Form - A (West Bengal Police Medical Insurance Policy for the year 2021-2022)
(Maximum 4 persons are allowed on 1 (Self) + 1 (Spouse) + 2 [Son (s) / Daughter (s)/ Brother (s)/ Sister (s)].
Policy Premium - Rs. 6,000/- (To be paid by the Corporation)
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Name of the Employee
Rank / Designation
Previous Year Genins Card ID, if any (2020- 2021)
Date of Birth
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