विदेश यात्रा मेडिक्लेम पॉलिसी

Risk Details
journey-details
plan-type *
plan-category *
sum-insured-plan *
Journey Start Date *
Journey End Date *
periodsof-insurance
trip-type *
purpose-of-visit *
भेंट के देश *
visiting-schengen-countries? *help
click-details
individual-details
नाम *
relationship *
dateofbirth *
omp-age
age-(mths)
pre-existing-ailments
व्यवसाय *
लिंग *
passport-no *
whether-engaged-in-winter-sports/mountaineering-etc
assignee-details
अनुदिष्ट नाम
assignee-relationship
medical-details
name-of-physician-in-india
 medical-details
address-of-phsician
date-of-medical-report
wether-handicapped-that-he-is-not-able-to-move
ओरिएण्टल कार्यालय का चयन करें  help
click-details
ओआईसीएल कार्यालय राज्य *
शहर / नगर *
शाखा/कार्यालय *
Customer Information Sheet Click Here
DECLARATIONS:
  1. 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.
  2. 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.
  3. 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.
  4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at anytime has attended on 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.
  5. I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority.
  6. I have carefully read the Prospectus and having understood the same, I propose for a policy in the standard form issued by the Company.
Please select a role to continue
lbl-txt-continue-with-agent
* lbl-txt-do-buy-policy-note
Please select a role to continue
Continue Direct
* lbl-txt-bde-buy--note
If LoV is NULL, kindly check BDE maping in INLIAS
Notification
Age should be between six months and 25 years
Notification
Age should be between 18 and 80 years
Notification
Age should be between 180 days and 80 years
Notification
Please select relationshipship before selection Date Of Birth.
Notification
Journey end date should be after the date/time of date the Policy is purchased and within 90 days
Notification
overseas-endate-validation-dialogue
Notification
overseas-endate-validation-dialogue3
Notification
Journey start date should be after the date/time of date the Policy is purchased and within 90 days
Notification
omp_multitriptype_dialogue
Notification
omp_scheone_dialogue
Notification
omp_schezero_dialogue