Ministry of Social Justice and Empowerment (MSJE)

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भारत सरकारGOVERNMENT OF INDIA
दिव्यांगजन सशक्तिकरण विभाग Department of Empowerment of Persons with Disabilities (Divyangjan)
सामाजिक न्याय एवं अधिकारिता मंत्रालय Ministry of Social Justice and Empowerment (MSJE)

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New Enrollment For Niramaya Health Insurance Scheme

Beneficiary UDID Details

Please don't use any slashes (/) in case of enrolment number

UDID Card No. Enroll No. of UDID

Enter Date of Birth :-

General Name : Email ID : Mobile (Mobile number linked with Bank Account of Person with Disabilities should be put here.) : Gender: DOB : Date format (MM/DD/YYYY) Age(Year) : UDID Card NO. : Beneficiary Aadhar Number : Copy of UDID Card : ** Upload only pdf file of UDID card Address Address : Address line 2 : State * : District* : City * : Pin Code * : Bank details Name of the Account Holder * : Bank account no. * : Bank Name * : Branch Name * : City * : IFSC code * : Disability Disability Type * : Disability % * :

General

Name *:

Email ID :

Mobile (Mobile number linked with Bank Account of Person with Disabilities should be put here.) *:

Gender*:

DOB *: Date format (MM/DD/YYYY)

Age(Year) *:

UDID Card NO. :

Beneficiary Aadhar Number *:

Copy of UDID Card : ** Upload only pdf file of UDID card

Address

Address *:

State * :

District* :

City * :

Pin Code * :

Bank details

Name of the Account Holder * :

Bank account no. * :

Bank Name * :

Branch Name * :

City * :

IFSC code * :

Disability

Disability Type * :

Disability % * :

New Enrollment For Niramaya Health Insurance Scheme

General

Address

Bank details

Disability

If you want to Enroll in Niramaya Scheme and Don't have Aadhar Card then you can fill '0' and submit your form.