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Health Insurance Portability Request

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You and the new insurer
Your present policy
What you ask for

Step 1 of 3

You and the new insurer

Your full name (the proposer)Needed

For example: Harjinder Singh Gill

Your addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

Your phone numberNeeded

A number somebody can be reached on. Ten digits is the usual Indian form, and a country code in front of it is fine if you want it there.

For example: 98765 43210

New insurer's nameNeeded

For example: ABC General Insurance Company Limited

New insurer's addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

More details — you may leave these

Your email addressYou may leave this

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For example: harjinder.gill@example.com

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The live draft

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HEALTH INSURANCE PORTABILITY REQUEST

A request to move a health policy from one insurer to another, with credit for the cover already earned.

TO:
The Underwriting Manager (Portability)
__________
__________

Sir / Madam,

1. MY PRESENT POLICY

2. MY REQUEST

2.2 I ask you to give me credit under the new policy for the cover already earned under my present policy, including the waiting periods already served, to the extent the portability rules allow.

2.4 I understand that you will decide on my request on your own terms, and that you may accept it, decline it or add conditions.

3. EXISTING ILLNESSES

3.2 I have given you, or will give you on your own form, every fact you ask about, and I have kept back none that you would reasonably want to know.

4. TIMING

4.2 I will not let my present policy lapse until you confirm the new policy in writing.

5. PAPERS ENCLOSED

Yours faithfully,

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