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Declaration to be obtained from the proposer at the time of seeking enhancement of sum insured

during renewals.

From
 

 
To
 
Star Health and Allied Insurance Company Limited
 
 
Dear Sirs,
 
Re : Renewal of policy no ________________________ ; Request for increase in sum
insured.

 I have asked for an increase in sum insured and I understand and agree that the enhanced sum
insured that is being given on my request will not be available for any illness, diseases, injury
already contracted under the preceding policy periods.

 Thanking you,
 
Yours faithfully
 
 
Signature
 
Place :
Date :
 

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