Formulario 6012 EsSalud: Registrate en +Vida Seguro de Accidentes

This article is ideal for you if you want to affiliate and protect with EsSalud, you will find everything about its benefits and how to fill out the Form 6012.

FORM 6012

Form 6012

Form 6012, as its name describes it, it is a form that must be completed in full to process the registration of the holder and beneficiaries in the + Life Insurance.

The following link is to download the Form 6012 in PDF format.

It is extremely important to read the conditions on the form and make sure that you meet all of them, to avoid complications in the process, and you must fill in all the fields requested in the form in order to have a successful registration.

How to complete the form

Filling out Form 6012 is a really easy process if you follow exactly all the instructions, this form is divided into boxes and tables to make the process much more comfortable.

The boxes divide the form by person, that is, there is a box corresponding to the owner, another to the employer, spouse or wife and another to the beneficiaries. As for the tables, they have codes for each option that we can choose, for For example, table number 2 indicates the countries, where each country has a code, so you will insert the code that corresponds to the chosen option.

To complete all requested fields, follow these steps:

  1. To get started, you need to download the original and updated form, you can download it from the link provided above.
  2. Later, you should read the box where it says “IMPORTANT”All indications and conditions for carrying out the process. and make sure you meet all the conditions set out
  3. Then it will print.
  4. Once this is done, we will fill in the field called «Employer identification».EMPLOYER DATA
  5. In this part, table number 2 appears, where you must insert the country, then you must look further down the form, where the tables appear and select the code that corresponds to the country and put it in the box.
  6. Field number 3 also appears, where you must indicate the type of Identification Document, as we did earlier, you must go to the options in the corresponding table and put the correct option, and then put the employer’s identification number.
  7. Then we go to the box “Data of the holder”, we will find box nº 4, where we will indicate the type of operation, we will put the code assigned to our option and we will indicate the option of tables 2 and 3, then, writing the identification number of the holder.CARRIER IDENTIFICATION
  8. In the same box we will put the full name of the owner
  9. We go to a subdivision of the box that corresponds to the owner, where we indicate all the data of the spouse or wife in a stable union, as we did with the data of the owner.OWNER'S DATA
  10. That done, we go to the Beneficiary Data box, we must expose the identification number of the beneficiaries, then table 5 appears that corresponds to the link, then we will indicate the correct code and insert the full name of each beneficiary.
  11. To finish with this box, we put the percentage that each beneficiary must pay, remembering that all agreed percentages must add up to 100%.
  12. Then, to fill in the form, we indicate an email, the registration date and the signature of the owner.

!Ready! We fill in all the fields requested by Form 6012.

Registration of titleholder and beneficiaries
+ Life Accident Insurance

Which is?

Accident insurance + LIFE is the accident insurance belonging to the entity EsSalud which provides its members with financial support in the event of death and total or partial disability in the event of an accident. Its coverage is supported by partner insurers Reinsurance and Rímac Insurance.

This institution offers protection 24 hours a day, every day of the year, inside and outside the nation.


EsSalud it is a decentralized public agency that is committed to fully meeting the needs and expectations of the insured population. It aims to provide coverage to the insured through the granting of prevention, promotion, recovery, rehabilitation, economic and social benefits, with a focus on health.


This entity was founded in August 12, 1936 And, since then, it has the vision of being a leader in Social Security in the entire American continent, exceeding the expectations of policyholders and employers in protecting their health and being recognized for its quality service, modern management and innovation. .

Its mission, like any public social security entity, is to protect the insured population, granting health, economic and social benefits with excellence, quality, efficiency and good corporate governance, collaborating with the Peruvian nation to achieve Universal Health Insurance ”.


EsSalud stands out for complying with all Social Security principles, such as: Solidarity, University, Equality, Unity, Scope and Aautonomy.


  • Remunerate the member or beneficiaries for the risks resulting from accidents in the event of death or total or partial permanent disability.
  • It is voluntary, independent and complementary to other insurance.
  • The Accident Insurance policy + Life is valid monthly, you have the option to automatically renew it through monthly payments with the payment of the corresponding premium.
  • This insurance protects you as an associate in case of disability, indemnifies your spouse or wife in a stable relationship, declared in case of death of the owner.


How is the process?

Before starting a process with + Life Accident Insurance, We must know the conditions that must be applied to be affiliated with this insurance:

  1. You should not have a serious physical condition, such as blindness, deafness, paralysis, or others that can complicate and significantly aggravate your risk.
  2. To make sure + LIFE You must be: Agricultural Insured, Regular + INSURED Insured, Optional Insured + HEALTH, Affiliated to EsSalud.

For the registration and accreditation of cardholders and beneficiaries in + Vida Seguro de Accidentes there are two options:

  • Affiliation of workers dependent on + Life: The employer or responsible entity makes the corresponding payment through the mechanisms established by SUNAT.
  • Affiliation of self-employed workers for + Vida: The insured person himself makes his payment through the mechanisms implemented in EsSalud.

Next, we will explain how to register and affiliate according to the options mentioned:

Affiliation of self-employed workers for + Vida


Identification document of the holder

O Form 6012 Registration of Owners and Beneficiaries + Life

To register you must follow the following steps:

  1. Download the Form 6012 and check that you meet the established conditions and requirements.
  2. Print the form and Indicate who or who your beneficiaries are.
  3. Sign up to be a member, for thatgo to any of the National Insurance and Economic Benefits Offices and apply for membership in + Life.
  4. Proceed to pay your insurance.
  5. Pay the monthly insurance premium at Banco de la Nación.


Affiliation of workers dependent on + Life

Follow the instructions below:

  1. Download the form and check if you meet the established conditions.
  2. Print the form and fill it out.
  3. Apply for membership, to get it you must apply to your employer, responsible entity or boss who makes the payment of of the monthly premium of your insurance through the collection mechanisms implemented by SUNAT.

!Important! If you want to report an accident, you must call 012110211 in Lima or 080010800 in the province.


  • It allows the owner and his immediate family to have comprehensive medical care in the situation in which they find themselves.
  • Financial support to make difficult moments more bearable, such as the death of a family member or any other loved one.
  • Convenient payment system.
  • Guarantees necessary to cover the situation of disability or dependence as a result of an accident or illness.
  • It offers health, protection, well-being, social and economic benefits to the employees of an employer.
  • Possibility to modify the policy over time.
  • It offers tranquility and well-being to those who hire them, providing them with the necessary shelter and protection.

Affiliate Owner Benefits:

  1. In case of death of the holder, + Vida grants a value of up to
  2. S / 75,000.00, as well as special coverings for mourning and burial.
  3. For total or partial permanent disability, the holder can receive a little more than S / 54,000.00.

benefit + life insurance

Spouse or concubine benefits:

  1. For accidental death or total permanent disability by accident, you receive up to S / 36,228.15.
  2. Additional coverage is provided for family helplessness and the death of both parents in the same accident S / 46,004.00.
  3. In addition, if the concubine or spouse is pregnant with the owner and he dies, she will receive S / 2,300.00.

Other benefits:

  1. Death from burns, drowning or electrocution receives S / 1,725.15.
  2. Total and definitive loss of hearing or vision, he also receives an amount of S / 1,725.15.
  3. For amputation of both arms or both legs, he also receives S / 1,725.15.

Benefits of additional special coverages:

  1. Benefit of mourning and burial: is received as an anticipated benefit S / 6,900.60. This applies when the owner and his spouse or concubine die or when the death is only the owner, the same amount is still received.
  2. Special life coverage: Accidental death due to medical negligence that was declared in a final judgment, you will receive S / 18,041.60.

Now that you know everything about the services and benefits of + Life accident insurance, EsSalud you can start enjoying this entity and thus provide you and your family with the security and protection you need.


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Daniel Martínez
Daniel Martínez
Como recién graduado, me encantaría poder entrar a formar parte de una empresa en la que poder aplicar todos mis conocimientos y, al mismo tiempo, que me permita desarrollarme profesionalmente. Gracias a mi formación especializada, considero que puedo aportar valor y seguir desarrollándome profesionalmente en una compañía que coincida con mis valores y expectativas.

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