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GOVERNMENT OF TELANGANA ABSTRACT

Agriculture and Cooperation Department - Rythu Bandhu Group Life Insurance Scheme 2018-19 – Implementation guidelines – Orders - issued.

AGRICULTURE AND COOPERATION (AGRI.II) DEPARTMENT

G.O.Ms.No. 63 Dated: 19-06-2018 Read the following:-

From Commissioner & Director of Agriculture, Hyd. Lr. No. Rythu Bandhu – (2)10/2018, Dt: 29-05-2018 and 09/06/2018.

ORDER:

The Commissioner & Director of Agriculture has submitted proposals for sanction of Rythu Bandhu Group Life Insurance Scheme for the farmers during 2018-19 in the reference read above.

2) The Government has proposed to introduce Group Life insurance scheme for all the farmers in the State of Telangana. All the holders of Pattadar Pass Books issued after the recently concluded Land Records updation programme will be eligible for enrolment in this scheme. The farmers in the age group of 18–59 as on 15.8.2018 would be covered under this Scheme and the sum assured of Rs.5.00 lakhs would be paid on death, due to any cause, to the nominee of that enrolled farmer, declared by him/her.

Objective of the Scheme:

The main objective of the scheme is to provide financial relief and security to the family members/dependents of the deceased farmer (Pattadar) in case of his/her death. In Telangana, majority of the Farmers are small and marginal and farming is the sole source of livelihood to them. In the event of the death of the farmer/ bread winner, their families are facing severe financial problems even for their day-to-day needs. Hence it is expedient to implement farmers Group Life Insurance Scheme so as to ensure financial security and relief to the bereaved members of the farmer’s family.

Road map for Operationalization of the Scheme:

To operationalize this scheme, a series of meetings were conducted by the Principal Finance Secretary, Principal Secretary, Agriculture, Commissioner, Agriculture and other senior officials of Finance and Agriculture Departments with officers of LIC of India. Based on those discussions with LIC of India and after internal deliberations, it is decided that the Group Life Insurance Scheme would be implemented through LIC of India. The reasons for selecting LIC of India are:

a) LIC’s claim settlement ratio is the highest amongst all insurance companies as per the data compiled by IRDAI. This would mean adequate confidence for the beneficiaries and also to the Government.

b) Only LIC can offer Group Life Insurance Schemes seamlessly integrated with Government of India’s Social Security Schemes.

c) The benefit of lowest possible premium rates and scope for further review of the premium subsequently.

d) Only LIC has the experience of successfully managing very large Social Security Schemes with membership running into crores. This means they have the experience and the ability to roll out the scheme whenever Government decides to commence it.

e) LIC is the only the Public Sector Life Insurance Company and Government of India provides sovereign guarantee to its policy holders.

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3) A Memorandum of Understanding with LIC, based on all the discussions and consultations, was signed in the presence of the Hon’ble Chief Minister on 4.6.2018. The salient features of the Memorandum are:

1. Eligibility: Pattadar Passbook holders in the State of Telangana who are between the ages 18–59 years as on 15th August 2018.

i. In case of new farmers (Pattadars) getting admitted into this Scheme during a Policy Year, Government will effect the insurance on their lives by paying full yearly premium and furnishing the data to the Corporation on monthly basis

ii. In case of insured farmers (Pattadars) losing Land on account of any reason, the insured member will continue to get insurance coverage till next annual renewal date.

2. The sum assured is Rs.5,00,000 (Rupees Five Lakhs) payable to the nominee(s) designated by the insured.

3. The premium payable in respect of the members is Rs. 1925/- per annum per member plus GST as applicable is to be paid extra and at present it is 18%. So, including GST, the premium works out to Rs. 2271.50.

i. The premium for subsequent years will be subject to actual claim experience based on the ERA (Experience Rating Adjustment). The conditions of assurance and rates of premium may be revised upward or downward by the Corporation based on claim experience on annual basis. The Government shall arrange to remit the renewal premium to the Corporation on or before the annual renewal date to P&GS Unit, Hyderabad.

ii. The Government of Telangana shall pay the premium on adhoc basis to LIC of India, on or before 1st of August every year. After receipt of members’ data and claim experience, the final premium will be intimated based on ERA and the same is payable by Government.

4. Representative of Government for administration of Scheme:

The Commissioner of Agriculture is designated as the Nodal Agency on behalf of the A&C Department, Government of Telangana.

The information about the number of farmers to be enrolled as members in the scheme and other details would be passed on to LIC in electronic form. The nomination forms would be collected from each and every eligible member by the Agriculture Extension Officers in the month of June-2018 initially and as and when the member gets enrolled subsequently.

The Commissioner & Director of Agriculture who is nominated as representative by Government will act for and on behalf of Government of Telangana and the insured Members in all matters relating to the scheme. The agreement made between the Corporation and the Government shall be binding on the representatives of Government and insured Members.

i. Government shall furnish to the Corporation the data of new insured Farmers (Pattadars) enrolled as members on monthly basis in electronic form.

ii. On each annual renewal date, the consolidated data of eligible farmers (Pattadars) may be submitted to Corporation on or before 1st of August along with adhoc premium

iii. The Government shall furnish to the Corporation online all the relevant particulars of the members as required for the administration of the scheme. They shall include

a. Data as per the enrolment form b. Annual premium

iv. In case of a farmer holding multiple Pattadar Pass Books, he/she will be enrolled as a single member only based on Aadhar identification. The Commissioner & Director of Agriculture shall take necessary care to de- duplicate the data before submission to the Corporation.

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v. The Corporation, after verification and admission of members into the Scheme, shall allot the Master Policy Numbers for the Scheme along with individual LIC id for each insured member and make such list available to the Government in electronic format.

vi. The Commissioner Agriculture shall ensure that all the eligible members have been allotted with the individual ids by the LIC and discrepancies, if any, with the master list provided to the LIC shall be separately notified and monitored.

5. Register of Insured Members:

The Commissioner & Director of Agriculture would be required to maintain and make available to Corporation, a soft copy of register of names of members covered under Group Life Insurance scheme.

Eligibility of Farmer:

1. The farmers in the age group of 18 to 59 years as on 15th August 2018 (born between 14.8.1959 to 15.8.2000, both days inclusive) for the year 2018-19 and having the new Pattadar Pass Books issued by the Government of Telangana are eligible to be enrolled under the scheme.

2. The age of the farmers would be determined based on the age as mentioned in the Aadhar card. In case only the year is mentioned in Aadhar card, the default date would be taken as 1st July of that particular year.

3. However, a farmer will be eligible for enrolling for a single policy only, even though he owns land in different villages/districts or has more number of PPBs. The farmer has to choose the village in which he prefers to be insured. Aadhar number will be used for de-duplication of the pattadar pass books data / enrolment data to ensure that that the farmer is issued only a single certificate.

4. Lateral Entry to the scheme: In case of mutation of land and issue of fresh pattadar pass book to the purchaser and if the purchaser is not already enrolled in the scheme, the purchaser will be enrolled into the Rythu Bandhu Group Life Insurance Scheme.

5. Such list of lateral entries, on a monthly basis, would be furnished by the Nodal Agency to the LIC. The date of enrolment and eligible age will be as on 1st of that particular month in which he/she is enrolled. The premium with respect to these additional members would be payable on a quarterly basis.

1. No other new entry of members into the scheme in between the policy running year will be entertained other than the above lateral entrants. Other new members crossing the minimum age at entry of 18 years into the scheme, will be enrolled only in the next renewal date of the policy.

Enrolment of the Farmers:

i. Commissioner of Agriculture is designated as the Nodal Agency on behalf of the Government of Telangana to implement the Rythu Bandhu Group Life Insurance scheme and the scheme will be administered by the LIC of India Ltd.

ii. The total number of farmers to be enrolled is based on the data to be furnished by the Revenue Department, indicating the details of the Farmers for whom PPBs have been issued after the Land records updation programme.

iii. Pre-populated enrolment/Nomination forms are printed and supplied to the districts based on the data of the PPBs distributed received from the CCLA or provided by the Collectors in the shape of attested hard copy.

iv. The Nomination forms are printed both in English and Telugu (in the same form).

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v. In the pre-populated forms, the names of the farmers are printed in Telugu, as available in the portal. The AEO, at the time of the enrolment of farmers, should ensure that the forms are filled both in English and Telugu and signature of the farmer is obtained on both sides.

vi. The Farmers’ Surname including the Fathers’ / Husbands’ Surname should be written in Full on both sides of the form.

vii. All the District Collectors will give attested hard copy of the farmers who have been given PPBs to the concerned DAOs. The DAOs in turn will share the data with the Divisional ADAs & MAOs to initiate the process of enrolment of farmers by the AEOs.

viii. The AEOs shall visit the farmer in person and fill up the Farmers enrolment- cum-nomination form along with the farmer’s signature (Annexure-I).

ix. The detailed circular instructions for collecting the nomination forms from the farmers for enrollment have already been separately issued.

x. The enrolment-cum-nomination forms shall be collected from each and every eligible member by the Agriculture Extension Officers in the month of June’ 2018. The AEO should indicate the serial number of the farmer in the list furnished by the Revenue department on the right hand corner of the form for future verification that the enrolment of the farmers is strictly as per the list furnished by the Revenue department/Collectors.

xi. The farmer should submit the nominee/nominees details in the enrolment or nomination form, duly signed by him designating the nominee/ nominees.

xii. In case the nominee is minor, the farmer has to provide the details of “Appointee” (Guardian), who is a major, along with his/her relationship with the nominee.

xiii. The farmers should have an Aadhar Card as it would be used as documentary proof for confirming correct name and the age of the farmer. If any farmer does not have an Aadhar card he should enroll himself/ herself for Aadhar card. The AEO during the visit to the Farmer has to verify the new PPB issued to him by the Revenue Authorities. A copy of the Aadhar card of the enrolled farmer should be collected and attached to the enrollment form as documentation proof.

xiv. AEOs should actively involve the Coordinators and members of Rythu Samanvaya Samithis at village and mandal level in the enrolment of farmers in the village

xv. All the above details shall be updated in Electronic Format in the Rythu Bandhu-Rythu Bima portal by the AEO under the supervision of the concerned MAO.

xvi. MAO concerned shall 100 % verify the forms collected by the AEOs i.e.

To ensure whether it is as per the list received given by the Revenue department/Collector concerned.

To verify whether the Name and Date of Birth are written as per the Aadhar.

The name and other details of the farmer and nominee has been properly entered in the portal

The PPB number and Aadhar number etc. are correctly entered in the portal

The name of the nominee as entered in the Aadhar is also correctly entered by the AEO in the portal

The MAO will also 100 % verify the data entered by the AEO in the MIS Portal from his login and then submit

xvii. The master list of all the members pertaining to a village shall be submitted by the AEO with a covering letter through proper channel to the DAO i.e duly attested by the concerned MAO and ADA®.

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xviii. The District wise lists will be furnished by the DAO to the C&DA designated as Nodal Agency.

xix. The same will be shared with the LIC so as to verify if all the enrolled farmers are updated in the MIS and passed to them i.e LIC.

xx. The Corporation reserves the right to verify such Register of members available with the Representative.

Enrolling Non-resident farmers:

The DAOs shall prepare village wise schedules for visiting the farmers’ households for collecting and filling the information in the nomination forms.

Different modes of publicity like Tom-tom, TV Scrolls and Newspapers shall give for enrolling the beneficiaries who are not residing in the villages.

AEO should take assistance of Sarpanch/Rythu Samanvaya Samithi Coordinators and others in the village to inform the non-resident Pattadars regarding the enrolment in the scheme.

AEOs, while visiting the households, should request the neighbours also to inform the non-resident farmers to enroll in the scheme.

Enrollment of new Pattadars (lateral entries) after 15th August:

a) The Mandal Agricultural Officers shall collect the details of the new Pattadars from the MRO by 5th of every month and should collect the nomination forms from the eligible Pattadars and to furnish the same to the District Agriculture Officer through proper channel and DAOs shall furnish the list of the new Pattadar Pass Books holders every month to C&DA.

Custody of the physical forms:

I. Nomination forms should be maintained at ADAs office concerned. Revenue Village wise bundles along with the covering letter duly signed by the AEO shall be forwarded to the MAO, who in turn shall certify and submit the mandal wise bundles to the ADA, under a copy to the DAO in the bundles, which are serially numbered.

II. All the nomination forms shall be under the safe custody of the ADA for a minimum period of two years.

III. All the claims settled forms should be kept separately and should be retained for a period of 10 years.

Verification of uploaded data:

The data shall be verified for de-duplication and age correctness at NIC by using Aadhar as documentary proof.

LIC also shall verify the by way of De-duplication at their level

Procedure for modifying the Nominee:

b) If any request for change in nominee is received from the enrolled farmer, it has to be obtained in the prescribed format and pin it to the original application form and the same shall be produced to the LIC at the time of claim.

Certificate of Insurance:

i. LIC would be issuing a Certificate of Insurance (Annexure II) to each and every farmer who is included in the scheme.

ii. LIC should print and send the Certificates of Insurance bundles Revenue village-wise and Mandal-wise to the DAOs by 5th of August’ 2018

iii. The distribution of the Certificates shall be commenced from 15th August 2018 onwards.

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iv. The Commissioner Agriculture shall develop a detailed procedure for receiving the individual insurance certificates from the LIC, verify them with reference to the master list made available in the MIS portal by the LIC and also for proper distribution of these certificates of insurance to all the members (Farmers/Pattadars)

Premium Payment:

i. The premium payable to LIC would be paid by the Commissioner of Agriculture on or before 1st August of every subsequent year. The Government shall pay a premium of Rs.1925/ annum/ member plus GST as applicable is to be paid extra and at present it is 18 %. Including GST, the premium works out to be Rs.2271.50/- per farmer.

ii. The premium for the subsequent years will be revised based on the measures of ERA (Experience Rate Adjustment). The second year premium would be decided based on the outgo from the scheme by LIC and would be adjusted accordingly.

Settlement of Claims:

The Scheme is operative for one full year i.e., from 15th August 2018 to 14th August 2019 and would be renewed on an annual basis. The master list of all the members would be furnished by the Nodal Agency to LIC on an annual basis.

i. In the event of death of the Insured Member while being covered under the scheme, the benefits under the Assurance on his life will be credited to the Account of the Nominee of the Beneficiary, on receipt of claim online along with the requirements to the satisfaction of LIC.

ii. The AEO should collect the claim form (Annexure III) along with the bank account details of the Nominee and the death certificate issued by the competent authority. The claim form along with the below mentioned documents shall be uploaded by the AEO in the Rythu Bandhu- Rythu Bhima portal.

iii. The requirement for death claim will be as under :

Claim intimation/Discharge form duly filled, signed and attested by the authorised signatory of the Nodal Agency.

Death Certificate original/duly attested copy.

Aadhar Card of the deceased and the nominee.

Nominee Bank Account Passbook, first page having details of the A/C holder, Account No. and IFSC Code of the Bank Branch.

iv. The insurance claim would be settled and amount would be paid based on a claim form (Annexure III). The amount would be paid into the account of the Nominee designated by the pattadar through electronic transfer only within 10 days.

v. The Corporation reserves the right to cause an investigation made into the genuineness of any claim preferred or disbursement effected.

vi. The settlement of Death Claims would be subject to receipt of valid claim-cum-discharge form with LIC id and copy of the Death Registration Certificate duly verified and attested by the Government or its representatives.

vii. Death Claims should be preferred with the Corporation within (6) months of the date of death of the insured member. In case of Claims delayed beyond (6) months, the Corporation may consider such Claims only on valid grounds and specific recommendations by the Government

viii. The claim amount is payable to the registered nominee only. However, the member has provision to alter the nomination during the term of the policy intimating to the Nodal Agency/Representative.

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ix. In case of disputed claims, neither the Life Insurance Corporation of India nor the Government of Telangana/Nodal Agency, viz., Department of Agriculture, Govt. of Telangana, will involve in deciding the legal heirs of the disputed claim. If such issue raises, it is upto the risk and responsibility of the claimant/s to obtain a suitable order from the competent court 0f law.

x. The Scheme implementing Agency, shall upload the death Claim requirements such as Claim form and death certificate on line. However, LIC reserves the right to call for the physical papers whenever required. The Scheme implementing Agency, shall also submit a summary of the Claims with due authentication in the format specified by LIC. The Authentication to be done by an authorized official of Government. Corporation shall down load the required information and process the claims online.

xi. The payment in respect of Claims admitted by the Corporation will be made to the credit of the bank account of the claimant as per the particulars provided with an intimation to claimant and implementation agency

xii. The Scheme shall be serviced by LIC by extending support at various levels to enable the scheme to run successfully. The Claims settlement will be within (10) working days from the date of receiving all the requirements. In case of delay, interest is payable as per IRDAI regulations from time to time

xiii. The grievance redressal mechanism stipulated by IRDAI shall be applicable for this scheme. Corporation shall provide the necessary information and assistance by Hyderabad Unit to the Government.

xiv. The Commissioner Agriculture shall monitor the claims promptly and for this purpose shall obtain the information from LIC as he may feel appropriate

xv. MIS statements relating to Claims based on available member’s data shall be provided by the Corporation at the request of the Government.

Termination of Assurance:

The assurance on the life of an insured member shall immediately terminate upon the happening of any of the following events and no benefit will become payable there under.

i. Discontinuance of contribution relating to the assurance or ii. The insured member attaining age 60, or iii. The insured member ceasing to satisfy one or more of the eligibility

conditions as specified under conditions of eligibility as per clause 1

Restraint on Assignment:

The benefits assured under the scheme are strictly personal and cannot be assigned, charged or alienated in any way. PORTAL for Scheme Implementation (Management Information System):

i. A separate module in the same Rythu Bandhu Portal is developed for entering the details of the farmers insured.

ii. An additional feature is provided in the existing Rythu Bandhu Portal, with respect to the Group Life Insurance (Rythu Bima).

The National Informatics Center (NIC), Telangana State is designated as nodal agency for development of MIS for Rythu Bandhu Group Life Insurance Scheme. The State Informatics Officer, NIC, Revenue and DAOs should ensure flow of registered farmers’ data in the portal to enable the LIC for issuing the Certificate of Insurance.

The portal shall have the facility of updating the daily registration of the farmers in the scheme, Revenue Village-wise and AEO cluster-wise and the Dash board is to be provided depicting the daily enrolment of farmers, no. of claims received and the claims settled by LIC along with amount.

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User IDs, accounts have to be created at all levels right from Prl Sec (Finance) / Prl Sec (A&C) / Commissioner of Agriculture / District Collector / District Agriculture Officer / ADA / MAO / AEO in the Rythu Bandhu-Rythu Bima Portal for viewing the dashboard and also updating by the implementing officers.

i. AEOs shall upload the details of the enrolled farmers in the Portal which will be shared with the LIC after authentication by the concerned MAO

ii. NIC will de-duplicate the data using Aadhar numbers to ensure that each farmer is enrolled only once for one bond only.

iii. NIC shall transfer the farmer’s registration data to LIC through Secured File Transfer Protocol (SFTP) and all the bulk transfers of data between NIC servers and LIC servers should be through SFTP.

iv. LIC after receiving the data will verify the data and if any errors are noticed it will intimate the same to the agriculture department along with reasons.

v. AEOs should once again attend to the error data and if rectifiable mistakes are there, they should correct the records and upload the corrected records in the portal which will be once again sent to LIC after authentication by MAO.

vi. LIC shall reverse-feed the beneficiaries data submitted to them in the Rythu Bandhu Rythu Beema portal assigning the unique LIC Id and policy number.

vii. For submitting the claims, AEOs shall have to fill the online claim form made available in the portal.

viii. AEOs shall upload the claim along with the discharge form and death certificate for processing of the claim by the LIC in case of death of the insured farmer. AEOs shall exercise utmost caution in entering the account number, bank name, bank branch and IFSC code details as the claim amount will be transferred online through the RTGS.

ix. The application will be forwarded to various levels

x. All the claims forwarded from the field by AEO online will be approved by MAO, and District Agricultural Officers through an officer designated at state level before sending to LIC. The online claim forms will be forwarded in batches to the LIC portal in a secured way.

xi. Commissioner & Director of Agriculture shall nominate an officer exclusively for verifying the claims and forwarding online to LIC.

xii. LIC to share / upload a copy of all the bonds/certificates of the farmers and share the data printed on bonds to NIC for incorporating into Portal.

xiii. NIC shall provide a facility of searching the Policy data of individual beneficiaries using the Pattadar pass book number as search key. If required the same may be used as a duplicate copy in case the bond is not traceable by his family members with respect to the deceased farmer.

xiv. LIC to provide the interface for tracking the claim settlement status in the Rythu Bandhu – Rythu Bima Portal.

Publicity and Training:

LIC shall provide necessary publicity material for implementation of the scheme and also provide the necessary training to the members of the Nodal Agency.

Benefits of the scheme:

The Nominee registered by the farmer (Pattadar) of the scheme shall be entitled to get Rs. 5.00 lakhs in case of death of the enrolled farmer due to any cause.

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Disentitlement for benefits and redress Grievances:

The farmer who has attained the age of 60 years shall cease to be a beneficiary.

Any grievance shall be addressed by the LIC (Implementing Agency) which shall dispose within thirty (30) days.

Power to remove the difficulties:

If any difficulty or doubt arises as to the interpretation of any of the provisions of the scheme, the decision of the Government shall be final and binding.

Power to amend scheme:

The state Government may by notification in the official Gazette, modify or amend the scheme for its proper implementation and in the interest of the farmers.

There are (3) types of forms as detailed below.

1) Application cum nomination form - Annexure I 2) certificate of Insurance - Annexure II 3) Claim form - Annexure III

Monitoring mechanism:

4) A state level Monitoring Committee under the chairmanship of APC shall be constituted with the following members:

1. APC & Principal Secretary (A&C Dept.) - Chairman 2. Commissioner & Director of Agriculture - Convener 3. Joint Secretary (Finance Dept.) - Member 4. Representative from CCLA - Member 5. State Information Officer, NIC - Member 6. Regional Manager (P&GS), LIC, Hyd - Member

The above committee shall meet once in three months so as to list out

new Pattadars for enrolment under Rythu Bima for arriving at the lateral entries if any to be insured and premium is to be paid to the Corporation and also Pattadars to be deleted based on the land registration records for the coming year The committee will meet periodically to review and also monitor the Status settlement of claims in the State. The committee shall also monitor the overall implementation of the scheme and give necessary guidance wherever necessary.

District level Monitoring Committee:

1. District Collector and Magistrate - Chairman2. District Agriculture Officer - Convener3. District Nodal officer of LIC - Member 4. District Panchayat Officer - Member

The above committee shall meet every month so as to list out new

Pattadars for enrolment under Rythu Bima for arriving at the lateral entries if any to be insured for submitting proposals to the Commissioner of Agriculture and also Pattadars to be deleted based on the land registration records for the coming year. The committee will also monitor the settlement of claims in the district in case of death of the farmers.

Mandal Level Monitoring Committee:

1. Revenue Divisional Officer - Chairman2. Assistant Director of Agriculture (R ) - Member3. Mandal Agricultural Officer - Convenor4 Mandal Revenue Officer - Member

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The above committee shall meet every month so as to list out new Pattadars for enrolment under Rythu Bima for arriving at the lateral entries if any to be insured for submitting proposals to the Commissioner of Agriculture and also Pattadars to be deleted based on the land registration records for the coming year. The committee will also monitor the settlement of claims in the district in case of death of the farmers.

5) The scheme will be implemented by the Department of Agriculture with the assistance of Revenue Department under the guidance and leadership of the District Collectors.

6) There is a budget provision of Rs. 500.00 Crores towards this scheme for the year 2018-19 and any additional amounts necessary may be authorized from the same Head of Account after due enumeration of all the members.

7) The expenditure of the scheme including the cost of printing nomination forms and incidental expenditure may be met from the budget provided under MH 2401- Agriculture - 800 other expenditure - SH (42) Insurance to farmers

(BY ORDER AND IN THE NAME OF THE GOVERNOR OF TELANGANA)

C.PARTHASARATHI APC & PRINCIPAL SECRETARY TO GOVERNMENT

To The Commissioner & Director of Agriculture, Hyderabad The State Information Officer, NIC, Hyderabad. The Director of Horticulture, Hyderabad. All Collectors/JCs/DAOs/DH&SOs. The Regional Manager (P&GS), LIC, Hyderabad. Copy to: The P.S. to Chairman “Telangana Rashtra Rythu Samanvaya Samithi”, Hyderabad. The P.S. to Minister (Finance) The P.S. to Minister (A&C) The P.S. to Chief Secretary The P.S. to Principal Secretary (Finance) The P.S. to Secretary to Chief Minister The P.S. to Principal Secretary to Chief Minister The General Administration (Cabinet) Department.

//FORWARDED BY ORDER//

SECTION OFFICER

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ANNEXURE-I

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ANNEXURE-II

LIC Of India, Pension & Group Schemes Unit, Hyderabad Division, 2nd floor, Jeevan Prakash Buildings, Secretariat Road, Saifabad,

Hyderabad, 500063. E-mail : bo_g504@licindia.com

Rythu Bandhu Group Life Insurance Scheme

CERTIFICATE OF INSURANCE

This is to certify that Shri/Smt ______________________________________________________of

(Name & Address of the Life Assured)

Village____________________________Taluk_____________________Dst____________________Pin____________ is covered under Telangana State Farmers’ Group Insurance bearing Master Policy Number GI ____________issued by Life Insurance Corporation of India, P&GS Unit, Hyderabad Division, commencing from ______________to______________ through its’ Master Policy Holder “ Department of Agriculture, Telangana State Govt’ .

The particulars of the insured member are ;

Master Policy No :- Master Policy Holder :- Department of Agriculture, Telangana State Govt. Insured Name :- Age / Dt.of birth :- LIC-Id :- Insurance Coverage :- Rs. 500,000/- Type of Coverage :- Any type of death ( Deaths due to any reason ) Nominee :- Name____________________Relation_______Age__ Date of Commencement :- 15th August 2018 Next Renewal Date :- Clauses applicable :- Nil

Place : _____________________________________________

Date of Issue : ( Seal & Signature of the Competent Authority)

NB : Please turn over for Scheme features ……

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ANNEXURE-III

Pension & Group Schemes Unit , Hyderabad Division 2nd Floor, Jeevan Prakash Buildings, Secratariate Road,

Saifabad, Hyderabad, Telengana . 500063Ph. 23420752 / 23232394

E-mail : bo_g504@licindia.com

Claim Form For Rythu Bandhu Group Life Insurance Scheme

OGI / Master Policy NO. ____________ / LIC ID No_______ .

PART A: (To be completed by the beneficiary) 1) Name and Address of the deceased : 2) Name and Address of Nodal Agency : Department of Agriculture, Telangana State 3) Date of Entry into the Scheme : 15.08.2018 4) Name of Nominee : 5) Full Address of the Nominee : 6) Relationship with Member : 7) Date of Death of Member : 8) Cause of Death : 9) Name & Address of the bank : 10) Bank Account No. (Nominee) :

11) IFSC Code No. of the Branch :

I hereby declare that the answers to all the above questions are true and correct in every respect .

Signature of the Nominee / Beneficiary Place : Date : Seal & Signature of MPH Place : Date : Witness : (Signature) Name : _____________________________ Place : Address : _____________________________ Date : _____________________________

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Pension & Group Schemes Unit , Hyderabad Division 2nd Floor, Jeevan Prakash Buildings, Secratariate Road,

Saifabad, Hyderabad, Telengana . 500063 E-mail : bo_g504@licindia.com

PART B

DISCHARGE RECEIPT

We _____________________________________________________________________hereby acknowledge receipt from Life Insurance Corporation of India a sum of Rs. ____________________ (Rupees ______________________________________________________) in full and final satisfaction and discharge of all our claims under the above master policy on the life of member ______________ ____________________________. Dated at ________________this __________________day of _____________________20 Revenue Stamp SEAL Signature of Authorised Official of the Nodal Agency (Mandal Agriculture Officer) PART C Please send the claim amount by cheque to the credit of Savings Bank A/c No.___________________ With IFSC Code No. ________________________ held by the beneficiary/nominee with _____________________________________________________________ _____________________________________________________________________________________ (Name and address of the Bank) SEAL Signature of Authorised Official of the Nodal Agency (Mandal Agriculture Officer)