RaiFinServ
← Get a Quote First
1
Personal
2
Bank
3
Members
4
Nominee
5
Documents
6
Review
Your
Personal Details
As the proposer, we need your KYC information.
Full Name
*
Required
Mobile Number
*
Valid 10-digit mobile required
Email Address
*
Valid email required
Permanent Address
*
Required
Qualification
*
Required
Occupation
*
Required
Annual Income
*
Select range
Below ₹5 Lakh
₹5 – 10 Lakh
₹10 – 15 Lakh
₹15 – 25 Lakh
₹25 – 50 Lakh
₹50 Lakh – 1 Crore
Above ₹1 Crore
Required
Pehchan ID
*
Enter "New" if first-time customer
Required
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Bank
Details
Required for premium auto-debit and claims settlement.
Bank Account Number
*
Valid account number required (6–20 digits)
IFSC Code
*
Valid IFSC required (e.g. SBIN0001234)
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Insured
Members
Add details for each person to be covered under the policy.
Number of members:
−
1
+
Member 1
Full Name
*
Required
Date of Birth
*
Required
Gender
*
Select
Male
Female
Other
Required
Height
*
Required
Weight
*
Required
Pre-Existing Disease
(if any)
Since When
(if PED)
Drinking
No
Occasional
Regular
Smoking
No
Occasional
Regular
Chewing
No
Occasional
Regular
Member 2
Full Name
*
Date of Birth
*
Gender
*
Select
Male
Female
Other
Height
*
Weight
*
Pre-Existing Disease
(if any)
Since When
(if PED)
Drinking
No
Occasional
Regular
Smoking
No
Occasional
Regular
Chewing
No
Occasional
Regular
Member 3
Full Name
*
Date of Birth
*
Gender
*
Select
Male
Female
Other
Height
*
Weight
*
Pre-Existing Disease
(if any)
Since When
(if PED)
Drinking
No
Occasional
Regular
Smoking
No
Occasional
Regular
Chewing
No
Occasional
Regular
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Nominee
Details
Who should receive the claim benefit if required?
Nominee Name
*
Required
Date of Birth
*
Required
Relation to Proposer
*
Select relation
Self
Spouse
Husband
Wife
Son
Daughter
Father
Mother
Brother
Sister
Grandfather
Grandmother
Grandson
Granddaughter
Father-in-law
Mother-in-law
Son-in-law
Daughter-in-law
Legal Guardian
Other Legal Heir
Other / Non-family
Required
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Upload
Documents
Accepted formats: PDF, JPG, JPEG, PNG — max 5 MB each. Files are uploaded securely as you select them.
Aadhar Card
*
📄
Tap to choose file
Proposer's Aadhar card
Aadhar is required
PAN Card
*
🪪
Tap to choose file
Proposer's PAN card
PAN is required
Cancelled Cheque
*
🏦
Tap to choose file
Cancelled cheque or passbook front page
Cheque is required
PED Documents
(Optional — only if pre-existing disease)
🩺
Tap to choose file (optional)
Medical reports for pre-existing conditions
Agreed Quote PDF
*
📋
Tap to choose file
The quote you agreed on with RaiFinServ
Agreed quote PDF is required
I agree to be added to a
WhatsApp group
by RaiFinServ for policy updates, and confirm all information provided is accurate and complete.
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Review & Submit →
Review &
Submit
Please verify everything before submitting.
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Submit Proposal →
✅
Proposal Submitted!
Thank you. Your details have been received securely.
Our team will reach out to you within 24 hours.