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I/We, the above named, do hereby, to the best of my/our knowledge and belief, warrant the truth of the foregoing statement in every respect, and
I/We agree if I/We have made of in any further declaration the Company may require respect of the said accident, shall make any false or faudulent
statement, or any suppression or concealment, the policy shall be void and all rights to recover thereunder in respect of past or future accidents shall
be forfeited.
I/We hereby declare that, notwithstanding anything to the contrary contained anywhere above, no credit of the service tax, education cess and
secondary and higher education cess mentioned on this invoice will be availed by me/us or under, my/our instruction. The eligibility to avail such a
credit vests in HDFC ERGO General Insurance Company Ltd. and I/we do not have any intention to avail such credits.
