THE NEW INDIA ASSURANCE COMPANY LIMITED & INDIAN ACADEMY OF NEUROLOGY



Payment Details :

Demand Draft   RTGS: Transfer funds   Debit/Credit Card/Net Banking


I hereby declare that the above information and answers are true to the best of my knowledge and the IAN Secretary is authorized to sign this policy on behalf of me.

I/we do hereby declare that the above statements and answers are true to the best of my knowledge and all Statutory Provisions are duly complied with, I agree that this proposal shall be the basis of the contract between me and The New India Assurance Co. Ltd.

Date * :
Place * : Signature of the Proposer


 

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