Card & Personal Details
ICICI Bank Credit Card or ICICI Bank Debit Card number*
Name*(As on card)
Date of birth*
Type of Policy*
  Annual Fee for single policy is Rs.1649/-

Communication Details
Address*
State*
City*
PIN code*
Residential Number
Office Number
Mobile Number*
Email ID
 
Please proceed to pay through ICICI Bank Net Banking
 
 Please note that this is auto renewal plan and will be renewed  automatically every year from the same mode of payment
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* This is a mandatory field