krishna sbi life policy term insurance

8/13/2019 Krishna Sbi Life Policy Term Insurance

1/36

V-7/24-07-12

Date : 19-Sep-2013

: 33689688

: 1G0 00200 508

: SBI Life - eShield Level CoverProduct Name

Policy No.

Customer No.

Mr Krishna Mohan CheguS/O CH GANGA RAMRKR AUTOMOBILES OLD MARKET MAIN ROAD DALLIRAJHARADURG - 491228CHATTISGARH, India

To,

RAIPUR PC /1G-PZ002413

1345638 / 13387 / No / SpeedPost / Indian / 127

SPEEDPOST - EA103042815IN

Father's Name:

Contact Details : 8602346511/ 2312482

Mr CH GANGA RAM

Dear Mr Krishna Mohan Chegu,

We welcome you in the SBI Life family and thank you for your trust in our products.

Joining SBI Life family will give you access to best customer service and large range of products which caters to most of your lifeinsurance needs.

You will find your Policy Document and First Premium Receipt with this letter. Please check all details and make sure that it iskept safely. Copy of the proposal form is also enclosed.

Please note this is a Regular premium payment insurance Policy. The premium due dates are : 18/09 every year

Your Contact PointFor any information/ clarification, please contact:

Your local service branch : RAIPUR PC, 1ST FLOOR, AJIT TOWERS,RAMSAGAR PARA RAIPUR (C.G.),RAIPUR -492001,CHATTISGARH or,

1.

Call us toll free at our customer service helpline 1800 22 2123/1800 22 9090/1800 425 90102.

In case you have any complaint/grievance, you may contact the following official for resolution:REGIONAL DIRECTOR,SBI LIFE INSURANCE CO. LTD., 133,2ND FLOOR, KAY KAY BUISNESS CENTRE,, M P NAGAR,ZONE 1,, BHOPAL, -462011

3.

E mail us at [email protected] or visit us at www.sbilife.co.in4.

Log on to http://mypolicy.sbilife.co.in to get registered in Customer Self service Portal fora) Viewing policy Details b) Premium Paid Certificate c) Changing personal Details

5.

All your servicing requests should be submitted to your local service branch asmentioned above or nearest SBI Life branch only.

6.

Free Look OptionIn case you are not satisfied with the Terms & Conditions as mentioned in the Policy Document, you have the option toreturn the policy to SBI Life Insurance Co. Ltd and cancel the cover within 30 days of receipt of the Policy Document. Insuch an event, the initial premium payments will be refunded as per Terms and Conditions of this policy and inaccordance with the Insurance Act, 1938 and Regulations made there under.

Looking forward to be your preferred Life Insurance Company for all your Life Insurance needs.

Yours truly,

Vivek SthalekarHead - New Business Processing

Note : The translated version of this letter in the regional language is printed overleaf for your convenience. However, should there be anyambiguity, the English version shall prevail.

Page 1 of 36


2/36

Date : 19-Sep-2013

: 33689688

: 1G0 00200 508

: SBI Life - eShield Level CoverProduct Name

Policy No.

Customer No.

Mr Krishna Mohan CheguS/O CH GANGA RAMRKR AUTOMOBILES OLD MARKET MAIN ROAD DALLIRAJHARADURG - 491228CHATTISGARH, India

To,

RAIPUR PC /1G-PZ002413

Contact Details : 8602346511/ 2312482

Father's Name: Mr CH GANGA RAM

Dear Mr Krishna Mohan Chegu,

h_ Eg~rAmB bmB\ n[adma _| AmnH m hm{XH dmJV H aVo h VWm h_mar `moOZmAm| _| {ddmg OVmZo Ho {bE Am^ma H Q> H aVo h.

Eg~rAmB bmB\ n[adma _| em{_b hmoZo go Amn ~ohVarZ JmhH godm VWm Eogr `moOZmAm| H s EH `mnH a|O VH nhM nm gH| Jo Omo AmnH s `mXmVa OrdZ ~r_m g~YrAmd H VmAm| H mo nyam H ao.

Bg n Ho gmW AmnH m n m b g r S > m ` y o Q > VWm n h b o r _ ` _ H s a r gbZ h. H n`m g^r {ddaUm| H s OmM H a b| VWm Bgo g^mb H a aI|.AmnHo Vmd n H s {V^r BgHo gmW gbZ h.

H n`m ZmoQ> H a| {H `h Regularr{_`_ ^wJVmZ nm{bgr h. r{_`_ H m ^wJVmZ H aZo H s {V{W`m 18/09 every yearh.

A m H m g n H { ~ X w{H gr OmZH mar/nQ>rH aU Ho {bE H n`m `hm gnH H a| :

AmnH s WmZr godmXm r emIm : RAIPUR PC, 1ST FLOOR, AJIT TOWERS,RAMSAGAR PARA RAIPUR (C.G.),RAIPUR -492001,CHATTISGARH `m,

1.

h_mar Q>mob \ s H Q>_a honbmBZ 1800 22 2123/1800 22 9090/1800 425 9010H mo H mb H a|2.H moB {eH m`V hmoZo na Amn g_mYmZ hoVw {ZZ{b{IV A{YH mar go gnH H a gH Vo h :REGIONAL DIRECTOR,SBI LIFE INSURANCE CO. LTD., 133,2ND FLOOR, KAY KAY BUISNESS CENTRE,, M PNAGAR, ZONE 1,, BHOPAL, -462011

3.

h_| `hm _ob H a| : [email protected] m `hm {d{OQ> H a| www.sbilife.co.in4.

{ZZ{b{IV hoVw H Q>_a go\ g{dg nmoQ>b _| a{OQ>a H aZo Ho {bE www.mypolicy.sbilife.co.in na bmJ AmZ H a|A) nm{bgr {ddaU XoIZm ~) r{_`_ ^wJVmZ g{Q>{\ Ho Q> g) `pVJV {ddaU H mo ~XbZm.

5.

D na {XE Jo WmZr godm emIm m {ZH Q>V Eg~rAmB bmB ~mM | hr AmnHo gmao godm g~Yr {ZdoXZ Om H amE OmZo Mm{hE.6.\ s b w { d H A J a A m n m b g r S > m ` y o Q > _ | C o { H J ` o { Z ` _ m| d e V m] g o g w > Z h m| V mo A m H o n m n m b g r S >m ` y o Q > H s m g o 30{ X Z m| H o A a n m b g r H m o E g ~ r m b m \B ` moao g H . { b . H mo b m > m o d ~ r m g a U H mo a H a o H m A { Y H ma h . E o r p W { V _ | A ma ^ H r _ ` _ ^ w V m H mo B g n m b g r H o { Z ` _ m| d e V m] V W m ~ r m A { Y { Z ` _

1938 V W m C g H o A J ~ Z m J ` o { d { Z ` _ m| H o A Z w ma b m >m { X ` m O m J m.

AmnH s g_V OrdZ ~r_m g~Yr O aVm| Ho {bE AmnH s ngXrXm bmB\ B`moaog H nZr ~ZZo H s Amem _|.

AmnH m ew^{MVH ,

{ddoH WboH a m - ` y { ~ O Z o mo o g J

Page 2 of 36


3/36

First Premium Receipt

Proposal No

Policy No

Channel Name

Sequence No

Received Date

Channel Code

:1G0 00200 508

:1G-PZ002413

: 8485830

:

:

: September 13, 2013

Policy Holder

Mr Krishna Mohan Chegu

Mode

Date of commencement of policy :September 18, 2013

:Annually Product/Plan :

Sum Assured: Rs.25,00,000/-

SBI Life - eShield Level Cover

Installment Premium Rs. 4,258

Service Tax & Education Cess Rs.527

Total Premium Amount Rs.4,785/-

No. of Premiums Paid 1

Total Amount Received Rs. 4,785/-

Next premium due on September 18, 2014

Due date of Premium payment :September 18, 2013

Payment Method :Online Selling

Amount of initial/first premium paid : Rs. 4,785/-

Rupees Four Thousand Seven Hundred Eighty Five Only

Received the amount as above.

Date : September 18, 2013

Note : In case of any discrepancies, you are kindly requested to advise us immediately. Call us toll free at our customer service helpline1800 22 2123or 1800 22 9090 or 1800 425 9010

No interest is payable on excess payments, if any, made by the policyholder. Any shortage/excess, will be adjusted against future premiums payable.

Premium paid under this policy is eligible for tax rebates under section 80C of the Income Tax Act, 1961, as applicable.

S/O CH GANGA RAM

RKR AUTOMOBILES OLD MARKET MAIN ROAD DALLI

RAJHARA

DURG - 491228

CHATTISGARH, India

Service Tax is applicable on premium as mandated by the government , effective 10 Sep 2004.

GST is applicable for the Jammu & Kashmir policies as mandated by government of Jammu & Kashmir .

'This Premium receipt is issued subject to realization of cheque'

Service Tax Registration Number : AAFCS2530PST001

Authorized Signatory

Page 3 of 36


4/36

Page 4 of 36


5/36


6/36

Page 6 of 36


7/36v 101 - 03_2013

SBI Life Insurance Company LimitedRegistration Number: 111 Regulated by IRDA

Policy Document

SBI Life - eSHIELD

UIN: 111N089V01

( A NON-PARTICIPATING TERM ASSURANCE PLAN )

Page 7 of 36


8/36v 101 - 03_2013

Welcome to your SBI Life eShield policy and thank you for preferring SBI Life Insurance Company Limited to provide you withinsurance solutions. The UIN allotted by IRDA for this product is 111N089V01.SBI Life eShield is also referred to as eShield in the

policy document.

The information you have given electronically in the web based proposal form, personal statement together with any medical reports and

other documents and declarations form part of this contract of insurance with us. Your policy document, comprising this policy schedulealong with the policy booklet and any endorsements, is evidence of the contract. You should read these carefully to make sure you aresatisfied. Please keep these in a safe place.

If you find any errors, please return your policy document for effecting corrections.

SBI Life eShield provides an excellent package of insurance solution. In return for your premiums we will provide benefits as describedin the following pages of the policy document. The benefits available under this policy are subject to the payment of future premiums asand when due.

Your Policy is a Non-participating traditional pure term assurance product,

The benefits will be paid to the person(s) entitled as set out in the policy document, on proof to our satisfaction, of such benefits havingbecome payable and of the title of the persons claiming the payments.

Please communicate any change in your mailing address or any other communication details as soon as possible.

Policy Schedule

Policy Number 1G0 00200 5081.Proposal No. 1GPZ0024132.

Proposal Date 12/09/20133.

Customer ID 336896884.

Identification

Name of the Life assured Mr Krishna Mohan Chegu5.

Date of Birth6.

Age at entry7.

Personal Information

11/03/1981

32

MaleGender8.

9. Mailing Address

Telephone Number with STD Code 231248210.

Mobile Number 860234651111.

E-Mail ID of the policyholder [email protected].

S/O CH GANGA RAMRKR AUTOMOBILES OLD MARKET MAIN ROAD DALLI RAJHARA

DURG,491228CHATTISGARH, India

Your Policy

SBI Life - eShield Policy Documen

If you require further information, please contact us.

Page 8 of 36


9/36v 101 - 03_2013

Name of the Nominee(s) Relationship with the life assured13.

Mrs Madhuri Chegu Chegu Wife 28

Age

Nomination

SBI Life - eShield Policy Documen

Name of Appointee(s) Relationship with Nominee14.

N.A. N.A.

Age

N.A.

27Premium Payment Term (Years)

Premium frequency Annual

Basic policy information

25,00,00020.

21.

22.

23.

Policy Term (Years) 27

Date of commencement of policy / risk

Date of expiry of term

Policy anniversary date

18/09/2013

18/09/2040

18/09

Important dates

Premium due dates 18/09 every year

15.

16.

17.

18.

19. Plan Option Level Cover

Sum Assured (Rs.)

Basic Policy Benefit

BenefitSum Assured

(Rs.)

Policy Term

(Years)

Premium

Paying Term

(Years)

Installment

Premium (Rs.)

Service Tax and

Cess (Rs.)

Base Policy 2500000.0

27 27 4,258 527 18/09/2039

Total Installment

Premium

including Service

tax and Cess4,785

Accidental Death

BenefitN.A.

Due Date of Last

Premium

Date of expiry

of term

18/09/2040

Service tax, cess and any other taxes payable may vary as per the taxation laws then applicable. Service tax is currently payable @ 12.00%

of premium, Education Cess @ 2.00% of service tax and Secondary and Higher Education cess @ 1.00% of service tax. The effective rateworks out to 12.36% of the installment premium.

Page 9 of 36


10/36v 101 - 03_2013

N.A.

Applicable Clauses

SBI Life - eShield Policy Document

N.A means ' Not applicable '

Signed for and on behalf of SBI Life Insurance Company Limited,

Date 18 September 2013 Mumbai

Designation Head - New Business Processing

Name Vivek Sthalekar

Place

The stamp duty of Rs 500.00/- (Rupees Five Hundred Only) paid by pay order, vide GRASS DEFACE No.0000024332201314 dated 10thJun 2013.Government Notification Revenue and Forest Department No. Mudrank 2004/4125/CR690/M-1, dated 31/12/2004.

(Signature)

Proper OfficerWe request you to read this policy schedule along with the policy booklet. If you find any errors,please return the policy for effecting

corrections.

*************************************************** End of Policy Schedule *****************************************

Authorised Signatory

Page 10 of 36


11/36

Policy Booklet

Table of Contents

1 Definitions ................................................................ ......................................................................... .......................................... 13

2 Abbreviations ........................................................................ ........................................................................ .............................. 14

3 Effective Sum Assured ........................................................................... .................................................................. ................... 14

3.1 Level Cover ............................................................ ........................................................................... .......................................... 14

3.2 Level Cover with Accidental Death Benefit ...................................................................... .......................................................... 14

3.3 Increasing Cover .................................................................. .......................................................................... .............................. 14

3.4 Increasing Cover with Accidental Death Benefit .................................................................. ...................................................... 14

4 Policy Benefits .......................................................................... ..................................................................... .............................. 15

4.1 Death Benefit ............................................................................ ..................................................................... .............................. 15

4.2 Paid-up Benefit .................................................................. ............................................................................ .............................. 15

4.3 Survival Benefit .................................................................... ......................................................................... .............................. 15

4.4 Maturity Benefit .................................................................. .......................................................................... .............................. 15

4.5 Surrender ........................................................... ..................................................................... ..................................................... 15

5 Accidental Death Benefit ................................................................................. ..................................................................... ....... 15

5.2 Definition of Accident ......................................................................... .............................................................................. ....... 15

5.3 Exclusions ........................................................................ .................................................................. .......................................... 16

6 Premiums ........................................................... ..................................................................... ..................................................... 16

7 Lapse and Revival ....................................................................... .................................................................. .............................. 16

8 Claims ....................................................................... ......................................................................... .......................................... 16

8.1 Death claim .......................................................................... .......................................................................... .............................. 16

8.2 Survival Claim ......................................................................... ...................................................................... .............................. 17

8.3 Maturity Claim ....................................................................... ....................................................................... .............................. 17

8.4 Surrender claim ........................................................................ ..................................................................... .............................. 17

9 Termination ............................................................ ........................................................................... .......................................... 17

9.1 Termination of death cover .............................................................................. ..................................................................... ....... 17

9.2 Termination of your policy ............................................................................. ...................................................................... ....... 17

10 General Terms .......................................................... ......................................................................... .......................................... 18

10.1 Free-look period ................................................................................................................................ .......................................... 18

10.2 Suicide exclusion .................................................................... ....................................................................... .............................. 18

10.3 Policy loan .................................................................... ..................................................................... .......................................... 18

10.4 Nomination ............................................................................ ........................................................................ .............................. 18

10.5 Assignment .............................................................. ........................................................................... ......................................... 18

10.6 Nondisclosure ....................................................................... ....................................................................... .............................. 19

10.7 Grace period ....................................................................................................................................... ......................................... 19

10.8 Misstatement of age ...................................................................... ................................................................. .............................. 19

10.9 Participation in profits .................................................................... .......................................................................... ................... 19

Page 11 of 36


12/36

10.10 Taxation ..................................................................................................................................................................................... 19

10.11 Date formats ........................................................... .......................................................................... .......................................... 19

10.12 Electronic transactions .......................................................................................................... ..................................................... 19

10.13 Notices ....................................................................................................................................................................................... 2011 Complaints ........................................................................... .......................................................................... .............................. 20

12 Relevant Statutes ................................................................ ........................................................................... .............................. 21

12.1 Governing laws and jurisdiction ................................................................................. ................................................................. 21

12.2 Section 41 of the Insurance Act 1938 ........................................................................... ............................................................... 21

12.3 Section 45 of the Insurance Act 1938 ........................................................................... ............................................................... 21

12.4 Provision 12 (1) of Redressal of Public Grievances Rules, 1998 ................................................................................................ 21

13 Index ............................................................................ ...................................................................... .......................................... 22

Page 12 of 36


13/36

This is your policy booklet containing the various terms and conditions governing your policy. This policy booklet should be read in

conjunction with the policy schedule and other related documents of your policy.

If you find any errors, please return the policy immediately for effecting corrections.

1 DefinitionsThese definitions apply throughout your policy document.The definitions are listed alphabetically. Items marked with alongside are provided in your policy schedule.

Expressions Meanings

1. Accidental Death Benefit is the benefit which is payable on death of the policyholder due to accident.2. Age is the age last birthday; i.e., the age in completed years.3. Age at entry is the age last birthday on the date of commencement of your policy.4. Appointee is the person who is so named in the proposal form or subsequently changed byendorsement, who has the right to give a valid discharge to the policy monies in case of the

death of the policy holder before the end of policy term while the nominee is a minor.

5. Assignee is the person to whom the rights and benefits under this policy are transferred by virtue ofassignment under section 38 of the Insurance Act, 1938.

6. Beneficiary the person nominated by the policy owner to receive all or part of the insurance benefitsunder the provisions of your policy. The Beneficiary is specified in the Application Form,the policy schedule and other written agreements of your policy, if any.

7. Date of commencement of policy /risk

is the date from which the insurance benefits under this policy are available.

8. Date of expiry of term is the date on which the benefits under this policy terminate on expiry of the benefit term.9. Death Benefit is the amount payable on death of the policyholder.10. Endorsement a change in any of the terms and conditions of your policy, agreed to and issued by us, in

writing.

11. Effective Sum Assured is as defined in the policy booklet.12. Free-look period is the period during which the policyholder has the option to return the policy and cancel

the contract.

13. Grace period is the period beyond the premium due date when the policy is treated as in-force.14. In-force is the status of the policy when all the due premiums have been paid.15. Initial Sum Assured is the Death Benefit offered by us at the time of the inception of policy for plan options:

Increasing Cover and Increasing Cover with Accidental Death Benefit.

16. Installment premium is the amount of money payable by you on each Premium Due Date in order to keep theinsurance cover in force under the provisions of your policy. This does not include theservice tax and other statutory levies which are payable by you in addition to the premium.

17. Lapse is the status of the policy when a premium is not paid before the end of grace period.18. Life assured is the person whose life is insured under this policy.19. Minor is a person who has not completed 18 years of age.20.Nominee

is the person who is named as the nominee in the proposal form or subsequently changedby endorsement, as per section 39 of the Insurance Act, 1938, who has the right to give avalid discharge to the policy monies in case of the death of the life assured during the termof the policy.

21.Non-participating means that your policy does not have a share in our profits.22. Policy anniversary is the same date each year during the policy term as the date of commencement of policy.If the date of commencement of policy is on 29th of February, the policy anniversary will

be the last date of February.

23. Policy document means the policy schedule, policy booklet, endorsements (if any), other written agreements(if any) mutually agreed by you and us during the time your policy takes effect.

24. Policy Schedule is the document that sets out the details of your policy.25. Policy Holder is the owner of the policy

Page 13 of 36


14/36

Expressions Meanings

26. Policy year is the period between two consecutive policy anniversaries; by convention, this periodincludes the beginning policy anniversary as the first day and excludes the next policyanniversary day at the end.

27. Policy Term is the period, in years, during which the insurance benefits are available28. Premium is the contractual amount payable by the life assured to secure the benefits under thecontract. This does not include service tax, cess and other statutory levies which are

payable in addition to the premium.

29. Premium frequency is the period between two consecutive premium due dates for the policy; only yearlypremium frequency is allowed under this policy.

30. Premium payment term is the period, in years, over which premiums are payable.31. Revival is the process by which the benefits lost under a lapsed policy, are restored.32. Revival period is a 2-year period from the due date of the First unpaid premium.33. Sum assured is the Death Benefit offered by us at the time of the inception of policy for plan options:

Level Cover and Level Cover with Accidental Death Benefit.

34. Surrender is the voluntary cessation of a benefit by the policyholder.35. Underwriting Process of assessment of risk at the time of inception or at the time of revival of the policy.Based on underwriting, a decision on acceptance or rejection of cover as well as

applicability of suitable revised premium and / or any other terms of the policy is taken.

36. We, Us, Our SBI Life Insurance Company Limited or its successors.We are regulated by the Insurance Regulatory and Development Authority (IRDA). Theregistration number allotted by the IRDA is 111.

37. You, Your is the person named as the policyholder.

2 Abbreviations

Abbreviation Stands forIRDA Insurance Regulatory and Development Authority

Rs. Indian Rupees

UIN Unique Identification Number (allotted by IRDA for this product)

These abbreviations bear the meanings assigned to them elsewhere in the policy booklet.

3 Effective Sum AssuredWe define Effective Sum Assured under various plan options as follows:

3.1 Level Cover3.1.1 Effective Sum Assured on any day is equal to the Sum Assured.3.2 Level Cover with Accidental Death Benefit3.2.1 Effective Sum Assured on any day is equal to the Sum Assured.3.3 Increasing Cover3.3.1 We will add 10% of the initial sum assured at the end of every 5 policy years if your policy is then in force. The effective sumassured would be the increased sum assured as applicable.

3.4 Increasing Cover with Accidental Death Benefit3.4.1 We will add 10% of the initial sum assured at the end of every 5 policy years if your policy is then in force. The effective sumassured would be the increased sum assured as applicable.3.4.2 Your Accidental Death Benefit would not be increased.

Page 14 of 36


15/36

4 Policy Benefits4.1 Death Benefit

If the policy is in-force on the date of death of the life assured, we will pay the benefit for the various plan options as follows:

4.1.1Level Cover4.1.1.1 If death of life assured occurs during the policy term, we will pay the sum assured.

4.1.2Level Cover with Accidental Death Benefit4.1.2.1 If death of life assured occurs during the policy term, we will pay the sum assured.4.1.2.2 If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit inaddition to the sum assured.

4.1.3Increasing Cover4.1.3.1 If death of life assured occurs during the policy term, we will pay the Effective Sum Assured on the date of death.

4.1.4Increasing Cover with Accidental Death Benefit4.1.4.1 If death of life assured occurs during the policy term, we will pay the Effective Sum Assured as on the date of death.4.1.4.2 If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit inaddition to the Effective Sum Assured as on the date of death.

4.2 Paid-up Benefit4.2.1 Your policy does not have any paid-up benefit.4.3 Survival Benefit4.3.1 Your policy does not have any survival benefit.4.4 Maturity Benefit4.4.1 Your policy does not have any maturity benefit.4.5 Surrender4.5.1 Your policy will not acquire any surrender value.4.5.2 Even if you surrender the policy, we will not pay any benefit.4.5.3 On receipt of your surrender request, your policy will terminate and we shall not have any liability under the policy.

5 Accidental Death Benefit5.1.1 This benefit applies only for plan options: Level Cover with Accidental Death Benefit and Increasing Cover with Accidental

Death Benefit.

5.1.2 The benefit is in-built in the above mentioned plan options.5.1.3 If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit in addition to

the Effective Sum Assured.5.1.4 We will pay the Accidental Death Benefit subject to all of the following:

5.1.4.1 Your policy is in-force.5.1.4.2 The life assured has died as a result of an accident as defined in this document.5.1.4.3 Such accidental death should be proved to our satisfaction.5.1.4.4 The death of the life assured should occur within 120 days from the date of accident.5.1.4.5 The death must be solely and directly due to Accident and independent of all other causes.5.1.4.6 The total Accidental Death Benefit sum assured under eShield policies put together will not exceed Rs. 50,00,000.5.1.4.7 If you have availed Accidental Death Benefit in addition to Rs. 50,00,000 by not disclosing previous insurancedetails under this product, we shall not pay the Accidental Death Benefit cover in excess of Rs. 50,00,000. If we come to

know of this on death of the life assured, we shall pay only the first Rs. 50,00,000.5.1.4.8 We would not refund the premium paid for the excess Accidental Death Benefit.

5.2 Definition of Accident5.2.1.1 An accident is a sudden, unforeseen and involuntary event, caused by outward, violent and visible means.

Page 15 of 36


16/36

5.3 ExclusionsWe will not pay the Accidental Death Benefit sum assured for deaths arising as a consequence of or occurring during the followingevents:

5.3.1 Infection: Death caused or contributed to, by any infection, except infection caused by an external visible woundaccidentally sustained.5.3.2 Drug abuse: Life assured under the influence of alcohol or solvent abuse or use of drugs except under the directionof a registered medical practitioner.

5.3.3 Self-inflicted injury: Intentional self-inflicted injury including the injuries arising out of attempted suicide.5.3.4 Criminal acts: Life Assureds involvement in criminal and / or unlawful acts with unlawful or criminal intent.5.3.5 War and civil commotion: War, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolutionor taking part in a riot or civil commotion.5.3.6 Nuclear contamination: The radioactive, explosive or hazardous nature of nuclear fuel materials or propertycontaminated by nuclear fuel materials or accident arising from such nature.5.3.7 Aviation: Life assureds participation in any flying activity, other than as a passenger in a commercially licensedaircraft.

5.3.8 Hazardous sports and pastimes: Taking part or practicing for any hazardous hobby, pursuit or any race notpreviously declared and accepted by us

6 Premiums6.1 You may pay the premiums on the premium due date or within the grace period.6.2 You have a choice to pay the premium 30 days before the premium due date6.3 You have to pay the premiums even if you do not receive renewal premium notice. There is no obligation on our part to sendyou renewal premium notices or reminders.

6.4 You will be liable to pay all applicable taxes as levied or revised by the Government and other statutory authorities from timeto time.6.5 If we receive any amount in excess of the required premium, we will refund the excess. We will not pay any interest on thisexcess amount.6.6 If we receive any amount lesser than the required premium and levies, we will not consider the same as premium till you paythe deficit.6.7 Insufficient premiums or excess premiums remitted shall be kept in deposit and the amounts kept in deposit shall not earnany interest.

7 Lapse and Revival7.1 If premiums are not paid within the grace period, your policy lapses. No benefits are then payable under your policy.7.2 You can revive your policy within the policy term during its revival period of 2 years from the date of First Unpaid Premium.7.3 You should write to us during the revival period requesting for revival.7.4 You have to submit Good Health Declaration and satisfy other underwriting requirements, if any.7.5 We may accept or reject your revivalrequest. We will inform you about the same.7.6 We may charge extra premium based on underwriting.7.7 You have to pay all due premiums, not paid during the revival period, along with interest. The due premiums would include

installment premium including any extra premiums intimated to you at the inception of your policy. If at the time of revival,

an extra premium is charged, you shall pay that extra premium also.7.8 Interest will be charged at a rate declared by us from time to time.7.9 You cannot revive your policy after the revival period.

8 Claims8.1 Death claim8.1.1 The nomineeorthe legal heir should inform the death of the life assured in writing, stating at least the policy number, cause ofdeath and date of death.

Page 16 of 36


17/36

8.1.2 We will require the following documents to process the claim:- Original policy document- Original death certificate from municipal / local authorities- Claimants statement and claim forms in prescribed formats- Hospital records including discharge summary, etc- Any other documents including post-mortem report, first information report where applicable

8.1.3 Claim under the policy may be filed with us within 90 days of date of claim event.8.1.4 However, without prejudice, in case of delay in intimation or submission of claim documents beyond the stipulated period inthe policy document, we, at our sole discretion, may condone such delay and examine the admissibility or otherwise of the claim, ifsuch delay is proved to be for reasons beyond the control of the nominee / claimant.

8.1.5 We will pay the claim to the assignee, if the policy is assigned.8.1.6 If the policy is not assigned , we will pay the claim to

8.1.6.1 the nominee, if the nominee is not a minor8.1.6.2 the appointee, if the nominee is a minor provided an appointee is appointed by you or to the legal guardians if there

is no appointee under the policy and the death claim arises during the minority of the nominee8.1.6.3 your legal heir, if nomination is not valid.

8.2 Survival Claim8.2.1 You cannot apply for survival claim as there is no survival benefit in your policy.8.3 Maturity Claim8.3.1 You cannot apply for maturity claim as there is no maturity benefit in your policy.8.4 Surrender claim8.4.1 You cannot apply for surrender claim as there is no surrender benefit in your policy.

9 Termination9.1 Termination of death coverThe death cover will terminate on the earliest of the following:

9.1.1 End of the grace period following discontinuation of premium.9.1.2 The date on which your policy terminates.9.1.3 Date on which we receive your free-look cancellation request.

9.2 Termination of your policyYour policy will terminate at the earliest of the following:

9.2.1 on settlement of death benefit.9.2.2 on the date of expiry of policy term.9.2.3 on payment of free-look cancellation amount.9.2.4 at the end of revival period, if not revived.9.2.5 on receipt of surrender request.

Page 17 of 36


18/36

10 General Terms10.1 Free-look period10.1.1 You have 30 days from the date of receipt of this policy document to review its terms and conditions. If you are not satisfied,you can return the policy stating the reasons for your objection.

10.1.2 We will then refund the premium paid after deducting the stamp duty paid, cost of medical expenses, if any, proportionate riskpremium for the period of cover and the proportionate taxes.

10.1.3 You cannot revive, reinstate or restore your policy once you have returned your policy.10.1.4 We will not pay any benefit under your policy after we receive your free-look cancellation request.10.2 Suicide exclusion10.2.1 If the life assured, whether sane or insane, commits suicide, within one year from the date of commencement of policy or dateof revival, we will not pay the death benefit.

10.2.2 We will only pay 80% of the premium paid. We will not consider taxes and extra premiums for the refund. In case of deathdue to suicide within one year of date of revival, we will not pay any benefits.

10.3 Policy loan10.3.1 Your policy will not be eligible for any loan.10.4 Nomination10.4.1 You have to make a nomination as per provisions of section 39 of the Insurance Act, 1938.10.4.2 You have to write to us if you want to change the existing nominees.10.4.3 You have to make a fresh nomination when you get your policy re-assigned to yourself.10.4.4 Nomination is for the entire policy and not for a part of the policy.10.4.5 We do not express any opinion on the validity or accept any responsibility in respect of any nomination you make.10.5 Assignment10.5.1 You have to write to us for effecting an assignment of your policy.10.5.2 On assignment, the assignee will be the sole owner of the policy.10.5.3 You have to make an assignment as per provisions of section 38 of the Insurance Act, 1938.10.5.4 Assignment is for the entire policy and not for a part of the policy.10.5.5 You have to submit your policy document along with a valid and duly attested deed of assignment.10.5.6 We will effect the assignment by endorsing your policy.10.5.7 The assignment shall be binding on the Company only from the date on which your assignment is duly registered with us andnot before, irrespective of the actual date of execution of the deed of assignment. If the deed of assignment is not properly executed,

we may, at our sole discretion, refuse to register the assignment.

10.5.8 Assignment will automatically cancel any existing nomination.10.5.9 Assignment will not be permitted where the policy is under the Married Womens Property Act, 1874.

Page 18 of 36


19/36

10.5.10We do not express any opinion on the validity or accept any responsibility in respect of any assignment you make.10.6 Nondisclosure10.6.1 We have issued your policy based on the statements in your proposal form, personal statement, medical reports and any otherdocuments.

10.6.2 If we find that any of this information is inaccurate or false or you have withheld any material information, we shall declareyour policy null and void but subject to section 45 of the Insurance Act, 1938.

10.6.3 We will not pay any benefits and we will also not return the amounts you have paid.10.7 Grace period10.7.1 You can pay your premiums within a grace period of 30 days from the due dates.10.7.2 Your policy will be treated as in-force during the grace period.10.7.3 If you do not pay your due premiums before the end of grace period, your policy lapses.10.7.4 You may revive your policy during the revival period.10.7.5 If death occurs during the grace period, we shall deduct the unpaid premium from the claim amount.10.7.6 If death occurs during the grace period, the effective sum assured will be paid assuming that the last due premium was paid.

10.8 Misstatement of age10.8.1 If we find that the correct age of the life assured is different from that mentioned in the proposal form, we will check youreligibility for the life cover as on the date of commencement.

10.8.1.1 If eligible,10.8.1.1.1 If the correct age is found to be higher, you have to pay the difference in premiums along with interest.10.8.1.1.2 We will terminate your policy, if you do not pay the difference in premiums and applicable interest.10.8.1.1.3 If the correct age is found to be lower, we will refund the difference in premiums without any interest.

10.8.1.2 If not eligible,10.8.1.2.1 We will terminate your policy.

10.9 Participation in profitsYour policy does not participate in our profits.

10.10 Taxation10.10.1You are liable to pay service tax, cess and statutory levies as per the applicable rates, along with the premium.10.10.2We shall collect the taxes and statutory levies along with the premium.10.10.3Taxes may change subject to future changes in taxation laws.10.11 Date formats10.11.1 Unless otherwise stated, all dates described and used in the policy schedule are in dd/mm/yyyy formats.10.12 Electronic transactions

Page 19 of 36


20/36

10.12.1We shall accept premiums and pay benefits through any approved modes including electronic transfers.10.13 Notices10.13.1We will communicate to you in writing and deliver the correspondence by hand, post, facsimile, e-mail or any other approvedmode.

10.13.2We will send correspondence to the mailing address you have provided in the proposal form or to the changed address that isintimated to us and recorded by us.

10.13.3You should also communicate in writing and deliver the correspondence by hand, post, facsimile, e-mail or any otherapproved mode.

10.13.4All your correspondence should be addressed to:SBI Life Insurance Company Limited,Central Processing Centre,Kapas Bhawan, Sector 10,

CBD Belapur,Navi Mumbai 400 614.Phone : 022 - 6645 6241E-mail: [email protected]

10.13.5It is important that you keep us informed of your changed address.

11 Complaints11.1 Grievance Redressal procedure11.1.1 If you have any query, complaint or grievance, you may approach any of our offices.11.1.2 You can also call us on our toll-free number.11.1.3 If you are not satisfied with our decision or have not received any response within 10 working days, you may write to us at:

Head Client Relationship,SBI Life Insurance Company LimitedCentral Processing Centre,Kapas Bhawan, Sector 10,CBD Belapur,Navi Mumbai 400 614.Telephone No: 022 6645 6241Fax: 022 6645 6655

Email Id: [email protected]

11.1.4 In case you are not satisfied with our decision, and the issue pertains to provision 12 (1) of the Redressal of Public GrievancesRules, 1998, you may approach the Insurance Ombudsman. You can lodge the complaint with the Ombudsman as perprovision 13 of the said rules. The relevant provisions have been mentioned in the section Relevant Statutes.

11.1.5 The address of the Insurance Ombudsman and the Redressal of Public Grievances Rules, 1998, are, available in the website ofIRDA, http://www.irdaindia.organd in our website http://www.sbilife.co.in. The address of the ombudsman at Mumbai is:Office of the Insurance Ombudsman (Maharashtra and Goa)

3rd

Floor, Jeevan Seva Annexe,S.V. Road, Santa Cruz (W),

Mumbai 400 054.Phone: +91 22 2610 6928Fax: +91 22 2610 6052Email: [email protected]

11.1.6 We have also enclosed the addresses of the insurance ombudsman.

Page 20 of 36


21/36

12 Relevant Statutes12.1 Governing laws and jurisdiction12.1.1 This is subject to prevailing Indian Laws. Any dispute that may arise in connection with this shall be subject to the jurisdictionof the competent Courts of Mumbai.

12.2 Section 41 of the Insurance Act 193812.2.1 (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or

continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of thecommission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a

policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer:Provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself onhis own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of suchacceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by theinsurer.(2) Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five

hundred rupees.

12.3 Section 45 of the Insurance Act 193812.3.1No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date ofcommencement of this Act and no policy of life insurance effected after the coming into force of this Act shall, after the expiry of twoyears from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal

for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue ofthe policy, was inaccurate or false, unless the insurer shows that such a statement was on a material matter or suppressed facts which it

was material to disclose and that it was fraudulently made by the policy-holder and that the policy holder knew at the time of makingit that the statement was false or that it suppressed facts which it was material t o disclose; Provided that nothing in this section shallprevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called inquestion merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly statedin the proposal.

12.4 Provision 12 (1) of Redressal of Public Grievances Rules, 1998The Ombudsman may receive and consider

(a) Complaints under Rule 13(b) Any partial or total repudiation of claims by an insurer(c) Any dispute in regard to premium paid or payable in terms of the policy(d) Any dispute on the legal construction of the policy, insofar as such disputes relate to claims(e) Delay in settlement of claims(f) Non-issue of any insurance document to customers after receipt of premium

12.5 Provision 13 of Redressal of Public Grievances Rules, 1998(1) any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint in writing to the

Ombudsman within whose jurisdiction the branch or office of the insurer complained against is located.(2) the complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly the name and

address of the complainant, the name of the branch or office of the insurer against which the complaint is made, the fact givingrise to complaint supported by documents, if any, relied on by the complainant, the nature and extent of the loss caused to thecomplainant and the relief sought from the Ombudsman.

(3) no complaint to the Ombudsman shall lie unless (a) the complainants had before making a complaint to the Ombudsman made a written representation to the insurer named in

the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period ofone month after the insurer concerned received his representation or the complainant is not satisfied with the reply given to

him by the insurer.(b) the complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the

representation of the complainant, and(c) the complaint is not on the same subject matter, for which any proceedings before any Court, or Consumer Forum or

Arbitrator is pending or were so earlier

***********************************************End of Policy Booklet*******************************************

Page 21 of 36


22/36

13 Index

AAccidentalDeathBenefit 11,13,14,15,16Age 11,13,19,21Appointee 13,17

BBeneficiary 13

DDeathBenefit 11,13,14,15,16,17,18

EEffectiveSumAssured 11,13,14,15,19Endorsement 13

FFreelook 11,13,17,18

GGraceperiod 11,13,16,17,19

IInforce 13,15,19InitialSumAssured 13,14Installmentpremium 13,16InsuranceRegulatoryandDevelopmentAuthority(IRDA) 14,20

LLapse 11,13,16LifeAssured 13,14,15,16,18,19

MMinor 13,17

NNominee 13,16,17

OOur 13,14,15,16,17,18,19,20

PPaidup 11,15Participating 13Policy 11,13,14,15,16,17,18,19,21Policyanniversary 13,14Policydocument 13,17,18PolicySchedule 13,19PolicyTerm 14Policyyear 14Policyholder 13,14Premium 13,14,15,16,17,18,19,21Premiumfrequency 14Premiumpaymentterm 14

RRevival 11,14,16,17,18,19Revivalperiod 14,16,17,19

SSurrender 11,14,15,17SurrenderValue 15

UUIN 14Underwriting 14,16Us13,14,16,17,18,20

WWe 14,15,16,17,18,19,20

YYou 13,14,15,16,17,18,19,20

Page 22 of 36


23/36

Insurance

Ombudsman,OfficeoftheInsuranceOmbudsman,2ndFloor,

AmbicaHouse,Nr.C.U.ShahCollege,AshramRoad,

AHMEDABAD380014.

Tel.: 07927546840 Fax:07927546142

Email: [email protected]

InsuranceOmbudsman,

OfficeoftheInsuranceOmbudsman,

JanakViharComplex,2ndFloor,6,MalviyaNagar,

Opp.Airtel,NearNewMarket,

BHOPAL(M.P.)462023.

Tel.: 07552569201 Fax:07552769203


InsuranceOmbudsman,


62,ForestPark,

BHUBANESHWAR751009.

Tel.: 06742596455 Fax:06742596429


OfficeoftheOmbudsman NameoftheOmbudsman ContactDetails AreasofJurisdiction

ListofOmbudsmen :

AHMEDABAD Shri P.Ramamoorthy Gujarat,UTofDadra&NagarHaveli,

DamanandDiu

BHOPAL MadhyaPradesh&Chhattisgarh

BHUBANESHWAR ShriB.P.Parija Orissa

CHANDIGARH Shri Manik Sonawane Pun ab Har ana Himachal Pradeshnsurance m u sman,


S.C.O.No.101

103,

2nd

Floor,

Batra

Building.

Sector

17

D,

CHANDIGARH160017.

Tel.: 01722706468 Fax:01722708274


InsuranceOmbudsman,


FathimaAkhtarCourt,4thFloor,453(old312),

AnnaSalai,Teynampet,

CHENNAI600018.

Tel.: 04424333668/5284 Fax:04424333664

Email:

[email protected]

InsuranceOmbudsman,

OfficeoftheInsuranceOmbudsman,2/2A,

UniversalInsuranceBldg.,AsafAliRoad,

NEWDELHI110002.

Tel.: 01123239633 Fax:01123230858


InsuranceOmbudsman,


JeevanNivesh,5th

Floor,

NearPanbazar

Overbridge,

S.S.

Road,

GUWAHATI781001(ASSAM).

Tel.: 03612132204/5 Fax:03612732937


Delhi&Rajasthan

, , ,

Jammu&Kashmir,UTofChandigarh

CHENNAI TamilNadu,UTPondicherryTownand

Karaikal(whicharepartofUTof

Pondicherry)

NEWDELHI ShriSurendraPalSingh

GUWAHATI ShriD.C.Choudhury Assam,Meghalaya,Manipur,

Mizoram,ArunachalPradesh,Nagaland

andTripura

Page 23 of 36


24/36

Insurance

Ombudsman,OfficeoftheInsuranceOmbudsman,6246,

1stFloor,MoinCourt,A.C.Guards,LakdiKaPool,

HYDERABAD500004.

Tel:04065504123 Fax:04023376599


InsuranceOmbudsman,


2ndFloor,CC27/2603,PulinatBldg.,

Opp.CochinShipyard,M.G.Road,

ERNAKULAM682015.

Tel:04842358759 Fax:04842359336


Ms.ManikaDatta

InsuranceOmbudsman,


4thFloor,HindusthanBldg.Annexe,4,C.R.Avenue,

Kolkatta700072.

Tel: 03322124346/(40) Fax: 03322124341

AndhraPradesh,KarnatakaandUTof

YanamapartoftheUTof

Pondicherry

OfficeoftheOmbudsman NameoftheOmbudsman ContactDetails AreasofJurisdiction

ShriR.Jyothindranathan Kerala,UTof(a)Lakshadweep,(b)

MaheapartofUTofPondicherry

KOLKATA Ms.ManikaDatta WestBengal,Bihar,JharkhandandUT

ofAndeman&NicobarIslands,Sikkim

HYDERABAD

KOCHI

Emai ::iom s pa@ sn .in

InsuranceOmbudsman,

Officeof

the

Insurance

Ombudsman,

JeevanBhawan,Phase2,6thFloor,

NawalKishoreRoad,Hazaratganj,

LUCKNOW226001.

Tel:05222231331 Fax:05222231310


InsuranceOmbudsman,


S.V.Road,Santacruz(W),

MUMBAI400054.

Tel:022

26106928

Fax

:022

26106052


UttarPradeshandUttaranchal

MUMBAI Maharashtra,Goa

Web:www.gbic.co.in

3rdFloor,JeevanSevaAnnexe, 3rd

Floor,JeevanSevaAnnexe,

S.V.Road,Santacruz(W), S.V.Road,Santacruz(W),

LUCKNOW

MUMBAI400021 MUMBAI400021.

Tel:02226106245 Tel:02226106980

Fax:02226106949 Fax:02226106949

Email

[email protected]

*Updatedason07thNovember2012

OFFICEOFTHEGOVERNINGBODYOFINSURANCECOUNCIL

Shri M.V.V. Chalam,SecretaryGeneral TheSecretary

ShriG.B.Pande

Page 24 of 36


25/36

PROPOSAL FORM SBI LIFE Shield

(UIN: 111N089V01)SBI LIFE INSURANCE COMPANY LTD.

Natraj, M.V. Road & Western Express Highway Junction,Andheri (East),Mumbai - 400 069.

1. ARE YOU AN EXISTING SBI LIFE CUSTOMER?

3. DETAILS OF LIFE TO BE ASSURED

11/MAR/1981Gender

CountryofResidence

ProposerName

Father's Name

DateofBirth

AgeProof

IdentityProof

Qualifications

Mr.KrishnaMohanChegu

ChGangaRam

Male

India

BirthCertificate

DrivingLicense

PostGraduate

:-

:-

:-

:-

:-

:-

:-

:-

Nationality Indian:-

AadharNo:-

(UniqueIdentificationNo.)

MaritalStatus

AreyouaPoliticallyExposedPerson(PEP)oracloserelativeofPEP

PEPsareindividualswhoareorhavebeenentrustedwithprominentpublicfunctions,i.e.heads/ministersofcentral/stategovt.,seniorpoliticians,seniorgovt,judicialormilitaryofficials,seniorexecutivesofgovt.companies,importantpoliticalpartyofficials,immediatefamilymemberofabovepersons(wouldincludespouse,parents,siblings,children,spousesparentsorsiblingsandcloseassociatesofpeps.)

DoyouhaveanyhistoryofconvictionunderanycriminalproceedingsinIndiaorabroad.

AnnualIncome(inRs.) PAN

IncomeProof SalarySlip

Domicile Urban

Areyouexposedtoanyspecialhazardassociatedwithyouroccupation(e.g.chemicalfactory,mines,explosives,corrosives,combativeduties,oilexploration,highseavoyageetc.)whichmayrenderyoususceptibletoinjuriesorillnesses?

No

No

2. IS LIFE ASSURED AN INSURANCE ADVISER OF SBI LIFE?

No

Married Occupation Service

No

500000 AZOPM2915R

577318478620

No

:- :-

:-

:-

:- :-

NameOfemployer :- VANDANAGLOBALLTD

Designation SAPCONSULTANT:-

Lengthofservice 2:-

AddressOfemployer

:- VANDANABHAWAN,VANDANAGLOBALLTD,MGROAD,RAIPUR

Years

Proposal No. : 1GPZ002413Date & Time: 12-Sep-2013 16:48:50

Page 25 of 36


26/36

PinCode

Tel.No.(Home)

Tel.No.(Office)

AddressLine1

AddressLine2

AddressLine3

State

MobileNo

EmailID

S/oCHGANGARAM

R.K.RAUTOMOBILES

OLDMARKET,MAINROAD,DALLIRAJHARA

491228DURGCity

CHATTISGARH

[email protected]

0861-2312482

-8602346511

:-

:-

:-

:-

:-

:-

:-

:

:

:

4. Communication Address

AddressProof RationCard:-

AddressLine1

AddressLine2

AddressLine3

City PinCode

S/oCHGANGARAM

R.K.RAUTOMOBILES

OLDMARKET,MAINROAD,DALLIRAJHARA

DURG 491228

State CHATTISGARH

:-

:-

:-

:-

:-

:-

:-

:-

:-

:-

:-

City :- DURG Gender Female:-

5. Permanent Address :

6. NOMINEE DETAILS

RelationshipwiththeProposer

FullName

Nominee/AppointeeAddress

DateofBirth

Mrs.MADHURICHEGUCHEGU

S/oCHGANGARAMR.K.RAUTOMOBILESOLDMARKET,MAINROAD,DALLIRAJHARA

04-Apr-1985

State CHATTISGARH

PinCode 491228

Wife

:-

RelationshipwiththeLifetobeAssured:

RelationshiptotheNominee:

FullName

DateofBirth Gender NA

NA

NA

NA

NA

:-

:-

:-

:-

:-

6.1. APPOINTEE DETAILS:


Page 26 of 36


27/36

7. DETAILS OF THE INSURANCE COVER PROPOSED:

7.1 BASIC PLAN DETAILS:

DoyouconsumeorhaveeverconsumedTobaccoinanyform(Cigarettes/Beedis/Gutka/Cigar,etc)? NoPlan Refer Product Sales Brochure forbenefits applicable) Policy Term Yrs.) Sum Assured Premium Payable

AnnualPremium(A) 4257.50

ServiceTaxAmount(B) 527

TotalInstallmentPremium(A+B) 4785

27 2500000 4785BI Life - eShield - Level Cover

"ServiceTaxpayablemayvaryasperthetaxationlawsthenapplicable."

"ThemaximumAccidentalDeathBenefitSumAssuredisrestrictedtoRs.50LakhsforallpoliciesownedbytheLifeAssuredundereShieldProduct".

10. FAMILY HISTORY OF THE LIFE TO BE ASSURED :

Relation Alive/NotAlive PresentAge/AgeatDeath

Haveanyofyourparents,brothersorsistersdiedorsufferedfromanyofthediseases/disordersspecifiedbelow?*

NatureofDisorder* Particulars,includingdateofdiagnosis.Ifnotalive,specify

causeofdeath.

Father Alive 61

Mother Alive 56

Spouse Alive 27

11. MEDICAL AND OTHER DETAILS OF THE LIFE TO BE ASSURED:

Height Weight5'9" 72kgs

VisibleIdentificationMarks,Ifany Yes

BlackmoleonrightsideofHead

8. DETAILS OF PREMIUM REMITTANCE :

NameasitappearsinBankAccount/Debit/creditcard

BankAccountnumber/LastfourDigitofCreditCardNumber

chKrishnaMohan

NameofBank/Creditcardissuer StateBankofIndia

9658

PaymentOptionselected NetBanking

Previous Insurance Details

NameofInsuranceCo.

Policy/ProposalNo.

YearofIssue

Product/Plan/Rider/Option

Medical(Y/N)

YearlyPremium(`)

SumAssured(`)

Self/Spouse/Parent(Pls.specify)

PolicyStatus

9.1 DO YOU HAVE ANY OTHER INDIVIDUAL LIFE INSURANCE POLICY OR HAVE YOU APPLIED FOR ONE? No

9.2 Is any of your proposals rejected, declined, postponed or accepted with additional premium by anyinsurance company?

No


Page 27 of 36


28/36

Duringthelastoneyear,hastherebeenanyincrease/decreaseinyourweightover5kgs? No

Duringthelast10years,haveyouundergoneoradvisedtoundergohospitalizationoranoperationoranyinvestigationortestsorMedicalTreatment?

No

Duringthelast5years,whetheryouwereunderanymedicaltreatment,undergonesurgeryorregularmonitoringformorethan14consecutivedays?

No

Duringthelast5years,haveyouremainedabsentfromyourplaceofwork(professionalornon-professional)ongroundsofhealthfor30consecutivedaysormore?

No

DoyouplanorhavebeenadvisedtoundergoanySurgery,orhospitalizationorvisittoadoctororpractionerforanyphysical,mentaloremotionalcondition,injuryorsicknessinnearfuture?

No

DoyouhaveanyPhysicaldeformityorcongenital/acquireddefect? No

HaveyouundergoneanytestforHIV? No

IfYeswasHIVpresent? No

Heartdisease(Chestpain,Vasculardiseaseetc)? No

HaveyouundergoneanytestforHepatitis-A/B/C? No

Ifyes,wasHepatitisA/B/CPresent? No

Haveyoumetwithanyaccidentorsufferedfromanyphysicalimpairments/headinjuries/lossofConsciousnessDuetoaccident?

No

Haveyoueverbeentestedortreatedorhaveyoubeenadvisedtoundergoinvestigationforasexually

transmitteddisease?

No

DoyouhavehighBloodpressureorhaveyoueversufferedortreatedorhaveyoubeenadvisedtoundergoinvestigationforHighBloodpressure?

No

DoyouhaveDiabetesorhaveyoueversufferedortreatedorhaveyoubeenadvisedtoundergoinvestigationforDiabetes?

No

Areyousufferingfrom,ordidyousufferorundergoinvestigationinthepastfromorhaveyoubeenadvisedtoundergoinvestigationortreatmentfor:Cancer/Leukemia/Lymphoma?

No

Kidneydisease(stones,bloodinurineetc)? No

Liverdisease(Jaundice/Hepatitisetc)? No

DigestiveDisorder(Ulcer,Gastricbleedingetc)? No

Lung/Respiratorydisease(TB,Asthma,Pneumoniaetc)? No

Goitre/Thyroid/OtherEndocrinediseases? No

Bone/Joint/Backdisease/Arthritisetc? No

Mentaldisorders(depression,anxietyetc)? No

Chronicinfections/Circulatory/Blooddisorder? No

Brain/Nervoussystemdisease/Stroke? No

Tumor/Cysts/Anyotherunusualgrowth/Lumps? No

Eyedisease/Eardisorders? No

Skindisorders(psoriasisetc)? No


Page 28 of 36


29/36

13. DETAILS OF HOBBIES AND PASTIMES:

14. DECLARATION BY THE LIFE TO BE ASSURED:

DoyouconsumeorhaveeverconsumedNarcoticsubstancesoraddictivedrugsinanyform?

DoyouconsumeorhaveeverconsumedTobaccoinanyform(Cigarettes/Beedis/Gutka/Cigaretc)

DoyouconsumeorhaveeverconsumedAlcoholinanyformorhaveyousufferedfromcomplicationsduetoalcoholconsumption?

No

No

No

Do you take part in any adventurous hobbies/activities that could be dangerous in any way, such as aviation (other thanfare paying passenger), mountaineering,any form of racing, etc?

No

Iherebydeclarethattheforegoingstatementsandanswershavebeengivenbymeafterfullyunderstandingthequestionsandthesamearetrue,accurateandcompleteineverymannerandthatIhavenotwithheldoromittedtogiveanyinformation.Further,Ihavenotprovidedanyfalseinformationinreplytoanyquestion.Iunderstandandagreethatthestatementsinthisproposalconstitutewarranties.IdoherebyagreeanddeclarethatthesestatementsandthisdeclarationshallbethebasisofthecontractofassurancebetweenmeandSBILifeInsuranceCo.Ltd.(Company)andthatifthereisanymis-statementorsuppressionofmaterialinformationorifanyuntruestatementsbecontainedthereinthesaidcontractshallbeabsolutelynullandvoidandallmoneyswhichshallhavebeenpaidinrespectthereofshallstandforfeitedsubjecttosection45oftheInsuranceAct1938.IalsounderstandandagreethatthecompanyshalladditionallylevyorrecoveralltheapplicabletaxeslikeServiceTax,Surcharges,Cess,etc.fromthepremiumwhicharenecessitatedbyvariousenactmentsofCentraland/orStateLegislaturesfromtimetotime.IundertaketoundergoallmedicaltestsasmayberequiredbytheCompanyforthegrantofinsurance.Notwithstandingtheprovisionofanylaw,usage,customorconventionforthetimebeinginforceprohibitinganydoctor,hospitaland/oremployerfromdivulginganyknowledgeorinformationaboutmeconcerningmyhealth,employmentonthegroundsofsecrecy,I,myheirs,executors,administratorsandassigneesoranyotherpersonorpersonshavinginterestofanykindwhatsoeverinthepolicycontractissuedtome,herebyagreethatsuchauthority,havingsuchknowledgeorinformation,shallatanytimebeatlibertytodivulgeanysuchknowledgeorinformationtotheCompany.IfurtheragreethatifafterthedateofsubmissionofthisproposalbutbeforetheissueofthepremiumreceiptbytheCompany(i)ifthereareanyadversecircumstancesconnectedwiththegeneralhealthofmyself,or(ii)ifaproposalforassuranceonmylifemadetoanyotherinsurancecompanyhasbeenwithdrawnordroppedoracceptedatanincreasedpremiumorontermsotherthanasproposedbyme,or,(iii)ifthereisanychangeinmyoccupation,IshallforthwithintimatethesametoSBILifeInsuranceCo.Ltd.inwritingtoreconsiderthetermsofacceptanceofthisproposal.Anyomissiononmyparttodososhallrenderthecontractofassuranceinvalid.Intheeventthatthisproposalisnotconvertedintoapolicy,IagreethattheCompanyhastherighttorecoverfromme,anymedicalexpensesincurredbytheCompany.IunderstandandagreethatSBILifewillnotberesponsibleforanydelayinpremiumpaymentirrespectiveofanymodeforremittanceopted.IunderstandthesignificanceofthecontractandthatthecontractwillbegovernedbytheprovisionsoftheInsurance

Act,1938,ITAct,2000andtheIndianContractAct,1872,andthatthesamewillnotcommenceuntilwrittencommunicationaboutacceptanceofthisproposalbythecompanyisreceivedbyme.Ialsoagreethattheamountheldinproposal/policydepositshallnotearnanyinterest.

IfurtherstatethatIhavethoroughlyreadtheproductfeaturesandhavecompletelyunderstoodthetermsandconditionsofthepolicyandagreethatbysubmittingthisapplicationthroughthecompanyswebsite,Iwillbeboundbysuchstatements/disclosuresofmaterialfactsinthesamemannerandtothesameextent,asifIhavesignedandsubmittedthewrittenproposalforinsurancetothecompany.

"IfurtherrequestSBILIFEtosendmeanyinformationrelatingtomyproposals/policiesandIherebygivemyconsenttoreceivesuchinformationthroughSMS/Email/Phone/Letter,notwithstandinganyRegulations/Statutoryprovisionstothecontrary.ThisconsentshallholdgoodevenifIregistermynumberwiththeNationalCustomerPreferenceRegister(NCPR)"I hereby declare that the deposit for this proposal has been paid from my own source/ income I further declare thatthe premium is paid from my credit / debit card / internet bank accountSection41oftheInsuranceAct,1938:(1)Nopersonshallalloworoffertoallow,eitherdirectlyorindirectly,asaninducementtoanypersontotakeorreneworcontinueaninsuranceinrespectofanykindofriskrelatingtolivesorpropertyinIndia,anyrebateofthewholeorpartofthecommissionpayableoranyrebateofthepremiumshownonthepolicy,norshallanypersontakingoutorrenewingorcontinuingapolicyacceptanyrebate,exceptsuchrebateasmaybeallowedinaccordancewiththepublishedprospectusesortablesoftheinsurer:


Page 29 of 36


30/36

Providedthatacceptancebyaninsuranceagentofcommissioninconnectionwithapolicyoflifeinsurancetakenoutbyhimselfonhisownlifeshallnotbedeemedtobeacceptanceofarebateofpremiumwithinthemeaningofthissub-sectionifatthetimeofsuchacceptancetheinsuranceagentsatisfiestheprescribedconditionsestablishingthatheisabonafideinsuranceagentemployedbytheinsurer.(2)Anypersonmakingdefaultincomplyingwiththeprovisionsofthissectionshallbepunishablewithfinewhichmayextendtofivehundredrupees

Section 45 of the Insurance Act 1938:NopolicyoflifeinsuranceeffectedbeforethecommencementofthisActshallaftertheexpiryoftwoyearsfromthedateofcommencementofthisActandnopolicyoflifeinsuranceeffectedafterthecomingintoforceofthisActshall,aftertheexpiryoftwoyearsfromthedateonwhichitwaseffected,becalledinquestionbyaninsureronthegroundthatastatementmadeintheproposalforinsuranceorinanyreportofamedicalofficer,orreferee,orfriendoftheinsured,orinanyotherdocumentleadingtotheissueofthepolicy,wasinaccurateorfalse,unlesstheinsurershowsthatsuchstatementswasonamaterialmatterorsuppressedfactswhichitwasmaterialtodiscloseandthatitwas

fraudulentlymadebythepolicyholderandthatthepolicyholderknewatthetimeofmakingitthatthestatementwasfalseorthatitsuppressedfactswhichitwasmaterialtodisclose;Providedthatnothinginthissectionshallpreventtheinsurerfromcallingforproofofageatanytimeifheisentitledtodoso,andnopolicyshallbedeemedtobecalledinquestionmerelybecausethetermsofthepolicyareadjustedonsubsequentproofthattheageofthelifeinsuredwasincorrectlystatedintheproposal.

I,Mr.KrishnaMohanCheguunderstandandagreethatbysubmittingthisproposalthroughtheCompany'swebsite,Iillbeboundbysuchstatements/disclosuresofmaterialfactsinthesamemannerandtothesameextent,asifI

havesignedandsubmittedawrittenproposalforinsurancetotheCompany.

Place:-Raipur

Date:-12-Sep-2013


Page 30 of 36


31/36

SBI Life Insurance Co. Ltd, Corporate Office: "Natraj", M.V Road & Western Express Highway Junction, Andheri (East), Mumbai400069

Central Processing Center: Kapas Bhavan, Plot No.3A, Sector No.10, CBD Belapur, Navi Mumbai400614

PS41/Ver1.0/ 1 Feb 2013Page 1 of 1

REQUESTFORCHANGEINPOLICYDETAILSPlease use separate form for each policy::Kindly fill all details in capitals::Any Corrections in the form need to be counter signed.

To,SBI Life Insurance Co Ltd, Branch_________________

Date Policy No

Name of the Policy Owner

Contact No

Email ID

Kindly amend my policy as belowAll fields are mandatory (At least one contact no is mandatory for processing your request. Contact nos mentioned above will be updated for future communication)

Change / Correction in Name Policy Holder Life Assured Nominee Appointee Life Beneficiary

Reason for Change (In case of Surname / Complete name Change)_________________________________________________ Change will be effected in all the policies where the client exists * For minor spelling corrections, supporting proof needs to be submitted

For married women with a change in surname, Marriage certificate or Declaration signed by two witnesses along with a copy of marriage invitation is needed.

For all other requests involving significant change a Gazette copy is required.

Change in Date of Birth Policy Holder Life Assured Nominee Appointee Life Beneficiary

Reason for Change: _____________________________________________________________________________________

Supporting proof attached: Birth Certificate School Certificate Passport PAN Driving Licence Others___________Change in Premium Payment Frequency: Kindly change my payment frequency to: (Please tick the desired option)

Yearly Half Yearly Quarterly Monthly

One of the following Auto debit modes is mandatory for monthly frequency. Select one and fill up the corresponding mandate.

ECS Direct Debit Standing Instructions EFT (for State Bank Group Account holders only)

For other frequencies, we strongly advise that you take the advantage of one of our various alternate premium pay methods. Please enquire with our staff for full details.

Change in Premium

Change in Sum Assured .

Change in Term / Vesting AgeDeletion of Rider: I would like to cancel the following riders: 1.______________________ 2.______________________

Update PAN Number (Self attested copy of the PAN Card is mandatory)I have understood the meaning and scope of the change request form and take complete responsibility of the changes submitted by me. Any changes

in the Policy / Personal details are subject to the policy terms and conditions and relevant underwriting guidelines.

Note: Changes are subject to product terms & conditions. Some changes are subject to underwriting approval and evidence of insurability including medicalexaminations as per the extant underwriting guidelines might be called for by SBI Life Insurance Company.

d d m m y y y y

Residence Office Mobile

s t d s t d m o b i l e

From d d m m y y y y TO d d m m y y y y

From Rs. TO Rs.

From Rs. TO Rs.

From Years TO Years

Signature of Policy Holder

Page 31 of 36


32/36

Page 32 of 36


33/36

SBI Life Insurance Co. Ltd, Corporate Office: "Natraj", M.V Road & Western Express Highway Junction, Andheri (East), Mumbai400069

Central Processing Center: Kapas Bhavan, Plot No.3A, Sector No.10, CBD Belapur, Navi Mumbai400614

PS40/Ver1.0/ 1 Feb 2013Page 1 of 1

REQUESTFORCHANGEINCONTACTDETAILSTo,

SBI Life Insurance Co Ltd, Branch __________________

Date Policy No

Name of the Policy Owner

Kindly amend my policy as below

Change in Address(TickOne) Correspondence Permanent Both

Request for Address change has to be submitted in person at any of the branches of SBI Life Insurance Co Ltd

Permanent Address must be of India and cannot be given as that of employer.

House # & Bldg / Society

Road / Sector & Landmark

City/Village & Taluka District State Pin

Country

Any one of the following documents will be accepted as Residence proof and should be produced in original for verification by SBI

Life official along with one photo identity proof and the form (Tick)

Driving License Passport Election ID Card Aadhar Card Ration Card Utility Bills not older than 6 months*

Rent/Lease agreement with last 3 months rent receipts Letter from recognized Public AuthorityBank passbook/ Account Statement with transactions till previous month Others (specify)_________________________

*Gas Bill not older than 3 months

Any one of the following documents will be accepted as photo identity proof and should be produced in original for verification bySBI Life official along with the form (Tick)

Driving License Passport Pan Card PIO Card with photograph Election ID Card Aadhar Card

Armed forces ID Card with Photograph Bank Passbook with photo Employer ID Card Ration Card with photo

Change in Contact Number / Email ID

(For office use only. To be filled in by Branch)

I confirm that the customer has visited the branch. I also confirm that I have verified the originals of the above documents.

Name & Designation: _________________________________,

Date_____________ Employee Code : ____________

Branch : ____________

Changes done in Portal on __________________. Changes done by:Sign & Name: ____________________________________________________

Designation & Employee Code: ______________________________________

d d m m y y y y

Residence Office Mobile

Contact No

Email ID

Signature of SBIL Employee

Signature of Policy Holder

Page 33 of 36


34/36

Page 34 of 36


35/36

Page 35 of 36


36/36

krishna sbi life policy term insurance

Documents