Because Every Ride Deserves Protection.

Declaration and Consent

I hereby declare that I am in Good Health. I also hereby agree to the Terms & Conditions (as per the Policy Document) of this policy and confirm that all the information and documents provided are true and correct. I also hereby authorize Guardian Life Insurance Limited and its representatives to contact me and to share my information on a confidential basis with third parties for evaluating & processing this proposal and future investigation(s) that may arise.

I am currently not receiving any treatment, have not been treated, and have not been advised to undergo treatment for Cancer, AIDS, Kidney, Liver or Lung Disorder, Brain Diseases, Heart or Blood Diseases. I am not currently totally or partially disabled to work due to sickness or an accident, and I do not have any physical impairment, psychiatric illness, or any mental or nervous disorder. I acknowledge that any pre-existing medical condition(s) that I had before the inception of this policy—whether diagnosed or undiagnosed—shall not be covered under this insurance policy, unless explicitly stated otherwise in the policy document. Any future claims arising directly or indirectly from such pre-existing conditions may be excluded from coverage.

I hereby also declare that I have not furnished any false information or concealed any material fact in my application. If any concealment of material fact or misstatement is proved in the future or at the time of settlement of claims, this contract shall be cancelled from the beginning of this policy, deposited premiums will be forfeited, and the claim shall be repudiated.