Please enter your Keyword for Search
    Review details and amend before you make a purchase

      • Policy Name


        Policy Period


    • Health Proposer Details

    • Health Insuree Details

    • Medical Question

    Please read over and accept the terms and conditions of the document
    Declaration & Warranty On behalf of all persons to be insured

    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.

    AML guidelines: 

    1. I/We hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of proceeds of crime related to any of the offense listed in preventions 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 been found guilty by any competent court of law under any of the statutes,directly or indirectly governing the prevention of money laundering in India. 

    Prohibition of Rebates - Section 41 of Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015

    Statutory warning-

    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 the 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 prospectuses or tables of the insurer.

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


    General Exclusions: 

    Medical Exclusions:

    • >Conditions related to or arising out of HIV or AIDS.
    • >Abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol.
    • >Congenital External Diseases, defects or anomalies.


    Non-Medical Exclusions:

    • >War or any act of war, act of foreign enemy or war like operations.
    • >Intentional self-injury or attempted suicide while sane or insane.
    • >Any Insured Person attempting to commit a breach of law with criminal intent
    • >Please refer to policy wordings for complete list of Benefits and Exclusions.
    Payment and refund:
    I hereby confirm that I am the policyholder as well as the owner of the credit card / debit card / Internet banking account or any other online payment method, through which I am paying the policy premium.

    Please note, in-case of a refund, the amount payable will automatically credited to the same account that you are using to pay the premium or can be refunded through a cheque in the name of the proposer.
    Information & Disclaimers