Health Insurance Step 2 For Family

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First Name(Required)

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Last Name(Required)

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DD/MM/YY(Required)

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Age(Required)

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Gender(Required)

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Mobile Number(Required)

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Email(Required)

Who do you want to be
Covered Under the SHIELD?

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Who do you want to be covered under the shield?(Required)

Myself

Me & My Family

Others

Plans(Required)

PKR
60,000

PKR
100,000

PKR
200,000

PKR
350,000

PKR
500,000

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Click on the desired COVERAGE you need

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Gender male

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Gender female

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Gender x

we would like to wish your family on their birthdays!

Add wife +(Required)

Please enter a number from 0 to 04.

Husband(Required)

Please enter a number from 0 to 1.

Add son +

Please enter a number from 0 to 6.

Add daughter +

Please enter a number from 0 to 6.

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No of Members(Required)

Wife’s Detail(Required)

Wife's Name(Required)

Husband’s Details(Required)

Husband Name(Required)

2nd Wife’s Birthday(Required)

2nd Wife Name(Required)

3rd Wife’s Birthday(Required)

3rd Wife Name(Required)

4rth Wife’s Birthday(Required)

4th Wife Name(Required)

Son's Detail(Required)

Son's Name(Required)

2nd son's Birthday(Required)

2nd Son Name(Required)

3rd son's Birthday(Required)

3rd Son Name(Required)

4rth son's Birthday(Required)

4th Son Name(Required)

5th son's Birthday(Required)

5th Son Name(Required)

6th son's Birthday(Required)

6th Son Name(Required)

Daughter's Details(Required)

Daughter's Name(Required)

2nd Daughter's Birthday(Required)

2nd Daughter Name(Required)

3rd Daughter's Birthday(Required)

3rd Daughter Name(Required)

4rth Daughter's Birthday(Required)

4th Daughter Name(Required)

5th Daughter's Birthday(Required)

5th Daughter Name(Required)

6th Daughter's Birthday(Required)

6th Daughter Name(Required)

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One Husband

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One Wife

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Two Wife

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Three Wife

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Four Wife

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One Son

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Two Son

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Three Son

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Four Son

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Five Son

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Six Son

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One Daughter

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Two Daughter

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Three Daughter

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Four Daughter

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Five Daughter

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Six Daughter

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Selected Products

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Products Number

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Annual Plan Coverage

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Maternity Aaram

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Maternity Salamati

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Maternity Aafiyat

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Maternity Rahat

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Maternity Tahafuz

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Aram without Mat

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Aram with Mat

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Salamati without Mat

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Salamati with Mat

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Aafiyat without Mat

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Aafiyat with Mat

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Rahat without Mat

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Rahat with Mat

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Tahafuz without Mat

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Tahafuz with Mat

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Nayab

Who do you want to be Covered Under the SHIELD?

Who do you want to be
Covered Under the SHIELD?