Bharti AXA Life Policy Number * :
PAN Number * :
Employee ID * :
Name * :
DOB * :
I, an employee of Cognizant Technology Solutions India Private Limited, hold a Bharti AXA Life Insurance policy. I authorize Bharti AXA Life to share with Cognizant the premium payment made by me. I understand and hereby acknowledge that Bharti AXA Life can disclose my said premium payment to Cognizant only on basis of this authorisation provided by me and that Bharti AXA Life shall not be liable to be for any loss or damage that I may suffer/incur as a consequence of disclosure of the said data/information by Bharti AXA Life.
 
Bharti AXa Life Insurance Company Limited. Reg no.: 130.
Reg. Address: 6th Floor. Unit - 601 & 602, Raheja Titanium, Off
Western Express Highway, Goregaon (East), Mumbai - 400 063.