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IN5IJRANaE
E-mail INDEMNITY LETTER
Max Life lnsurance Company Limited.
90-A Operations Centre
Gurgaon-122015
Haryana
Proposal No.
Name of the Proposer:
Name of the Insured lif different):
/Policyholder Signalure:
In consideralion of Max Life Insurance agreeing to accepi from me, from llme lo iime,
inslruclions purporling lo come from me through my e-mail address regislcred wilh l\,4ax Life
Insurance, not bearing an original signalure ("E,mail instructions
),
in respect of any sLlch E-
mail inslruction sent by me and acted upon by Max Life Insurance, l/we confirrn that:
1 | am aware ofthe poss ble risks involved in conneclion with the giving ofany E-mail
2lvlaxLfelnsuranceisherebyirievocablyandunconditonallyauthorzedroacronmyE-mai
nslruclons, and which l',lax Life Insurance in lls sole dscretion beleves ro have emanaled
Irom me since lhey are sent lrom my regislered Email address regislere.l and Max Llfe
Insurance shall not be able lor acling in good faith on such E mail instru.lion:,
3. Shall not al any t me d sputs or challenge the E mail instruciions g ven by me and they shatl
be binding upon me and lhese instruclions are inevocable
4 | undedake ro keep [,lax Life Insurance indemnified at atttimes agarnst, and l. save [,4ax Lte
Insurance harmless kom all aclions. prcceedings, cl6ims, losses, damages. cosrs and
expenses which rnay be brought against [/ax Life Insurance or suffred or incurred by Max
Lfe lnsufance and which shall have arisen outofor in conneciion with l\,4ax Lrle Insurance
accept ng E'mail nslruclons liom me and acting lhereon. whelher or not lhe same are
confimed in wiling by me
o
Date:
Note : The l^demnity ls applicable ror cerlain speciic seryice requests only.
[,4ax Life Insurance/!ma lndemnity/ V1.0
l\,Iax Life lnsunce Co. Ltd
Operalon cenler,90-A, Udyog Vihar Sector 18, Gurgaon- 122A15
Registered Ofllce : N4ax House 3 Foor 1 Dr Jha L4a, Okhta, New Dethi 1iO02O. India
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MS Joirt ltnture
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IN5LRANCE
MAX LIFE INSURANCE CO.LTD
Anne,(ure A- NRI/PtO/Foreign National Questionna ire
lKrndlyatlach atlcsted copy or passpon
showina laresl e.try to r.dra)
lD.pendc.LryVolk'ng/vis'lmg)
Cuiient Counlry of Rsidenco
Oale ol latest.ntry to India:
Coutrtry/Counlries visied noquently:
lfyou hold an Indi.n Bank account,
please provide details :
l/wchrcbydecarsrhailhoabo rue rn very respeci and /wealreelorlrlaringlrrislobeparl
or lhe Grcup Cred( L're Insurance Poricy
/wehrcbyacknowdqe undersla^d6^dr9rcerhalanyd'sputesregardrnsrh6propoe/po'cy(rtrsued).shal begovemd
by Indian Laws:nd suqed lotursdlcl'on or Cou.ls alNew Derh' "
s,s"ai"ro or ProposeC/_
{ll
matof and drflerent nonr Proposea
.-
A Mrx Indis and
)
l,ls JoiDa Vertrrc
[,laxLife Inso4ce 45_05062012_VER1.3