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starFOR EXISTING POLICY

Have query on premium, payout or any servicing need?

Dedicated NRI Helpdesk:

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Monday - Saturday | 10 am - 7 pm IST
Call charges apply

Plus IconFOR NEW POLICY

Want to buy a new policy online?

For Indian Residents

Call Icon +91 22 6984 9300

Give missed call for a call back:

Call Icon +91 11 6615 8748

Monday - Sunday | 8 am - 11 pm IST

Exclusively for NRIs

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Give missed call for a call back:

call +91 11 4473 0242

Available All Days | 24 x 7

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Application for reinstatement
of lapsed policy

Download the below documents to proceed

Life assured details

Personal details

Contact details

+91

Current Address

Few more details

Change in weight in last 12 months?

Please state amount and cause if known

Have you smoked or otherwise used tobacco products in the last 12 months?

Tobacco

Alchohol

Narcotics

Are you employed in the armed forces, paramilitary or police forces or fire brigade?

Occupation questionaire

download-icon
Uploaded 0 file

Are you now a member of any military force, engaged or are considering engaging in any hazardous sports or events (e.g. motor racing, climbing, scuba diving Insured/Policyholder etc.) or flying in any aerial device other than as a fare paying passenger on a regularly scheduled airline or travel overseas other than for vacation or holiday?

Have you changed your occupation from the date of policy issuance /last revival?

Occupation (e.g. Chemical factory, Mines, explosives, radiations, corrosive chemicals etc)/Avocation (e.g. Aviation, other than fare paying passenger, diving, mountaineering, any form of racing etc) associated with any specific hazard/ risk.

Occupation questionaire

download-icon
Uploaded 0 file

Are you politically exposed person?

Policy holder details

Personal details

Contact details

+91

Current Address

Few more details

Change in weight in last 12 months?

Please state amount and cause if known

Have you smoked or otherwise used tobacco products in the last 12 months?

Tobacco

Alchohol

Narcotics

Are you employed in the armed forces, paramilitary or police forces or fire brigade?

Occupation questionaire

download-icon
Uploaded 0 file

Are you now a member of any military force, engaged or are considering engaging in any hazardous sports or events (e.g. motor racing, climbing, scuba diving Insured/Policyholder etc.) or flying in any aerial device other than as a fare paying passenger on a regularly scheduled airline or travel overseas other than for vacation or holiday?

Relevant hobbies questionaire

download-icon
Uploaded 0 file

Have you changed your occupation from the date of policy issuance /last revival?

Occupation (e.g. Chemical factory, Mines, explosives, radiations, corrosive chemicals etc)/Avocation (e.g. Aviation, other than fare paying passenger, diving, mountaineering, any form of racing etc) associated with any specific hazard/ risk.

Occupation questionaire

download-icon
Uploaded 0 file

Are you politically exposed person?

Medical details
Have you EVER HAD any of the following?

Have you been infected with HIV (Human Immunodeficiency Virus), been diagnosed as having HIV antibodies or suffered from an AIDS related condition?

Insured
Policy holder

Diabetes, thyroid disorders or any other hormone disorder?

Insured
Policy holder

Asthma, pneumonia, tuberculosis, emphysema, coughing up blood, persistent cough, or any other disorder of the chest or lungs?

Insured
Policy holder

High blood pressure, palpitations, chest pain, raised cholesterol, heart attack, or any other disorder of the heart or blood vessels?

Insured
Policy holder

Hepatitis (including Hepatitis B carrier), liver disorder, gall bladder disorder, ulcer, bleeding from the stomach or bowel, hemorrhoids or any other disorder of the digestive tract?

Insured
Policy holder

Kidney or bladder disorder, urine abnormality or genital organ disorder?

Insured
Policy holder

Cancer, tumor, cyst or growth of any kind?

Insured
Policy holder

Anemia, hemophilia, leukemia or any other blood disorder?

Insured
Policy holder

Back or neck complaint, arthritis, gout, physical disability or other disorder of the bones joints or muscles?

Insured
Policy holder

Any illness that has caused you to be absent from work for a continuous period of 7 days or more?

Insured
Policy holder
Medical details 02

Stroke, epilepsy, fits recurrent headache, paralysis, faints or any other disease or disorder of the brain, spinal cord or nerves?

Insured
Policy holder

Depression, anxiety, schizophrenia or any other mental or nervous disorder?

Insured
Policy holder
Medical details 03

Have you had any other illness, injury, operation or abnormality not mentioned under any question above which is recurrent or has symptoms persisting for more than 7 days?

Insured
Policy holder
Medical details 04

Do you have any symptoms or condition for which you intend to attend a doctor in the future

Insured
Policy holder
Medical details 05

In the last 5 years, have you attended doctor or any other medical facility for investigation or diagnostic tests (such as blood or urine, X-ray, ultrasound, CT scan,biopsy, ECG, Angioplasty, Bypass Surgery, Brain Surgery, Heart Valve Surgery, Aorta Surgery or Organ Transplant or any treatment for Cancerous growth, of any kind etc.)?

Insured
Policy holder

Kindly provide below details

Please attach complete personal reports copy to reinstate your policy (*Applicable for all treatments done in last 5 years)

download-icon
Uploaded 0 file
Female life questions

Are you now pregnant? if 'yes', please state expected delivery date DD/MM/YYYY

Insured
Policy holder

Have you undergone any gynecological investigations for illness, internal checkups, breast checks such N as mammogram or biopsy?

Insured
Policy holder

Have you ever consulted a doctor because of an irregularity at the breast, vagina, uterus, ovary, N fallopian tubes, menstruation, complications during pregnancy or child delivery Yes No Yes No or a sexually transmitted disease?

Insured
Policy holder

Have you suffered from any other disorder of the breast or reproductive organs, abnormal smear test(s) and irregular menses?sexually transmitted disease?

Insured
Policy holder
Covid-19 Questions

Are you, or have you been in close with anyone who have been quarantined or who have been diagnose with novel coronavirus (SARS-CoV-2/COVID-19) ? if yes, please provide details.

Insured
Policy holder

Are you , or have you ever been serving a notice of quarantine in any form imposed by local health authorities or goverment or airport authority for possible exposure to novel coronavirus (SARS-CoV-2/COVID-19) ? if yes please provide more details like location, dates, quarantine period.

Insured
Policy holder

Have you ever advised to be tested to rule in, or rule out, a diagnosis of novel coronavirus (SARSCoV-2/COVID-19) ? Or, are you awaiting the result of a test which have already been submitted for novel coronavirus (SARC-CoV-2/COVID-19)?

Insured
Policy holder

Have you ever tested positive for the novel coronairus (SARC-CoV-2/COVID-19)? if yes, provide the date of positive diagnosis.

Insured
Policy holder

Have you experienced any of the following symptoms within last 14 days?

Insured
Policy holder
Travel Declaration

Are you currently residing outside of India?

Insured
Policy holder

Kindly provide below details

Do you intend to travel abroad in next 3 months?

Insured
Policy holder

Kindly provide below details

Additional medical declrataion *The following to be answered if Life Assured has opted for Health Products/ Critical Illness benefit

Do you have any physical defects, impairment, deformities and/or any condition affecting mobility, sight and/or hearing?

Insured
Policy holder

In the past 10 years have you been diagnosed, treated or sought treatment or advice for cancer (including N skin cancer or ulcerated moles), tumor or leukemia?

Insured
Policy holder

In the past 5 years have you had any diagnostic tests e.g. Mammogram, X-ray, ultrasound, CT scan, biopsy, N blood or urine test for any lump, cyst, tumor, chronic lesions or growths of any kind?

Insured
Policy holder

Have 2 or more immediate family members (natural parents & siblings) ever been diagnosed below age 60 N with cancer, tumor or leukemia?

Insured
Policy holder

Has your father been diagnosed with bowel or colon cancer, below age 60?

Insured
Policy holder

Has your mother been diagnosed with breast cancer, below age 60?

Insured
Policy holder

Important note

In case of policy on the life of Juvenile, where Payor Benefit / Waiver of Premium Plus rider is attached, it is mandatory to fill the details of policyholder.

 

Validity

90 days from date of submitting the health certificate

Declaration and authorization