Health Insurance Step3 (Popup)

This field is hidden when viewing the form

First Name(Required)

This field is hidden when viewing the form

Last Name(Required)

This field is hidden when viewing the form

YYYY/MM/DD(Required)

This field is hidden when viewing the form

Age(Required)

This field is hidden when viewing the form

Gender(Required)

This field is hidden when viewing the form

Mobile Number(Required)

This field is hidden when viewing the form

Email(Required)

Who do you want to be
Covered Under the SHIELD?

Plans(Required)

PKR
60,000

PKR
100,000

PKR
200,000

PKR
350,000

PKR
500,000

Salamati Plan

Annual Plan Coverage

PKR 350,000

For One Individual

Specialized investigation included

Room & Borad included

Online OPD included

Cashless Treatment included

Yearly Premium

PKR

Tahafuz Plan

Annual Plan Coverage

PKR 60,000

For One Individual

Specialized investigation included

Room & Borad included

Online OPD included

Cashless Treatment included

Yearly Premium

PKR

Rahat Plan

Annual Plan Coverage

PKR 100,000

For One Individual

Specialized investigation included

Room & Borad included

Online OPD included

Cashless Treatment included

Yearly Premium

PKR

Aafiyat Plan

Annual Plan Coverage

PKR 200,000

For One Individual

Specialized investigation included

Room & Borad included

Online OPD included

Cashless Treatment included

Yearly Premium

PKR

Aaram Plan

Annual Plan Coverage

PKR 500,000

For One Individual

Specialized investigation included

Room & Borad included

Online OPD included

Cashless Treatment included

Yearly Premium

PKR

This field is hidden when viewing the form

For family female

This field is hidden when viewing the form

Gender male

This field is hidden when viewing the form

Gender female

This field is hidden when viewing the form

Gender x

This field is hidden when viewing the form

Add wife +(Required)

Please enter a number from 0 to 4.

This field is hidden when viewing the form

Husband(Required)

Please enter a number from 0 to 4.

This field is hidden when viewing the form

Add son +(Required)

Please enter a number from 0 to 6.

This field is hidden when viewing the form

Add daughter +(Required)

Please enter a number from 0 to 6.

This field is hidden when viewing the form

No of Members(Required)

This field is hidden when viewing the form

Husband Birthday(Required)

This field is hidden when viewing the form

Wife’s Birthday(Required)

This field is hidden when viewing the form

2nd Wife’s Birthday(Required)

This field is hidden when viewing the form

3rd Wife’s Birthday(Required)

This field is hidden when viewing the form

4rth Wife’s Birthday(Required)

This field is hidden when viewing the form

son's Birthday(Required)

This field is hidden when viewing the form

2nd son's Birthday(Required)

This field is hidden when viewing the form

3rd son's Birthday(Required)

This field is hidden when viewing the form

4rth son's Birthday(Required)

This field is hidden when viewing the form

5th son's Birthday(Required)

This field is hidden when viewing the form

6th son's Birthday(Required)

This field is hidden when viewing the form

Daughter's Birthday(Required)

This field is hidden when viewing the form

2nd Daughter's Birthday(Required)

This field is hidden when viewing the form

3rd Daughter's Birthday(Required)

This field is hidden when viewing the form

4rth Daughter's Birthday(Required)

This field is hidden when viewing the form

5th Daughter's Birthday(Required)

This field is hidden when viewing the form

6th Daughter's Birthday(Required)

This field is hidden when viewing the form

Selected Products

This field is hidden when viewing the form

Products Number

This field is hidden when viewing the form

Annual Plan Coverage

This field is hidden when viewing the form

Maternity Aaram

This field is hidden when viewing the form

Maternity Salamati

This field is hidden when viewing the form

Maternity Aafiyat

This field is hidden when viewing the form

Maternity Rahat

This field is hidden when viewing the form

Maternity Tahafuz

This field is hidden when viewing the form

Aram without Mat

This field is hidden when viewing the form

Aram with Mat

This field is hidden when viewing the form

Salamati without Mat

This field is hidden when viewing the form

Salamati with Mat

This field is hidden when viewing the form

Aafiyat without Mat

This field is hidden when viewing the form

Aafiyat with Mat

This field is hidden when viewing the form

Rahat without Mat

This field is hidden when viewing the form

Rahat with Mat

This field is hidden when viewing the form

Tahafuz without Mat

This field is hidden when viewing the form

Tahafuz with Mat

Who do you want to be Covered Under the SHIELD?

Salamati Plan

PKR 350,000

PKR

Tahafuz Plan

PKR 60,000

PKR

Rahat Plan

PKR 100,000

PKR

Aafiyat Plan

PKR 200,000

PKR

Aaram Plan

PKR 500,000

PKR

Who do you want to be
Covered Under the SHIELD?