MEDICAL INSURANCE WAIVER/CONSENT
Email address *
All students enrolled at FIIB have to submit proof of their Medical Insurance. Alternately, FIIB offers Medical Insurance under its group policy for interested students. Indicate your preference below for opting-out or opting-in to the FIIB Group Medical Insurance.
I would like to:
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Part A
I want to avail for FIIB’s group medical policy.
Policy Coverage - INR 50,000/- annually for 2 years
Premium for Two years - INR 3,000/-

The coverage under FIIB Group Policy are valid for both years of the students’ enrollment at FIIB.
My details for the group medical policy are as mentioned below : Name
Gender
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Date of Birth
MM
/
DD
/
YYYY
Address
Mobile Number
Email ID
Part B
I undertake that I have a Medical Insurance Policy in my name with following details:
Policy Number
Name of the Company
Date of Issue
MM
/
DD
/
YYYY
Date of Expiration
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