• Arthritis / spondylosis or any other bone / muscle / joint disorder
• Disease of the nose / throat / ear / eye / dental
• Anaemia / leukemia or any other blood disorder
• HIV / AIDS / any sexually transmitted disorder
• Psychiatric / mental illness or sleep disorders
• DUB, Fibroid, Cyst, Fibroadenoma or any other Gynaecological disorder, menopause & GPAL History
• Been addicted to alcohol / Smoking / Pan Masala / Gutka / narcotics / habit forming drugs or under any detoxication therapy
• Been under any regular medication (self / prescribed including hormones or OC Pills)
• Undertaken any lab tests like blood / urine / stool or any imaging tests like sonography / MRI / CT / X-Rays in the last 5 yrs
• Undertaken any surgery or advised any surgery in the last 10 yrs or is a surgery pending?
• Suffered from any other illness / disease / accident / injury
• Is any of the proposed insured pregnant?
• Any complaint of diabetes, hypertension or any complication during current or earlier pregnancy?
Adults/Childs Detail
No. of Persons
Sum Insured
Deductible
DOB
Relation
1 Adult
2 Adult
3 Adult
4 Adult
1 Child
2 Child
3 Child
1 Adult
2 Adult
3 Adult
4 Adult
1 Child
2 Child
3 Child
* All field's are mandatory
In case of any grievance / complaint :
Level 1:
In case of grievances write at: for Securities Broking and Investment Advisory services: grievance@rsec.co.in
Level 2 :
Please contact Compliance Officer of the Stock Broker/Investment Advisory/Depository
Participant (Ms. Shailly Shanbhag)
Email-ID (rsec.compliance@relianceada.com) and Phone No. +91-22-4168 1200
Level 3 :
You may also approach CEO and Principal Officer for Investment Advisory Services (Mr. Lav Chaturvedi)
Email-ID (rsm.ceo@relianceada.com) and Phone No. + 91-22-4168 1200
If not satisfied with the response of the Stock Broker / Depository Participant, contact the concerned Stock Exchange / Depository at the following:
In case not satisfied with the response related to Investment Advisory Service, please contact the concerned SEBI regional / local office at: SEBI Bhavan BKC, Plot No.C4-A, 'G' Block, Bandra-Kurla Complex, Bandra (East), Mumbai - 400051, Maharashtra
