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For Comparative Insurance Quote: Om Plaza, 430/7, 1st Floor, Sant Nagar, East of Kailash, New Delhi-65
Phone: 011-41324957, 41623784, Mob:+91-8447757651 & 53 Email: ria1@surekhae.com
Overseas Travel Health Insurance Policies from India
 
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(1) Overseas Travel Health Insurance   (2) Salient Points of Overseas Travel Insurance
(3) Best & Economical Policy for Overseas Travel   (4) Selection of Overseas Travel Insurance
(5) Specimen proposal form of ICICI Lombard   (6) Policy wording individual overseas travel insurance (Tata AIG)*
(7) Policy Wording/ Proposal Form/ Brochure   (8) Policy wording overseas travel insurance (ICICI Lombard)
(9) Product details of Various Companies for Overseas Travel Insurance/Policy
 
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5- Specimen proposal form of ICICI Lombard Students Overseas Mediclaim policy
12.Any additional information relevant to the policy applied for Note: Please use additional sheets if space is not sufficient to complete details I/We authorise the Company and all other group companies of ICICI Bank Group and their agents to exchange, share or part with all the information relating to my personal and financial details and information to other ICICI Bank Group companies/ Banks/ Financial Institutions/ Credit Bureau/ Agencies/ Statutory Bodies as may be required and I/We will not hold the Company and all other group companies of ICICI Bank Group and their agents liable for use of this information.
GLOBETROTTER PROPOSAL FORM OVERSEAS INDIVIDUAL TRAVEL INSURANCE POLICY
I/We agree that the Policy shall become voidable at the option of the Company, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular 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.
I/We, the undersigned hereby declare and warrant that the above statements are true, accurate and complete. I/We desire to effect an insurance as described herein with the Company and I/We agree that this proposal and declarations hereto shall be the basis of contract between me/us and the Company and I/We agree to accept a Policy subject to the conditions prescribed by the Company.
I/We agree that the issuance of Policy/Cover Note shall be subject to realisation of premium cheque.
I/We hereby agree and confirm that if the amount collected is less than the premium quoted or revised as per changes in sum proposed for insurance or scope of cover desired by me/us, the proposal shall be considered for acceptance for a reduced sum appropriate to the premium
Signature of the Proposer
STATUTORY WARNING
PROHIBITION OF REBATES
(Under Section 41 of Insurance Act 1938)
  1. No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property, in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the Insurer.
  2. Any person making default in complying with the provisions of this section shall be punishable with fine, which may extend to five hundred rupees.
MEDICAL DECLARATION CUM STATEMENT FOR PERSONS AGED 70+
Medical Details (to be completed by the Proposer)
  1. Are you in good health and free from physical and mental disease or infirmity?
  2. Have you ever suffered from any illness or disease up to the date of making this proposal?
  3. Do you have any physical defect or deformity?
  4. Have you ever been admitted to any hospital/nursing home /clinic for treatment or observation?
  5. Have you suffered from any illness/disease or had an accident in the 12 months preceding the first day of insurance?
  6. If the answer is "Yes" to any of the above, please give details:
    • Nature of illness/disease/injury & treatment received
    • Date on which first treatment taken
    • First treatment completed is continuing
    • Name of attending medical practitioner/surgeon with his address and telephone no.
  7. Please give details of any positive existence of any ailment, sickness or injury which may require medical attention whilst on tou
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