

According to Regulation 3(d), 3(f) & 3(g) of Insurance Regulatory and Development Authority (IRDA) (Manner of Receipt of Premium) Regulations, 2002, the premium to be paid by any person proposing to take an insurance policy (hereinafter referred to as the proposer) or by the policyholder to an insurer may be made through credit/debit card held in his name, Internet or E-Transfer. The insurance company has right to cancel the insurance contract in case I am/ have been found guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money laundering in India. I understand that the Insurance Company has the right to call for documents to establish sources of funds. I hereby confirm that all premiums have been/will be paid from genuine sources and no premiums have been/will be paid out of proceeds of crime related to any of the scheduled offences listed in Prevention of Money Laundering Act, 2002. Any Document required by the Company before issuance of a policy or for processing application or Claim settlement or premium refund shall be provided by me to the Company.

The premium is paid for purchase of insurance policy through net banking account or credit/debit card issued in my name, i.e. Validity of Certificate of Registration: In Force Category of Certificate: Health Insurance. Tax benefits are subject to changes in tax laws. Claim settlement ratio for the financial year of 21-22. Group Activ Travel, Product UIN : ADITGBP19020V011819. Activ Care, Product UIN: ADIHLIP20001V011920 7. Group Activ Secure (IRDAI/HLT/ABHI/P-H(G)/V.-17) 3. Group Activ Health (IRDAI/HLT/ABHI/P-H(G)/V.-17) 2. Limited under licensed user agreement(s). These trademark/Logos are being used by Aditya Birla Health Insurance Co. Trademark/Logo Aditya Birla Capital is owned by Aditya Birla Management Corporation Private Limited and Trademark/logo HealthReturns™, Healthy Heart Score and Active Dayz are owned by Momentum Metropolitan Life Limited (Formerly known as MMI Group Limited). For more details on risk factors, terms and conditions please read terms and conditions carefully before concluding a sale. Address:- 9th Floor, Tower 1, One World Centre, Jupiter Mills Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai 400013.
