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Please have one final look at the details you have provided us with. This information will be printed on your policy, so it's important to ensure that everything is accurate.
Name | Age | Relationship With Proposer | Nominee Name | Nominee DOB | Relationship With Proposer | Age | Appointee Name | Passport Number | PED | PED Description : |
---|---|---|---|---|---|---|---|---|---|---|
Praful Bangal | 28 | Self | tadada | 29/10/1995 | Brother | 22 | ||||
Praful Bangal | 28 | Self | tadada | 29/10/1995 | Brother | 22 |
Disclaimer: Declared pre-existing condition(s) other than 9 listed ailments shall be covered only in case of life-threatening medical condition up to 10% of Medical Expenses - Accident and Illness Sum Insured or USD/Euro 10000 per policy whichever is lower.
Additional covers
Smart Travel
Terms & Conditions
I declare that the information provided in this application is correct. The insured is currently in India and is a resident of India holding a valid Indian passport/Indian work or residence permit. The applicant is above 18 years of age.
I understand that, Notwithstanding any other terms under this agreement, no insurer shall be deemed to provide coverage or will make any payments or provide any service or benefit to any insured or other party to the extent that such cover, payment, service, benefit and/or any business or activity of the insured would violate any applicable trade or economic sanctions law or regulation.
I/ We further declare that I/We are not travelling abroad for obtaining medical treatment or against the advice of a medical practitioner or I/We are waitlisted for any kind of medical treatment abroad or have received a terminal prognosis for a medical condition or against any government advisory.
I/ We further declare that I/We are have a non-immigrant visa.
I/ We further declare that I/We are not a Professional / Semi Professional sports person.
I/ We further declare that I/We are not engaging in any kind of Adventure sports activities during trip.
I/ We further declare that any of the travelling members is pregnant having foetal gestational age up to 9 weeks or more than 6 months.
I/ We further declare that Pre-existing diseases declared on behalf of any insured person is not related to Brain and Neurological conditions (Stroke, Acute paralysis, Multiple sclerosis), Major organ failure (Heart / Liver / Kidney / Lung), Chronic Obstructive Pulmonary Disease (COPD) / Progressive Lung Disease, Blood disorder (Hemophilia, Thalassemia, any anaemia other than iron deficiency anaemia), Cardiac Ailments, Chronic Liver disease, Crohns disease, Ulcerative colitis, Cirrhosis of Liver, Chronic Kidney Ailments, Insulin Dependent Diabetes or suffering from cancer(Any type of Cancer or malignant tumour of any kind). In the event of mis-representation of facts, I understand that the policy shall be voidable and Insurer shall cancel the policy and premium shall be forfeited.
I further more understand that declared pre-existing conditions shall be covered up to 10% of Medical Expenses - Accident and Illness Sum Insured or USD/Euro 10000 per policy whichever is lower in case of life-threatening medical condition.
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 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 insurer and that the policy will come into force only after full payment of the premium chargeable.
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.
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.
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.
I would like to protect and contribute in conserving the environment and help save paper by authorizing Zurich Kotak General Insurance Company (India) Limited (Formerly known as Kotak Mahindra General Insurance Company Limited) to send all my policy and service related communication in soft copy to the email id as mentioned in the application form.
I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or Goods and Service Tax Portal or Ministry Of Corporate Affairs Portal or National Securities Depository Limited portal for the purpose of undertaking KYC.
I/We hereby agree for sharing my/our medical records with the Insurer/ TPA through ABHA number mentioned in the proposal form. (Applicable for cases wherein ABHA number is available)
AML guidelines:
64VB:
Commencement of risk cover under the policy is subject to receipt of premium by Zurich Kotak General Insurance Company (India) Limited (Formerly known as Kotak Mahindra General Insurance Company Limited)
General Exclusions:
We shall not liable for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of:
For complete list of detailed exclusion, please refer Policy Wordings
I have read and understood the policy wordings
Zurich Kotak General Insurance Company (India) Limited
Smart Travel
Zurich Kotak General Insurance Company (India) Limited. CIN: U66000MH2014PLC260291; IRDAI Reg. No. 152; Registered Office: 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai- 400063. Maharashtra, India.Toll Free: 1800 266 4545,Email: care@zurichkotak.com
Corporate Office: 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western
Express Highway, Goregaon (East), Mumbai- 400063. Maharashtra, India.Toll Free: 1800 266 4545,
Email: care@zurichkotak.com
UIN -ZUKTIOP24156V022324
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With respect to Health Premier, zone refers to grouping of locations based on similar medical and hospitalization costs.
Zone Classification is done on the following basis
Also, the premium you pay and co-payment applicable is determined based on the city where you reside.
Applicable Zone |
Treatment Taken at |
Co-payment applicable |
Zone II |
Zone I |
10% |
Zone III |
Zone I |
20% |
Zone III |
Zone II |
10% |