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Complete Health Insurance Renewal

Name of the applicant :

Policy number :


Tax Details

I want to update GSTIN/UIN number

GSTIN/UIN number*

PAN number

Constitution of business

Please select Constitution of business

Customer type

Please select Customer type

GST registration status

Please select GST registration status

Select coverage period

For 2 years : (`)
For 1 year : (`)

Insured Contact Details

Update my profile with the below address

Address line 1*

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Address line 2

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City & State*

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Please enter pincode


Please enter landmark

Email address*

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We will email policy to this ID

Mobile number*

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I/We have read and understood the terms and conditions of the Policy and confirm to abide by the same.

I/We hereby agree that the insurance coverage under the Policy will commence only on realization of full premium, receipt of complete medical reports (wherever applicable) and subject to medical underwriting approval by the Company. Receipt of proposal form by the Company shall not be construed as acceptance of proposal. Company in its sole discretion reserves the right to accept or reject any proposal without assigning any reasons thereof.

I accept the declaration and agree with the Terms and Conditions
Date: Insurance is the subject matter of solicitation. Misc 129

Note : Total Premium payable is inclusive of applicable Service Tax / Sales tax & Cess. The same is subject to change in accordance with GST Regulations as applicable.

ICICI Lombard General Insurance Ltd. is one of the largest private sector general insurance company in India offering insurance coverage for motor, health, travel, home, student travel and more. Policies can be purchased and renewed online as well. Immediate issuance of policy copy online.
ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo belongs to ICICI Lombard GIC Ltd assigned by Northbridge Financial Corporation solely for the territory of India. Insurance is the subject matter of the solicitation. The advertisement contains only an indication of cover offered. For more details on risk factors, terms, conditions and exclusions, please read the sales brochure carefully before concluding a sale. ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400025. Reg. No.115. Fax no - 022 61961323. CIN: L67200MH2000PLC129408.
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