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Sr.Citizens Toll free no: 1800226970
Customer Care No: 02266131199    
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IC Name * Policy No *
Health India ID No. Policy Holder Name *
Mobile No. Email ID
Name of Account Holder *
Account Number *
IFSC Code*
Name of Bank *
Branch Name MICR Code
Branch Address
Type of Account * Submitted By *
Upload Cancelled Cheque with duly filled and signed ECS Form* (Allow Only : *.jpg,*.jpeg,*.png,*.tiff,*.pdf)

I accept all the below terms and conditions

Terms and Conditions
  1. I hereby declare that the information furnished in this ECS Form is true & correct to the best of my knowledge & belief. If I have Made any false or untrue statement, suppression or concealment of any material fact, my right to claim reimbursement shall be Forfeited.
  2. I agree that I shall not hold TPA/Insurance Company responsible for delay or non-receipt of the payment for any reason whatsoever after issue of the instructions for payment by Insurer/TPA based on the above.
  3. As per the revised RBI guidelines, Canceled cheque should have pre-printed name of account holder.
           Note: your banker should be a participant of NEFT/RTGS Facility.

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