I hereby agree to make payments of premiums to, and authorise ICICI Prudential Life Insurance Company (“the Company”) to debit the
given Credit Card account with the amount of the premium as would be applicable for the insurance plan and policy for the term
chosen by me and obtaining the credit of such amount in favour of the Company.
For Standing Instruction, I hereby authorise the Company to continue debiting the Credit Card account with the amount of the
subsequent premiums as applicable under the insurance plan and policy obtaining the credit of such amount in favour of the
Company for the duration of the insurance plan and policy, subject to the terms and conditions under the policy.
I understand and agree that the risk under the insurance plan and the policy will be assumed by the Company only after my credit card
account is debited with the amount of the premium and not earlier. I understand and agree that non-receipt in case of the first premium
payable under the policy shall result in the policy becoming void, whereas in respect of subsequent premiums shall result in lapsation
of the Policy, such lapsation being governed by the terms and condition of the policy.
I hereby agree and confirm that the Credit Card issuing bank is not acting as an agent of the Company or myself in accepting the debit
to the Credit Card account with the premium amount(s), or otherwise dealing with the premium amounts(s) payable under the policy,
in any manner.
I understand and agree that in the event my Credit Card account expires, or is not renewed by me for any reason, I shall comply with
the Company's direction in ensuring that any premium amount payable by me is paid to Company through any of the modes of
payment prevailing and made available by the Company at that point of time.
Please tick if you would like to choose to auto-debit
subsequent premium payments on your credit card
Please tick if you would like to debit only this current
premium amount due