Proposer Details

Name Mr. Nallagandla Raj Prakash Reddy(Married) Address Vidyavathi,9­4­78/79 Radha KRISHNA balikaha bhavan,nanal nagar

Date of Birth 23­11­1978 Mobile No xxxxxx7092
Primary Email chendreddy@gmail.com City Hyderabad(Telangana)
Pincode 500008 State Telangana

Member Information
Birth Date (DD­ Relationship with
Name Height(In) Weight(Kgs) Gender Proposer MaritalStatus Nominee Age Occupation BMI
MM­YYYY) Nominee

Relation Nallagandla Raj Prakash Nallagandla Self

68 76 Male 23­11­1978 Yes Married Wife 40 25.4758294983718
Self Reddy Vidyavathi Employed

Relation Nallagandla
Nallagandla Vidyavathi 59 96 Female 04­08­1981 ­­ Married Wife 38 Salaried 42.7464227522537
Spouse Vidyavathi

Relation Nallagandla
Nallagandla Keerthana 48 16 Female 28­09­2013 ­­ Single Wife 5 Student 10.7639104167097
Daughter Vidyavathi

Relation Nallagandla
Nallagandla Yoganand Reddy 50 49 Male 05­05­2010 ­­ Single Wife 9 Student 30.3800607601215
Son Vidyavathi

Booking Information
Ref ID Insurer Plan Sum Insured Term Premium Proposal No Payment Status
144620182 Max Bupa Health Recharge 500000 1 2964 81100090794 Successful
144619155 Max Bupa Health Companion with Recharge (Money Saver) 300000 1 12257 PBPF29580296 Successful

Medical Information
Member Name Question Answer Description Policy Type
Is the applicant currently suffering from any symptom(s) or complaint(s) persisting from more than five
Nallagandla Raj Prakash Reddy No Health Policy
consecutive days for which he/she has not consulted a doctor?
Nallagandla Raj Prakash Reddy Treating Doctor's name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Other than routine health check­up, has the applicant EVER undergone or been advised to undergo any
Nallagandla Raj Prakash Reddy diagnostic test/investigation including but not limited to Thyroid Profile, Treadmill test, Angiography, No Health Policy
Echocardiography, Endoscopy, Ultrasound, CT Scan, MRI, Biopsy and FNAC?
Nallagandla Raj Prakash Reddy Treating Doctor's name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Has the applicant EVER been prescribed or taken any form of treatment or medication (including oral /
Nallagandla Raj Prakash Reddy No Health Policy
inhalation / injection), for a period of more than seven days?
Nallagandla Raj Prakash Reddy Treating Doctor's name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Has the applicant EVER undergone or been advised to undergo or does he/she plan to undergo any
Nallagandla Raj Prakash Reddy Yes Health Policy
form of surgery or procedure?
Nallagandla Raj Prakash Reddy Treating Doctor's name and Contact Details Yes DrV Chandra mohan Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) Yes Complete Health Policy
Nallagandla Raj Prakash Reddy Dosage Yes 100 mg Health Policy
Nallagandla Raj Prakash Reddy Medication Yes Pain tablets Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition Yes 10 days Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY Yes 17­06­2019 Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone Yes Kidney stones surgery Health Policy
Since you have answered Yes in the previous questions, please tick the relevant box(es) below,
Nallagandla Raj Prakash Reddy Yes Health Policy
corresponding to the type(s) of disorder and/or body system(s) affected.
Nallagandla Raj Prakash Reddy Any other conditions No Health Policy
Nallagandla Raj Prakash Reddy Skin disorders (Psoriasis, leucoderma, eczema, dermatitis, erthyema, vitiligo, etc.) No Health Policy
Blood­related disorders (HIV / AIDS, anaemia, thalassaemia, haemophilia or any other blood related
Nallagandla Raj Prakash Reddy No Health Policy
problem.)
Gynaecological disorders (Fibroid, cyst, menstrual disorder, pelvic infection, breast lump / mass,
Nallagandla Raj Prakash Reddy No Health Policy
endometriosis, etc.)
Ear, nose, eye and throat disorders (Recurrent ear discharge, polyp, persistent sinusitis, hearing loss,
Nallagandla Raj Prakash Reddy No Health Policy
vision problem, nasal septum disorders, laryngitis / adenoiditis / tonsillitis, etc.)
Bone and muscle disorders (Arthritis, ligament / cartilage tear, bone fracture or pain, chronic joint /
Nallagandla Raj Prakash Reddy No Health Policy
muscle pain, gout, sciatica, etc.)
Endocrine disorders (Abnormal thyroid function, goitre, hypothyroidism, impaired glucose tolerance test,
Nallagandla Raj Prakash Reddy No Health Policy
abnormal HbA1c, abnormal growth hormone function, etc.)
Psychiatric and nervous disorders (brain/spine) (Sudden loss of consciousness, decrease in strength /
Nallagandla Raj Prakash Reddy movement of limbs, paralysis, loss of speech or memory, tremors, stroke, seizure / epilepsy / fits, No Health Policy
Parkinsonism, Alzheimer's, etc.)
Stomach, intestine, liver, gall bladder, pancreas, appendix disorders (Stones, persistent stomach pain,
Nallagandla Raj Prakash Reddy sudden loss of weight, hemorrhoids, ulcer, blood in vomiting or stool, painful defecation, ulcerative No Health Policy
colitis, Crohn's disease, jaundice, hepatitis, pancreatitis, appendicitis, etc.)
Lung and respiratory disorders (Persistent hoarseness / cough, difficulty in breathing, asthma, chronic
Nallagandla Raj Prakash Reddy No Health Policy
bronchitis, tuberculosis, any lung infection, etc.)
Heart and circulatory system related disorders (Swelling of leg(s), painful / visible leg veins, high
Nallagandla Raj Prakash Reddy cholesterol, chest pain, breathlessness on exertion, palpitations, loss of consciousness, angina, heart­ No Health Policy
attack, etc.)
Kidney, urinary and prostate disorders (Stones, sugar / albumin / blood in urine, pain/difficulty in
Nallagandla Raj Prakash Reddy Yes Health Policy
urination, dialysis, kidney failure, etc.)
Cancer & related disorders (Benign/malignant tumour, leukaemia, lumps, swelling, mass, cysts, changes
Nallagandla Raj Prakash Reddy No Health Policy
in mole, etc.)
Nallagandla Raj Prakash Reddy Does the applicant have diabetes or pre­diabetes or has he/she EVER had high blood sugar? No Health Policy
Nallagandla Raj Prakash Reddy Treating Doctor's name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Nallagandla Raj Prakash Reddy How long ago was the applicant first diagnosed with diabetes / pre­diabetes / high blood sugar? No Health Policy
Nallagandla Raj Prakash Reddy Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via No medicine? No Health Policy
Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via Homeopathic or other
Nallagandla Raj Prakash Reddy No Health Policy
AYUSH treatment?
Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via Oral diabetic
Nallagandla Raj Prakash Reddy No Health Policy
medication?
Nallagandla Raj Prakash Reddy Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via Insulin? No Health Policy
Nallagandla Raj Prakash Reddy Does the applicant have Hypertension or High Blood Pressure? No Health Policy
Nallagandla Raj Prakash Reddy Treating Doctor's name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Nallagandla Raj Prakash Reddy How long ago was the applicant first diagnosed with Hypertension / High Blood Pressure? No Health Policy
Nallagandla Raj Prakash Reddy How does the applicant manage his/her Hypertension / High Blood Pressure? No Health Policy
Nallagandla Raj Prakash Reddy Chewable tobacco / Gutkha / Pan Masala No Health Policy
Nallagandla Raj Prakash Reddy Please specify consumption in number of pouches per week No Health Policy
Nallagandla Raj Prakash Reddy Alcohol No Health Policy
Nallagandla Raj Prakash Reddy Spirit (ml per week) No Health Policy
Nallagandla Raj Prakash Reddy Wine (no of glasses per week) No Health Policy
Nallagandla Raj Prakash Reddy Beer (no of pints per week) No Health Policy
Nallagandla Raj Prakash Reddy Cigarettes / Bidi / Cigar No Health Policy
Nallagandla Raj Prakash Reddy Please specify per week consumption No Health Policy
Nallagandla Raj Prakash Reddy Illicit drugs No Health Policy
Nallagandla Raj Prakash Reddy Please specify per week consumption No Health Policy
Have your parents, brothers or sisters had Cancer, Diabetes, Hypertension (high blood pressure), Heart
or Kidney disease, Polycystic kidney disease, Mental or nervous disorder (including Alzheimer's Disease),
Nallagandla Raj Prakash Reddy No Health Policy
Stroke, Multiple sclerosis, Motor neuron disease or any other hereditary disorders which is
persistent/long in nature?:
Nallagandla Raj Prakash Reddy Age at Onset No Health Policy
Nallagandla Raj Prakash Reddy Age at Death No Health Policy
Nallagandla Raj Prakash Reddy Cause of Death No Health Policy
Nallagandla Raj Prakash Reddy Specify Age No Health Policy
Nallagandla Raj Prakash Reddy Is Alive No Health Policy
Nallagandla Raj Prakash Reddy Family History Disease/ Disorder No Health Policy
Nallagandla Raj Prakash Reddy Relationship to Insured ­ Brother No Health Policy
Nallagandla Raj Prakash Reddy Age at Onset No Health Policy
Nallagandla Raj Prakash Reddy Age at Death No Health Policy
Nallagandla Raj Prakash Reddy Cause of Death No Health Policy
Nallagandla Raj Prakash Reddy Specify Age No Health Policy
Nallagandla Raj Prakash Reddy Is Alive No Health Policy
Nallagandla Raj Prakash Reddy Family History Disease/ Disorder No Health Policy
Nallagandla Raj Prakash Reddy Relationship to Insured ­ Sister No Health Policy
Nallagandla Raj Prakash Reddy Age at Onset No Health Policy
Nallagandla Raj Prakash Reddy Age at Death No Health Policy
Nallagandla Raj Prakash Reddy Cause of Death No Health Policy
Nallagandla Raj Prakash Reddy Specify Age No Health Policy
Nallagandla Raj Prakash Reddy Is Alive No Health Policy
Nallagandla Raj Prakash Reddy Family History Disease/ Disorder No Health Policy
Nallagandla Raj Prakash Reddy Relationship to Insured ­ Mother No Health Policy
Nallagandla Raj Prakash Reddy Age at Onset No Health Policy
Nallagandla Raj Prakash Reddy Age at Death No Health Policy
Nallagandla Raj Prakash Reddy Cause of Death No Health Policy
Nallagandla Raj Prakash Reddy Specify Age No Health Policy
Nallagandla Raj Prakash Reddy Is Alive No Health Policy
Nallagandla Raj Prakash Reddy Family History Disease/ Disorder No Health Policy
Nallagandla Raj Prakash Reddy Relationship to Insured ­ Father No Health Policy
Nallagandla Raj Prakash Reddy To be answered for all female applicants who have EVER been pregnant No Health Policy
Nallagandla Raj Prakash Reddy Treating Doctor's name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Nallagandla Raj Prakash Reddy Please specify the number of live births (if any) No Health Policy
Nallagandla Raj Prakash Reddy Please specify the number of pregnancies (if any) No Health Policy
Nallagandla Raj Prakash Reddy Undergone abortion No Health Policy
Nallagandla Raj Prakash Reddy Undergone abnormal or complicated pregnancy No Health Policy
Nallagandla Raj Prakash Reddy Undergone caesarian section or premature delivery No Health Policy
Nallagandla Raj Prakash Reddy Currently pregnant No Health Policy
Nallagandla Raj Prakash Reddy Are you a politically exposed person (PEP) or a close relative of PEP? No Health Policy
Has any proposal for life, health, hospital daily cash or critical illness insurance on the life of the
Nallagandla Raj Prakash Reddy applicant ever been declined, postponed, loaded or been made subject to any special conditions such as No Health Policy
exclusions by any insurance company?
Nallagandla Raj Prakash Reddy Qualification Yes Matric Health Policy
Nallagandla Raj Prakash Reddy Have you ever been hospitalized for more than 5 days No Health Policy
Nallagandla Raj Prakash Reddy Treating Doctor"s name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Nallagandla Raj Prakash Reddy Do you have any pre­existing diseases / conditions? No Health Policy
Nallagandla Raj Prakash Reddy Treating Doctor"s name and Contact Details No Health Policy
Nallagandla Raj Prakash Reddy Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Raj Prakash Reddy Dosage No Health Policy
Nallagandla Raj Prakash Reddy Medication No Health Policy
Nallagandla Raj Prakash Reddy Duration of Condition No Health Policy
Nallagandla Raj Prakash Reddy Since DD/MM/YYYY No Health Policy
Nallagandla Raj Prakash Reddy Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Is the applicant currently suffering from any symptom(s) or complaint(s) persisting from more than five
Nallagandla Vidyavathi No Health Policy
consecutive days for which he/she has not consulted a doctor?
Nallagandla Vidyavathi Treating Doctor's name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Other than routine health check­up, has the applicant EVER undergone or been advised to undergo any
Nallagandla Vidyavathi diagnostic test/investigation including but not limited to Thyroid Profile, Treadmill test, Angiography, No Health Policy
Echocardiography, Endoscopy, Ultrasound, CT Scan, MRI, Biopsy and FNAC?
Nallagandla Vidyavathi Treating Doctor's name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Has the applicant EVER been prescribed or taken any form of treatment or medication (including oral /
Nallagandla Vidyavathi No Health Policy
inhalation / injection), for a period of more than seven days?
Nallagandla Vidyavathi Treating Doctor's name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Has the applicant EVER undergone or been advised to undergo or does he/she plan to undergo any
Nallagandla Vidyavathi No Health Policy
form of surgery or procedure?
Nallagandla Vidyavathi Treating Doctor's name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Since you have answered Yes in the previous questions, please tick the relevant box(es) below,
Nallagandla Vidyavathi No Health Policy
corresponding to the type(s) of disorder and/or body system(s) affected.
Nallagandla Vidyavathi Any other conditions No Health Policy
Nallagandla Vidyavathi Skin disorders (Psoriasis, leucoderma, eczema, dermatitis, erthyema, vitiligo, etc.) No Health Policy
Blood­related disorders (HIV / AIDS, anaemia, thalassaemia, haemophilia or any other blood related
Nallagandla Vidyavathi No Health Policy
problem.)
Gynaecological disorders (Fibroid, cyst, menstrual disorder, pelvic infection, breast lump / mass,
Nallagandla Vidyavathi No Health Policy
endometriosis, etc.)
Ear, nose, eye and throat disorders (Recurrent ear discharge, polyp, persistent sinusitis, hearing loss,
Nallagandla Vidyavathi No Health Policy
vision problem, nasal septum disorders, laryngitis / adenoiditis / tonsillitis, etc.)
Bone and muscle disorders (Arthritis, ligament / cartilage tear, bone fracture or pain, chronic joint /
Nallagandla Vidyavathi No Health Policy
muscle pain, gout, sciatica, etc.)
 Endocrine disorders (Abnormal thyroid function, goitre, hypothyroidism, impaired glucose tolerance test,
Nallagandla Vidyavathi No Health Policy
abnormal HbA1c, abnormal growth hormone function, etc.)
Psychiatric and nervous disorders (brain/spine) (Sudden loss of consciousness, decrease in strength /
Nallagandla Vidyavathi movement of limbs, paralysis, loss of speech or memory, tremors, stroke, seizure / epilepsy / fits, No Health Policy
Parkinsonism, Alzheimer's, etc.)
Stomach, intestine, liver, gall bladder, pancreas, appendix disorders (Stones, persistent stomach pain,
Nallagandla Vidyavathi sudden loss of weight, hemorrhoids, ulcer, blood in vomiting or stool, painful defecation, ulcerative No Health Policy
colitis, Crohn's disease, jaundice, hepatitis, pancreatitis, appendicitis, etc.)
Lung and respiratory disorders (Persistent hoarseness / cough, difficulty in breathing, asthma, chronic
Nallagandla Vidyavathi No Health Policy
bronchitis, tuberculosis, any lung infection, etc.)
Heart and circulatory system related disorders (Swelling of leg(s), painful / visible leg veins, high
Nallagandla Vidyavathi cholesterol, chest pain, breathlessness on exertion, palpitations, loss of consciousness, angina, heart­ No Health Policy
attack, etc.)
Kidney, urinary and prostate disorders (Stones, sugar / albumin / blood in urine, pain/difficulty in
Nallagandla Vidyavathi No Health Policy
urination, dialysis, kidney failure, etc.)
Cancer & related disorders (Benign/malignant tumour, leukaemia, lumps, swelling, mass, cysts, changes
Nallagandla Vidyavathi No Health Policy
in mole, etc.)
Nallagandla Vidyavathi Does the applicant have diabetes or pre­diabetes or has he/she EVER had high blood sugar? No Health Policy
Nallagandla Vidyavathi Treating Doctor's name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Nallagandla Vidyavathi How long ago was the applicant first diagnosed with diabetes / pre­diabetes / high blood sugar? No Health Policy
Nallagandla Vidyavathi Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via No medicine? No Health Policy
Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via Homeopathic or other
Nallagandla Vidyavathi No Health Policy
AYUSH treatment?
Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via Oral diabetic
Nallagandla Vidyavathi No Health Policy
medication?
Nallagandla Vidyavathi Does the applicant manage his/her diabetes / pre­diabetes / high blood sugar via Insulin? No Health Policy
Nallagandla Vidyavathi Does the applicant have Hypertension or High Blood Pressure? No Health Policy
Nallagandla Vidyavathi Treating Doctor's name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Nallagandla Vidyavathi How long ago was the applicant first diagnosed with Hypertension / High Blood Pressure? No Health Policy
Nallagandla Vidyavathi How does the applicant manage his/her Hypertension / High Blood Pressure? No Health Policy
Nallagandla Vidyavathi Chewable tobacco / Gutkha / Pan Masala No Health Policy
Nallagandla Vidyavathi Please specify consumption in number of pouches per week No Health Policy
Nallagandla Vidyavathi Alcohol No Health Policy
Nallagandla Vidyavathi Spirit (ml per week) No Health Policy
Nallagandla Vidyavathi Wine (no of glasses per week) No Health Policy
Nallagandla Vidyavathi Beer (no of pints per week) No Health Policy
Nallagandla Vidyavathi Cigarettes / Bidi / Cigar No Health Policy
Nallagandla Vidyavathi Please specify per week consumption No Health Policy
Nallagandla Vidyavathi Illicit drugs No Health Policy
Nallagandla Vidyavathi Please specify per week consumption No Health Policy
Have your parents, brothers or sisters had Cancer, Diabetes, Hypertension (high blood pressure), Heart
or Kidney disease, Polycystic kidney disease, Mental or nervous disorder (including Alzheimer's Disease),
Nallagandla Vidyavathi No Health Policy
Stroke, Multiple sclerosis, Motor neuron disease or any other hereditary disorders which is
persistent/long in nature?:
Nallagandla Vidyavathi Age at Onset No Health Policy
Nallagandla Vidyavathi Age at Death No Health Policy
Nallagandla Vidyavathi Cause of Death No Health Policy
Nallagandla Vidyavathi Specify Age No Health Policy
Nallagandla Vidyavathi Is Alive No Health Policy
Nallagandla Vidyavathi Family History Disease/ Disorder No Health Policy
Nallagandla Vidyavathi Relationship to Insured ­ Brother No Health Policy
Nallagandla Vidyavathi Age at Onset No Health Policy
Nallagandla Vidyavathi Age at Death No Health Policy
Nallagandla Vidyavathi Cause of Death No Health Policy
Nallagandla Vidyavathi Specify Age No Health Policy
Nallagandla Vidyavathi Is Alive No Health Policy
Nallagandla Vidyavathi Family History Disease/ Disorder No Health Policy
Nallagandla Vidyavathi Relationship to Insured ­ Sister No Health Policy
Nallagandla Vidyavathi Age at Onset No Health Policy
Nallagandla Vidyavathi Age at Death No Health Policy
Nallagandla Vidyavathi Cause of Death No Health Policy
Nallagandla Vidyavathi Specify Age No Health Policy
Nallagandla Vidyavathi Is Alive No Health Policy
Nallagandla Vidyavathi Family History Disease/ Disorder No Health Policy
Nallagandla Vidyavathi Relationship to Insured ­ Mother No Health Policy
Nallagandla Vidyavathi Age at Onset No Health Policy
Nallagandla Vidyavathi Age at Death No Health Policy
Nallagandla Vidyavathi Cause of Death No Health Policy
Nallagandla Vidyavathi Specify Age No Health Policy
Nallagandla Vidyavathi Is Alive No Health Policy
Nallagandla Vidyavathi Family History Disease/ Disorder No Health Policy
Nallagandla Vidyavathi Family History Disease/ Disorder No Health Policy
Nallagandla Vidyavathi Relationship to Insured ­ Father No Health Policy
Nallagandla Vidyavathi To be answered for all female applicants who have EVER been pregnant Yes Health Policy
Nallagandla Vidyavathi Treating Doctor's name and Contact Details Yes Dr mamatha Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) Yes Complete Health Policy
Nallagandla Vidyavathi Dosage Yes 100 mg Health Policy
Nallagandla Vidyavathi Medication Yes Pain tablets Health Policy
Nallagandla Vidyavathi Duration of Condition Yes C section Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY Yes 28­09­2013 Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone Yes Usg Health Policy
Nallagandla Vidyavathi Please specify the number of live births (if any) Yes 2 Health Policy
Nallagandla Vidyavathi Please specify the number of pregnancies (if any) Yes 2 Health Policy
Nallagandla Vidyavathi Undergone abortion No Health Policy
Nallagandla Vidyavathi Undergone abnormal or complicated pregnancy No Health Policy
Nallagandla Vidyavathi Undergone caesarian section or premature delivery Yes Health Policy
Nallagandla Vidyavathi Currently pregnant No Health Policy
Nallagandla Vidyavathi Are you a politically exposed person (PEP) or a close relative of PEP? No Health Policy
Has any proposal for life, health, hospital daily cash or critical illness insurance on the life of the
Nallagandla Vidyavathi applicant ever been declined, postponed, loaded or been made subject to any special conditions such as No Health Policy
exclusions by any insurance company?
Nallagandla Vidyavathi Qualification Yes Graduate Health Policy
Nallagandla Vidyavathi Have you ever been hospitalized for more than 5 days No Health Policy
Nallagandla Vidyavathi Treating Doctor"s name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Nallagandla Vidyavathi Do you have any pre­existing diseases / conditions? No Health Policy
Nallagandla Vidyavathi Treating Doctor"s name and Contact Details No Health Policy
Nallagandla Vidyavathi Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Vidyavathi Dosage No Health Policy
Nallagandla Vidyavathi Medication No Health Policy
Nallagandla Vidyavathi Duration of Condition No Health Policy
Nallagandla Vidyavathi Since DD/MM/YYYY No Health Policy
Nallagandla Vidyavathi Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Is the applicant currently suffering from any symptom(s) or complaint(s) persisting from more than five
Nallagandla Keerthana No Health Policy
consecutive days for which he/she has not consulted a doctor?
Nallagandla Keerthana Treating Doctor's name and Contact Details No Health Policy
Nallagandla Keerthana Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Keerthana Dosage No Health Policy
Nallagandla Keerthana Medication No Health Policy
Nallagandla Keerthana Duration of Condition No Health Policy
Nallagandla Keerthana Since DD/MM/YYYY No Health Policy
Nallagandla Keerthana Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Other than routine health check­up, has the applicant EVER undergone or been advised to undergo any
Nallagandla Keerthana diagnostic test/investigation including but not limited to Thyroid Profile, Treadmill test, Angiography, No Health Policy
Echocardiography, Endoscopy, Ultrasound, CT Scan, MRI, Biopsy and FNAC?
Nallagandla Keerthana Treating Doctor's name and Contact Details No Health Policy
Nallagandla Keerthana Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Keerthana Dosage No Health Policy
Nallagandla Keerthana Medication No Health Policy
Nallagandla Keerthana Duration of Condition No Health Policy
Nallagandla Keerthana Since DD/MM/YYYY No Health Policy
Nallagandla Keerthana Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Has the applicant EVER been prescribed or taken any form of treatment or medication (including oral /
Nallagandla Keerthana No Health Policy
inhalation / injection), for a period of more than seven days?
Nallagandla Keerthana Treating Doctor's name and Contact Details No Health Policy
Nallagandla Keerthana Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Keerthana Dosage No Health Policy
Nallagandla Keerthana Medication No Health Policy
Nallagandla Keerthana Duration of Condition No Health Policy
Nallagandla Keerthana Since DD/MM/YYYY No Health Policy
Nallagandla Keerthana Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Has the applicant EVER undergone or been advised to undergo or does he/she plan to undergo any
Nallagandla Keerthana No Health Policy
form of surgery or procedure?
Nallagandla Keerthana Treating Doctor's name and Contact Details No Health Policy
Nallagandla Keerthana Current Status (e.g. Complete/Partial Recovery or Ongoing Treatment) No Health Policy
Nallagandla Keerthana Dosage No Health Policy
Nallagandla Keerthana Medication No Health Policy
Nallagandla Keerthana Duration of Condition No Health Policy
Nallagandla Keerthana Since DD/MM/YYYY No Health Policy
Nallagandla Keerthana Details of symptoms or investigations or diganosis or procedure/ surgery undergone No Health Policy
Since you have answered Yes in the previous questions, please tick the relevant box(es) below,
Nallagandla Keerthana No Health Policy
corresponding to the type(s) of disorder and/or body system(s) affected.
Nallagandla Keerthana Any other conditions No Health Policy
Nallagandla Keerthana Skin disorders (Psoriasis, leucoderma, eczema, dermatitis, erthyema, vitiligo, etc.) No Health Policy
Blood­related disorders (HIV / AIDS, anaemia, thalassaemia, haemophilia or any other blood related