1. I/We declare and confirm that all the replies to the questions and the details furnished in the proposal, and the reports of any medical examination, if any, are provided to the best of my knowledge. I/ We declare that no material information required by the Company to assess the risk on my life is withheld with me.
2. In order to enable the Company to assess the risk under this proposal and any time thereafter, I/We hereby authorize the past and present employer(s)/ business associates of mine, my medical practitioner/ hospital/ medical source/ any life and non-life Insurance Company/ organization or Life Insurance Association to release to the Company the records of employment/ business or other details of mine as may be considered relevant for acceptance or otherwise of the proposal.
3. I/ We declare that the deposit towards the first premium and the renewal premium to be paid under the Policy are from legally assessed source of Income. In case the premium is paid from any other account other than my /our own, I/we shall ensure that such payment is permitted under Section 80D of the Income Tax Act, 1961. I/We declare that in case I/we are found guilty of any offence relating to Anti Money Laundering law, the Company will be in within the rights to cancel the policy issued pursuant to this proposal & forfeit all the premium.
4. I/We undertake to notify the Company forthwith, in writing, of any changes in my/our health, occupational and financial state and any proposal for insurance made with any other company between the date of this proposal and the date of the acceptance of risk by the Company.
5. I/We agree and confirm to the use of electronic medium, including email, as a mode for communication from and to the Company.
6. I/We hereby understand and agree that the replies to the questions in the proposal, the details furnished in the enclosed questionnaires, the reports of any medical examination, or laboratory tests, my proof of age and this declaration will be the basis of the contract of assurance between me and Pramerica Life Insurance Limited ( the “Company'') and that if any statement made in the proposal for insurance or to any medical examiner, or referee, or friend of mine, or in any other document leading to the issue of the policy is inaccurate or false, is on a material matter or facts which is material to disclose ,or if any information provided or disclosure made by me/us at the time of proposal are in variance with my/own financial position or health condition, physical or mental, as at the time of proposal or if any of the documents submitted by me is found to be fake or forged then action will be taken immediately as per provisions of Section 45 of Insurance Act 1938 as amended from time to time.
7. I/We agree and declare that the Company may without any reference to me (or to my beneficiary, as the case may be) disclose any information contained in the proposal, the annexure, in the reports of any medical examination / laboratory tests or in the documents submitted by me / or procured by the Company to any other insurer or to any reinsurer, to any claims investigator or any service provider engaged by the Company for servicing the policies. Likewise the Company may make available copies of the proposal form, annexures, reports of any medical examination laboratory tests or any documents submitted by me(or, as the case may be, by my beneficiary) or procured by the Company to any insurer to any claims investigator or any service provider engaged by the Company for servicing the policies. So also the Company may without any reference to me (or, as the case may be, to my beneficiary) furnish to any court / tribunal or other authority any such information or proposal, annexure, reports or documents as may be required of the Company or as may be considered necessary by the Company.
8. I will abide by Company’s directions on medicals through any medium. The Company or Company’s representative/s may contact me/ us at the address provided in the proposal form.
9. I/We undertake to provide scanned copy of my/ our signature for the contract as and when called for by The Company.
10. If policy is opted in Electronic format, the rules and regulations of IRDA of India & Insurance Repository Services pertaining to an eIA which are in force now have been read by me and I have understood the same and I agree to abide by and to be bound by the rules as are in force from time to time for such e Insurance Account(eIA). I hereby declare that the particulars given herein are true, correct and complete to the best of my knowledge and belief, the documents submitted along with this application are genuine and I am not making this application for the purpose of contravention of any Act, Rules, Regulations or any statute or legislation or any Notifications, Directions, issued by any governmental or statutory authority from time to time. I authorize Insurance Repository to send any policy and account related information through email and SMS on the contact details given by me. In case of any physical policies being issued by the insurance company from whom I obtain e-policy, the address in the eIA account shall override the address provided for the physical policies, I understand that all the communication relating to any physical/e-policy will be sent to the address registered with Insurance Repository. I further agree that any false/misleading information given by me or suppression of any material fact will render my Policy for termination and further action.
11. I hereby authorize Insurance Repository/the Insurance Company to disclose, share, remit in any form, mode or manner, all/any of the information provided by me to the respective insurance Companies and/or to their authorized agents and representatives in which I may transact/have transacted including all changes, updates, to such information as and when provided by me. I hereby agree to provide any additional information/documentation that may be required by the Authorized Parties, in connection with this application.
12. In the event that the application is not converted into a policy, I/we agree that the Company has the right to recover applicable medical and administration expenses.
13. I/we submit the mandate to credit my/our account towards all payment against the above policy and agree and understand that payout would be processed through electronic mode of payment and will be affected at select cities as per facilities/arrangements of the Company.
14. I authorize PLIL to contact me overriding my registry on NDNC.
15. In case of standing instructions authorization, I understand:
As per Regulation 3(d), IRDA (Manner of Receipt of Premium) Regulations, 2002, in case, the proposer/policy holder opts for premium payment through credit/debit card, the payment must be made only through credit/debit card issued on the name of such proposer/policyholder.
In case the transaction is being declined, the policy holder is liable to pay the outstanding premium by any other premium payment option as per the terms and conditions of the policy issued, failing which the policy will become lapsed due to non-payment of premium in accordance to the policy terms and conditions.
Authorization will remain in effect till intimated otherwise by the policy-holder or revocation or termination of the Standing Instructions.
If there is some change or renewal of the Credit/Debit Card or any details relating to the Credit/Debit Card, it should be intimated one month before the due date to Pramerica Life Insurance Limited
If payment date falls on Sunday or Public holiday the same will be effected next working day.
For termination of Standing Instructions, the policy-holder can contact any of the touch points of Pramerica Life Insurance Limited.