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Term Life Insurance

Name of the Insured *
Contact Details *
Email ID *
Date Of Birth *
Gender *
Sum Assured
Smoking Habits *
Coverage Till Age
Pre Existing Disease (PED)

By visiting the and/or registering yourself at, you authorize Prudent Insurance Brokers Private Limited (including its authorized representatives and its business partners) to contact you via email or phone call or SMS and offer you our services for the product you have opted for which reasons your information may be collected in the manner as detailed under this Policy.