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  • Annexure-1 (Declaration)

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    Jyotish Guru
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    The proposer confirms having filled out the insurance proposal form themselves and that all health-related facts provided about themselves and other proposed individuals are correct. The proposer also confirms that nobody proposed for insurance has undergone any medical tests or procedures revealing undisclosed health problems other than what was mentioned in the proposal form.

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    ane

    Original Title

    Annexure-1 (Declaration) (6) (2)(2) (2)

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    The proposer confirms having filled out the insurance proposal form themselves and that all health-related facts provided about themselves and other proposed individuals are correct. The proposer also confirms that nobody proposed for insurance has undergone any medical tests or procedures revealing undisclosed health problems other than what was mentioned in the proposal form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    5 views1 page

    Annexure-1 (Declaration)

    Uploaded by

    Jyotish Guru
    The proposer confirms having filled out the insurance proposal form themselves and that all health-related facts provided about themselves and other proposed individuals are correct. The proposer also confirms that nobody proposed for insurance has undergone any medical tests or procedures revealing undisclosed health problems other than what was mentioned in the proposal form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Declaration attached to & forming part of Star Comprehensive Insurance

    Proposal form: No. ____________

    I confirm having filled up the proposal myself and the facts


    mentioned relating to me / other persons proposed for insurance relating
    to the health status is correct and nobody had undergone any test or
    medical examination procedure which has shown any health problem
    what so ever nature, other than what has been mentioned in the
    proposal form referred to herein.

    Place : Signature of the Proposer


    Date :

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