OF INCOMPLETE FORMS WILL BE CONSIDERED INVALID FOR HEALTH INSURANCE COVERAGE. Name of Employee: S/O, D/O, W/O : Date of Birth Height : Designation : Marital Status Weight : Date of Joining : Date of Confirmation : NIC # : Employer s Name & A.

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