Get Application Form For Enrolment Renewal Of Psb Mediclaim

Completing the application form for enrolment renewal of the PSB Mediclaim is an essential step for users seeking to maintain their health insurance coverage. This guide provides clear, step-by-step instructions to assist you in filling out the form accurately and efficiently.

Follow the steps to complete your application form online:

1. Press the ‘Get Form’ button to access the APPLICATION FORM FOR ENROLMENT RENEWAL OF PSB MEDICLAIM and open it in your document management tool.
2. Begin by affixing your latest photograph in the designated area on the form.
3. Fill in your personal information: - Enter your name as the ex-employee. - Include your father’s or partner’s name.
4. Provide your PF code and the name of your spouse.
5. List the date of birth for both yourself and your spouse in the appropriate sections.
6. Enter the date of your retirement along with the office from which you retired, including both the name and code.
7. Indicate the name of the pension paying branch and its corresponding code.
8. Mention your designation at the time of retirement.
9. Complete the present address details, including the pin code, and your mobile number.
10. Add your telephone number with the appropriate STD code and provide a valid email ID.
11. Select the type of retirement you are eligible for membership, ensuring to attach any necessary documentary proof if applicable.
12. Authorize the deduction of Rs. 500 from your CBS account for the enrolment or renewal fee by stating your account number.
13. Review and confirm your declaration by agreeing to the terms and conditions, ensuring all information is truthful.
14. Place your signature along with your spouse's signature, including the dates.
15. Ensure that the branch in charge certifies the pension information and verifies the accuracy of your CBS account number.
16. Finally, send the completed application form directly to the Head Office for processing, ensuring it is filled out accurately and in full.

Complete your application form online today to ensure continuity of your PSB Mediclaim coverage.