Staff Family Details
For Mediclaim and other Schemes
Employee Name
Please Select
ABHINAV KUMAR
AJIT KUMAR DEV
AJIT MANDAL
CHHATTU KUMAR
CHINTAMANI MAHTO
DAYASHANKAR YADAV
GAJENDRA YADAV
GANESH TURI
HIRALAL MAHTO
JHUPAR TURI
JITENDRA MANDAL
KARTIK PATEL
MANISH MANDAL
PRAKASH DAS
PRATAP KUMAR
RAJESH YADAV
RAJU MAHTO
RAJU YADAV
RAMCHANDRA DAS
RITESH DUBEY
RITESH KUMAR
ROHIT PASWAN
ROHIT YADAV
ROSHAN BHATTARAI
SAHDEV YADAV
SANJAY MAHTO
SANTOSH YADAV
TEKLAL MAHTO
UMESH MAHTO SMALL
UMESHKUMAR MAHTO BIG
VINAY PARIKH
VINAY TIWARI
Status
Please Select
Unmarried
Married
Staying with Guardians
Father's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Job
Business
No work
Mother's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Job
Business
No work
Wife's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Job
Business
No work
Children
Please Select
0
1
2
3
4
5
1st Child Name
First Name
Last Name
Gender
Please Select
Son
Daughter
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Study
Job
Business
No work
Marital Status
Please Select
Married
Unmarried
2nd Child Name
First Name
Last Name
Gender
Please Select
Son
Daughter
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Study
Job
Business
No work
Marital Status
Please Select
Married
Unmarried
3rd Child Name
First Name
Last Name
Gender
Please Select
Son
Daughter
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Study
Job
Business
No work
Marital Status
Please Select
Married
Unmarried
4th Child Name
First Name
Last Name
Gender
Please Select
Son
Daughter
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Study
Job
Business
No work
Marital Status
Please Select
Married
Unmarried
5th Child Name
First Name
Last Name
Gender
Please Select
Son
Daughter
Date of Birth
-
Month
-
Day
Year
Date
Work
Please Select
Study
Job
Business
No work
Marital Status
Please Select
Married
Unmarried
Submit
Should be Empty: