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    "Yuva Raksha": (Group Insurance Scheme For Students)

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    zeeshan shaikh
    This document contains a registration form for a group insurance scheme called "YUVA RAKSHA" for students. The form collects information such as the student's name, class, address, date of birth, blood group, guardian's name and signature, amount of premium paid, and signatures of the student and institute representative. It notes that a copy of the completed form should be submitted along with the student's admission form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    "Yuva Raksha": (Group Insurance Scheme For Students)

    Uploaded by

    zeeshan shaikh
    60 views1 page
    This document contains a registration form for a group insurance scheme called "YUVA RAKSHA" for students. The form collects information such as the student's name, class, address, date of birth, blood group, guardian's name and signature, amount of premium paid, and signatures of the student and institute representative. It notes that a copy of the completed form should be submitted along with the student's admission form.

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    Yuva Raksha

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    This document contains a registration form for a group insurance scheme called "YUVA RAKSHA" for students. The form collects information such as the student's name, class, address, date of birth, blood group, guardian's name and signature, amount of premium paid, and signatures of the student and institute representative. It notes that a copy of the completed form should be submitted along with the student's admission form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    60 views1 page

    "Yuva Raksha": (Group Insurance Scheme For Students)

    Uploaded by

    zeeshan shaikh
    This document contains a registration form for a group insurance scheme called "YUVA RAKSHA" for students. The form collects information such as the student's name, class, address, date of birth, blood group, guardian's name and signature, amount of premium paid, and signatures of the student and institute representative. It notes that a copy of the completed form should be submitted along with the student's admission form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    “YUVA RAKSHA”

    (GROUP INSURANCE SCHEME FOR STUDENTS)


    STUDENTS REGISTRATION FORM
    (Copy to be submitted alongwith the Admission Form)

    1. Name of Insured (Student) :- ______________________________________

    2. Class :- ______________________________________

    3. Residential Address :- ______________________________________

    ______________________________________

    ______________________________________

    ______________________________________

    4. Students’ Date of Birth :- ______________________________________

    5. Blood Group :- ______________________________________

    6. Name of the Guardian :- ______________________________________

    7. Signature of the Guardian :- ______________________________________

    8. Amount of premium paid :- ______________________________________


    In Cash or in Cheque (details)

    ________________________
    Student’s Signature

    ---------------------------------------------------------------------------------------------------------------------------

    FOR OFFICE USE ONLY


    Received from student (Name ______________________________________ of

    ___________________ course ) premium of Rs. ______________________ against the receipt

    no. ____________ dated _______________________.

    Institute / Department / College Seal / Stamp with Signatures

    (College to preserve the slip alongwith Admission Form)

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