The document is an application form for a cancer insurance policy. It requests basic personal details like name, date of birth, contact information.Visit the Cover Virginia website at coverva. Full Name (Max 40. Char). LIC's Cancer Cover (Plan No. 905, UIN : 512N314V02). All Virginia Oncology Associates (VOA) locations have a Patient Benefits Representative (PBR) who is dedicated to serving the individual needs of every patient. Enrollment Form - Family Child Care.