Free form template · Word

Insurance Details Update Form

An insurance details update form lets employees review and change their group insurance choices, such as covered members, voluntary top-ups and nominee for life cover. HR typically circulates it at policy renewal or when an employee becomes eligible for a higher grade of cover.

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[Company Logo][Company Name]

GROUP INSURANCE DETAILS UPDATE FORM

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Grade:: [Grade]
Policy Year:: [DD/MM/YYYY] to [DD/MM/YYYY]

1. Current Cover (HR to pre-fill)

Policy	Sum Insured (₹)	Premium Paid by	Employee Choice
Group Medical Cover (GMC)	[Amount]	Company	[Continue / Change]
Group Term Life (GTL)	[Amount]	Company	[Continue]
Group Personal Accident (GPA)	[Amount]	Company	[Continue]
Voluntary Top-up	[Amount]	Employee	[Opt in / Opt out]

2. Members Covered under GMC

Name	Relationship	Date of Birth	Add / Retain / Remove
[Employee Name]	Self	[DD/MM/YYYY]	Retain
[Name]	[Relationship]	[DD/MM/YYYY]	[Action]
[Name]	[Relationship]	[DD/MM/YYYY]	[Action]

3. Nominee for GTL and GPA

Nominee Name
Relationship
Share (%)

4. Premium Deduction Consent

I opt for the voluntary cover marked above and authorise [Company Name] to deduct ₹[Amount] from my salary in [number] instalments.

Privacy notice: [Company Name] collects the details on this page only for enrolling you and your members in group insurance and supporting claims. Access is limited to authorised HR staff, and the record will be kept for the policy period and the retention period for benefits records, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.

Employee
[Employee Name]
Date: [Date]

HR Benefits
[HR Name]
Date: [Date]

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What this template includes

Policy-wise summary of GMC, GTL and GPA cover
Covered members table
Voluntary top-up selection with premium
Salary deduction consent for paid options
Nominee for life and accident cover
Confirmation that data goes to insurer and TPA only

When to use it

Annual renewal of group mediclaim, term life and accident policies
Opting into a voluntary top-up or parental cover
Promotion to a grade with a higher sum insured
Correcting member details rejected by the TPA

How to customise this template

1Enter your actual sum insured slabs and premiums
2Remove policies you do not offer
3Add your TPA name and claims helpline
4State the renewal window dates
5Link to the dependent details form for detailed additions

HR tips

Share the policy summary before asking employees to choose
Never deduct top-up premium without signed consent
Do not ask for medical history unless the insurer requires it for top-ups
Confirm enrolment with each employee once the insurer accepts

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Frequently asked questions

What is the difference between GMC, GTL and GPA?+

GMC is group medical cover for hospitalisation, GTL is group term life insurance paying on death, and GPA covers accidental death or disability.

Can I increase my health cover?+

Many employers offer voluntary top-ups at the employee's cost during the renewal window.

Who sees the information on this form?+

HR benefits staff, the insurer and the TPA, only for enrolment and claims.

All 50 employee personal & master records →

[Company Logo][Company Name]

PF MEMBER DETAILS CORRECTION REQUEST

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
UAN:: [UAN]
PF Member ID:: [Member ID]

Field	As per PF Record	Correct Detail	Proof Attached
Name	[As recorded]	[Correct]	[PAN / Masked Aadhaar]
Date of Birth	[DD/MM/YYYY]	[DD/MM/YYYY]	[Birth certificate / Class 10 certificate]
Father / Spouse Name	[As recorded]	[Correct]	[Proof]
Date of Joining	[DD/MM/YYYY]	[DD/MM/YYYY]	[Appointment letter]
Date of Exit (previous)	[DD/MM/YYYY]	[DD/MM/YYYY]	[Relieving letter]

Reason for the Mismatch
Online Request Number (if raised by employee)

HR Action Log

Date	Action	By	Status
[DD/MM/YYYY]	[Request verified]	[HR Name]	[Pending / Approved]
[DD/MM/YYYY]	[Submitted on employer portal]	[HR Name]	[Status]
[DD/MM/YYYY]	[Outcome communicated]	[HR Name]	[Status]

Privacy notice: [Company Name] collects the details on this page only for correcting your PF member record. Access is limited to authorised HR staff, and the record will be kept for the duration of employment and the statutory period for PF records, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.

Form · Word

PF Details Update Form

Download .docx

[Company Logo][Company Name]
ESIC INSURED PERSON DETAILS UPDATE FORM
Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
ESIC IP Number:
[IP Number]
Employer Code:
[ESIC Employer Code]
Type of Update
- Change of dispensary
- Addition of family member
- Removal of family member
- Correction of personal details
- Change of address / mobile
Dispensary
Current Dispensary
New Dispensary (Self)
New Dispensary (Family)
Family Members
Form · Word
ESIC Details Update Form
Download .docx
[Company Logo][Company Name]
EMPLOYEE CONTACT DETAILS FORM
Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
Department:
[Department]
Date:
[Date]
Type of Submission
- New joiner
- Update to existing details
Phone and Email
Primary Mobile Number
Alternate Mobile Number (optional)
Personal Email ID
Official Email ID (HR to fill)
Addresses
Form · Word
Employee Contact Details Form
Download .docx

Current Dispensary
New Dispensary (Self)
New Dispensary (Family)

Primary Mobile Number
Alternate Mobile Number (optional)
Personal Email ID
Official Email ID (HR to fill)

[Company Logo][Company Name]

EMPLOYEE FAMILY DETAILS FORM

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Date of Joining:: [Date of Joining]
Date:: [Date]

Please list only those family members who should be covered under a benefit. Leave the form blank if you do not wish to enrol anyone.

Sl.	Name of Family Member	Relationship	Date of Birth	Gender	Residing with Employee (Y/N)	Dependent (Y/N)	Purpose
1	[Name]	[Spouse]	[DD/MM/YYYY]	[Gender]	[Y/N]	[Y/N]	[Insurance / ESIC / Nomination]
2	[Name]	[Son / Daughter]	[DD/MM/YYYY]	[Gender]	[Y/N]	[Y/N]	[Purpose]
3	[Name]	[Relationship]	[DD/MM/YYYY]	[Gender]	[Y/N]	[Y/N]	[Purpose]
4	[Name]	[Relationship]	[DD/MM/YYYY]	[Gender]	[Y/N]	[Y/N]	[Purpose]

Benefits Selected

Group health insurance
ESIC family coverage (if wages within the ESI limit)
Use as reference for nominations

Privacy notice: [Company Name] collects the details on this page only for enrolling your family members in the benefits selected and supporting nominations. Access is limited to authorised HR staff, and the record will be kept for the period the benefit is active and the retention period thereafter, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.

Form · Word

Employee Family Details Form

Download .docx

[Company Logo][Company Name]

DEPENDENT ADDITION / DELETION FORM

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Policy No.:: [Policy Number]
Date:: [Date]

Action (Add / Remove / Change)	Dependant Name	Relationship	Date of Birth	Meets Policy Criteria (Y/N)	Proof Attached	Effective Date
[Add]	[Name]	[Child]	[DD/MM/YYYY]	[Y/N]	[Birth certificate]	[DD/MM/YYYY]
[Remove]	[Name]	[Relationship]	[DD/MM/YYYY]	[Y/N]	[NA]	[DD/MM/YYYY]
[Action]	[Name]	[Relationship]	[DD/MM/YYYY]	[Y/N]	[Proof]	[DD/MM/YYYY]

Reason for Change

Birth / adoption
Marriage
Dependant crossed age limit
Annual renewal choice
Death of dependant
Other: [Specify]

Premium Contribution (if applicable)

I authorise [Company Name] to recover ₹[Amount] per [month / year] from my salary towards the premium for the dependants added above, as per the company insurance policy.

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Employee Dependent Details Form

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[Company Logo][Company Name]
UAN DETAILS UPDATE FORM
Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
Date of Joining:
[Date of Joining]
Establishment Code:
[PF Establishment Code]
Section 1: UAN Status (tick one)
- I have an existing UAN
- I have never been a PF member (new UAN required)
- I have more than one UAN
Section 2: Existing UAN Details
UAN
Previous Employer Name
Previous PF Member ID
Date of Exit from Previous Employer
UAN Activated (Yes / No)
Section 3: KYC Status on UAN
Form · Word
UAN Update Form
Download .docx

Name
Relationship
Mobile Number
Alternate Number
City
Language(s) spoken

Name
Relationship
Mobile Number
City

UAN
Previous Employer Name
Previous PF Member ID
Date of Exit from Previous Employer
UAN Activated (Yes / No)

[Company Logo][Company Name]

EDUCATION QUALIFICATION UPDATE FORM

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Designation:: [Designation]
Date:: [Date]

New Qualification Details

Qualification (e.g. B.Com, MBA, Diploma)
Specialisation
University / Board
Institution / Study Centre
Mode (Regular / Part-time / Distance / Online)
Year of Passing
Grade / CGPA / Percentage
Certificate Number

Linked Benefit

No benefit claimed; profile update only
Education reimbursement claim (ref: [Reference Number])
Company-sponsored programme (agreement ref: [Reference Number])

Verification (HR use)

Form · Word

Education Qualification Update Form

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Insurance Details Update Form

Preview of the form

1. Current Cover (HR to pre-fill)

2. Members Covered under GMC

3. Nominee for GTL and GPA

4. Premium Deduction Consent

What this template includes

When to use it

How to customise this template

HR tips

Frequently asked questions

HR Action Log

PF Details Update Form

Type of Update

Dispensary

Family Members

ESIC Details Update Form

Type of Submission

Phone and Email

Addresses

Employee Contact Details Form

Benefits Selected

Employee Family Details Form

Reason for Change

Premium Contribution (if applicable)

Employee Dependent Details Form

Primary Emergency Contact

Secondary Emergency Contact

Optional Medical Alert

Emergency Contact Update Form

Section 1: UAN Status (tick one)

Section 2: Existing UAN Details

Section 3: KYC Status on UAN

UAN Update Form

New Qualification Details

Linked Benefit

Verification (HR use)

Education Qualification Update Form

Insurance Details Update Form

Preview of the form

1. Current Cover (HR to pre-fill)

2. Members Covered under GMC

3. Nominee for GTL and GPA

4. Premium Deduction Consent

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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