I declare that the information provided in this application is correct. The insured is currently in India and is a resident of India holding a valid Indian passport/Indian work or residence permit. The applicant is above 18 years of age.
I also confirm that this policy is not being issued to cover risks directly or indirectly associated with travel in, to, or through Afghanistan, Cuba or Democratic Republic of Congo.
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/We 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 Insurance 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 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 Insurance 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 have read and understood the above mentioned Terms & Conditions.
Statutory Warning -
"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 ... Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakh rupees."
Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited.
For complete list of detailed exclusions, please refer policy wordings.
I have read and understood the policy wordings.
Registered Office: Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai-400013, Maharashtra, India.
CIN: U85110MH2000PLC128425.
IRDA Registration No.: 108.
Toll Free: 1800 266 7780 / 1800 22 9966 (for senior citizens).
Email: customersupport@tataaig.com
Fax: 022 66938170
Website: www.tataaig.com
UIN: TATTIOP25045V022425