Form - B (West Bengal Police Medical Insurance Policy for the year 2021-2022)
(Maximum 6 persons are allowed on 1 (Self) + 1 (Spouse) + 2 [Son (s) / Daughter (s)/ Brother (s)/ Sister (s)] + 2 (Either parents or In-laws).
Policy Premium - Rs. 10,500/- (Rs. 6,000/- to be paid by the Corporation and Rs. 4,500/- to be deducted from the salary of November, 2021 of the employee)
Sign in to Google to save your progress. Learn more
Email *
Name of the Employee *
Rank / Designation *
Previous Year Genins Card ID, if any (2020- 2021)
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Mobile No. *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy