To,

ManipalCigna Health Insurance Company Limited

401/402, Raheja Titanium, Western Express Highway
Goregaon East, Mumbai - 400063

SUB: Undertaking for Non-Submission of pre-joining mandatory documents

Dear Sir/Madam,

This is in reference to my appointment with ManipalCigna Health Insurance Company Limited, I

hereby confirm that the following documents will be submitted by me on or before ………………………..
(date), failing which the company is authorized to take appropriate action as per the terms of the
Letter of appointment issued to me.

Sl No. Details of the Document Timelines for submission

1
2
3
4

Thanks & Regards,

Employee Signature: _________________________ Date:_________________

Employee Name: __________________________

PS ID: _____________________________________