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Nominee Details


Note: Nominee once added can be deleted / modified post account opening using Equitas Internet / Mobile banking.

Guardian Details
  • Per Transaction limit of INR 25,000 (eg, if 2 transactions are being done each transaction should be Rs.25000 or lesser only).
  • Per day cumulative Transaction limit of INR 25,000 (eg you can do multiple transaction upto Rs.25000 in a day).
  • Per month cumulative transaction limit of INR 3,00,000 since the date of account opening (eg you can do multiple transaction upto Rs.3,00,000 in a month)
Acknowledgement
  • I hereby decline to presently nominate any individual and I understand and acknowledge the risks and consequences associated with nomination not given by me. I hereby declare that if I wish to make nomination in future, I shall update the same with the Bank.
Other Bank Details


Note: Please complete your full KYC before 12 months from the date of online account opening, else your Equitas account will be closed and the balance available in your Equitas A/C will be credited to your other bank account details provided below

Our Products






  • Death due to accident
  • Total & permanent disability due to accident
  • Completely Digital Policy
  • Customers Aged 18-70 years are eligible
  • Zero wait period
  • check "i" button for exculsions
  • 1 Year
  • 100% payment sum assured will be done.


Personal Accident Cover

at Rs.

Application Id:

123456

Application Id:

123456

Application Id:

123456

Terms and conditions
  • I have read and understood the brochure, prospectus, sales literature & Policy wordings and confirm to abide by the same.
  • I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the risk acceptance 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 application including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and / or Regulatory Authority.
  • Receipt of the Application by the Company shall not be constructed as acceptance of my application. I hereby agree that the insurance coverage shall commence only on realization of full premium and on receipt of complete medical reports (wherever applicable) and subject to underwriting by the Company. The Company at its sole discretion reserves the right to accept or reject any application form without assigning any reason thereof.
  • I understand that the policy shall become void at the option of the company, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure of any material fact in the Application Form/Personal statement, declaration and connected documents or any material information having been withheld by me or anyone acting on my behalf.
  • I hereby declare that the person(s) proposed to be insured would submit to medical examinations, before the nominated doctors of the Company, or undergo diagnostic or other medical tests, as suggested by the Company for its underwriting, if need arises.
  • I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company.
  • I consent to receive information from the Company through physical, electronic or telecommunication means from time to time.
  • I declare that i am not suffering from any pre-existing disease & if found that i have been suffering from any pre-existing disease post purchasing the policy, my insurance cover will be null & void.
  • I here by state that the address updated in Bank records shall be taken as address on record for the purpose of GST.
  • I hereby confirm that the contents of the application form and connected documents have been fully explained to me/us and I/We have fully understood the significance of the proposed contract
  • I agree for the policy terms and conditions and will pay the displayed premium amount to Reliance General Insurance Company Ltd.
  • I confirm that I am a Equitas Small Finance Bank Customer and if found that i am not a customer of Equitas Small Finance Bank, my policy will be cancelled and the premium amount will be refunded to my bank account from Reliance General Insurance Company Ltd as per the policy terms and conditions.
  • I hereby declare that on my behalf & on behalf of all persons proposed to be insured that the above statements, answers and/or particulars given by me in this proposal form are true and complete in all respects to the best of my knowledge and that i am authorized to propose on behalf of these other persons.
  • I hereby agree to automatically debit my Equitas Bank account mentioned in the digital form for all future payment with regards to this policy
  • 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 lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
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Funding Details
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Refid:#

123456


*If no Original PAN or E-PAN - relax, enjoy the existing Selfe account valid for 1 year from account opening date




Refid:#

123456


*If no Original PAN or E-PAN - relax, enjoy the existing Selfe account valid for 1 year from account opening date