The New India Assurance Company Limited
                    Head Office: 87, M G Road, Fort, Mumbai-400001 
                       
                         BHAGYASHREE CHILD WELFARE POLICY 
    (For girl child in the age group 0-18 years whose parents’ age does not exceed 60 years)

                                       PROPOSAL FORM

1.	Name of the girl child to be insured: ________________________________________ 

2.	Address: _____________________________________________________________

3.	Age (Completed years): ________________________________________________

4.	Date of Birth: ________________________________________________________

5.	Name and age of the parent/s: Sri ________________________________________

    Age: _______________________________________
   
   Smt: _______________________________________
  
   Age: ________________________________________

6.	Address of the parents: __________________________________________________

7.	Name of the nominated guardian: _________________________________________

8.	Address of the guardian: ________________________________________________

9.	Period of Insurance: From _____________________ to  ______________________

I/We, hereby declare that the information furnished above are true and correct to my/our knowledge and belief.

Place: _______________			________________________

Date: _______________        			 Signature of the Proposer/s

                                 PROHIBITION OF REBATES:
        The following is an extract of Section 41 of Insurance Act 1938
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 of any kind of risk relating to live 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 or renewing continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses of rebates 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 five hundred rupees.

NOTICE:
Maximum amount receivable:
   Attention is drawn to Condition No. 5 above when the Insured is having more than one BHAGYASREE CHILD WELFARE POLICY in force at the time of the accident or injury.
  Renewal of the Policy after expiry:
 It will be necessary for the Insured to contact the nearest office and obtain a fresh insurance   after the expiry of the Policy as renewal notice or intimation will not be sent by the office.