Bharat Darshan Policy

Risk Details
Journey Details
Sl No. *
Plan Opted *
Destination *
Journey Start Date *
Total Travel Period *
Proposer Name *
Mode Of Travel *help
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Journey End Date *
Number of persons covered *
Place of origin of Trip/Residence 
State From *
City From *
District From *
Destination 
State To *
City To *
District To *
Individual Details
Sl No. *
Relationship with Proposer *
Date of birth *
Nationality *
Identity Proof of the Proposer *
Country of issue of Passport
Name *
Age *
Gender *
Any physical disability exceeding 25%(Y/N)
Assignee Details
Name *
Relationship with Proposer *
Age *
Share percentage (%) *
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OICL Office State *
City/Town *
Branch/Office *
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
Whether any agent is involved for this proposal?
* If 'NO' is selected, the policy will be issued under code of Development Officer without an Agent.
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
Journey start date should be after the date/time of date the Policy is purchased and within 90 days