Standard Declarations:
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 authorised 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 insurer and that the policy will come into force only after full payment 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 that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the person to be insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured /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 of the insured/proposer for the sole purpose of underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory authority.
Other Declarations:
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 hereby declare and confirm that I am making the premium payment towards this application through my own bank account/credit card. I declare that the premiums paid have not been generated from the proceeds of any criminal activities /offences and I shall abide by and confirm to the prevention of Money Laundering Act, 2002 or any other applicable laws.
4. I/We agree and confirm to the use of electronic medium, including email, as a mode for communication from and to the Company.
5. 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 Ltd ( 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 the Company shall be authorized to repudiate my claim and terminate /cancel the policy in accordance with terms and conditions of the policy and as per provisions of Section 45 of Insurance Act 1938 as amended from time to time.
6. 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.
7. 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.
8. I/We undertake to provide scanned copy of my/ our signature for the contract as and when called for by The Company.
9. 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.
10. 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.
11. 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.
12. I hereby declare and confirm that the above mentioned contact number belongs to me and I agree to receive the communication and service messages from Pramerica Life Insurance Limited on my (logo) WHATSAPP number.
