HOSPITAL INDEMNITY INSURANCE - QUOTE
SUM INSURED
*
NUMBER OF BEDS IN HOSPITAL
*
minimum 15 beds
NO OF OUT-PATIENTS LAST YEAR (ACTUAL)
NO OF IN-PATIENTS LAST YEAR (ACTUAL)
TOTAL NUMBER OF QUALIFIED & UNQUALIFIED STAFF
TOTAL NUMBER OF VISITING DOCTORS
RADIOACTIVE TREATMENT DONE? IF YES FILL IT AS 1. (IF NOT LEAVE IT)
TOTAL PREMIUM
PREMIUM WITH 18% GST
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