Personal Accident Policy

Name

Gender

Mobile No

+91

Email

Date of Birth

Nominee Name

Nominee Relation

Address

Pincode

Payout Option

Have you ever been diagnosed with or are you under treatment for any disability/deformity?

Yes No

Has any company ever declined to issue/renew a Personal Accident policy for any proposed?

Yes No

Does your job require you to be involved with any hazardous activity, significant manual labor, operating heavy machinery, handling hazardous material, working at heights/underground/construction sites, oil rigging, high voltage, high temperature, working in aircrafts or sea-going vessels or adventure sports or armed forces?

Yes No

Have you ever been entrusted with prominent public functions?

Yes No

Do you participate in Adventure/ extreme sports?

Yes No

Do you have an existing personal Accident/Health Insurance policy with Religare or any other Insurer?

Yes No


Product Features

* This Personal Accident Policy is issued by Religare Health Insurance Company Ltd and the Sum Insured is 1 lakh.
* Accidental hospitalization expenses would be covered upto 1 lakh and Accidetal Death and Disability would be covered for 1 lakh INR.
* In case of Accidental Hospitalization, Rs.2,000 would be provided as cash payout per day in Option - 1 and Rs.3,000 per day in Option - 2 and Rs.4,000 per day in Option - 3 with 1 day deductible.