I hereby declare, on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the best of my knowledge and that I am authorised to propose on behalf of these persons. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurance company and that the policy will come into force only after full payment of the premium chargeable. I understand that acceptance of the proposal is subject to evaluation of the proposal by Company's medical team I further declare that I will notify in writing any change occurring in the occupation or general health of the person proposed for insurance after the proposal has been submitted but before communication of the risk acceptance by the company. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person to be insured or from any past or present employer concerning anything which affects the physical or mental health of the person to be insured and seeking information from any insurer to whom an application for insurance on the person to be insured has been made for the purpose of underwriting the proposal and/or claim settlement. I authorize the company to share information pertaining to my proposal including the medical records of the person to be insured for the sole purpose of underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory authority. Prohibition of Rebates: (Section 41 of the Insurance Act): No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relation to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer.

Any person making default in complying with the provision of this section shall be liable for a penalty which may extend to ten lakh rupees.

I also confirm that the source of funds for premium paid under this policy is legal.

I hereby agree and confirm that:

I also confirm that the source of funds for premium paid under this policy is legal.

I hereby agree and confirm that:

  • The premium is paid for purchase of insurance policy through net banking account or credit/debit card issued in my name, i.e. proposer/policyholder.
  • And all premium has been paid from genuine sources and no premium has been paid out of proceeds of crime related to any of the scheduled offences listed in Prevention of Money Laundering Act, 2002. I understand that the Company has the right to call for documents to establish sources of funds. The company has right to cancel the insurance contract in case I am found guilty by any competent court of law directly or indirectly governing prevention of money laundering in India.

I have read and agree to the Terms and Conditions. I understand that by clicking on Yes and making a payment, I accept the policy terms


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