a) I / We hereby declare that the statements made by me/us while submitting the information through online interface/physical proposal form, for the purpose of obtaining this Policy are true to the best of my/our knowledge and belief and I/we hereby agree and understand that these declaration shall form the basis of the contract between me/us and ___insurer_name___ (Company). I/We further declare that, we shall promptly intimate the Company within three days, should there be any additions or alterations are carried out to the Insured Property after the submission of the proposal.

b) I / we have fully understood the significance of furnishing true information to the Insurer and are aware that the proposed contract be rescinded by the Insurer, if the information submitted is found to be false or incorrect in any form or manner.

c) I / We declare that the rate of NCB stated above by me/us is correct and that no claim has arisen in the expiring policy. I/We further undertake that, if this declaration is found to be incorrect, all benefits under the policy in respect of Section I of the policy will stand forfeited.

d) I / We further understand and agree that the Company will seek confirmation of above stated details from my/our previous insurers. Pending receipt of necessary confirmation, I/we agree that, though coverage under the policy will be available to me/us, the Company will be liable to release the payment towards any claims under Section I of the policy only after a confirmation from my/our previous Insurer in this regard is received. In the event this declaration is found to be incorrect, any and all coverage available under Section I of the policy from the date of commencement of the policy shall stand automatically forfeited.

e) I / We understand that “no person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in accordance with the prospectus or tables of the Insurer. Any person making default in complying with the provisions of this section shall be punishable with a fine, which may extend to Rupees Ten Lakh.

f) I / We understand that the policy issued by the Company shall be voidable at the option of the Company in the event of mis-representation, mis-description or non-disclosure of any particulars by me/us. I/We know that any person who, knowingly and with intent to defraud the Company or other persons, files a proposal for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company’s sole discretion and result in a denial of insurance benefits otherwise available under the policy.

g) I / We understand that there at the time of processing of claim or at any time during the subsistence of the policy, the Company may ask for several information including the documents and I/We undertake to provide all such information/documents immediately upon receipt of such request from the Company, failing which the Company may rescind the policy contract at its option.

h) I / We understand that the Company may require to transfer my/our information to third party service providers or to associate companies in India or abroad for the purpose of analysis and I/we hereby accord my/ our consent for transfer of such information.

i) I / We declare that the Add On Coverage of Previous Year Policy stated above by me/us is correct. I/We further undertake that, if this declaration is found to be incorrect, all benefits under the policy in respect of Add On of the policy will stand forfeited.

a. I/We hereby declare that the statements made by me/us while submitting the information through online interface/physical proposal form, for the purpose of obtaining this Policy are true to the best of my/our knowledge and belief and I/we hereby agree and understand that these declaration shall form the basis of the contract between me/us and Liberty General Insurance Limited. I/We further declare that, we shall promptly intimate the Company within three days, should there be any additions or alterations are carried out to the Insured Property after the submission of the proposal.

b. I/we have fully understood the significance of furnishing true information to the Insurer and are aware that the proposed contract be rescinded by the Insurer, if the information submitted is found to be false or incorrect in any form or manner.

c. I/We declare that the rate of NCB stated above by me/us is correct and that no claim has arisen in the expiring policy. I/We further undertake that, if this declaration is found to be incorrect, all benefits under the policy in respect of Section I of the policy will stand forfeited.

d. I/We further understand and agree that the Company will seek confirmation of above stated details from my/our previous insurers. Pending receipt of necessary confirmation, I/we agree that, though coverage under the policy will be available to me/us, the Company will be liable to release the payment towards any claims under Section I of the policy only after a confirmation from my/our previous Insurer in this regard is received. In the event this declaration is found to be incorrect, any and all coverage available under Section I of the policy from the date of commencement of the policy shall stand automatically forfeited.

e. I/We understand that “no person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in accordance with the prospectus or tables of the Insurer. Any person making default in complying with the provisions of this section shall be punishable with a fine, which may extend to Rupees Ten Lakh.

f. I/We understand that the policy issued by the Company shall be voidable at the option of the Company in the event of mis-representation, mis-description or non-disclosure of any particulars by me/us. I/We know that any person who, knowingly and with intent to defraud the Company or other persons, files a proposal for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company’s sole discretion and result in a denial of insurance benefits otherwise available under the policy.

g. I/ We understand that there at the time of processing of claim or at any time during the subsistence of the policy, the Company may ask for several information including the documents and I/We undertake to provide all such information/documents immediately upon receipt of such request from the Company, failing which the Company may rescind the policy contract at its option.

h. I/We understand that the Company may require to transfer my/our information to third party service providers or to associate companies in India or abroad for the purpose of analysis and I/we hereby accord my/ our consent for transfer of such information.

i. I/We declare that the Add On Coverage of Previous Year Policy stated above by me/us is correct. I/We further undertake that, if this declaration is found to be incorrect, all benefits under the policy in respect of Add On of the policy will stand forfeited."

‘I/we, hereby declare that I/we have an insurable interest in the insured property that is being purchased and I am paying premium through my/our credit /debit/prepaid card/internet banking. In case, later it isfound to be paid from the account of a person other than me/us, I/we shall be responsible for all risks and consequences, including cancellation of the policy by Liberty General Insurance Limited’

I/We hereby declare that the statement, answers given by me/us in this proposal form are true to the best of my knowledge and belief. It is hereby understood and agreed that the statements, answers and particulars provided herein above are the basis on which this insurance is being granted and that if, after the insurance is effected, it is found that any of the statements, answers or particulars are incorrect or untrue in any respect, the Company shall have no liability under this insurance. I/We agree and undertake to convey to Liberty General Insurance Limited any change/alterations carried out in this risk proposed for insurance after submission of this proposal form.

I/we hereby confirm that I/we have understood the product coverages and terms & conditions and thereafter have agreed to purchase the policy by making payment of premium amount.

I/We, the undersigned hereby declare and warrant that the insurance contract and policy to be issued by Edelweiss General Insurance Company Ltd [Company] is subject to the declarations, warranties, statements and particulars given in this proposal form. The statements and particulars given in this form are complete, true and accurate to the best of my/our personal knowledge and belief. I/We have clearly understood the terms and conditions [T & C] to the insurance contract and agree that the statements and particulars given in this proposal form shall be held to be promissory and shall be the basis of the insurance contract between me/us and the Company and the Company shall have no liability under the insurance contract if it is found that any of my/our statements or particulars or declarations in this proposal form or other documents are incorrect and or untrue or suppressed any information or provided misleading or false information in any respect on any matter to the grant of a cover. I/ We will accept the usual T & C and form of the policy prescribed and issued by Company.

I/We hereby agree and undertake that I/ We are agreeable to receive one page policy document without enclosing the T & C of policy and I hereby authorise Company that all T & C of policy can be displayed in the website of Company. The salient features of the policy, terms and conditions of this proposal have been explained to me/us in vernacular language, and I/ We agree to the same.

I/We have read and understood the Privacy Policy of your Company at www.edelweissinsurance.com and I hereby unconditionally agree and bind myself to all terms and conditions of your Privacy Policy, as amended from time to time.

Certified that the contents of the Proposal Form and documents have been fully explained to the Proposer and that he/they have fully understood the significance of the proposed contract***

***This is required only where, for any reason, the Proposal Form and other connected papers are not filled by the Prospect/Proposer.

PROHIBITION OF REBATES (Insurance Act-1938, Section 41)

1. No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect or any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown in the policy, nor shall any person taking out of renewing or continuing a policy accept any rebate except such rebate as may be allowed in accordance with the prospectus or table of the Insurer.

2. Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to 10 lac rupees.

Note: Your Policy will not issue instantly and its risk start date will be T+2 day.