0% found this document useful (0 votes)
619 views1 page

UMID For Employee

This document outlines the fields and required documents for an employee and their family members to submit an application for medical insurance through the UMID program. It lists the registration fields for the employee including their PF/employment number, PAN number, date of birth, and application fields for family members such as name, date of birth, relationship to employee, and contact details. It also provides a checklist of common documents required for all applicants like photographs and ID proofs as well as relationship-specific documents needed for different family members like birth certificates, marriage certificates, and bona fide certificates for students over age 21.

Uploaded by

AbhiCute2010
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
619 views1 page

UMID For Employee

This document outlines the fields and required documents for an employee and their family members to submit an application for medical insurance through the UMID program. It lists the registration fields for the employee including their PF/employment number, PAN number, date of birth, and application fields for family members such as name, date of birth, relationship to employee, and contact details. It also provides a checklist of common documents required for all applicants like photographs and ID proofs as well as relationship-specific documents needed for different family members like birth certificates, marriage certificates, and bona fide certificates for students over age 21.

Uploaded by

AbhiCute2010
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Application Form Fields for Employee & Family Members

Employee Registration Fields Checklist of Documents for Submission of UMID Application


PF/Empl Number (11 digits) As a ready reckoner the following is the check-list for mandatory fields and documents to be scanned in
PAN Number JPEG/JPG format for advanced preparedness to initiate the application in a full-fledged manner:
Date of Birth Common Documents for All:
 Photograph of Employee & all the dependants
 Signature of employee
Employee Application  Old Medical ID card of employee
Field Names  ID proof of all individual dependants.
Gender
Blood Group Relation with Marital Documents required
Aadhaar No* employee Status
Residential Address* Mother Widow Father death certificate
Health Unit Opted* Step mother Widow Father death certificate
City* Son Unmarried If student above 21 yrs, Bonafide Certificate
Pincode* Daughter Divorced Divorce Decree
Email ID Daughter Widow Marriage Certificate & Death certificate of her husband
Step son Unmarried If student above 21 yrs, Bonafide Certificate
Step Daughter Divorced Divorce Decree
Family Members’ Application Step Daughter Widow Marriage certificate & Death Certificate of her husband
Field Names Brother Unmarried Father Death Certificate and If student above 21 yrs, Bonafide
Family Member Name* Certificate
Date of Birth Step - brother Unmarried Father Death Certificate and If student above 21 yrs, Bonafide
Relation* Certificate
Marital Status* Sister Unmarried Father Death Certificate
Phy./Men. Challenged* Sister Divorced Father Death Certificate and Divorce Decree
Blood Group Sister Widow Father Death Certificate, Marriage Certificate & Death certificate of her
Residential Address* husband
City* Step-sister Unmarried Father Death Certificate
Pincode Step-sister Divorced Father Death Certificate and Divorce Degree
Health Unit Opted Step-sister Widow Father Death Certificate, Marriage Certificate & Death certificate of her
Aadhaar No husband
PAN # In case of Physically/Mentally challenged dependents – Railway Doctor Certified Medical
Email ID Certificate to be uploaded.
Mobile No. * Note: The (*) Marked Fields are the Mandatory Fields in the Application Form.

You might also like