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Besto Health Card Form

Besto Health Card Form

Get the Besto Health Card: access emergency support, medical aid, and community care when you need it.
Please enable JavaScript in your browser to complete this form.
(Write in CAPITAL LETTERS):
(DD/MM/YYYY): ____ / ____ / ______
Gender
Marital Status
Residential Address
Permanent Address
Income Range
Government Approved ID No
Click or drag a file to this area to upload.
Aadhaar Card, PAN Card (For India) Nationality Card (For Nepal) (Accepted formats: JPEG, PNG, PDF)
Click or drag a file to this area to upload.
Certificate (Birth Certificate/PAN Card) (Accepted formats: JPEG, PNG, PDF, DOC)
Click or drag a file to this area to upload.
(Accepted formats: JPEG, PNG, PDF)
Click or drag a file to this area to upload.
(Passport Size) (Accepted formats: JPEG, PNG, PDF)
Are you a Minor?
(If Yes, upload Guardian Consent Letter with signature - DOC, PDF)

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