Premium Calculation
               
Total Members:
Children:
  Age Band of Eldest Member
   

Choose your Plan:

PLAN
OPTION 1 AED 30,000 Personal Accident cover for Primary member and Family Floater Medical Insurance cover for INR 5,00,000
OPTION 2 AED 60,000 Personal Accident cover for Primary member and Family Floater Medical Insurance cover for INR 10,00,000
OPTION 3 AED 90,000 Personal Accident cover for Primary member and Family Floater Medical Insurance cover for INR 15,00,000
OPTION 4 AED 150,000 Personal Accident cover for Primary member and Family Floater Medical Insurance cover for INR 25,00,000

  Tenure:     1 year     2 year     3 year
  Your premium is: 
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AED
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Your Proposal Form

Proposer`s Details

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Details of person (s) to be insured

 Health Questionnaire

Does any proposed insured currently or in past Diagnosed/Suffered/Treated/Taken Medication for any of the following conditions ?

Yes No
Declaration *
  1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and / or particulars given by me are true and complete in all respects to the best of my knowledge and that I am authorized to propose on behalf of these other persons.
  2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the underwriting policy of the insurer and that the policy will come into force only after full payment of the premium chargeable.
  3. I understand that any undisclosed or incorrect or incomplete or misleading material information disclosed in this proposal may result in rejection of claim, termination of policy and premium forfeiture by Insurance company.
  4. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured / proposer after the proposal has been submitted but before communication of the risk acceptance by the company.
  5. I declare that I consent to the company seeking medical information from any doctor or hospital who / which at any time has attended on the person to be insured/ proposer or from any past or present employer concerning anything which affects the physical or mental health of the person to be insured / proposer and seeking information from any Insurer to whom an application for insurance on the person to be insured / proposer has been made for the purpose of underwriting the proposal and / or claim settlement.
  6. I authorize the company to share information pertaining to my proposal including the medical records of the Insured/ Proposer for the sole purpose of underwriting the proposal and / or claims settlement and with any Governmental and / or Regulatory authority.
  7. I hereby authorize Gargash Insurance Services to collect premium on behalf of National Takaful Company P.S.C.-Watania. I also understand that the Healthcare Claims in India are administered by Religare Health Insurance Company (India) through their Network providers. For list of the Network providers in India please visit List of Network Hospitals.
  8. I hereby acknowledge that I have read and understood all the Terms & Conditions of 'MY INDIA CARE' policy and give my consent by clicking 'PROCEED TO PAY' link
Your Proposal will be saved and sent as it is to your id
So that you may continue later from it.
Once If you choose save & continue later the proposal.You can view the proposal from "Draft History screen".

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your proposal
Application No Plan Type Policy Period
Year
Medical Sum Insured :    Personal Accident Sum Insured :    
Your premium is: AED
Person(s) Covered Date Of Birth Your UAE Address