MEDICAL INSURANCE WAIVER/CONSENT
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:
Opt-in for the FIIB Group Medical Insurance Policy [Fill Part A of the Form Below]
Opt-out of the FIIB Group Medical Insurance Policy [Fill Part B of the Form Below]
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
Date of Birth
I undertake that I have a Medical Insurance Policy in my name with following details:
Name of the Company
Date of Issue
Date of Expiration
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