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Policy no.


Insured Name

Kiran rakesh khanna

Premium due date


Premium frequency


Owner name

Kiran khanna

Policy lapsed days

190 days

Total premium to be paid

₹ 5330

Dear Policy holder,

We are taking forward your request to revive the policy. Please note if your signature is in vernacular language,
download the form and complete it in presence of a witness who should sign the declaration mentioned on
health certificate.

The witness has to be 21 years old and above, who is not the beneficiary of this policy. Witness should know
English language and also language which is known to you.

You would be redirected to payment site. Please keep your bank details handy.

Your health certificate and medical reports (if any) would be reviewed by us and accordingly you would receive
our decision on reinstatement of your policy.

While raising the request in case if there is a timeout after making the successful payment, then request you to
visit this page after 2 working days and submit the Health certificate request or visit our nearest branch or email
to from your email id registered with us.

Net Payable Amount: 101088.00

Kindly provide us with few details and health declaration to proceed with the revival of the policy.

Will you sign the form in vernacular signature

Please download this form and visit the nearest TataAIA branch with the filled form

OTP verification

For security of your policy details, please enter OTP sent to your registered mobile no. 8956****** and registered email ra****


Please enter valid OTP