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Thanks for your interest in securing your baby’s future with LifeCell. Please provide the following information to process your transaction.
Our executive will contact you to guide you in selecting the service, payment plan and completing the enrolment process.
The umbilical cord collection kit would be dispatched to you immediately upon verification of your enrolment

*  Mandatory Fields
 
Mother's Name * Mother's Date of Birth *
       
Address 1 * Address 2
       
City * State
       
Country * Pincode *
       
Landline Mobile
Mobile Mobile 2
Email Expected Delivery Date *   
       
Preferred  Contact Date Preferred  Contact Time
        Eg : 9:30 AM , 6:00 PM
Amount Rs. 5000
Terms & Conditions
a) Payment of enrolment fee does not confirm your enrolment to the service and every online enrolment
will be subject to scrutiny & acceptance by LifeCell and shall be communicated subsequently.
b) Enrolment fee once paid is non-refundable except under certain conditions under the discretion of LifeCell
c) LifeCell reserves the right to accept online enrolment based on factors related to delivery of the service.

I accept above terms and conditions.
*  Husband's Name
 
             
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