Get Quote: Cancer Insurance Plan

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

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Basics About You (Insured)

Mr#1,Ms#2
Mr#1,Ms#2
Please enter the value for First Name
Please enter the value for middle name
Please enter the value for last name
Please enter the value for father's/husband's name
Male#M,Female#F
Male#M,Female#F
Single#SNG,Married#MRD,Divorced#DVR,Widow(er)#WDR
Single#SNG,Married#MRD,Divorced#DVR,Widow(er)#WDR
Please enter the value for full name prior to marriage
Please enter the value for spouse's occupation
Please enter the value for insurance cover on spouse
Please enter the value for spouse's annual income
Please enter the value for spouse's policy number (Optional)

<=6 months#Less,>6 months#Greater
<=6 months#Less,>6 months#Greater
Indian#I,NRI#O
Indian#I,NRI#O
Graduate#GRA,Illiterate#ILL,Primary School#PRS,Higher Secondary#HIS,Post Graduate #POG,Professional#PRO
Graduate#GRA,Illiterate#ILL,Primary School#PRS,Higher Secondary#HIS,Post Graduate #POG,Professional#PRO

Basics About You (Proposer)

Mr#1,Ms#2
Mr#1,Ms#2
Please enter the value for First Name
Please enter the value for middle name
Please enter the value for last name
Please enter the value for father's/husband's name
Male#M,Female#F
Male#M,Female#F
Single#SNG,Married#MRD,Divorced#DVR,Widow(er)#WDW
Single#SNG,Married#MRD,Divorced#DVR,Widow(er)#WDW
Please enter the value for full name prior to marriage
Please enter the value for spouse's occupation
Please enter spouse existing sum assured value
Please enter the value for spouse's annual income
Please enter the value for spouse's policy number

<=6 months#Less,>6 months#More
<=6 months#Less,>6 months#More
Please enter the value for mobile number
Please enter the value for alternate mobile number
Please enter the value for email address
Indian#I,NRI#O
Indian#I,NRI#O
Graduate#GRA,Illiterate#ILL,Higher Secondary#HIS,Post Graduate#POG,Professional#PRO
Graduate#GRA,Illiterate#ILL,Higher Secondary#HIS,Post Graduate#POG,Professional#PRO

Your Communication Address (Proposer)

Enter the value for permanent House No./Apt. Name/Society
Enter the value for permanent Road/Area/Sector
Enter the value for permanent landmark
Enter the value for pincode
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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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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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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
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
Please fill in the amount as per your latest income proof

Employment Details for Proposer

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
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
Please fill in the amount as per your latest income proof
Please enter correct PAN number

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

Please Acknowledge this to Proceed

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

Central Insurance Repository Limited#CIR,Karvy Insurance Repository Limited#KVY,CAMS Repository Services Limited#CAM
Central Insurance Repository Limited#CIR,Karvy Insurance Repository Limited#KVY,CAMS Repository Services Limited#CAM
Aadhar No
Central Insurance Repository Limited#CIR,Karvy Insurance Repository Limited#KVY,CAMS Repository Services Limited#CAM
Central Insurance Repository Limited#CIR,Karvy Insurance Repository Limited#KVY,CAMS Repository Services Limited#CAM

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?

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
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
Issued#issued,Pending #pending,Lapsed#lapsed,Declined for Medical Reasons#declined,Extra Premium#extra,Coverage Reduction#reduction,Postponed#postponed
Issued#issued,Pending #pending,Lapsed#lapsed,Declined for Medical Reasons#declined,Extra Premium#extra,Coverage Reduction#reduction,Postponed#postponed
CI(Critical Illness)#DD,Cancer#Cancer
CI(Critical Illness)#DD,Cancer#Cancer
Name Sum Type Status
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.

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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.

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Nominee Details

Mr.#1,Ms.#2
Mr.#1,Ms.#2
Please enter the value
Please enter the value
Please enter the value
Please enter the value
Male#M,Female#F
Male#M,Female#F
Spouse#SPOUSE,Parents#PARNTS,Others#OTHERS
Spouse#SPOUSE,Parents#PARNTS,Others#OTHERS
Brother#BRO,Daughter#DGHTR,Grand Child#GNDCLD,Sister#SISTER,Son#SON
Brother#BRO,Daughter#DGHTR,Grand Child#GNDCLD,Sister#SISTER,Son#SON

Appointee Section

Please enter appointee full name
Brother#BRO,Daughter#DGHTR,Parents#PARNTS,Sister#SISTER,Son#SON,Spouse#SPOUSE,Others#OTHERS
Brother#BRO,Daughter#DGHTR,Parents#PARNTS,Sister#SISTER,Son#SON,Spouse#SPOUSE,Others#OTHERS

Bank Details of Proposer

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

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

Cigarette#Cigarette,Beedis#Beedis,Cigar#Cigar,Gutka#Gutka,Flavoured Pan Masala#FlavouredPanMasala,Khaini#Khaini
Cigarette#Cigarette,Beedis#Beedis,Cigar#Cigar,Gutka#Gutka,Flavoured Pan Masala#FlavouredPanMasala,Khaini#Khaini
Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally
Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally
Type Frequency qunatity

Does the insured consume or has ever consumed alcohol?

Beer#Beer,Wine#Wine,Hard Liquor#HardLiquor
Beer#Beer,Wine#Wine,Hard Liquor#HardLiquor
Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally
Per Day#Per Day,Per Week#Per Week,Per Month#Per Month,Occasionally#Occasionally
Type Frequency qunatity

Height & Weight

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Feet-Inches#FT,Cms#CM
Feet-Inches#FT,Cms#CM

Health

Your premium may increase basis the medical conditions disclosed by you and subject to underwriting assessment.

Has the insured ever been investigated, diagnosed or treated for any of the following:

a. Has the insured suffered from, undergone investigation or treatment for any forms of cancer, sarcoma, tumor, or pre-cancerous conditions?

b. Has any of your parents (below age 60 yrs.), sisters or brothers suffered from any forms of cancer or tumour?

Is the insured suffering from or has 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?

Has the 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 period of 15 days continuously?

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

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

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

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

Payor Details

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

Spouse#Spouse,Parents#Parents,Other#Other
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.

CKYC

CKYC

What is CKYC?

Do you have a CKYC number?

CKYC Number
Mother's First Name
Mother's Last Name
City/Place of Birth

Address Proof

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

Identification Proof

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

Title

First Name

Middle Name

Last Name

Father's/Husband Name

DOB of Nominee

Gender

Relation with Nominee

Relation

Appointee Name

Relation with Appointee

Bank A/C Number

Account Holder Name

IFSC Code

MICR code

Bank and Branch Name

Type of Bank Account

Banking Since

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:

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

Address Proof

Identification Proof

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

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Toll Free Number 1800 200 3383

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Waiver of Premium Plus Rider

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The coverage of this rider will be 35 years.

71% customers who bought Term Plan also bought WOP

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Your Payment Summary

Your equote number -

Sum assured

Term years

Plan Premium

Service Tax(%) Goods and Service Tax*

Total Payable Premium

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GST Includes all taxes and cess

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(%) Goods and Service Tax*

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Your premium amount may change based on the GST applicable in your communication address.

GST Includes all taxes and cess

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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.

(2 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)

Payor Photo

For insured