VIPHUB

You apply this policy for

Title

Full Name

Contact Number

NIC

Name of the Guardian

Relationship

Date Of Birth

Permanent Address

Hospitalization Benefit within Sri Lanka - Annual/Event Limit	Rs.100,000
Total Hospital room charges including admission fees per event	Rs.30,000
Specialized services per event	Rs.20,000
All other expenses including, Surgeon's & Doctor' charges, Operational expenses, Medical Expenses and Emergency, Transport per Event	Rs.50,000
PREMIUM WITH TAXES	Rs. 850.00