This document contains a customer confidential report for Tata AIA Life Insurance Company regarding a policy for Mrs. Vijay. It includes basic details about the policy number, name of the life assured and proposer. The advisor confirms that they are not aware of any information that could negatively impact the underwriting conditions. The advisor also declares that they have verified all applicant details and recommendations, explained the product correctly, and recommend this proposal for insurance.
This document contains a customer confidential report for Tata AIA Life Insurance Company regarding a policy for Mrs. Vijay. It includes basic details about the policy number, name of the life assured and proposer. The advisor confirms that they are not aware of any information that could negatively impact the underwriting conditions. The advisor also declares that they have verified all applicant details and recommendations, explained the product correctly, and recommend this proposal for insurance.
This document contains a customer confidential report for Tata AIA Life Insurance Company regarding a policy for Mrs. Vijay. It includes basic details about the policy number, name of the life assured and proposer. The advisor confirms that they are not aware of any information that could negatively impact the underwriting conditions. The advisor also declares that they have verified all applicant details and recommendations, explained the product correctly, and recommend this proposal for insurance.
This document contains a customer confidential report for Tata AIA Life Insurance Company regarding a policy for Mrs. Vijay. It includes basic details about the policy number, name of the life assured and proposer. The advisor confirms that they are not aware of any information that could negatively impact the underwriting conditions. The advisor also declares that they have verified all applicant details and recommendations, explained the product correctly, and recommend this proposal for insurance.
This document has to be completed and submitted along with all application forms.
To be filled by the Advisor / Specified Person / Broker / Employee after meeting the Life Assured / Proposer with respect to underwriting risk assessment of the Life Assured / Proposer:
I hereby state that I have made reasonable enquiries about the Life Assured / Proposer and I confirm the following:
Policy number: C198177560
Name of the Life Assured: MRS VIJAY Name of the Proposer: MRS VIJAY
Life Assured Proposer
Question (Y/N) (Y/N) Are you aware of / have observed any information that may adversely effect underwriting conditions, including, habits/ heath conditions; No Income inconsistency; Other material facts
If answer to any of the above questions is YES, please provide details here
Declaration: I hereby declare that the forgoing statements are true to the best of my knowledge and detailed enquiries done by me. I further declare that I have verified the identity and address of the Life Assured / Proposer and the proof submitted for the same in original. I have verified and ensured that the details (PAN / phone / contact details / NACH details) of the Life Assured / Proposer mentioned in the policy application form are correct. I have appropriately enquired about the Life Assured / Proposer medical condition / habits /existing Insurance and I have disclosed all material facts correctly in the policy application form. In my view the Life Assured / Proposer lifestyle matches with the income declared by him as well as his financial background as assessed by me. The Life Assured / Proposer has signed / authenticated the application form. I have not withheld any information, which could impact the underwriting decision of the Proposal. I have correctly explained product features, benefits and policy terms & conditions to the Life Assured / Proposer. I have not made any improper payments to Goverment Officials or their Close Relatives to secure the business. I have not made any statement to the Life Assured / Proposer contrary to the Code of Conduct. I recommend this proposal for insurance.
Date: 18-09-2023 Signature/Authentication: Place:
Agent/Specified Person/Employee Name: RAJENDRA SINGH NIRWAN Agents/Employee Mobile Number: 9213034024
Agent/Specified Person/Employee Code: 5707592 Agents/Employee Home Telephone Number: 18602669966
Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110) CIN: U66010MH2000PLC128403. Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor / Intermediary or visit Tata AIA Life¿s nearest branch office or call 1-860-266-9966 (local charges apply) or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com. ¿ L & C/Misc/2021/Jun/0321.
BEWARE OF SPURIOUS / IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public FRAUD PHONE CALLS! receiving such phone calls are requested to lodge a police complaint.
