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Get Max Life Insurance Company Health Declaration Form 2012

CLARATION FORM (Please write in BLOCK LETTERS, Correction/Overwriting must bear full signature) Policy Number: Request Type: Reinstatement of policy Addition of Rider ; Name of the Rider/s ; Others/Statement of good health Increase in Sum Assured ; Sum Assured (e.g.: new number case) NOTE: For Reinstatement of policy; Statement of good health Complete Section A For Increase in Sum Assured; Addition of rider POLICY HOLDER Complete Section A + B LI.

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