I agree that the insurance benefit available to me shall become voidable in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any particulars in the application form / personal statement, declaration and connected documents or any material information has been withheld by me or anyone acting on my behalf to obtain insurance benefit. I hereby declare that I am not aware of any neglect and omission or error or existence of any circumstances likely to give rise to a claim thereof. I hereby declare, incase of false declaration the Insurance Company shall have the right to cancel the policy. The insurance company shall have the right to change the premium and conditions agreed to subject to such terms and conditions been communicated to me. I hereby agree that my enrollment for insurance would be at the sole discretion of the insurance company. I declare and warrant that the information I have given in this proposal form in relation to myself (or my other person or categories of person to be insured) and any documentation of information accompanying it or arising out of the answers I have given is complete and accurate in all respects. I understand and agree that this proposal and other information and documentation I have given or will give, relating to myself or any other person to be insured, will be the basis of any insurance that you may issue, and I also understood the consequences of any default. I also consent and authorize you to seek information from any doctor who has ever attended me or any other person to be insured, and also from any life or non-life insurance office to which a proposal for a critical illness or any other health cover has been made. Coverage subject to realization of payment.

Online Transaction Facility - Terms and Conditions:

I have read and understood the terms and conditions governing the Online Transaction Facility of ICICI Lombard General Insurance Company Limited through the internet. I agree to abide by the same.

Third Party Payment Disclaimer

Payment of premium by way of cheque/ demand draft/ credit card/ debit card should be made through the account or card pertaining to the proposer or the policy holder only. Any payment made through the account or card of a third party would render the contract of insurance invalid.

Important

The information that you give to us on this proposal or in any supplemental information form or documentation supplied by you or on your behalf will influence our decision to offer insurance and the terms upon which to offer it. Further, any policy we issue will be based on what you have told us. It is therefore important that your answers are complete and accurate in all respect.

The questions in this proposal are indicative rather than exhaustive. You must provide us with all information relevant to the risk to be insured, even if it is not the subject of a question in this proposal. If you are in any doubt as to what information should be given, please email us at customersupport@icicilombard.com. Any failure to provide us with full and accurate information may mean that your claim under any insurance issued is rejected and your policy is declared void.

No insurance cover will be in force until we have approved it and the premium and has been paid.

Statutory Warning - Prohibiton Of Rebates (Under Section 41 of Insurance Law) (Amendment Act 2015)

No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property, in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the Insurer.

Any person making default in complying with the provisions of this section shall be liable for a penalty, which may extend to ten lakhs rupees.