Online Insurance
Insurance Form Are you Agent of JLIC?
1. Insured's Information
 
 
2. Insurance Detail and Supplementary Contracts(Optional Benefit)
3. In Case of Deceased Father
4. In Case of Deceased Mother
5. Do you have siblings?
6. Check the option below for child insurance
7. Health and common question
I hereby declare that all given answer of questions asked above are true and complete and I have not concealed any conditions or facts required for insurability risk assessment of life to be assured. I understand that if any such facts are proved to be concealed or not true, agreement between me and Jyoti Life Insurance Company Limited shall be void from the date of commencement of this agreement and I will have no objection if company denies to pay claim on this ground. I agree that this proposal form, declaration and attached health details documents shall be the integral part of this agreement between me / life to be assured and Jyoti Life Insurance Company, I understand that date mentioned in first insurance premium receipt along with its policy number issued to me by the Jyoti Life Insurance shall be the date of commencement of this insurance. I agree to accept life insurance policy related documents issued by the insurer. I authorize Jyoti Life Insurance Company Limited to obtain information from any medical doctor or any medical facilities at any time from where I/ life to be assured is getting medical checkups and also to inquire and collect necessary information at any time from other insurer where I/ life to be assured had applied for insurance. I give all rights to such concern person or organization to provide information required for the purpose of insurance and I shall not file a complaint on ground of laws or rules and regulations against publishing such information.