PRADHAN MANTRI JEEVAN JYOTI BIMA YOJANA
Declaration of Good Health
I have read and understood the Scheme rules and I hereby give my consent to become a member of the Scheme.
I hereby declare that I am in sound health and am not suffering or have suffered from any critical illness or condition requiring medical treatment, as on date. (critical illness is defined as follows: The applicant should not have suffered / be suffering from AIDS, cancer, condition requiring open chest surgery, history of typical chest pain, kidney failure, brain stroke or paralysis or having undergone a major organ transplantation such as heart, lung, liver or kidney. If the applicant had suffered from any of the above critical illness, they are not eligible to join the scheme)
I hereby declare that the above statements are true in all respects and that I agree and declare that the above information shall form the basis of admission to the above scheme and that if any information be found untrue, my membership to the scheme shall be treated as cancelled.
PRADHAN MANTRI SURAKSHA BIMA YOJANA
Declaration of Good Health
I have read and understood the Scheme rules and I hereby give my consent to become a member of the Scheme.
I hereby declare that I am in sound health and am not suffering from any physical disability If the applicant had suffered from any physical disability (Physical disability defined as “Loss of both eyes / Loss of use of both hands or feet / Loss of sight of one eye and loss of use of hand or foot / Total and irrecoverable loss of sight of one eye or loss of use of one hand or foot) , they will need to apply for this scheme from the nearest Bank branch by declaring the said disability in the application form and, will not be able to apply for this scheme through Internet Banking.
I hereby declare that the above statements are true in all respects and that I agree and declare that the above information shall form the basis of admission to the above scheme and that if any information be found untrue, my membership to the scheme shall be treated as cancelled.