New Member Registration Form

( Only Life Members of the IMA Karnataka State Branch are eligible to apply. )

INDIAN MEDICAL ASSOCIATION’S KARNATAKA PROFESSIONAL PROTECTION SCHEME (R)

Member Personal Information











Do you Have Professional Indemnity from any other Company.

If the member of KPPS is also insured by any insurance company / companies and if a complaint is field against him, the KPPS undertakes to offer him services of panel advocates for his defence. In that case if he refuses to accept the offer and chooses to be defended by insurance company only, then KPPS will not have any liability for outcome of the case.

Contact/Address Information







Bank/Payment Information


Note: Premium amount break up is as follows...
  • Admission Fee = Rs.100/-
  • Annual subscription fee = Rs.2000/-
  • Advance Fraternity Contribution = Rs.1000/-
  • GST (+18%) = Rs.558/-
  • Total Amount = 3700/-(42 rupees round off)


Note: Please upload only in JPEG, JPG, PNG, or PDF format (maximum size: 500KB).

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Aadhar

PAN

KMC REG. CERTIFICATE

Agreement:

I HEREBY AGREE TO THE TERMS AND CONDITIONS AND JURISDICTION OF IMA KSB KPPS. For more information please read