www.adityabirlacapital.com
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13.126.162.195
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Submitted URL: http://bit.ly/abhi-renewal
Effective URL: https://www.adityabirlacapital.com/healthinsurance/buy-insurance-online/
Submission Tags: falconsandbox
Submission: On August 30 via api from US
Effective URL: https://www.adityabirlacapital.com/healthinsurance/buy-insurance-online/
Submission Tags: falconsandbox
Submission: On August 30 via api from US
Form analysis 2 forms found in the DOM
Name: renewForm —
<form name="renewForm" class="renew-form ng-pristine ng-valid ng-valid-minlength ng-valid-maxlength ng-valid-pattern" ng-submit="checkLogin(auth,renewForm)" novalidate="">
<div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 text-right lbl-pad-btm">
<div class="col-lg-12 col-md-12 pad-l-r-0"><label class="lbl-txt">Your Policy Number <span class="any-two-red-clr">*</span></label></div>
<div class="col-lg-9 col-md-9 pad-l-r-0 pull-right"><input type="tel" class="form-control textbox-style phone-group ng-pristine ng-untouched ng-valid ng-empty ng-valid-minlength ng-valid-maxlength" name="policynumber" id="policynum"
ng-model="auth.policynumber" minlength="16" maxlength="19" placeholder="00-00-0000000-00"></div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 text-right lbl-pad-btm">
<div class="col-lg-12 col-md-12 pad-l-r-0"><label class="lbl-txt">Proposer’s Date of Birth</label></div>
<div class="col-lg-9 col-md-9 pad-l-r-0 pull-right"><input class="form-control textbox-style phone-group ng-pristine ng-untouched ng-valid ng-empty ng-valid-pattern ng-valid-maxlength" name="dob" type="tel" placeholder="DD/MM/YYYY"
ng-model="auth.dob" date-directive="" maxlength="10"
ng-pattern="/^(?:(?:31(\/|-|\.)(?:0?[13578]|1[02]))\1|(?:(?:29|30)(\/|-|\.)(?:0?[1,3-9]|1[0-2])\2))(?:(?:1[6-9]|[2-9]\d)?\d{2})$|^(?:29(\/|-|\.)0?2\3(?:(?:(?:1[6-9]|[2-9]\d)?(?:0[48]|[2468][048]|[13579][26])|(?:(?:16|[2468][048]|[3579][26])00))))$|^(?:0?[1-9]|1\d|2[0-8])(\/|-|\.)(?:(?:0?[1-9])|(?:1[0-2]))\4(?:(?:1[6-9]|[2-9]\d)?\d{2})$/"
ng-disabled="(auth.policynumber != '' && auth.txtMobileNumber != '') || auth.txtMobileNumber != ''"></div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 text-right">
<div class="col-lg-12 col-md-12 pad-l-r-0"><label class="lbl-txt"><span class="any-two-red-clr">OR</span></label></div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 text-right lbl-pad-btm">
<div class="col-lg-12 col-md-12 pad-l-r-0"><label class="lbl-txt">Proposer’s Mobile Number</label></div>
<div class="col-lg-9 col-md-9 pad-l-r-0 pull-right"><input type="text" class="form-control textbox-style phone-group ng-pristine ng-untouched ng-valid ng-empty ng-valid-pattern ng-valid-minlength ng-valid-maxlength"
ng-model="auth.txtMobileNumber" id="txtMobileNumber" name="txtMobileNumber" minlength="10" maxlength="10" ng-pattern="/^[6789]\d{9}$/" ng-disabled="(auth.policynumber != '' && auth.dob != '') || auth.dob != ''"
placeholder="Mobile Number"></div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 text-right proceed-btn-pad-btm"><a href="javascript:void(0);" ng-click="gotoPageGAParam('click-button','proceed','renew')"><button type="submit" class="btn proceed-btn">ABHI Karo</button></a>
</div>
</div>
</form>Name: help_form —
<form name="help_form" id="callUsForm" ng-class="{'form-error':showErrors}" class="ng-pristine ng-invalid ng-invalid-required ng-valid-pattern ng-valid-minlength ng-valid-maxlength">
<div class="textbox leadformh">
<input class="helpinputbox help-email-icon ng-pristine ng-untouched ng-valid ng-empty" name="txtHelpName" id="txtHelpName" ng-model="auth.FIRSTNAME" placeholder="Name" valid-name="">
</div>
<div class="textbox leadformh">
<input class="helpinputbox help-mob-icon ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-pattern ng-valid-minlength ng-valid-maxlength" name="txtHelpMobile" placeholder="Mobile Number" valid-number="" maxlength="10"
ng-model="auth.MOBILE" required="" minlength="10" ng-pattern="/^[6789]\d{9}$/">
<!-- ngIf: help_form.txtHelpMobile.$error.required --><span class="error-help-txt errorPhone ng-scope" ng-if="help_form.txtHelpMobile.$error.required">Please enter mobile no</span><!-- end ngIf: help_form.txtHelpMobile.$error.required -->
<!-- ngIf: (!help_form.txtHelpMobile.$error.minlength && help_form.txtHelpMobile.$error.pattern) || help_form.txtHelpMobile.showError -->
<!-- ngIf: help_form.txtHelpMobile.$error.minlength -->
</div>
<!-- <div class="textbox leadformh">
<select class="helpinputbox" ng-model="auth.CITY" name="txtHelpCity" required>
<option value="">City</option>
<option value="Mumbai">Mumbai</option>
<option value="Delhi">Delhi</option>
<option value="Hyderabad">Hyderabad</option>
<option value="Chennai">Chennai</option>
<option value="Kolkata">Kolkata</option>
<option value="Bangalore">Bangalore</option>
<option value="Pune">Pune</option>
<option value="Ahmedabad">Ahmedabad</option>
<option value="Chandigarh">Chandigarh</option>
<option value="Kochi">Kochi</option>
<option value="Kanpur">Kanpur</option>
<option value="Lucknow">Lucknow</option>
<option value="Indore">Indore</option>
<option value="Patna">Patna</option>
<option value="Bhopal">Bhopal</option>
<option value="Amritsar">Amritsar</option>
<option value="Shimla">Shimla</option>
<option value="Raipur">Raipur</option>
<option value="Allahabad">Allahabad</option>
<option value="Gandhinagar">Gandhinagar</option>
<option value="Ranchi">Ranchi</option>
<option value="Dehradun">Dehradun</option>
<option value="Cuttak">Cuttak</option>
<option value="Jamshedpur">Jamshedpur</option>
<option value="Gurugram">Gurugram</option>
</select>
<span class="error-help-txt errorEmail" ng-if="help_form.txtHelpCity.$error.required">Please select city</span>
</div> -->
<!-- <div class="textbox leadformh" ng-if="auth.CITY == 'Mumbai' || auth.CITY == 'Delhi' || auth.CITY == 'Hyderabad'">
<p style="font-size:13px">Preferred Call time to book an appointment</p>
<select class="helpinputbox" ng-model="auth.PREFERREDCONTACTIBLETIME" name="txtHelpPct" required>
<option value="">Preferred Contactible Time</option>
<option value="8 AM-10 AM">8 AM-10 AM</option>
<option value="10 AM-12 PM">10 AM-12 PM</option>
<option value="12 PM-2 PM">12 PM-2 PM</option>
<option value="2 PM-4 PM">2 PM-4 PM</option>
<option value="4 PM-6 PM">4 PM-6 PM</option>
<option value="6 PM-8 PM">6 PM-8 PM</option>
</select>
<span class="error-help-txt errorEmail" ng-if="help_form.txtHelpPct.$error.required">Please select Preferred Contactible Time</span>
</div> -->
<div class="textbox leadformh">
<div class="floatcheck">
<span class="error-help-txt errorTick" style="display:none">*</span>
<input type="checkbox" class="helpcheckbox ng-pristine ng-untouched ng-valid ng-not-empty" ng-model="chkAuth" name="txtHelpCheck" id="txtHelpCheck" disabled="true">
</div>
<p class="desctxt">I authorize ABHICL and associate partners to contact me through me email/call/SMS. This will override registry on the DNCR</p>
</div>
<div class="textbox sub-buttons text-center" style="min-height:auto">
<!-- <button type="button" class="cp-common-btn" name="txtSubmit" id="txtSubmit" ng-click="btnHelpBuy(auth,help_form.$invalid,'book')" ng-if="auth.CITY == 'Mumbai' || auth.CITY == 'Delhi' || auth.CITY == 'Hyderabad'">Book an Appointment</button> -->
<button type="button" class="cp-common-btn" name="txtSubmit" id="txtSubmit" ng-click="btnHelpBuy(auth,help_form.$invalid,'request' , 'request-a-callback') ">Request a Callback</button>
</div>
</form>Text Content
HEALTH INSURANCE Aditya Birla Health Insurance Co. Limited Renew your Policy Help us find your policy Renew your Policy Help us find your policy Your Policy Number * Proposer’s Date of Birth OR Proposer’s Mobile Number ABHI Karo For more product information and buying assistance – Kindly share your details Please enter mobile no * I authorize ABHICL and associate partners to contact me through me email/call/SMS. This will override registry on the DNCR Request a Callback Request for Support CONNECT WITH OUR EXPERTS +91 Please provide your contact details for our Experts to Assist you. CancelConnect SHARE WITH OTHERS Anyone with the link can guide youCopy link *Your personal information will be masked and will not be shared with anyone. Done MAKE A SELECTION Select one DenyProceed Chat with the Agent Revoke edit access Show agent details -------------------------------------------------------------------------------- End Session FEEDBACK On a scale of 1-10, how likely are you to recommend Cobrowse to a friend or colleague? 012345678910 No ThanksSubmit CONNECT WITH OUR EXPERTS Our Customer Support Agent will be connecting with you shortly. Please wait. OK CONNECT WITH OUR EXPERTS We would like to assist you in filling your form. By clicking 'Allow' our Customer Service Agent will be able to see your screen and assist you. Please don't worry, your personal data is safe and will not be visible to our Agent CancelAllow CONNECT WITH OUR EXPERTS Our Customer Service Agent would like to meet you through video conferencing. By clicking 'Connect' our Customer Service Agent and you will be connected on a video conferencing. DeclineConnect VIDEO CALL NoYes AUDIO CALL NoYes CO-BROWSING ALERT* -------------------------------------------------------------------------------- Upon clicking on Pay button, you will be directed to payment gateway page to complete your transaction. For your security reasons, please note your co-browsing session will be paused during this session and our sales agent will not be able to view your details. Ok CONNECT WITH OUR EXPERTS OK Our Customer Service Agent has requested Edit Access to help you in filling the form. You can revoke edit access from the navigation bar. Would you like to allow? DenyAllow undefined AGENT DETAILS You are connected to an official agent Close