Read full document

Adsfasdf

  • By
  • June 2013
  • 1485 Words
  • 64 Views
Page 1 of 5
| THE ORIENTAL INSURANCE COMPANY LIMITEDRegd.Office:Oriental House,P.B.No.7037,A-25/27,Asaf Ali Road,New Delhi-110 002 HAPPY FAMILY FLOATER POLICYPROPOSAL FORM * PROPOSAL FORM AND SELF DECLARATION FORM TO BE FILLED IN BLOCK LETTERS AND IN DUPLICATE. * PLEASE ATTACH TWO STAMP SIZE PHOTOGRAPHS OF EACH INSURED PERSON. * THE COMPANY WILL NOT BE ON RISK UNTIL THE PROPOSAL HAS BEEN ACCEPTED BY THE COMPANY AND COMMUNICATION OF THE ACCEPTANCE HAS BEEN GIVEN TO THE PROPOSER IN WRITING ON RECEIVING FULL PAYMENT OF PREMIUM. * THE INSURED ABOVE 60 YRS. OF AGE HAS TO UNDERGO PRE INSURANCE HEALTH CHECK UP THROUGH COMPANY’S AUTHORISED DIAGNOSTIC CENTRE AND COST OF SUCH EXPENSES TO BE BORNE BY HIM.1. NAME OF THE INSURED PERSON AND RELATIONSHIP WITH THE PROPOSER. S No| Name of the insured| Relationship with Proposer| Sex M/F| Whether dependant on the proposer Y / N| Date of Birth| Age (in completed years)| Occupation| Sum Insured for family (Rs)| 1.| | | | | | | | |

2.| | | | | | | | |
3.| | | | | | | | |
4.| | | | | | | | |
5.| | | | | | | | |
6.| | | | | | | | |
7.| | | | | | | | |
2. PLAN OPTED: S.No.| Plan opted| Sum Insured opted for P.A.| | Silver| Gold| |
| Without Add-On| With P.A.| Without Add-On| With P.A.| With Plan ‘A’| With Plan ‘B’| With Plan ‘A’+P.A.| With Plan ‘B’+P.A.| | 1.| | |
2.| | |
3.| | |
4.| | |
5.| | |
6.| | |
7.| | |
3. ADDRESS & TELEPHONE NO. / MOBILE NO. / E-MAIL ADDRESS:  | | | | | | | | | | | | | | | | | | | | | | | | |  | | | | | | | | | | | | | | | | | | | | | | | | |  | | | | | | | | | | | | Mobile No| | | | | | | | | | | Ph.No| | | | | | | | | E-mail| | | | | | | | | | | | | 4. PERMANENT ACCOUNT NO. (ISSUED BY INCOME-TAX AUTHORITIES):  | | | | | | | | | | | | | | 5. NAME - ADDRESS &...

Rate this document

What do you think about the quality of this document?

Share this document

Let your classmates know about this document and more at Studymode.com