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Personal Information

Plan – Individual Registration

Ayusman Card

Employee Name

Full Name

Father's/Husband's Name

Date of Birth

Gender

Male

Female

Other

Mobile Number

WhatsApp Number

Email Address

Aadhar Number

Address Details

State

District

Village/Town

Pin Code

Full Address With Block & Tehsil

Documents Upload

Aadhaar Card

Upload both front and back sides

Front Side

JPG, PNG or PDF • Max 5MB

Back Side

JPG, PNG or PDF • Max 5MB

Preview

Front side preview

Back side preview

Passport Size Photo

Recent color photograph

Upload Photo

JPG or PNG • Max 5MB

Preview

Passport photo preview

Pre Registration – ₹10

Upload Screenshot

Payment Mode
Online Cash

Family Head Information

Plan – Family Registration

Ayusman Card

Employee Name

Full Name This field is required

Father's/Husband's Name

Aadhar Number

Email Address

Date of Birth

Gender

Male

Female

Mobile Number

WhatsApp Number

Family Address

State

District

Village/Town

Pin Code

Full Address With Block & Tehsil

Additional Family Members

Documents Upload (For Family Head)

Aadhaar Card (Family Head)

Upload both front and back sides

Front Side

JPG, PNG or PDF • Max 5MB

Back Side

JPG, PNG or PDF • Max 5MB

Preview

Front side preview

Back side preview

Passport Size Photo (Family Head)

Recent color photograph

Upload Photo

JPG or PNG • Max 5MB

Preview

Passport photo preview

Family Registration Preview

Pre Registration – ₹10

Screenshot Upload

Payment Mode

Online

Cash

Please fill all required fields for all family members

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