Newsletter of COMPASS for January 2022 release Members Directory 2021 launched
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Details of Persons Interested to Be added in the proposed Group Health Insurance of COMPASS

    • Name of Member*

    • Name of Company*

    • Membership Number

    • Contact Number*

    • Contact Email*

    • Details for Person to be insured
    • Name*

    • Age*

    • Sex*

      MaleFemale

    • Date of Birth*

    • Pre-existing Disease

    • Spouse
    • Name

    • Age

    • Sex

      MaleFemale

    • Date of Birth

    • Pre-existing Disease

    • Child 1
    • Name

    • Age

    • Sex

      MaleFemale

    • Date of Birth

    • Pre-existing Disease

    • Child 2
    • Name

    • Age

    • Sex

      MaleFemale

    • Date of Birth

    • Pre-existing Disease

    • Father / Father-in-aw
    • Name

    • Age

    • Date of Birth

    • Pre-existing Disease

    • Mother / Mother-in-law
    • Name

    • Age

    • Date of Birth

    • Pre-existing Disease