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SBI Life Insurance Company Limited

Date: 26/07/2013
AMAR RAJENDRA MUDIRAJ,
139 MHADA COLONY OPP PRATAPNAGAR
OSMANPURA DEER BAZAR
AURANGABAD
AURANGABAD
MAHARASHTRA
India
431001
Dear Customer,
Ref: Policy No : 44033820801
Component SBILife - Base Cover SBILife - Accidental Death Benefit
UIN

111L068V01

111A019V01

This is with reference to your request for the revival of the above mentioned policy. We would like to inform you that
based on the current status of your policy account, we are pleased to enclose the revival quotation, as applicable.
Revival Quotation :
Frequency : Annually
Installment Premium : Rs.100000.00
Premium not paid since : 17/01/2013

If paid by

Latest Due

16/08/2013 17/01/2013
16/09/2013 17/01/2013

Other dues
Net revival
pending on Policy
Amount (A+BDeposit (E)
the Policy
C+D-E)
(D)
0.00
0.00
0.00
100000.00
0.00
0.00
0.00
100000.00

No. of
Total
* Interest
Late Fee (B)
Premiums Amount (A)
Waived (C)
1
1

100000.00
100000.00

0.00
0.00

(The Premium displayed in the quotation schedule is subject to change based on the underwriting decision and Issue
of quotation doesnot mean acceptance of any risk on the policy by us.)
Other Requirements:1. Declaration of Good Health (DGH)
Any further health requirements if required for revival will be intimated to you.
Kindly make your payments vide cheque / Draft in favour of 'SBI Life Insurance Co. Ltd.Policy No. 44033820801'
We request you to kindly comply with the requirements, as mentioned above along with the premium due, specified in
the above quotation schedule, to enable us to revive your policy.
Do revert if you need further clarifications.Or email info@sbilife.co.in
Assuring you of our best services at all times.
This is a computer generated statement and does not require any signature.

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SBI Life Insurance Company Limited

FOR DEPARTMENTAL USE
Date: 26/07/2013
Policy No

44033820801

Policy Holder's Name

AMAR RAJENDRA MUDIRAJ

Date of Commencement

17/01/2012

Sum Assured

1000000.00

Plan

SBILIFE - Smart Performer

Term

Date of Birth

27/06/1984

Age as on Date

29

Installment Premium

100000.00

Frequency

Annually

Premium not paid since

17/01/2013

SUC

906158.7724

Original Terms of
Acceptance

Accepted at Normal Rate

Quotation Schedule:

If paid by

Latest Due

16/08/2013 17/01/2013
16/09/2013 17/01/2013

Other dues
Net revival
pending on Policy
Amount (A+Bthe Policy
Deposit (E)
C+D-E)
(D)
0.00
0.00
0.00
100000.00
0.00
0.00
0.00
100000.00

No. of
Total
Interest
Late Fee (B)
Premiums Amount (A)
Waived (C)
1
1

Other Requirements:1. Declaration of Good Health (DGH)

100000.00
100000.00

0.00
0.00