proposal form - pos - mediclassic insurance policy (individual) - … · 2020-07-15 · proposal...
TRANSCRIPT
Health
Insurance
HealthInsurancePersonal & Caring
The Health Insurance Specialist
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDRegd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam,
Chennai - 600 034. « Phone : 044 - 28288800 « Email : [email protected]
Website : www.starhealth.in « CIN : U66010TN2005PLC056649 « IRDAI Regn. No. : 129
Proposal Form No.:
HealthInsurancePersonal & Caring
The Health Insurance Specialist
POS - MEDICLASSIC INSURANCE POLICY (INDIVIDUAL)
Unique Identification No.: SHAHLIP20063V031920
Proposal Form - Unique Reference No.: SHAI/PR0037
Ref. No. The company will not be on risk until the proposal has been accepted and full payment of premium has been received. Please fill up the form in block letters.Policy No.
Policy Issuing Office : SM CODE SM NAME
POS CODE POS NAME
POS GST No. PAN No.
Name of the Proposer Mr / Mrs / Ms.
Date of Birth DD/MM/YYYY
Occupation of the Proposer
Annual Income Rs.
Residencial Address:
Office Address:
Email ID Mobile Number
Period of Insurance From: To:
GST Number PAN Number
Nominee’s NameRelationship to the Proposer
Date of Birth Age in Yrs
DD/MM/YYYY
Name of the Appointee(if nominee is a minor)
Relationship to the Nominee
Age in Yrs
(Incase of Multiple nominees a separate form containing nominee details should be enclosed duly specifying the % to each nominee)
I would like to receive my insurance policy and all the information related to the proposed insurance policy through insurance repository Yes / Non n
If you already have an e-Insurance Account (eIA) number, kindly provide e-Insurance Account (eIA) number _____________________________________
If you don't have an e-Insurance Account (eIA) number, choose any one Insurance Repository
c KARVY c CAMSRep - CAMS Insurance Repository & Services c CIRL - Central Insurance Repository Limited c NDML - NSDL Data Management Services limited
Bank Details of the Proposer
Account Number Type of Account : q SB q CA q Others please specify______________
Name of the Bank Name of the Branch IFSC Code
Please attach a photo copy of cancelled cheque leaf of the above Bank Account.
Payments Details Annual Premium Rs. Mode of Payment : Cash / Chque / DD / Credit Card / Debit Card / NEFT / CC Mandate
Cheque / DD No. Date Drawn on Branch
Please attach any one proof of Date of Birthq Birth Certificate q Voter ID q PAN Card
q Driving License q Aadhar Card q Any other Govt. Recognised Proof
Please affixstamp sizephotographof InsuredPerson - 1
Please affixstamp sizephotographof InsuredPerson - 2
Please affixstamp sizephotographof InsuredPerson - 3
Please affixstamp sizephotographof InsuredPerson - 4
Please affixstamp sizephotographof InsuredPerson - 5
Please affixstamp sizephotographof InsuredPerson - 6
STA
R H
EA
LTH
AN
D A
LL
IED
IN
SU
RA
NC
E C
OM
PA
NY
LIM
ITE
D
Acknow
ledgem
ent
Rec
eive
d th
e pr
opos
al f
or _
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__ p
olic
y fr
om M
r/ M
rs/
Ms.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__ a
long
with
pay
men
t of
R
s___
____
____
____
__/-
by
Cas
h / v
ide
Che
que/
DD
No.
___
____
____
____
____
____
____
dt._
____
____
____
____
____
____
dra
wn
on _
____
____
____
____
____
____
____
. The
Cas
h/C
hequ
e gi
ven
by y
ou is
ban
ked
for
oper
atio
nal c
onve
nien
ce a
nd b
anki
ng o
f the
Cas
h/C
hequ
e do
es n
ot m
ean
acce
ptan
ce o
f ris
k by
us.
The
rec
eipt
of
the
Cas
h/C
hequ
e w
ill a
lso
be a
ckno
wle
dged
by
our
offic
e vi
de a
dvan
ce p
rem
ium
rec
eipt
. If
the
prop
osal
is a
ccep
ted,
the
cov
er w
ill c
omm
ence
fro
m t
he d
ate
of t
he a
dvan
ce p
rem
ium
rec
eipt
, su
bjec
t to
rea
lizat
ion
of t
he
Che
que.
If th
e pr
opos
al is
not
acc
epte
d, th
e am
ount
pai
d w
ill b
e re
fund
ed. C
onta
ct o
ur o
ffice
, in
case
pol
icy
is n
ot r
ecei
ved
with
in 1
5 da
ys fr
om th
e da
te o
f pay
men
t of p
rem
ium
.N
ame
& C
od
e o
f th
e
Sig
nat
ure
of
the
D
ate:
P
lace
: au
tho
rise
d p
erso
n:
a uth
ori
sed
per
son
:
Health
Insurance
1. I
here
by d
ecla
re, o
n m
y be
half
and
on b
ehal
f of a
ll pe
rson
s pr
opos
ed to
be
insu
red,
that
the
abov
e st
atem
ents
, ans
wer
s an
d/or
par
ticul
ars
give
n by
me
are
true
and
com
plet
e in
all
resp
ects
to th
e be
st o
f my
know
ledg
e an
d th
at I
am a
utho
rized
to p
ropo
se o
n be
half
of
thes
e ot
her
pers
ons.
2.
I un
ders
tand
tha
t th
e in
form
atio
n pr
ovid
ed b
y m
e w
ill f
orm
the
bas
is o
f th
e in
sura
nce
polic
y is
sub
ject
to
the
Boa
rd a
ppro
ved
unde
rwrit
ing
polic
y of
the
insu
rer
and
that
the
pol
icy
will
com
e in
to f
orce
onl
y af
ter
full
paym
ent
of t
he p
rem
ium
char
geab
le. 3
. I fu
rthe
r de
clar
e th
at I
will
not
ify in
writ
ing
any
chan
ge o
ccur
ring
in th
e oc
cupa
tion
or g
ener
al h
ealth
of t
he li
fe to
be
insu
red/
prop
oser
afte
r th
e pr
opos
al h
as b
een
subm
itted
but
bef
ore
com
mun
icat
ion
of th
e ris
k ac
cept
ance
by
the
com
pany
. 4. I
dec
lare
and
cons
ent t
o th
e co
mpa
ny s
eeki
ng m
edic
al in
form
atio
n fr
om a
ny d
octo
r or
from
a h
ospi
tal w
ho/w
hich
at a
nytim
e ha
s at
tend
ed o
n th
e pe
rson
to b
e in
sure
d/pr
opos
er o
r fr
om a
ny p
ast o
r pr
esen
t em
ploy
er c
once
rnin
g an
ythi
ng w
hich
affe
cts
the
phys
ical
or
men
tal h
ealth
of
the
pers
on to
be
insu
red/
prop
oser
and
see
king
info
rmat
ion
from
any
insu
rer
to w
hom
an
appl
icat
ion
for
insu
ranc
e on
the
pers
on to
be
insu
red/
prop
oser
has
bee
n m
ade
for
the
purp
ose
of u
nder
writ
ing
the
prop
osal
and
/or
clai
m s
ettle
men
t. 5.
I au
thor
ize
the
com
pany
to
shar
e in
form
atio
n pe
rtai
ning
to
my
prop
osal
incl
udin
g th
e m
edic
al r
ecor
ds o
f th
e in
sure
d/pr
opos
er f
or t
he s
ole
purp
ose
of u
nder
writ
ing
the
prop
osal
and
/or
cla
ims
settl
emen
t an
d w
ith a
ny G
over
nmen
tal a
nd/o
r R
egul
ator
y au
thor
ity.
I co
nfirm
tha
t th
e pa
ymen
t is
mad
e
thro
ugh
my
card
/ ba
nk a
ccou
nt. I
als
o co
nfirm
that
the
sour
ce o
f fun
ds fo
r pr
emiu
m p
aid
unde
r th
is p
olic
y is
lega
l. I h
ereb
y co
nfirm
that
the
feat
ures
of t
he p
rodu
ct h
ave
been
und
erst
ood
by m
e.
Dec
lara
tio
n
Proposal Form No.:
Pro
hib
itio
n o
f R
ebat
es:
Sec
tio
n 4
1 o
f In
sura
nce
Act
193
8. N
o p
erso
n s
hal
l al
low
or
off
er t
o a
llow
, e
ith
er d
irec
tly
or
ind
irec
tly,
as
an i
nd
uce
men
t to
an
y p
erso
n t
o t
ake
ou
t o
r re
new
or
con
tin
ue
an i
nsu
ran
ce i
n r
esp
ect
of
any
kin
d o
f ri
sk r
elat
ing
to
liv
es o
r p
rop
erty
in
In
dia
, an
y re
bat
e o
f th
e w
ho
le o
r p
art
of
the
com
mis
sio
n p
ayab
le o
r an
y re
bat
e o
f th
e p
rem
ium
sh
ow
n o
n t
he
po
licy,
no
r sh
all
any
per
son
tak
ing
ou
t o
r re
new
ing
or
con
tin
uin
g a
po
licy
acce
pt
any
reb
ate,
exc
ept
such
reb
ate
as m
ay b
e al
low
ed i
n a
cco
rdan
ce w
ith
th
e p
ub
lish
ed p
rosp
ectu
ses
or
tab
les
of
the
insu
rer.
An
y p
erso
n
mak
ing
d
efau
lt
in
com
ply
ing
w
ith
th
e p
rovi
sio
ns
of
this
se
ctio
n s
hal
l be
liab
le f
or
a p
enal
ty w
hic
h m
ay e
xten
d t
o t
en la
kh r
up
ees.
Th
e co
nte
nts
of
the
pro
po
sal f
orm
an
d f
eatu
res
of
the
pro
du
ct h
ave
bee
n f
ully
exp
lain
ed t
o m
e an
d I
hav
e fu
lly u
nd
erst
oo
d t
he
sig
nifi
can
ce o
f th
e
pro
po
sed
co
ntr
act.
WH
ER
E T
HE
PR
OP
OS
ER
IS
ILL
ITE
RA
TE
OR
SIG
NS
IN A
LA
NG
UA
GE
DIF
FE
RE
NT
FR
OM
TH
AT
OF
TH
E L
AN
GU
AG
E O
F
TH
E P
RO
PO
SA
L F
OR
M.
Dat
eS
ign
atu
re /
Th
um
b im
pre
ssio
n o
f th
e p
rop
ose
rN
ame
of
the
per
son
wh
o e
xpla
ined
Sig
nat
ure
of
the
per
son
wh
o e
xpla
ined
I her
eby
con
firm
th
at t
he
det
ails
hav
e b
een
exp
lain
ed t
o t
he
pro
po
ser.
Sig
nat
ure
/ T
hu
mb
im
pre
ssio
n o
f th
e p
rop
ose
r:
Pla
ceD
ate
Nam
e
PO
S -
ME
DIC
LA
SS
IC IN
SU
RA
NC
E P
OL
ICY
(IN
DIV
IDU
AL
)
Sub
mitt
ed t
he a
bove
pro
posa
l fo
r __
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
polic
y al
ong
with
pay
men
t of
Rs.
____
____
____
____
____
____
____
_/ b
y ca
sh/v
ide
cheq
ue/D
D n
o __
____
____
____
____
____
__
date
d __
____
____
____
____
____
____
____
dra
wn
on _
____
____
____
____
___.
I un
ders
tand
that
the
cash
/che
que
give
n is
ban
ked
for o
pera
tiona
l con
veni
ence
and
com
men
cem
ent o
f ris
k is
sub
ject
to th
e ac
cept
ance
of p
ropo
sal b
y yo
u.
PO
S -
ME
DIC
LA
SS
IC IN
SU
RA
NC
E P
OL
ICY
(IN
DIV
IDU
AL
)
PRO / POSMCI / V.4 / 2020POS - Mediclassic Insurance Policy (Individual) - Proposal Form POS - Mediclassic Insurance Policy (Individual) - Proposal Form4 of 4 1 of 4
Pin Code:
Pin Code:
NO
MIN
AT
ION
Det
ails
of
the
pers
on p
ropo
sed
for
insu
ranc
eIn
sure
d P
erso
n -
1In
sure
d P
erso
n -
2In
sure
d P
erso
n -
3In
sure
d P
erso
n -
4In
sure
d P
erso
n -
5In
sure
d P
erso
n -
6
Nam
e
Gen
der
Dat
e o
f B
irth
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
Hei
gh
t (c
ms)
W
eig
ht
(kg
s)C
MS
KG
SC
MS
KG
SC
MS
KG
SC
MS
KG
SC
MS
KG
SC
MS
KG
S
Rel
atio
nsh
ip w
ith
pro
po
ser
Occ
up
atio
n
An
nu
al In
com
e (R
s.)
Do
yo
u
wan
t G
old
P
lan
[A
pp
licab
le
for
PO
S -
Med
icla
ssic
Insu
ran
ce P
olic
y (I
nd
ivid
ual
)]c Y
ES
/
c N
Oc Y
ES
/
c N
Oc Y
ES
/
c N
Oc Y
ES
/
c N
Oc Y
ES
/
c N
Oc Y
ES
/
c N
O
Su
m In
sure
d O
pte
d (
Rs.
) /
*Ple
ase
chec
k br
ochu
re fo
r th
e av
aila
ble
SI o
ptio
ns
Add
-ons
: [A
pplic
able
for
PO
S M
edic
lass
ic In
sura
nce
Pol
icy
(Indi
vidu
al)]
- D
o y
ou w
ant
add
on
cov
ers
- If
Yes,
Ple
ase
tick
(ü)
(Pat
ient
Car
e ad
d-on
is a
vaila
ble
only
for
Insu
red
Per
sons
abo
ve 6
0yrs
of
age.
)
c
Hos
pita
l Cas
h
c
Pat
ient
Car
e
c
Hos
pita
l Cas
h
c
Pat
ient
Car
e
c
Hos
pita
l Cas
h
c
Pat
ient
Car
e
c
Hos
pita
l Cas
h
c
Pat
ient
Car
e
c
Hos
pita
l Cas
h
c
Pat
ient
Car
e
c
Hos
pita
l Cas
h
c
Pat
ient
Car
e
Exi
stin
g
Insu
ran
ce
Co
vera
ge
wit
h
this
co
mp
any
and
an
y o
ther
co
mp
any
- g
ive
det
ails
1. N
ame
of th
e In
sura
nce
Com
pany
2. P
erio
d o
f In
sura
nce
3. S
um
Insu
red
(R
s)
4. P
olic
y N
o.
Det
ails
of
Cla
ims
1. A
ilmen
t fo
r w
hic
h
Cla
im w
as m
ade
Yea
rY
YY
YY
YY
YY
YY
YY
YY
YY
YY
YY
YY
Y
2. C
laim
Am
ou
nt
Pai
d /
Rej
ecte
d
Hea
lth H
isto
ry :
Ple
ase
prov
ide
answ
er
in
deta
il.A
mer
e da
sh is
not
suf
ficie
nt.
Fam
ily P
hys
icia
n's
Nam
e:__
____
____
____
____
____
____
____
____
____
____
____
____
____
Ph
on
e:__
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
Reg
n N
o:_
____
____
____
____
____
____
____
____
___
1.
Is t
he
per
son
pro
po
sed
fo
r in
sura
nce
in
go
od
h
ealt
h f
ree
fro
m p
hys
ical
an
d m
enta
l d
isea
se
or
infi
rmit
y. If
no
t g
ive
det
ails
2.
Has
th
e pe
rson
pr
opos
ed
for
insu
ranc
e co
nsul
ted
/ d
iagn
osed
/ t
aken
tre
atm
ent
/ be
en
adm
itted
for
any
illne
ss/in
jury
. If Y
es, g
ive
deta
ils
3.
Do
es t
he
per
son
pro
po
sed
fo
r in
sura
nce
hav
e an
y co
mp
licat
ion
s d
uri
ng
/ f
ollo
win
g b
irth
. If
ye
s, p
leas
e su
bm
it a
ll n
eces
sary
do
cum
ents
.
4.
Has
th
e p
erso
n p
rop
ose
d f
or
insu
ran
ce e
ver
suff
ered
or
suff
erin
g f
rom
an
y o
f th
e fo
llow
ing
a) D
iab
etes
Mel
litu
s -
If Y
es, s
ince
wh
en
b)
Hig
h B
P, C
ho
lest
ero
l - If
Yes
, sin
ce w
hen
c) H
eart
Dis
ease
- If
Yes
, sin
ce w
hen
d)
Str
oke
, ep
ilep
sy,
fain
tin
g
atta
ck,
chro
nic
h
ead
ach
e, P
arki
nso
n's
dis
ease
, A
lzh
eim
er's
d
isea
se, -
If Y
es s
ince
wh
en
e) T
ub
ercu
losi
s,
asth
ma,
o
ther
re
spir
ato
ry
infe
ctio
ns
- If
Yes
, sin
ce w
hen
f)
Dis
ease
of
bo
nes/
join
ts,
slip
ped
di
sc,
spin
al
diso
rder
, inj
ury
to li
gam
ents
- If
Yes
, sin
ce w
hen
g)
Can
cer,
P
re
Can
cero
us
Les
ion
-
If
Yes
, si
nce
wh
en
h) G
ynec
olog
ical
dis
orde
r su
ch a
s D
UB
, Fib
roid
U
teru
s,
Ova
rian
cys
t -
or
have
und
ergo
ne
cesa
rean
/ H
ys-
tere
ctom
y If
Yes,
sin
ce w
hen
i)
Trea
tmen
t fo
r su
b
fert
ility
o
r h
as
bee
n
advi
sed
fo
r? (
answ
er i
f ap
plic
able
) –
If Y
es
pro
vid
e d
etai
ls.
j)
Dis
ease
o
f S
tom
ach
, In
test
ine,
L
iver
, G
all
bla
dd
er /
Pan
crea
s, K
idn
ey,
Uri
nar
y b
lad
der
, U
rin
ary
Trac
t D
isea
ses
- If
Yes
, sin
ce w
hen
k) D
isea
se o
f P
rost
rate
/ F
istu
la /
Pile
s / G
enit
al
dis
ease
s -
If Y
es, s
ince
wh
en
l)
Cat
arac
t an
d o
ther
dis
ease
s o
f th
e ey
e an
d
EN
T d
isea
se -
If Y
es s
ince
wh
en
m)
An
y O
ther
Pro
ble
m (
Ple
ase
Sp
ecif
y)
5.
Has
th
e p
erso
n/s
pro
po
sed
fo
r in
sura
nce
a) U
nd
erg
on
e an
y m
edic
al t
est?
b)
Pre
scri
bed
an
y m
edic
ines
? If
yes
i) N
ame
the
illn
ess
for
wh
ich
m
edic
ines
h
ave
bee
n p
resc
rib
ed
ii) D
etai
ls o
f m
edic
ines
and
dru
gs p
resc
ribed
.
iii)P
erio
d fo
r w
hich
thes
e dr
ugs
wer
e ta
ken.
c) B
een
ad
vise
d f
or
any
surg
ery
/ tre
atm
ent
? -
If
Yes
, giv
e d
etai
ls
d)
Rec
eive
d
/rec
eivi
ng
an
y p
aym
ent
for
any
dis
abili
ty
/ in
jury
/
illn
ess/
d
isea
se.
Giv
e d
etai
ls
6.
Do
es t
he
per
son
pro
po
sed
for
insu
ran
ce
a) C
hew
Tob
acco
- If
Yes
, sin
ce w
hen
b) S
mo
ke -
If Y
es, s
ince
wh
en
c) C
on
sum
e A
lco
ho
l -
If Y
es,
sin
ce
wh
en
7.
Is t
he
per
son
pro
po
sed
fo
r in
sura
nce
po
siti
ve
for
HIV
If
yes,
ple
ase
men
tio
n y
ou
r C
D4c
ou
nt
(Ple
ase
atta
ch p
roo
f)
Dec
lara
tion
of
the
PO
S :
I /
We
confi
rm t
hat
the
prod
uct‘s
sui
tabi
lity
has
been
expl
aine
d t
o t
he p
ropo
ser.
The
info
rmat
ion
fur
nish
ed in
the
pro
posa
l is
true
to
the
best
of m
y kn
owle
dge
and
rec
omm
end
acc
epta
nce
of th
e pr
opos
al. (
Ple
ase
Enc
lose
Insu
ranc
e A
gent
’s C
onfid
entia
l Rep
ort,
If A
ny)
PO
S C
od
eN
ame
of th
e P
OS
Sig
nat
ure
of
the
PO
S
BU
SIN
ES
S
TY
PE
Soc
ial S
ecto
r C
lass
ifica
tion*
: q
Yes
q N
o
If Ye
s:q
a. U
norg
aniz
ed S
ecto
r q
b. O
ther
Cat
egor
ies
of P
erso
ns
q c
. Eco
nom
ical
ly V
ulne
rabl
e or
Bac
kwar
d C
lass
es
q d
. Inf
orm
al S
ecto
r
Rur
al S
ecto
r C
lass
ifica
tion
(Thi
s cl
assi
ficat
ion
is b
ased
upo
n th
e ad
dres
s of
the
prop
oser
) : q
Urb
an q
Rur
al
* “S
ocia
l Sec
tor”
incl
udes
uno
rgan
ised
sec
tor,
info
rmal
sec
tor,
econ
omic
ally
Vul
nera
ble
or b
ackw
ard
clas
ses
and
othe
r ca
tego
ries
of p
erso
ns, b
oth
in r
ural
and
urb
an a
reas
.
a.
“Uno
rgan
ised
sec
tor”
incl
udes
sel
f-em
ploy
ed w
orke
rs s
uch
as a
gric
ultu
ral l
abou
rers
, bid
i wor
kers
, bric
k ki
ln w
orke
rs, c
arpe
nter
s, c
obbl
ers,
con
stru
ctio
n w
orke
rs, fi
sher
men
, ham
als,
han
dicr
aft a
rtis
ans,
han
dloo
m a
nd k
hadi
wor
kers
, lad
y ta
ilors
, lea
ther
and
tann
ery
wor
kers
, pap
ad m
aker
s, p
ower
loom
w
orke
rs,
phys
ical
ly h
andi
capp
ed s
elf-
empl
oyed
per
sons
, pr
imar
y m
ilk p
rodu
cers
, ric
ksha
w p
ulle
rs,
safa
ikar
mac
haris
, sa
lt gr
ower
s, s
eric
ultu
re w
orke
rs,
suga
rcan
e cu
tters
, te
ndu
leaf
col
lect
ors,
tod
dy t
appe
rs,
vege
tabl
e ve
ndor
s, w
ashe
rwom
en,
wor
king
wom
en in
hill
s, d
aily
wag
ers,
hire
d dr
iver
s an
d co
olie
s or
suc
h ot
her
cate
gorie
s of
per
sons
;.
b.
“Eco
nom
ical
ly V
ulne
rabl
e or
Bac
kwar
d C
lass
es”
mea
ns p
erso
ns w
ho li
ve b
elow
the
pove
rty
line;
c.
“Oth
er C
ateg
orie
s of
Per
sons
” in
clud
es p
erso
ns w
ith d
isab
ility
as
defin
ed in
the
Per
sons
with
Dis
abili
ties
(Equ
al O
ppor
tuni
ties,
Pro
tect
ion
of R
ight
s an
d F
ull P
artic
ipat
ion)
Act
, 199
5 an
d w
ho m
ay n
ot b
e ga
infu
lly e
mpl
oyed
; and
als
o in
clud
es g
uard
ians
who
nee
d in
sura
nce
to p
rote
ct s
past
ic p
erso
ns o
r pe
rson
s w
ith d
isab
ility
;
d.
“Inf
orm
al S
ecto
r” in
clud
es s
mal
l sca
le, s
elf-
empl
oyed
wor
kers
typi
cally
at a
low
leve
l of o
rgan
isat
ion
and
tech
nolo
gy, w
ith th
e pr
imar
y ob
ject
ive
of g
ener
atin
g em
ploy
men
t and
inco
me,
with
het
erog
eneo
us a
ctiv
ities
like
ret
ail t
rade
, tra
nspo
rt, r
epai
r an
d m
aint
enan
ce, c
onst
ruct
ion,
per
sona
l and
dom
estic
se
rvic
es a
nd m
anuf
actu
ring,
with
the
wor
k m
ostly
labo
ur in
tens
ive,
hav
ing
ofte
n un
writ
ten
and
info
rmal
em
ploy
er-e
mpl
oyee
rel
atio
nshi
p;
2 of 4 3 of 4POS - Mediclassic Insurance Policy (Individual) - Proposal FormPOS - Mediclassic Insurance Policy (Individual) - Proposal Form