in which of the following situations is SMQ not applicable and a full underwriting form is filled??
Answers
Answer:
MEMBER INFORMATION FORM
[IMPORTANT NOTE: Any cancellation and alteration must be countersigned by Member.
Please do not Sign Blank Information Form]
Plan
Name:
HDFC Life Group Health Shield
Options:
Benefit Option^ (Please
select your Benefit Option)
Benefit Description
Sum Insured (INR)
Premium (INR)
Option A
Daily Hospital Cash Benefit
Option B
Surgical Benefit
Option C
Critical Illness Benefit
Option D
Critical Illness excluding Cancer Benefit
Option E
Critical Illness excluding Cardiac Benefit
Option F
Critical Illness excluding Cancer and Cardiac Benefit
Option G
Cancer Cover
Option H
Cardiac Cover
Option I
Personal Accident Cover
^Only one out of options (C), (D), (E) and (F) can be chosen. ; Cancer Cover Benefit option cannot be chosen with Option C and E ; Cardiac Cover
Benefit cannot be chosen with Option C and D ;
Total/Single Premium (INR)______________ __ Member Cover Term: 1 Year (Yearly Renewable) Credit Linked _______ months
Premium Mode: << Single/ Annual / Half Yearly / Quarterly / Monthly >>
Particulars of Member: Mr/Mrs.
Date of Birth/: dd/mm/yyyy/ Gender: M /F/Tg Height :_____ Cms Weight: ____Kgs
Address for Communication:___________________________________________________________________________________________________
Mobile/ Telephone No.________________________________________ Email Id: ______________________________________________________
Name/Address/ Tel number of Family Physician: _______________________________________________________________________________
_________________________________________________________________________________________________________________________
Nationality: ___________________________________________ Country of Residence: ___________________________________________
Occupation: ____________________Annual Income:_______________________ Nature of Duties: ___________________________________________