[Company Logo][Company Name]
REQUEST FOR ADDITION OF MEMBERS
- Ref. No.:
- [Reference Number]
- Date:
- [Date]
To,
[Insurer / Broker Name]
[Address]
Subject: Addition of members under Policy No. [Policy Number] – [Company Name]
Dear Sir/Madam,
Please add the following members to our group policy(ies) with effect from the dates mentioned below. Kindly adjust the applicable premium against our CD Account No. [Account Number] and share the endorsement copy and e-cards at the earliest.
| Emp ID | Member Name | Relationship | Date of Birth | Gender | Effective Date | Policies (GMC/GTL/GPA) | Sum Insured (₹) |
|---|---|---|---|---|---|---|---|
| [Employee ID] | [Employee Name] | Self | [DD/MM/YYYY] | [M/F] | [Date of Joining] | [GMC, GTL, GPA] | [Amount] |
| [Employee ID] | [Member Name] | Spouse | [DD/MM/YYYY] | [M/F] | [DD/MM/YYYY] | [GMC] | [Amount] |
| [Employee ID] | [Member Name] | Child | [DD/MM/YYYY] | [M/F] | [DD/MM/YYYY] | [GMC] | [Amount] |
| [Employee ID] | [Employee Name] | Self | [DD/MM/YYYY] | [M/F] | [Date of Joining] | [GMC, GTL] | [Amount] |