1. I/We hereby declare that the particulars given are correct and complete.
2. I/We authorise the mentioned bank to debit my/our account if my/our auto debit e-mandate is active and until I/we give a written request for cancellation of auto debit e-mandate.
3. I/We undertake to keep sufficient funds in the account mentioned in the e-mandate as on the date of execution of debit.
4. I/We hereby authorise the Bank/Tech Process Solutions Ltd/Bill desk/any other intermediaries to communicate my/our funding account number and any other account details (as may be necessary) to HDFC Life Insurance Company Limited (HDFC Life) for the specific purpose of recovering my/our HDFC Life premium payments through a debit instruction to my/our account.
5. I/We hereby authorise HDFC Life, in the instance of the auto debit failing for any reason, to authorise the Bank/Tech Process Solutions Ltd/Bill desk to recover the premium payable through a direct debit to my/our account with the mentioned bank.
6. I/We understand in case of auto debit, the Net Asset Value (NAV) would be allotted on the day of receipt subject to realisation. If the debit happens on a holiday, Saturday or Sunday, the NAV of the subsequent working day will be considered.
7. The premium will be debited starting from the premium due date, which occurs after the date of this e-mandate, till the last premium due date unless the instruction is revoked.
8. Maximum amount registered will be up to 1.5 times of the modal premium amount. Higher amount will be registered to accommodate any increase in premium due to changes in taxes, scheduled increase as per product specification or changes in frequency payment.
9. Debit frequency will be tagged as and when presented.
10. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/we will not hold HDFC Life or the other intermediaries responsible.
11. I/We hereby authorise HDFC Life to debit my account with the amount of taxes and other levies as may be stipulated by the Government, from time to time, on the premium amount and for this purpose, no further or revised authority is required by HDFC Life.
12. I/We wish to avail the e-mandate facility and hereby express my/our unconditional consent to debit the premium amount above through participation in direct debit. I/We understand and agree that premium amount to be debited from my/our account may vary due to taxes and other statutory levies as may be applicable from time to time.
13. I/We understand and accept that the transaction will be effected on the policy on the due date (provided the day is working day). I/We agree to discharge the responsibility expected of me/us as policyholder(s) under the policy. I/We take full responsibility of correctness of the details filled herein.
14. I/We understand and agree that submission of this form does not mean that the request will be processed.
15. I/We understand that any payout under the policy shall be strictly in accordance with the policy terms and conditions. Also, any payment shall be subject to realisation of the last renewal premium payment.
16. I/We agree that in the event of any violation by me/us of any undertaking confirmed herein, HDFC Life shall be entitled to invoke remedies available to it in terms of the policy document.
17. I/We agree that in the event of the Bank being unable to debit my/our account for want of sufficient funds or for any other reason, HDFC Life shall be entitled to deal with my/our policy in the manner as described in the policy provisions, unless the payment is received by any alternate mode on or before the specified date.
18. In case auto debit request is given within 10 days of current premium due date, amount for the current due may be debited in the grace period of the policy, subject to realisation of all last premium payment.
19. For SI with HDFC bank, premium will be debited from your account on debit date. However, in case of failure, we will debit your account anytime again upto 180 days from date of debit.
20. I authorize the Company to deduct all the outstanding premium along with interest (in case of non Unit Linked Products) for the purpose of revival. I am aware that in case of Conventional products, company may deduct the Mortality and the other charges for the period while the policy was in lapsed stage. I understand that the Company reserves the right to refuse revival of the policy.
21. In case a preferred day of debit is selected, the debit attempt will done on the Preferred Billing Date instead of the premium due date.
22. I authorize HDFC Life to debit premium starting from the next premium due date, which falls after the date of submission of this e-mandate, and it will continue till the last premium due date, unless the instruction is revoked by me.
23. I authorize HDFC Life to activate mandate on a higher amount than the actual premium amount, keeping a buffer to ensure successful auto-debit in future.
24. I authorize HDFC Life - In case a preferred debit date is selected, the debit attempt will be made on the Preferred Billing Date, instead of the premium due date.
25. I authorize HDFC Life to register mandate for a few days beyond the policy term to debit last premium in grace, if asked by me.
26. I ensure to fund my account / card before the due date. Non receipt of Premium by grace end date may result in interest & late fee charges on policy. I hereby agree and confirm that in case of delay in premium debit interest and late fee charges as applicable shall also be debited from my account / card.
27. I agree to pay the Convenience Fee (incl. applicable taxes) that Payment partner of HDFC Life will levy while paying premium via Credit Card, and understand that such fee shall be non-refundable.
28. I acknowledge that HDFC Life is not liable to provide any invoice for Non-Refundable Convenience Fee (incl. applicable taxes) that Payment Partner will levy and the fee will not be adjusted against my policy.
29. I understand that in case of auto-debit registration, for all subsequent premiums collected via Standing Instruction on my Credit card, convenience fee (incl. applicable taxes) shall be levied by the payment partner of HDFC Life, and such fee shall be non-refundable.