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Max Life Cancer Insurance Plan

Lump Sum ₹ 1,000 on a premium of

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First Name Please enter your first name

Mobile Number +91 Mobile Number should start with 7,8,9 Mobile Number should be 10 digits

Email address Incorrect email address format

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₹

till Maturity Age

Years

Premium

₹ 5444

Annually
Half-yearly
Quarterly
Monthly

*Your premium is inclusive of GST and all applicable taxes, cess and levies as imposed by the Government. Max Life Cancer Insurance Plan (UIN - 104N093V03), A Non-Linked Non-Participating Individual Pure Risk Premium Health Insurance Plan.

For payment modes other than annual, it is mandatory to pay through credit card with standing instructions.

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I’m buying for I was born on I am

I’m buying for

myself

I was born on I am

male
female

Your choice of protection.

till Years

Your Premium (Inclusive of Service tax.)

Post-purchase benefits

Free Look period of 30 days

Allows you to return the policy and get your money back within 30 days

Lifelong benefits

Save Tax

Get tax benefits under the sections: 80C, 80D, 80DD, and 10(10D)

Before you proceed to buy, tell us a bit about yourself

First name Please enter your first name

Mobile number +91 Mobile number should start with 7,8,9. Mobile number should be 10 digits.

Email address Please enter valid email address

I accept the terms and conditions and authorize Max Life Insurance to contact me
*For transgender please select male to continue with purchase and write to us at online@maxlifeinsurance.com

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Basics About You (Insured)

Insured Title

Mr#1,Ms#2

Insured First Name

Please enter the value for First Name

Insured Middle Name

Please enter the value for middle name

Insured Last name

Please enter the value for last name

Father's/Husband's Name

Please enter the value for father's/husband's name

Insured Date of Birth

Insured Gender

Male#M,Female#F

Insured Marital Status

Single#SNG,Married#MRD,Divorced#DVR,Widow(er)#WDR

Full name prior to marriage

Please enter the value for full name prior to marriage

Spouse's Occupation

Please enter the value for spouse's occupation

Spouse existing Sum Assured of Cancer/Critical Illness/dreaded disease Insurance

Please enter the value for insurance cover on spouse

Spouse's Annual Income

Please enter the value for spouse's annual income

Spouse Policy number with Max Life

Please enter the value for spouse's policy number (Optional)

I am pregnant

Number of Months

<=6 months#Less,>6 months#Greater

Insured Nationality

Indian#I,NRI#O

Education

Graduate#GRA,Illiterate#ILL,Primary School#PRS,Higher Secondary#HIS,Post Graduate #POG,Professional#PRO

Basics About You (Proposer)

Salutation

Mr#1,Ms#2

First Name

Please enter the value for First Name

Middle Name (Optional)

Please enter the value for middle name

Last Name

Please enter the value for last name

Father's/Husband's Name

Please enter the value for father's/husband's name

DOB

Gender

Male#M,Female#F

Marital Status

Single#SNG,Married#MRD,Divorced#DVR,Widow(er)#WDW

Full name prior to marriage

Please enter the value for full name prior to marriage

Spouse's Occupation

Please enter the value for spouse's occupation

Spouse existing Sum Assured of Cancer/Critical Illness/dreaded disease Insurance

Please enter spouse existing sum assured value

Spouse's Annual Income

Please enter the value for spouse's annual income

Spouse Policy number with Max Life

Please enter the value for spouse's policy number

I am pregnant.

Number of months

<=6 months#Less,>6 months#More

Mobile Number

Please enter the value for mobile number

Alternate Mobile Number (Optional)

Please enter the value for alternate mobile number

Email Address

Please enter the value for email address

Nationality

Indian#I,NRI#O

Education

Graduate#GRA,Illiterate#ILL,Higher Secondary#HIS,Post Graduate#POG,Professional#PRO

Use this information for all email communications

Your Communication Address (Proposer)

House No./Apt. Name/Society

Enter the value for permanent House No./Apt. Name/Society

Road/Area/Sector

Enter the value for permanent Road/Area/Sector

Landmark (Optional)

Enter the value for permanent landmark

State

City

Pincode

Enter the value for pincode

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Sorry!

It seems you are not eligible to purchase Max Life Cancer Insurance Plan. You can check out other Max Life Plans and choose the one that suits your need best.

click on max life home page to view all products.

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It seems you are not eligible to purchase Max Life Cancer Insurance Plan. You can check out other Max Life Plans and choose the one that suits your need best.

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Electronic Insurance Account will safeguard the insurance policy documnets of policy holders in electronic format.

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Employment and Insurance

Employment Details for Insured

Salaried#Salaried,Professional#Profsnl,Self Employed/Business owner#Selfempl,Self Employed from Home#Self Employed from Home,Housewife#Housew,Retired#Retired,Student#Studen,Agricultrue#Agricult,Labourer#Labourer,Others#Others

Please specify occupation type

Name of the Employer

Job Title

Annual Income

Please fill in the amount as per your latest income proof

Employment Details for Proposer

Occupation Type

Salaried#Salaried,Professional#Profsnl,Self Employed/Business owner#Selfempl,Self Employed from Home#Slfemply,Housewife#Housew,Retired#Retired,Student#Studen,Agriculture#Agricult,Labourer#Labourer,Others#Others

Please specify occupation type

Name of the Employer

Job Title

Annual Income

Please fill in the amount as per your latest income proof

PAN(Permanent Account Number)

Please enter correct PAN number

Form 60

Only applicable for person belonging to Arunachal Pradesh, Manipur, Mizoram, Nagaland, Tripura, Jammu & Kashmir.

Neither my income nor the income of any other person in the respect of which I am assessable under the act in the excess of the maximum amount not chargeable to income tax in any previous year.

Please Acknowledge this to Proceed

Provide details for Electronic Insurance Policy What is Electronic Insurance Policy?

Provide existing E-Insurance Account Number

Open E-Insurance Account Number

Preferred Insurance repository that you would like to have eIA with

Karvy Insurance Repository Limited#KVY,CAMS Repository Services Limited#CAM

Enter E-Insurance Account Number(e-IA)

Aadhar No

Central Insurance Repository Limited#CIR,Karvy Insurance Repository Limited#KVY,CAMS Repository Services Limited#CAM

Do you have Aadhaar Card no. or Aadhaar Enrollment no.?

Yes No

I have an

Aadhaar Card Number

Please enter valid aadhaar number

Aadhaar card enrollment number

Please submit physical enrolment copy after proposal form completion.

Enter Enrollment Number

My mobile number is updated in UIDAI and I want to proceed paperless journey through OTP authentication

Enter OTP

You have only 1 attempts

You have entered wrong OTP.Try resending OTP again.

Did not receive your OTP within 60 sec?

You have tried maximum times. Please try sending OTP.

You have exceeded maximum attempts, please proceed with physical aadhaar option

Please enter valid aadhaar number

Your Aadhaar is not linked with your mobile number.Please Proceed with physical aadhar submission.

Something went wrong. Please try after sometime.

My mobile number is not updated in UIDAI. I will submit the physical copy of adhaar

Your Aadhaar has been successfully verified!!

Insurance History

These details are crucial to process your application. Please state any life insurance cover including savings, investment or term insurance except for credit life insurance. We may have additional requirements based on the overall insurance coverage.

Do you have any life and/or Critical Illness Insurance plans/riders that is active or has ever been declined/postponed or accepted with modified terms?

Yes No

Name of Insurance Company

Max Life Insurance Co. Ltd #Max Life Insurance Co. Ltd ,Bajaj Allianz Life Insurance Company Limited#Bajaj Allianz Life Insurance Company Limited .,Birla Sun Life Insurance Co. Ltd#Birla Sun Life Insurance Co. Ltd ,HDFC Standard Life Insurance Co. Ltd#HDFC Standard Life Insurance Co. Ltd ,ICICI Prudential Life Insurance Co. Ltd #ICICI Prudential Life Insurance Co. Ltd ,ING Vysya Life Insurance Company Ltd.#ING Vysya Life Insurance Company Ltd.,Life Insurance Corporation of India #Life Insurance Corporation of India ,PNB Metlife India Insurance Co. Ltd.#PNB Metlife India Insurance Co. Ltd.,Kotak Mahindra Old Mutual Life Insurance Limited#Kotak Mahindra Old Mutual Life Insurance Limited ,SBI Life Insurance Co. Ltd#SBI Life Insurance Co. Ltd ,Tata AIA Life Insurance Company Limited#Tata AIA Life Insurance Company Limited ,Reliance Life Insurance Company Limited.#Reliance Life Insurance Company Limited.,Aviva Life Insurance Company India Limited#Aviva Life Insurance Company India Limited,Sahara India Life Insurance Co. Ltd.#Sahara India Life Insurance Co~ Ltd.,Shriram Life Insurance Co. Ltd.#Shriram Life Insurance Co~ Ltd.,Bharti AXA Life Insurance Company Ltd.#Bharti AXA Life Insurance Company Ltd.,Future Generali India Life Insurance Company Limited#Future Generali India Life Insurance Company Limited,IDBI Federal Life Insurance Company Ltd#IDBI Federal Life Insurance Company Ltd,Canara HSBC Oriental Bank of Commerce Life Insurance Company Ltd.#Canara HSBC Oriental Bank of Commerce Life Insurance Company Ltd.,AEGON Religare Life Insurance Company Limited.#AEGON Religare Life Insurance Company Limited. ,DLF Pramerica Life Insurance Co. Ltd.#DLF Pramerica Life Insurance Co. Ltd.,Star Union Dai-ichi Life Insurance Co. Ltd.#Star Union Dai-ichi Life Insurance Co. Ltd.,IndiaFirst Life Insurance Company Limited#IndiaFirst Life Insurance Company Limited,Edelweiss Tokio Life Insurance Co. Ltd.#Edelweiss Tokio Life Insurance Co. Ltd.,Others#Others

Policy No

Total Sum Assured

Policy Status

Issued#issued,Pending #pending,Lapsed#lapsed,Declined for Medical Reasons#declined,Extra Premium#extra,Coverage Reduction#reduction,Postponed#postponed

Type of Policy

CI(Critical Illness)#DD,Cancer#Cancer

Add new

Name	Sum	Type	Status

Add new

Name	Sum	Type	Status

We regret to inform that you are not eligible for the selected plan basis the income amount entered. If you have entered the income amount by mistake, please click ‘Reselect’ to reselect the income or type again.

RESELECT

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It seems you are not eligible for avail Cancer Care Insurance. Please check out other products from max life and choose the one that suits your need.

Home

Nominee Details

Title

Mr.#1,Ms.#2

First Name

Middle Name (Optional)

Last Name

Father's/Husband's Name

DOB of Nominee

Gender

Male#M,Female#F

Relation with Nominee

Spouse#SPOUSE,Parents#PARNTS,Others#OTHERS

Guardian Section

Full Name

Guardian Relation

Brother#BRO,Daughter#DGHTR,Parents#PARNTS,Sister#SISTER,Son#SON,Spouse#SPOUSE,Others#OTHERS

Bank Details of Proposer

Bank A/C Number

Account Holder Name

IFSC Code

MICR Code

Bank and Branch Name

Type of Bank Account

CURRENT ACCOUNTS#Current,SAVING ACCOUNTS#Savings,OTHERS / FIXED / TERM ACCOUNTS#Others

Banking Since

IFSC code should be 11 and MICR should be 9 characters

Provide correct IFSC Code

Provide correct MICR Code

Provide correct IFSC and MICR Codes

Lifestyle & Well-being

Habit

Does the insured consume or has ever consumed Tobacco/Nicotine products in the last one year?

Yes No

Type of Tobacco/Nicotine products consumed

Cigarette#Cigarette,Beedis#Beedis,Cigar#Cigar,Gutka#Gutka,Flavoured Pan Masala#FlavouredPanMasala,Khaini#Khaini

Type of Tobacco/Nicotine products consumed

Cigarette#Cigarette,Beedis#Beedis,Cigar#Cigar,Gutka#Gutka,Flavoured Pan Masala#FlavouredPanMasala,Khaini#Khaini

provide details

Frequency

Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally

Frequency

Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally

provide details

Quantity (In sticks/pouches)

Add new

Type	Frequency	qunatity

Does the insured consume or has ever consumed alcohol?

Yes No

Type of alcohol consumed

Beer#Beer,Wine#Wine,Hard Liquor#HardLiquor

Type of alcohol consumed

Beer#Beer,Wine#Wine,Hard Liquor#HardLiquor

provide details

Frequency

Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally

Frequency

Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally

provide details

Quantity in ml

Add new

Type	Frequency	qunatity

Height & Weight

Height In

Feet-Inches#FT,Cms#CM

Height In

Feet-Inches#FT,Cms#CM

provide details

for e.g 5'06"

Weight (in Kgs)

Payor Details

Is the premium payment done by someone else other than you (Payor)?

Yes No

Parents

Spouse#Spouse,Parents#Parents,Other#Other

Please note that 'Know Your Customer (KYC) documents, i.e., ID proof, address proof and latest photograph of the person making the payment would be required as per regulatory guidelines. So, kindly email us at online@maxlifeinsurance.com or upload them.

Do payor have Aadhaar Card no. or Aadhaar Enrollment no.?

Yes No

Does payor have an

Aadhaar Card Number

Please submit the payor’s physical Aadhaar card copy after Proposal form completion

Enter aadhaar card number

Aadhaar card enrollment number

Please submit the payor’s physical Aadhaar enrolment copy after Proposal form completion

Enter Enrollment Number

Your Aadhaar has been successfully verified!!

First Name of Payor

Middle Name of Payor (Optional)

Last Name of Payor

PAN Number

Date of Birth

Age Cannot be less than 25 Years.

Address

Annual Income

CKYC

CKYC is a centralized repository of KYC records of customers in the financial sector with uniform KYC norms and inter-usability of the KYC records across the sector with an objective to reduce the burden of producing KYC documents and getting those verified every time when the customer creates a new relationship with a financial entity.

CKYC

What is CKYC?

Do you have a CKYC number?

Yes No

CKYC Number

Mother's First Name

Mother's Last Name

City/Place of Birth

Address Proof

Select your address proof type

Passport#9,Driving License#10,Aadhaar/UID Card#13,Voter ID#17,Nrega ID#18,Others#20

Please Specify

Address proof Expiry Date

Identification Proof

Select your ID proof type

Pan Card#PC,Passport#PP,Driving License#DL,Voter ID#VID,Adhaar#Adhaar,NREGA ID#NI

ID Proof Number

ID Proof Expiry Date

ckycNumber = Please enter correct value. # expiryDate = Date should be greater than today's date # expirydaqteMismatch = Expiry date doesn't match.

Confirm Your Details

Basics About You

Basics About You(Insured)

Insured Details

Insured Name

Insured Father's/Husband's name

Insured Date of birth

Insured Gender

Insured Marital Status

Full Name Prior to Marriage

Spouse Occupation

Total insurance cover on spouse

Spouse's Annual Income

I am Pregnant

Number of Months

Insured Nationality

Education

Basics About You(Proposer)

Name

Father's/Husband's name

Date of birth

Gender

Marital Status

Full Name Prior to Marriage

Spouse Occupation

Total insurance cover on spouse

Spouse's Annual Income

I am Pregnant

Number of Months

Mobile Number

Email Address

Nationality

Education

Correspondence Address

Employment Details

Employment Details for Insurer

Occupation Type

Name of the Employer

Job Title

Annual Income

Employment Details for Proposer

Occupation Type

Name of the Employer

Job Title

Annual Income

PAN(Permanent Account Number)

Form 60

Neither my income nor the income of any other person in the respect of which i am assessable under the act in the excess of the maximum amount not chargeable to income tax in any previous year

Do you wish to hold this policy electronically with any Insurance Repository? What is Electronic Insurance Policy?

Provide existing E-Insurance Account Number

Preferred Insurance repository that you would like to have IA with

Please enter your 12 digit Aadhar card number

Insurance History

Do you have any life and/or Critical Illness Insurance plans/riders that is active or has ever been declined/postponed or accepted with modified terms?

Nominee Details

Title

Father's/Husband Name

DOB of Nominee

Gender

Relation with Nominee

Relation

Guardian Name

Relation with Guardian

Bank Details

Bank A/C Number

Account Holder Name

IFSC Code

MICR code

Bank and Branch Name

Type of Bank Account

Banking Since

Lifestyle & Well-being

Habit

Do insured consume or have ever consumed Tobacco/Nicotine products in the last one years?

Do insured consume or have ever consumed alcohol?

Height and Weight

Height

Weight(in kgs)

Health

Have insured ever been investigated/Diagnosed or treated for any of the following: a. Have you suffered from or received investigation or treatment for any form of Cancer, sarcoma, tumor, or pre-cancerous conditions? b.Have any of your parents (below age 60 yrs), sisters or brothers suffered from any form cancer or tumours?

Details:

Is insured suffering from or ever suffered from , Hepatitis B, Hepatitis C, Liver disease, fatty liver due to alcohol, Barrett's Oesophagus, Crohn's Disease, Peptic Ulcer, Ulcerative Colitis, HIV/AIDs, Chronic Glomerulonephritis, Chronic Kidney Disease, Polycystic Kidney Disease, Anaemia?

Details:

Have insured suffered from or been investigated for any of the following in the past 12 months:

a. Recurrent cough, hoarseness of voice, or difficulty in swallowing for a Continuous period of 15 days?

b. Any persistent loss of blood or unusual discharge from any part of the body?

c. Weight loss more than 5 kg within 6 months?

d. Any ulceration, growth, nodule, cyst or lump in any part of the body?

Details:

Have insured undergone any of the listed investigations below or have had abnormal findings in the last 12 months (if applicable)

A. Ultrasound

B. Endoscopy/Colonoscopy

C. CT SCAN/MRI/PET SCAN

D. Biopsy/FNAC

E. PAP Smear

F. Mammography

G. Blood test for cancer diagnosis

Details:

Payor Details

Is the premium payment done by someone else other than you (Payor)?

Name of Payor

Gender

PAN Number

Relationship with Life Insured

Address

Annual Income

₹

Date of Birth

CKYC

Do you have a CKYC number?

CKYC number

Mother's First Name,Last Name

City/Place of Birth

Address Proof

Address Proof Type

Please specify

Address Proof Expiry Date

Identification Proof

ID Proof Type

ID Proof Number

ID Proof Expiry Date

Sorry!

As per your question selection, you are not eliglible for cancer care plans, please contact customer care and look for other plans on Max Life

Talk to our representative

Toll Free Number 1800 200 3383

Max Life Home Page

Add Waiver of Premium Plus Rider to get the maximum benefit out of your plan.

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Waiver of Premium Plus Rider

Get the Premium waiver for just 550 per annum in case of critical illness or dismemberment.

The coverage of this rider will be 35 years.

71% customers who bought Term Plan also bought WOP

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One Time Password (OTP) Authentication

You will receive a four digit verification code on and within the next 60 seconds.

This code will be valid for 30 min.

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You have a maximum of 5 attempts

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E-bank statement

E-bank statement's description.

Upload Document

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Upload Your Documents

Please upload the following self-attested documents to complete your application process. This is required to validate the information as provided by you in the application.

(10 MB limit per document. Only PDF, Tiff & JPEG allowed)

In case, you face any issues during upload, you may email the same to us at online@maxlifeinsurance.com

For proposer

Photograph(recent) tick

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Perfios document is uploaded successfully.

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What is e-bank statement?

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Max Life Cancer Insurance Plan

Get details on your email and SMS to continue buying the policy later

Get Your Cancer Insurance Quote

Before you proceed to buy, tell us a bit about yourself

Basics About You (Insured)

Basics About You (Proposer)

Your Communication Address (Proposer)

Employment and Insurance

Employment Details for Insured

Employment Details for Proposer

Insurance History

Nominee Details

Guardian Section

Bank Details of Proposer

Lifestyle & Well-being

Habit

Height & Weight

Health

Payor Details

CKYC

What is CKYC?

Address Proof

Identification Proof

Confirm Your Details

Basics About You(Insured)

Insured Details

Basics About You(Proposer)

Employment Details for Insurer

Employment Details for Proposer

Insurance History

Habit

Height and Weight

Health

Add Waiver of Premium Plus Rider to get the maximum benefit out of your plan.

Waiver of Premium Plus Rider

Your Payment Summary

Complete your payment

Choose Your Credit Card

Important Message

Choose your Credit Card type

Choose your Debit Card type

Select your Bank

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Complete your payment

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Important Message

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Upload Document

Upload Your Documents

For proposer

For insured