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HOW TO USE THIS SHEET

1. Click on "USE TEMPLATE" button on top-right (you can download this sheet as an Excel file)
INSTRUCTIONS
1. Group cover doesn't allow any selection. If you choose to cover spouse/kids, you will have to cove
married employees and all dependent children. If you choose to cover parents, you will have to cove
employees.
2. Group cover requires minimum 7 members. E.g., if you are a company of 4 employees (and 3 spo

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DISCLAIMER
1/ No sensitive data is being stored via this sheet
Company Legal Entity Name: yellow dwelling private limited
Company Trade Name: The yellow dwelling
Company Website: www.theyellowdwelling.com
No 9, CMR Road, HRBR 3rd Block 4A Main Road,
Company Postal Address: Kalyan nagar Bangalore – 560043
Mandatory Mandatory for Mandatory for
Mandatory for quotes Mandatory during finalisation
for quotes quotes quotes
Date of birth
(in DD-MMM-
YYYY format)
as per
PAN/Aadhar
Employee ID Name (as per PAN/Aadhar Card) Relationship Gender Card
319 R Namrata Pillai Self Female 3/25/2001
270 Aditi Soni Self Female 3/12/1998
278 Gaurav Gupta Self Male 3/27/1979
278 Nidhi Gupta Wife Female 3/7/1981
317 Mapoof basha Anwar Self Male 12/25/1997
29 Srinivasan Velusamy Self Male 7/20/1981
259 Sanaboina Snigdha Self Female 12/24/1998
240 Niranjan H C Self Male 10/30/2000
29 Logambal S Wife Female 6/11/1989
29 V S Iniyan Son Male 5/25/2012
3 Chandru V Self Male 2/1/1996
297 Satish Kumar B Self Male 7/7/2000
1 N.Sundara Moorthy Self Male 10/27/1954
29 Vela V Son Male 10/11/2017
1 S.Selvam Wife Female 3/7/1963
257 S. Umme Kulsum Self Female 9/17/2003
Mandatory during
Mandatory for quotes Mandatory during finalisation
finalisation

Sum insured Email ID of Employees Phone number of Employees


numbratacreates@gmail.com 9606298293
soni98.aditi@gmail.com 7697154335
gauravg1432@gmail.com 9930654743
gauravg1432@gmail.com 9930654743
Mapoofbasha@gmail.com 9524144716
srini.orangeimpex@gmail.com 9994103279
snigdha.sanaboina@gmail.com 7347432374
niranjanhc2000@gmail.com 9611236758
srini.orangeimpex@gmail.com 9994103279
srini.orangeimpex@gmail.com 9994103279
chandruvenkatesh.connect@gmail.com 9611861154
sathishkumar2773@gmail.com 9789066267
nsmoorthy80@gmail.com 9841417272
srini.orangeimpex@gmail.com 9994103279
nsmoorthy80@gmail.com 9841417272
kulsumumme239@gmail.com 7760326406
Company Legal Entity Name:
Company Trade Name:
Company Website:
Company Postal Address:
Mandatory Mandatory for
Mandatory for quotes Mandatory during finalisation
for quotes quotes

Employee ID Name (as per PAN/Aadhar Card) Relationship Gender


E001 Dave Mathews Self Male
E002 Ben Park Self Male
Mandatory for quotes Mandatory for quotes Mandatory for quotes Mandatory for quotes
Date of birth Sum Assured
(DD-MMM-YYYY) (can be a fixed amount of a
as per PAN/Aadhar Card Designation CTC multiple of the CTC)
6-Jan-1995 CEO ₹95,00,000 ₹2,85,00,000
5-May-1994 VP - Sales ₹75,00,000 ₹2,25,00,000
Mandatory during Mandatory during
finalisation finalisation

Email ID of Employees Phone number of Employees


dave@work.com 9876543210
ben@work.com 8967452301
Company Legal Entity Name:
Company Trade Name:
Company Website:
Company Postal Address:
Mandatory Mandatory for
Mandatory for quotes Mandatory during finalisation
for quotes quotes

Employee ID Name (as per PAN/Aadhar Card) Relationship Gender


E001 Dave Mathews Self Male
E002 Ben Park Self Male
Number of deaths in last 3
years

Current active covid cases


Mandatory for quotes Mandatory for quotes Mandatory for quotes Mandatory for quotes

Sum Assured
(A fixed amount, eg 30L, 50L
Date of birth or
(DD-MMM-YYYY) a multiple of the CTC, eg 3x
as per PAN/Aadhar Card Designation CTC or 5x)
6-Jan-1995 CEO ₹95,00,000 ₹2,85,00,000
5-May-1994 VP - Sales ₹75,00,000 ₹2,25,00,000
Mandatory during Mandatory during
Mandatory for quotes Mandatory for quotes
finalisation finalisation

Covid Status Vaccination Status Email ID of Employees Phone number of Employees


dave@work.com 9876543210
ben@work.com 8967452301

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