FBS REGISTRATION

Family Benefit Scheme Registration

Complete your registration by providing your personal, membership, nominee and document details.

Personal

Membership

Address

Nominee

Documents

Review

STEP 1

Personal Information

Title

Surname

Full Name

Gender

Date of Birth

Your Age

Mobile Number

Email Address

STEP 2

Membership Details

IDA / Specialty Dental Association Membership No

Do you have any health problems ?

Registartion Fee

Contributory Deposit

Medical Fee

Nonmember Fee

RazorPay Fee

RazorPay GST

Total Amount

Date of Birth Proof

DOB Proof Type

DOB Proof Attachment JPG, PNG or PDF (Max 2 MB)

Membership Documents

Membership Number

IDA Membership Certificate

State Dental Council Registration

STEP 3

Address Details

Permanent Address

Address

City

District

State

Pincode

Phone Number

Communication Address

Same as Permanent Address

Address

City

District

State

Pincode

Phone Number

STEP 4

Nominee Details

You can add up to 3 nominees. Total nominee percentage must equal 100%.

Nominee 1

Nominee Name

Relationship

Mobile Number

Email Address

Share %

Nominee 2 (Optional)

Nominee Name

Relationship

Mobile Number

Email Address

Share %

Nominee 3 (Optional)

Nominee Name

Relationship

Mobile Number

Email Address

Share %

Total Percentage 0%

STEP 5

Upload Supporting Documents

Upload clear scanned copies in JPG, PNG or PDF format. Maximum file size: 2 MB per file.

Member Photograph

Passport Size Photograph

Aadhaar Card

Front & Back (Single PDF/Image)

IDA Membership Certificate

Date of Birth Proof

Health Certificate

State Dental Council Registration

Nominee 1 Aadhaar

Nominee 2 Aadhaar

Nominee 3 Aadhaar

STEP 6

Review & Submit

Please review all information carefully before submitting your registration.

Personal Information

Name
-

Gender
-

Date of Birth
-

Mobile
-

Email
-

Membership Details

Membership Type
-

IDA Number
-

Reference
-

Address Details

Permanent Address

Communication Address

Nominee Details

Name	Relationship	Mobile	Percentage

Uploaded Documents

✔ Member Photo

✔ Aadhaar Card

✔ IDA Membership

✔ DOB Proof

✔ Health Certificate

✔ SDC Registration

✔ Nominee 1 Aadhaar

✔ Nominee 2 Aadhaar

✔ Nominee 3 Aadhaar

Membership Reference Name

I hereby declare that the information furnished by me is true and correct to the best of my knowledge. I agree to abide by the rules and regulations of the AP IDA Family Benefit Scheme.

Main Menu

Family Benefit Scheme Registration

Personal Information

Membership Details

Date of Birth Proof

Membership Documents

Address Details

Permanent Address

Communication Address

Nominee Details

Upload Supporting Documents

Member Photograph

Aadhaar Card

IDA Membership Certificate

Date of Birth Proof

Health Certificate

State Dental Council Registration

Nominee 1 Aadhaar

Nominee 2 Aadhaar

Nominee 3 Aadhaar

Review & Submit

Permanent Address

Communication Address