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Proposal Type

New Application Renewal Agent Recruitment

Payment for

Proposal Number *

Amount *

Proposer's Name *

Mobile *

Email *

Proposal Number

Agent Recruitment Form Number

Proposer's Name

Application Type

Payment Type

Agent Recruitment Fee

Email Address

Mobile

Payment Mode

Amount

{{proposer_data.amount}} (INR)

Email Address*

Communication will be sent on email address/mobile number available with us or as provided above. In case of any change, please contact customer service team.

Mobile Number*

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Pan Card number mandatory for premium above 1 lakh

Your PanCard Number

Please enroll for instalment/renewal premium payment through NACH or standing instruction

I hereby agree and confirm all T&Cs

X Disclaimer :
According to Regulation 3(d), 3(f) & 3(g) of Insurance Regulatory and Development Authority (IRDA) (Manner of Receipt of Premium) Regulations, 2002, the premium to be paid by any person proposing to take an insurance policy (hereinafter referred to as the proposer) or by the policyholder to an insurer may be made through credit/debit card held in his name, Internet or E-Transfer.
As per Anti-Money Laundering / Counter Financing of Terrorism (AML/CFT) guidelines issued by IRDA for general insurance companies are required to carry out Know Your Customer (KYC) norms at the settlement stage where Claim payout /premium refund crosses a threshold of Rs. 1 lakh per claim /premium refund.
Company may, at its sole discretion, call for any document before issuance of a policy or for processing the application of Claim payout /premium refund.
Terms and conditions
The premium is paid for purchase of insurance policy through net banking account or credit/debit card issued in my name, i.e. proposer/policyholder.
Any Document required by the Company before issuance of a policy or for processing application of Claim payout / premium refund shall be provided by me to the Company. Whenever it is sought by the Company.
I hereby confirm that all premiums have been/will be paid from genuine sources and no premiums have been/will be paid out of proceeds of crime related to any of the scheduled offences listed in Prevention of Money Laundering Act, 2002. I understand that the Company has the right to call for documents to establish sources of funds. The insurance company has right to cancel the insurance contract in case I am/ have been found guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money laundering in India.