Happy Family Floater Policy

Primary insured details
Date of birth *
Gender *
PAN number
Whether suffering from pre-existing disease(PED)? *help
Click here for details
Upload a photograph of the person to be insured *
Please upload the passport size (preferred) photograph(Only JPG, JPEG are allowed).
Plan details
Plan *
Sum Insured *
Do you want to extend the coverage for Personal Accident? *
TIP: You can extend the coverage for Personal Accident also with an additional premium of Rs 60 only(per lakh/ per member)
Start date *
End date
Name of the nominee for primary insured *
Relationship with the insured *
Gender of nominee *
Nominee date of birth *
Age of nominee *
Do you want to avail Waiver of Proportionate Deduction Clause? *help
Click here for details
Do you want to avail Life Hardship Survival Benefit? *help
Click here for details
Do you wish to insure your spouse?
Do you wish to insure your dependent children?
Do you wish to insure your father?
Do you wish to insure your mother?
Do you wish to insure your father-in-law?
Do you wish to insure your mother-in-law?
Do you wish to insure your sibling?
Name and address of family physician  help
Click here for details
Name of family physician
Address of family physician
Select your branch office  help
Click here for details
OICL Office State *
City/Town *
Branch/Office *
TPA / NON - TPA
Please opt for TPA Service *
TPA name *
Customer Information Sheet Click Here
Declaration
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.
Please select a role to continue
Whether any agent is involved for this proposal?
* If 'NO' is selected, the policy will be issued under code of Development Officer without an Agent.
Please select a role to continue
Continue Direct
* 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
Pre Existing Diseases
Since you are suffering from Pre Existing Disease(PED), you are requested to contact the nearest OICL office for policy issuance.
Dependent on the proposer
Since you are not dependent on the proposer, you are requested to contact the nearest OICL office for policy issuance.
Alert
Since you are married, you are requested to contact the nearest OICL office for policy issuance.