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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.
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 offence 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 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.
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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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