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Buy New Family Floater Policy

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Happy Family Floater Policy ** All amounts in INR All fields with * are mandatory Primary Insured Details Date of Birth * Gender * Please specify illnesses/conditions * Suffering since

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Photograph
Please upload the passport size (preferred) photograph while proceeding to buy policy.Uploading the photograph is not mandatory for calculating the premium.

Plan Details Plan * Sum Insured * Do you want to extend the coverage for Personal Accident? * Personal Accident Sum Insured * Name of the Nominee for Primary Insured * Relationship with Nominee * Policy Start Date * Policy End Date Do you wish to insure your Spouse? Do you wish to insure your dependent Children? Do you wish to insure your Father? Do you wish to insure your Mother? Name* Date of Birth* Occupation * Dependent on the proposer? * Name of the Nominee * Relationship with Nominee * Do you want to extend the coverage for Personal Accident? * Personal Accident Sum Insured * Please specify illnesses/conditions * Suffering since Tip: You can extend the coverage for Personal Accident also with an additional premium of Rs 60 only(per lakh/ per member) Tip: You can extend the coverage for Personal Accident also with an additional premium of Rs 60 only(per lakh/ per member)

No file selected.
Photograph
Please upload the passport size (preferred) photograph while proceeding to buy policy.Uploading the photograph is not mandatory for calculating the premium.

Do you wish to insure your Father in law? Do you wish to insure your Mother in law?

Name and Address of your Family Physician Name of family physician

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Buy New Family Floater Policy

http://www.orientalinsurance.org.in/BuyNewWeb/faces/BuyNewFamilyFl...

Address of family physician

TPA/NON-TPA Do you wish to opt for TPA services? Tip: You get 5% discount if you opt out of TPA(Third Party Administrator) Service

Select your Branch Office State of OICL Office * City/Town * Branch/Office *

Premium Service Tax Total Premium

4503 557
5060

Declaration I/ we declare that the statements made by me/ us in this proposal form are true and to the best of my/ our knowledge and belief and I/ we hereby agree that this declaration shall form the basis of the contract between me/ us and The Oriental Insurance Company Ltd.. I/ we also declare that if any additions or alterations are carried out after the submission of this proposal form and/ or issuance of policy document, the same would be conveyed to The Oriental Insurance Company immediately. I/ we hereby agree to and authorise the disclosure to the insurer or the TPA or any other person nominated by the insurer any and all Medical records and information held by any Institution/ Hospital or Person from whom the insured person has obtained any medical or other treatment to the extent reasonably required by either the insurer or the TPA in connection with any claim made under this policy or the insurers liability there under. I/ we further declare that I/ we have read the prospectus and have understood the same. I accept the policy, subject to terms, exceptions and conditions prescribed therein and further disclose that on the event of finding any thing contrary to what has been declared by me, I/ we shall be held responsible for all consequences thereof and insurance company shall incur no liability under this insurance. I/ we further declare that the Insurance Company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner intentionally or recklessly or otherwise misrepresented or concealed or non disclosure of material facts or making false statements or submitting false bills whether by the Insured Person or Institution/ Organization on his behalf. Such action shall render this policy null and void and all benefits hereunder shall be forfeited. Company may take suitable legal action against the Insured Person/ Institution/ Organization as per Law. Agree Disagree Premium Calculation Sheet

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