BAJAJ ALLIANZ CYBER INSUTANCE

If you fall sick, you can either get your medical bills reimbursed or avail cashless treatment in our network hospitals (where we settle your bill directly with the hospital). To avail cashless treatment, give us a missed call on 01246174722

Please note:

Pre-existing diseases are not covered
Hospitalisation due to covid-19 is also covered

Please note:

Pre-existing diseases are not covered
Hospitalisation due to covid-19 is also covered

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First Name *

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Last Name *

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Mobile Number*

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Date Of Birth

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Email ID*

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Select Gender

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I agree to the data privacy policy

I want to get my quote and policy details on

Family Floater:

Policy start date:

Sum insured= ₹50000

Please Select Your Plan *

Plan 1

₹ 3172

Premium Details

Plan 2

₹ 3172

Premium Details

Plan 3

₹ 3172

Premium Details

Plan 4

₹ 3172

Premium Details

₹ 2,065

Price Breakup

For Spouse

Name

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DOB

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Gender

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For Parents

Name

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DOB

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For Childrens

Name

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DOB

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Please select gender

₹ 2,065

Price Breakup

Any past claim history?*

Have you been a victim of any of the perils covered under the policy in the past?*

₹ 2,065

Price Breakup

House No./Buliding No.

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Street Locality / Landmark *

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Pincode

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State *

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City *

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Area *

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Other area

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Do you have CKYC number *

Enter CKYC number:

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Enter PAN number :

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Select Document:

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Enter :

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Enter Passport File Number:

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Are you or any of the proposal applicants a PEP* or a close relative of PEP*?

Declaration

1. I/We, the undersigned hereby declare and warrant that the above statements are true, accurate and complete. I/We desire to have an insurance policy as described herein with the Company and I/We agree that this proposal and declarations hereto shall be the basis of contract between me/us and the Company and I/We agree to accept a Policy subject to the conditions prescribed by the Company.
2. I/We agree that the Policy shall become null and void, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the proposal form/personal statement, declaration and connected documents, or any material information has been withheld by me/us or anyone acting on my/our behalf to obtain any benefit under this Policy.
3. I/We agree that the issuance of Policy shall be subject to realisation of premium cheque.
4. I/We hereby give voluntary consent to BAGIC/Company to share my/our personal information and data provided in this proposal form with its group companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures being in place to safeguard my/our personal information.
5. I/We agree for AML (Anti Money Laundering) Declaration applicable as selected from below:

I agree

₹ 2,065

Price Breakup

Policy start date: