NRI 360

NRI 360 Enrollment

Patient Name(Required)

Patient Name

Gender

Age

Phone

Email(Required)

Address

Landmark

City

Pin code/ZIP Code

Date Of Birth (required)

MM slash DD slash YYYY

Anniversary Date

Sponsor/Caretaker Details

Sponsor name

Sponsor Relationship

Sponsor Mobile Number

Sponsor Email

Sponsor City

Country

Sponsor Country

Plan Details

Select Plan: Gold, Silver, Platinum

Plan Type: Single Couple

Duration: Quarterly, half-yearly , Annual