MAS Care
(Medical Assistance Scheme)
A unit of Muneerul Islam Sangham Thana · 0497 2769010 · 6282612340
Application Form
Name of Applicant
Date of Birth
Select an option
Family Unit
Individual Unit
Kids
−
+
House Name
Ward Name
Choose an option
Thana
KazanaKotta
Other
Address
Phone
Aadhaar Number of Applicant
Existing Diseases If any
Additional Member Details
Additional Member Name
Date of Birth
Relation to Applicant
Aadhaar Number
Existing Diseases If any
Total: Rs
1000
Base amount (covers up to 2 adults) = Rs.1000 + Rs.250 per child.
Terms & Conditions
I have read and accept the Terms & Conditions
Download PDF
📋 Receipt No.
(For Office Purposes Only)
Submit Application
