Get Application Form For New Applicants 'sbi Health Assist ' 2021-22 - Annexure-i

Filling out the Application Form for 'SBI Health Assist' is a straightforward process that ensures SBI retirees receive the health insurance benefits they deserve. This guide provides clear and detailed instructions to help you complete the form online efficiently and accurately.

Follow the steps to successfully complete your application online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the date of payment of premium, journal number, and amount paid in the designated fields.
3. Affix a colored joint photograph of yourself and your partner in the specified area.
4. Fill in your particulars, including your P.F Index No., HRMS ID, PF ID (if applicable), and remarks as needed.
5. Provide your name, date of joining the bank, date of retirement, and the position you retired from.
6. Indicate your age as of retirement and select your gender using the available options.
7. Specify your status as either a pensioner, family pensioner, or retiree, and tick the applicable category.
8. If applicable, indicate whether you have been dismissed from service or if Rule 19(3) was invoked on your retirement.
9. Enter your date of birth and, if necessary, the date of death for deceased employees.
10. Provide your current address for communication, including house number, building name, street name, and nearest landmark.
11. Fill in your landline and mobile phone numbers, ensuring the mobile number is valid for registration under the e-Pharmacy scheme.
12. Input your email ID and spouse's name, along with their date of birth.
13. If you have disabled children, include their names and attach a valid disability certificate from an authorized medical officer.
14. Indicate the branch that pays your pension and fill in your pension account number and IFSC code.
15. Select your basic cover plan by ticking the applicable boxes for your desired sum insured and premiums.
16. Complete the premium calculation section by summing the base plan premium and any critical illness cover if selected.
17. Declare your nominee by filling out their name and relation to you.
18. Provide debit authority by authorizing the bank to deduct the insurance premium from your pension account.
19. Ensure you sign at the bottom of the application form and include the date and place of signing.
20. Upon completion, you can save changes, download, print, or share the form as required.

Complete your application online today to secure your health insurance benefits.