Personal Details
Medical History
Lifestyle

Has any of your family members undergone the following treatment in the last 2 years?

This helps us improve our suggestions.

Conditions like heart attack/stroke, rheumatic heart disease, ischemic heart disease, chest pain, CABG, circulatory system

Cardiac

Joint Replacement

Transplants like major organ/ bone marrow transplant

Transplant

Conditions like tumour / lump of any kind

Cancer

Bariatric Surgery

Eye

Infertility

Conditions like fits (epilepsy), any disease of brain or nervous system

Brain Science

Bone & Spine

ENT

Conditions like kidney failure, disorder of urinary tract or kidneys

Nephro/Kidney Treatment

Hernia

Mental/Psychiatric Conditions

Hepatitis

Congenital/Birth Defects/Disease

Other

Any other treatment you want to add

None of the above applies to me and my family.

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FG Need Analysis

Generali Central Insurance Company Limited (formerly known as Future Generali India Insurance Company Limited), Unit 801 and 802, 8th floor, Tower C, Embassy 247 Park, L.B.S. Marg, Vikhroli (W), Mumbai - 400 083. IRDAI Registration No: 132 | License Category: General | CIN: U66030MH2006PLC165287

| Website: www.generalicentral.com |
Email: GCIcare@generalicentral.com | Call us at: 1800-220-233 / 1860-500-3333 / 022-67837800 | Fax No: 022 4097 6900. Trade Logo displayed above belongs to M/S Assicurazioni Generali - Societa Per Azioni and used by Generali Central Insurance under license.

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