ICICI Lombard General Insurance Company Ltd : Universal Protection Insurance Policy

I propose to opt for HDFC Ergo: Sarv Suraksha, ICICI Lombard: Universal protection Insurance Policy, Bajaj Allianz: Suraksha Kavach, Aditya Birla Health Insurance Company : Group Active Secure, Max Bupa Health Insurance Company Ltd : Max Health Plus

I understand that the Advantage policy is issued by HDFC Ergo: Sarv Suraksha, ICICI Lombard: Universal protection Insurance Policy, Bajaj Allianz: Suraksha Kavach, Aditya Birla Health Insurance Company : Group Active Secure, Max Bupa Health Insurance Company Ltd : Max Health Plus,

I authorize HDFC Ergo: Sarv Suraksha, ICICI Lombard: Universal protection Insurance Policy, Bajaj Allianz: Suraksha Kavach, Aditya Birla Health Insurance Company : Group Active Secure, Max Bupa Health Insurance Company Ltd : Max Health Plus, and associate partners to contact
ICICI Lombard

It is essential that you answer fully and accurately all the question contained in this proposal, and that you provide us with any and all condition information relevant to the risk to be insured or our decision as to the acceptance of the risk or the term upon which it should be accepted. Your failure
to comply with this obligation now may result in the rejection of your claim and the avoidance of your policy when a claim is made. If you are in any doubt about the information to be given, please seek the advice of your insurance advisor. The liability of HDFC Ergo: Sarv Suraksha, ICICI
Lombard: Universal protection Insurance Policy, Bajaj Allianz: Suraksha Kavach, Aditya Birla Health Insurance Company : Group Active Secure, Max Bupa Health Insurance Company Ltd : Max Health Plus, DOES NOT commence until THE Company has accepted the proposal and the full
premium has been paid. Participation by HDFC BANK customer shall be purely on voluntary. The contract of insurance is between HDFC Ergo: Sarv Suraksha, ICICI Lombard: Universal protection Insurance Policy, Bajaj Allianz: Suraksha Kavach, Aditya Birla Health Insurance Company :
GroupActive Secure, Max Bupa Health Insurance Company Ltd : Max Health Plus, and the insured and not between HDFC Bank and the HDFC Bank shall not warranty / guarantee or be liable for the services provided by HDFC Ergo: Sarv Suraksha, ICICI Lombard: Universal protection
Insurance Policy, Bajaj Allianz: Suraksha Kavach, HDFC Bank shall not take responsibility for settlement of claims and HDFC Ergo: Sarv Suraksha, ICICI Lombard: Universal protection Insurance Policy, Bajaj Allianz: Suraksha Kavach, Aditya Birla Health Insurance Company : Group Active
Secure, Max Bupa Health Insurance Company Ltd : Max Health Plus, decisions in this regard shall be fnal. Any grievance with respect to insurance policy/ claims/ settlement shall be taken up with HDFC Ergo: Sarv Suraksha, ICICI Lombard: Universal protection Insurance Policy, Bajaj Allianz:
Suraksha Kavach, Aditya Birla Health Insurance Company : Group Active Secure, Max Bupa Health Insurance Company Ltd : Max Health Plus, and HDFC Bank shall not be responsible/ liable for the same. Customers are requested to read the offer document before taking the insurance. It is
at your will to buy this policy offered by insurer . You are at liberty to choose your own insurer for your insurance need.

ICICI Lombard General Insurance Company Ltd: Universal Protection Insurance Policy. Product UIN: IRDAI/HLT/BAXA/P-H(G)/V.I/63/2016-17. & Group Personal Accident: BHAPAG19021V011819
HDFC Ergo General Insurance Company Ltd. / ICICI Lombard General Insurance Company Ltd / Bajaj Allianz General Insurance
Company Ltd. Aditya Birla Health Insurance Company, Max Bupa Health Insurance Company Ltd.

In consideration of the payment of such monies under the Policy by the Company in the aforesaid manner, I shall completely discharge HDFC
Ergo General Insurance Company Ltd / ICICI Lombard General Insurance Company Ltd / Bajaj Allianz General Insurance Company Ltd, Aditya
Birla Health Insurance Company Ltd, Max Bupa Health Insurance Company Ltd, from all liability, claims under the Policy and the same shall
be binding on me and my heirs, executors, administrators, successors or legal representatives, as the case may be.

HDFC Bank has arrangement with Insurance Companies - HDFC ERGO General Insurance Company Limited, ICICI Lombard
General Insurance Company Limited & Bajaj Allianz General Insurance Company Limited, Aditya Birla Health Insurance
Company Ltd, Max Bupa Health Insurance Company Ltd & relevant details of the products have been disclosed to me.