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 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 insurance company and that the policy will come into force only after full payment 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 company seeking medical information from any doctor or hospital who 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 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 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/We have understood the purpose of Aadhaar authentication and hereby state that I/We have no objection in providing my Aadhaar details for verification.

I/We confirm that the premium amount(s) being/to be paid against/under this proposal is/shall be from bona fide sources and not in violation of the provisions of the PML Act, 2002, and its amendments. I/We agree to fully cooperate with the company if document(s) to establish source of such premium amount(s) is/are called for, and understand that the company possesses absolute and sole discretion to cancel the policy, as and if issued, basis my/our conviction by a court of law or competent authority under/relating to the PML Act, 2002 and its amendments.