Enrollment in Group Mediclaim and Group Personal Accident - Lakme Lever

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Please provide Employee Information

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* 1. Franchise Name

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* 2. Franchise HR Head Name

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* 3. Salon Location

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* 4. Employee Name

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* 5. Gender

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* 6. Date of Birth

Date / Time

Date

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* 7. Marital Status

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* 8. Date of Joining

Date / Time

Date

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* 9. Employee Email ID

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Sum Insured For Group Mediclaim is INR 100,000

Sum Insured For Group Personal Accident is INR 300,000

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* 10. The above information is correct.

I Confirm.