I/ We have read and understood the terms and conditions of the Policy and confirm to abide by the same.
I/We hereby agree that the insurance coverage under the Policy will commence only on realization of full premium or on due receipt of the subsequent premiums (as agreed) on receipt of complete medical reports (wherever applicable) and subject to medical underwriting approval by the Company. Receipt of proposal form by the Company shall not be construed as acceptance of proposal. Company in its sole discretion reserves the right to accept or reject any proposal without assigning any reasons thereof.
I/We hereby declare that I/We will submit to medical examinations by the nominated doctors of the Company or undergo diagnostic or othe medical tests, as suggested by the Company for its medical underwriting.
I/We hereby declare that the Company reserves the right to enquire from any physicians, nurse, hospital official or employee or any person, institution for all or any information regarding the medical history of the proposed and that the Company shall have the right to ask proposed for the medical check-up. The refusal to submit medical information by any person mentioned in the schedule or any Medical Practitioner, clinic, or institution shall be construed as a waiver of benefits by me/us Company shall have no further obligation towards me/us.
I/We, the undersigned hereby declare that the above statements and particulars are true, accurate and complete and I/ declare and agree that this declaration and the answers given above shall be held to be promissory and shall be the basis of the contract between me/us and the Insurer.
I/we authorize the Company and their agents to exchange, share or part with all the information relating to my/our personal and financial details with Government bodies I Regulatory Authorities/ Statutory bodies or under court orders as may be required and I/ we will not hold the Company and its agents liable for use of this information.
I /we agree that the Policy shall become void at the option of the Insurer, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material fact' in the Proposal form/personal statement, declaration and connected documents, or any material information has been withheld by me/us or anyone acting on my/our behalf to obtain any benefit under this policy.
• A material fact is one that is likely to influence the Company's acceptance or assessment of the proposal.
The information that you give to us on this proposal form or in any supplementary information for or documentation supplied by you or on your behalf will influence our decision to offer insurance and the terms upon which to offer it. Further, any policy we issue will be based on what you have communicated to us. It is therefore important that your answers are complete and accurate in all respect.
The question in this proposal are indicative rather than exhaustive. You must provide us with all information relevant to the risk to be insured, even if it is not the subject of a question in this proposal. If you are in any doubt as to what information should be given, you should liaise with your insurance advisor/ company.
Acceptance of your proposal would be subject to receipt of complete medical reports (wherever applicable),
medical underwriting and realization of full premium amount by the company and the insurance coverage will commence from the date of underwriting by the company.