Self Registration | Bima

Good Health Declaration Question *

Have you ever been diagnosed with or treated for cancer/heart attack/heart disease/kidney disease/stroke/paralysis?

Has any previous Life insurance proposals to any insurance company been declined within the last 3 years?

Are you on treatment for Diabetes?

Select the Suitable Insurance Cover

Tier *

Plan Option *

Individual

Joint

Price * Auto-complete according to the product tier and plan option

Insured Member Details

Name *

NIC *

Gender *

Male

Female

Date of Birth *

Mobile *

Preferred language *

City *

Occupation *

Add another member

Spouse Name *

Spouse Date of birth *

Nominee Details

Name *

Mobile *

Relation *

Spouse

Child

Parent

Brother / Sister

Fields marked with * are mandatory.

BIMA Life Product Tier *

Type *

Premium *

BIMA Health Product Tier *

Type *

Premium *

Total Premium *

Insured Member Details

Insured Name *

NIC *

Date Of Birth *

Automatically completed according to NIC

Gender *

Automatically completed according to NIC

Mobile Number *

+94

Preferred Language *

Location *

Occupation *

Nominee Details

Name *

Mobile *

+94

Relationship *

Fields marked with * are mandatory.

Welcome to BIMA Self Registration Portal

Select the Suitable Insurance Cover

Insured Member Details

Nominee Details

Insured Member Details

Nominee Details

Nominee (Joint Policy) Details