I declare that all the information I have provided are true and accurate to the best of my knowledge, and that I am authorized to propose on the behalf of my family.

I understand that my information is subject to the insurer's Board-approved underwriting policy, will be the basis for my health insurance, and that it will not take effect until I have paid the premium due.

I also promise to notify any change in occupation or general health of my family after the proposal has been submitted, but before the acceptance of the risk by the company.

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.

I authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal underwriting and / or claims settlement and with any Governmental and / or Regulatory authority

I hereby permit/ authorise Acko General Insurance to collect, store, communicate and process information relating to the policy(ies)and all transactions related therewith, including the sharing and disclosing the public authorities, of any confidential information as required by law and to send me information in relation to the Policy and Acko General Insurance products & services, irrespective of whether I am registered with National Customer Preference Register (NCPR) [(Formerly the National Do Not Call Registry (NDNC)] or not.

To protect the environment and save paper, I consent to ACKO contacting me by email or phone instead of in physical form and to share all documents, updates and alerts electronically.

I attest that the information I provided is accurate to the best of my knowledge, and I agree that the Company may alter/cancel my coverage if it is found to be false in any way.