INSTRUCTIONS FOR REGISTRATION

Welcome to the registration process for enrolling your elders into the Complementary Care Plus Plan (details provided to you by mail) offered exclusively to our qualifying care-counselors.  In case you have not received the Plan details or have questions about it, please contact the Samarth Operations team before proceeding with registration.

Please provide the essential details for the parents and/in-laws who you would like to enroll for this plan. (They need to be above 55 years of age at the time of enrolment.) By registering for the plan, you are agreeing to abide by the terms and conditions of the plan.

Once you have submitted the details in the following form, the team may contact you for verification of information, eligibility or further details before initiating the onboarding process. After the onboarding, Samarth will make best efforts to initiate the support as soon as possible. The time to start may vary depending on the location and other situational constraints.

Please proceed to provide the information for registration below, filling the form accurately.

Thank you.

Please enter your details

    Your Name *


    Your Care Counsellor Agreement Number *

    (This number is at the bottom of your Care Counsellor Agreement. To sign the new Agreement, click here )

    Your Email * (as per Samarth records)

    Enroll Your Parents

    YesNo

    Enter Parents' Address*


    Enroll Your Mother

    Name *


    Email

    Mobile No

    Date of Birth *

    Enroll Your Father

    Name*


    Email

    Mobile no

    Date of Birth*

    Enroll Your In-Laws

    YesNo

    Enter Your In-Laws Address*


    Enroll Your Mother-in-Law

    Name*


    Email

    Mobile No

    Date of Birth*

    Enroll Your Father-in-Law

    Name*


    Email

    Mobile No

    Date of Birth*