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WARANGAL DIVISION
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(Established by the Life lnsurance Corporation Act, 1956)

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JEEVAN ANAND (WtTl-r PROFITS) (W|TH ACCTDENT BENEFIT)
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THE LIFE INSUHANCE CORPOFATION OF INDIA (hereinafter called 'the Corporation") having received a Proposat and Declaration and the first premium from the proposer and the

or persons claiming payment and ofthe cotrectness ofthe Age ofthe Lile Assurecl slated in the proposal ii not previously admitled.

placed on the Policy by the Corporation shall be deemed part oithe policy.

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Pollcy No,, Dato ot laHe Tdm Md Sum lnslalmcnt Prsmium Payabt€
Due Dale
CommEncomont Pr€mium Paylng AlEu16d
and Mode n' Rs Proposal llo. A Date
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Dat6 T6.m ol Paymert

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Age of Life Assured
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WhetherAge Admitted

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Eala slLast Payment

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Sum Alsured logetherwith

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fie .. Sum Assured together with
: . : :. accrued bonus
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S. On Life Assurcds,death,after tho €ild of ths

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Towhom Sum Assured Payable

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The Proposer or his Assignees or Nominees underSection 39 of the lnsutance Act, 1938 or proving Executors or Adminlstratrors
or other Legal Representatives who should take out representation to his Estate or limited to the morieys payable under this poticy
from any Court of any State or territorV of the Unim of lndia.
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Period during which premium payatlle Till the stipulated date of Last Pavmeni
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Dates when premium payable On the stioulatdd due date in
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Special Provisions
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and to which all communications relating to the policy should be addressed:

f({i+ r Date :
BRANCH OFFICE ADDRESS
qTqffl ,/ Examineci

ififust {ET Tabte No. : 149