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1. I 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 am authorized to propose on behalf of these other persons.
2. 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 receipt of the premium chargeable.
3. I further declare that I 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.
4. I declare and consent to the company seeking medical information from any doctor or from a hospital who at any time has attended on the life to be insured/proposer or from any past or present employer concerning anything which affects the physical or 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.
5. I 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.
6. I have read the details mentioned in Customer Information sheet and confirm having noted the details.
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I/we hereby declare that the statement made by me/us in this proposal form is true to the best of my/our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the contract between me/us and Oriental insurance company Ltd. I/we also hereby declare that if any additions or alterations are carried out after the submission of this proposal form then the same would be conveyed to the insurer immediately. I/we also understand that if any incorrect details are entered, the claim may not be awarded.
PROHIBITION OF REBATES (Section 41 of the Insurance Act 1938 provides) 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 prospectus or tables of the Insurer. 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.
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Declaration
PROHIBITION OF REBATES (Section 41 of the Insurance Act 1938 provides) 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 prospectus or tables of the Insurer. 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.
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* If 'Yes' is selected, the policy will be issued under code of BDE without an Agent and Broker.
If LoV is NULL, kindly check BDE maping in INLIAS
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Please select relationshipship before selection Date Of Birth.
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Age should be between 3 months and 25 years
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Age should be between 18 years and 65 years
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Please select relationshipship and Date Of Birth before selection of Sum Insured
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Sum Insured amount should be less than or equal to Primary Insured
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For Age > = 50 Sum Insured allowed is 5,00,000 or 10,00,000
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