You are buying for 0 Membersand your premium is(includes applicable taxes)*
I/ We hereby declare, on my behalf and 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/We am/ are authorized to propose on behalf of these other persons.
I understand that the information provided by me will form the basis of 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 receipt of the premium chargeable.
I/ We further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured/ proposer after the proposal has been submitted but before communication of the risk acceptance by the company.
I/We declare and consent to the company seeking medical information from any hospital who at anytime has attended on the life to be insured/ proposer or from any past or present employer concerning anything which affects the physical and mental health of the life to be assured/proposer and seeking information from any insurance company to which an application for insurance on the life to be assured/ proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
I/ We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory Authority.
I authorize Tata AIG General Insurance Company Limited and associate partners to contact me via e-mail, phone or SMS.
1.I/We hereby confirm that all premiums have been/will be paid from bonafide sources and no premium have been/will be paid out of proceeds of crime related to any of the offence listed in Prevention of Money Laundering Act,2002.
2.I understand that the Company has the right to call for documents to establish sources of funds.
3.The insurance company has right to cancel the insurance contract in case I am/have found guilty by any competent court of law under any statutes, directly or indirectly governing the prevention of money laundering in India.
I have read and understood the above mention Terms & Conditions.
Section 41 of Insurance Act 1938 (Prohibition of rebates):
1.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 relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
2.Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to ten lakh rupees.
Commencement of risk cover under the policy is subject to receipt and realisation of payable premium by Tata AIG General Insurance Company Limited
This entire Policy does not provide benefits for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of:
1. suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted Injury or Illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV) infection; or
2. serving in any branch of the Military or Armed Forces of any country, whether in peace or War, and in such an event We, upon written notification by You, shall return the pro rata premium for any such period of service during the circumstances described in a Hazard; or
3. being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Physician and taken as prescribed; or
4. Participation in an actual or attempted felony, riot, crime, misdemeanor, or civil commotion; or
5. Operating or learning to operate any aircraft, or performing duties as amember of the crew on any aircraft; or
6. War, civil War, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power; or
7. ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel; or
8. The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment; or
9. congenital anomalies or any complications or conditions arising therefrom; or
10. participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sports, any bodily contact sport or any other hazardous or potentially dangerous sport for which You are untrained.
For complete list of detailed exclusions & conditions, please refer policy wordings.
I have read and understood the above mention Terms & Conditions
Tata AIG General Insurance Company Limited,
Registered Office: Peninsula Business Park, Tower A, 15thFloor, G.K.Marg, Lower Parel, Mumbai - 400013, Maharashtra, India.
Registered with IRDA of India Registration No. 108
Email Id email@example.com.
Toll Free Number: 1800 266 7780
Fax Number 022 6693 8170
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2008, Tata AIG General Insurance Company Limited, all rights reserved.
Registered Office : Peninsula Business Park, Tower A, 15thFloor, G.K.Marg, Lower Parel, Mumbai-400 013, Maharashtra, India. CINNumber : U85110MH2000PLC128425.
Registered with IRDA of India Regn. No. 108. Insurance is the subject matter of the solicitation.
For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.
Toll Free Number : 1800 266 7780 / 1800 22 9966 (only for senior citizen policy holders). Email Id –firstname.lastname@example.org. Fax Number – 022 66938170
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