Apply for Maternity Cover at Bajaj Finserv

Pregnancy Complications Cover Application Form

Premium: Rs. 499 | Sum Insured: Rs. 50,000 | Duration: 1 year

*This product is for existing customers only

Full Name

Date Of Birth

Mobile Number

I authorize Bajaj Finserv representative to call /SMS towards this application and other products/services. This consent overrides my registration for DNC/NDNC. T&C

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Personal Details

Full Name

Date of birth

Contact Details

Flat / House Number

Street Name

Area

Pin Code

City

Personal Email ID

Mobile Number

Nominee Details

Nominee Name

Payment Option

As an existing Bajaj Finance customer, we provide you with the added convenience of the Bank A/C Auto Debit Facility, through which the premium amount is automatically deducted from your bank account in next 7 working days. You can also choose to Pay Online Now, with multiple options such as online account transfers, UPI, Mobile Wallets, Credit or Debit Cards.

Dear Customer Kindly confirm your Bank A/C Details to debit the Permium Amount

Bank Name	Bank A/c Number	MICR Code

I authorise Bajaj Finance Limited to deduct the premium amount from my bank account in the next 7 working days

Please accept the terms and conditions

Pregnancy Complications Cover Application Form

Payment Option

Thank you for your interest, unfortunately legal restrictions prevent us from allowing you access to this part of the website.