Date : 28/01/2020

MR GAURI SHANKAR Verma

Rampur kala
Rampur Kalan
Rampur Kalan
TANDA TEHSEEL 224190

Dear Sir/Madam,

Re: SUD/SLS - OTHERS LOAN/510014877

We welcome you to the SUD Life family and thank you for your faith in us.
It is our privilege to have you as our esteemed Policy holder and assure you of
our best services at all times.
We consider this moment to be the start of long term journey with you and it will
be our aim to strengthen this relationship between you and Star Union Dai-ichi
Life Insurance Company Ltd.
It shall be our endeavour to see to it that while you enjoy the journey, we stand
guard and take care of all your financial worries. We shall also make it our
privilege to take your suggestions on way we travel along.
We request you to quote your aforesaid application no. in all your future
correspondence with us, as this will help us serve you better.
Assuring you our best.

Regards
Yours truly,

Authorized signatory
IRDA Regn. No.-142
UIN : 142N073V01
SLS - OTHERS LOAN
Branch Code: 6936
Bank of India
Tanda
Tanda-Akbarpur Road, Near Corporation Bank, Uttar Pradesh

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
 CERTIFICATE OF INSURANCE
SUD LIFE SAMPOORNA LOAN SURAKSHA
(Non Linked Non-Participating Group Credit Life Insurance Plan)

Star Union Dai-ichi Life Insurance Company is pleased to acknowledge the Insured
Member’s joining in “SUD Life Sampoorna Loan Suraksha” for the Master Policy
mentioned below, under which the Insured Member is provided insurance cover,
subject to the terms and conditions contained in the Master Policy issued to the
Master Policyholder

Master Policyholder details:

Master Policy No MR001022 Address of the Master Star House, Bandra Kurla
Policyholder Complex, Bandra East
Master Policyholder Name Bank of India Relationship with Group Lender
Insured Member(Conf)

Insured Member details:

Name of Insured member
Address
Date of Birth
Name of the Co-borrower
MR GAURI SHANKAR Verma Insured Member ID 28590922
Rampur kala Rampur Kalan Loan Account Number 693673410000048
Rampur Kalan TANDA TEHSEEL
224190
11/10/1973 Age admitted at Entry 46
Date of Birth of the Co-
borrower

Insurance Cover details:

Membership Form No 510014877 Certificate of Insurance MR001022-1867400
(COI) No
Cover Start Date 28/01/2020 Cover End date 27/01/2025
Initial Sum Assured Rs.190000.00 Loan Amount 190000.00
Total Premium including 2089.78
GST, if any
Policy Term 5 Premium payment frequency Single
Interest rate on loan 11.00 Loan Type SLS - Others Loan
Moratorium period option N Moratorium Period -
Moratorium Option Moratorium Option 2(No
1(Interest Paid) Interest Paid)
Joint Life Cover Opted No Joint Life Option chosen
Maturity Benefit NIL

Nominee Details:
Name of Nominee 1 MR Siyaram verma Age 65 Nomination share(in %) Relationship with Other
Insured member
Name of Nominee 2 Age 0 Nomination share(in %) Relationship with
Insured member
Name of Nominee 3 Age Nomination share(in %) Relationship with
Insured member
Name of Appointee(If Age Relationship of Appointee with nominee
nominee is minor)
*GST as per prevailing rates and subject to changes from time to time.

In the event of any inconsistency or contradiction between the terms and conditions of the Master
Policy (a Member can obtain or refer to the copy of the Master Policy which is available with the
Master Policyholder) and this Certificate of Insurance (COI), the terms and conditions contained in
the Master Policy will prevail.

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
Please read the contents of this COI carefully to ensure that you understand the terms and conditions
of your coverage under this Insurance. This is only a summary of the major features of the Scheme (as
given below) and for complete details, please refer the Master Policy document maintained by the
Master Policyholder.
In case You are not satisfied with the terms and conditions of the Certificate of Insurance, then you
may return the Certificate of Insurance within the free look period of 15 days from the date of
receipt of this Certificate of Insurance specifying the reasons thereof. In such event, You will be
entitled to a refund of premium received by Us excluding proportionate risk premium for the period of
cover, any expenses incurred by Us on medical examination, if any and the stamp duty. All the rights
under this Certificate of Insurance and the Master Policy shall cease.

1.Benefits:

a.Death Benefit:
If the Insured Member dies during the Policy Term and whilst the Insured Member’s coverage under the
Master Policy is in force, We will pay the Sum Assured (as per the loan schedule in the Certificate of
Insurance) i.e. the loan outstanding as per the loan schedule at the beginning of the policy month
during which the death occurs.
On payment of Death Benefit as above, all insurance cover provided under this insurance cover would
automatically be terminate.

b.Maturity Benefit:
Maturity benefit not available under this Master Policy.

c.Surrender Benefit:
Insured Member or the Master Policyholder as the case may be, have an option to surrender the
Insurance Cover / Master Policy at any time during the policy term.

i. In the event of surrender of insurance cover by the Insured Member, the insurance cover shall be
terminated and We will pay the following surrender value:-

SV factor multiplied by premiums paid (excluding taxes, if any) multiplied by (unexpired policy term
in month/ total policy term in months) multiplied by (Sum Assured at the time of surrender**/Initial
Sum Assured)

**In case the Insured Member has opted for moratorium period, then the sum assured benefit at the time
of surrender will be equal to the minimum initial sum assured or the sum assured at the time of
surrender.

Surrender Value factors are as follows:

Year 1 2 3 4 5 & above

SV Factors 70% 75% 80% 85% 90%

ii. In the event of surrender of Master Policy by the Master Policyholder, an option will be given to
the Insured Member either to withdraw from the policy or to continue in the policy.

In case if the Insured Member opts to continue in the policy, the life cover for the Insured Member
will continue as per the terms & conditions this master policy till the coverage is terminated for
that member.

In case if the Insured Member opts to withdraw from the policy, the surrender value for the Insured
Member will be paid and life cover will cease immediately for that Insured Member.

2.Termination of Cover:
The cover on the life of an Insured Member(s) will cease on the happening of the earliest of the
following:
a. Upon payment of the surrender value under the Master Policy on surrender;
b. Upon expiry of term of the loan;
c. Upon death of the Insured Member.
d. Upon cancellation of the Master Policy/ Insurance Cover under free look cancellation.

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
3.Suicide Exclusions:
In case of voluntary group, if the Insured Member commits Suicide (whether sane or insane) within 12
month from date of inception of the insurance cover, then the Nominee/ Beneficiary will receive 80% of
premiums paid (excluding taxes, if any), provided the policy is in-force and all the benefits for that
insured member will cease.

Suicide exclusion is not applicable for the Insured Members(s) covered under the Group on compulsory
basis.

4.Initial Sum Assured:

In case the borrower has already taken loan, prior to opting for Insurance, the initial Sum Assured is
upto the actual loan outstanding as on the date of commencement of risk.

In case the borrower has taken the loan and simultaneously opting for Insurance, the initial Sum
Assured is upto the initial loan amount sanctioned by the Bank/ Financial Institution.

5.Moratorium period option:

If the date of disbursement of loan and the loan repayment start date are different, then the Insured
Member can avail this benefit.
Option 1 Option 2
Insured Member choses to pay the interest during this Insured Member does not chose to pay the interest
period during this period
Treatment of Sum Assured Treatment of Sum Assured

Sum Assured will remain constant and will be equal to In this case, the Sum Assured will increase during
Initial Sum Assured throughout this period. Post the the moratorium period and the sum assured will be
completion of moratorium period, the Sum Assured will equal to the initial Sum Assured plus the accrued
decrease during the outstanding term of the policy. interest during the moratorium period. After the
moratorium period, the sum assured will decrease
during the outstanding term (total term of policy
minus moratorium period) of the policy.
(Where; Outstanding Term = Total Term of the policy minus moratorium period)

6.Claims:
i.Insured Member, or the Nominee/ Beneficiary under the Master Policy must notify the claim to the
Company in writing preferably within 180 days from the date of the death of the Insured Member along
with the following documents for processing a claim.
ii.The primary documents normally required for processing a claim are:
a.Original Certificate of Insurance issued to each Insured Member
b.Claimant’s statement/ Claim Form authenticated by Master Policyholder
c.Copy of Death certificate issued by the Municipal Authority/Local Authority
d.Police panchnama, Police Inquest Report and FIR copy where applicable
e.Post Mortem Report/Coroners verdict in case of accidental deaths
f.Any other document or information required by us for assessing and approving the claim request.
iii.The claim intimation shall be send to any of Our branch offices or to Our Registered Office
address.
iv.In case of Regulated Entities i.e. RBI regulated Scheduled Bank (including Co-operative Banks and
Small Finance Banks), NBFC’s with Certificate of Registration, National Housing Board regulated
Housing Financial Companies, National Minority Development Finance Corporation (NMDFC) and its states
channelizing Agency, the death benefit to the extent of loan outstanding will be paid in favour of the
Master Policyholder, provided the Insured Member provide an authorization to do so. The balance, if
any will be paid in the name of the Nominee/Beneficiary of the Insured Member and may be sent to the
Master Policyholder for administrative convenience and onward transmission. The Insured Members may
provide the said authorization either on the Entry Date or at a later date. However, in the event
specific authorizations are not obtained from the Insured Member(s), the entire claim proceeds will be
paid by the Company to the Nominee/ Beneficiary of the Insured Member.
v.In case of Other than Regulated Entities, the death benefit would be payable to the
Nominee/Beneficiary of the Insured Member.

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
7.Joint Borrower Option:
Joint borrowers can be only two members who have availed joint loan from the banks.
There are two options available for the joint borrowers under the Master Policy which are as stated
below:-
Option 1 Option 2
Each Joint Borrower be insured for entire loan amount Each Joint Borrower be insured up to his/ her share
of loan
Under this Option, in case of death of any of two Under this joint life arrangement, the primary
borrowers, the death benefit (as stated under Clause borrower and the co-borrower of the loan will be
1(a)) will be payable in case of first death only and covered with the primary borrower as the first life
the cover on life of the second borrower will cease and co-borrower as the second life with the cover in
immediately. We will also pay surrender value, if respect of each life as per their respective share of
any, to the surviving life/life assured, and the outstanding loan amounts.
cover on the life of the second borrower will cease
immediately. No other benefit is payable to the Under this Option, in case of death of one of the
surviving member. joint borrowers, the death benefit (as stated under
Clause 1(a)) corresponding to that Joint borrower
In case of simultaneous death of the co-borrower will be paid, and the cover on the life of the
anytime during the policy term, the death benefit remaining joint borrower will continue for the
equal to loan amount outstanding will be payable with balance policy term.
respect to the primary borrower and the surrender
value with respect to the secondary borrower will be
payable and the contact will cease immediately.

On death of any of the co-borrower during the policy

term, if the claim is repudiated by the Company, then
no death benefit will be payable in respect of that
co-borrower however, the life cover for the surviving
member will continue till the end of the policy term.

8.Assignment:
Assignment should be in accordance to Section 38 of Insurance Act 1938, as amended from time to time.
(A Leaflet containing the simplified version of the provisions of Section 38 is enclosed in Annexure –
1 for reference).

9.Nomination:
Nomination is allowed as per the provisions of Section 39 of Insurance Act 1938, as amended from time
to time.
(A Leaflet containing the simplified version of the provisions of Section 39 is enclosed in Annexure –
2 for reference).

10.Fraud and Misrepresentation & Forfeiture:

Fraud, Misrepresentation and forfeiture would be dealt with in accordance with provisions of Section
45 of the Insurance Act 1938 as amended from time to time.
(A Leaflet containing the simplified version of the provisions of Section 45 is enclosed in Annexure –
3 for reference).

11.Grievance Redressal:
Any grievance/complaint pertaining to the insurance cover may be addressed to the Company or the
Master Policyholder who shall in turn write to us.

12.Notice:
Any notice, information or instruction to the Company must be in writing. The Company may change the
address stated above and intimate the Master Policyholder of such change by suitable means.

Signed for and on behalf of the Star Union Dai-ichi Life Insurance Company Limited.

Authorized signatory
Subhash Chandra
SVP & Head - Customer Strategy and Management
SLS - Others Loan –Group Term Insurance Plan

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
 Annexure - 1

Section 38 - Assignment and Transfer of Insurance Policies

Assignment or transfer of a policy should be in accordance with Section 38 of the Insurance Act, 1938
as amended from time to time. The extant provisions in this regard are as follows:
1.This policy may be transferred/assigned, wholly or in part, with or without consideration.
2.An Assignment may be effected in a policy by an endorsement upon the policy itself or by a separate
instrument under notice to the Insurer.
3.The instrument of assignment should indicate the fact of transfer or assignment and the reasons for
the assignment or transfer, antecedents of the assignee and terms on which assignment is made.
4.The assignment must be signed by the transferor or assignor or duly authorized agent and attested by
at least one witness.
5.The transfer of assignment shall not be operative as against an insurer until a notice in writing of
the transfer or assignment and either the said endorsement or instrument itself or copy there of
certified to be correct by both transferor and transferee or their duly authorized agents have been
delivered to the insurer.
6.Fee to be paid for assignment or transfer can be specified by the Authority through Regulations.
7.On receipt of notice with fee, the insurer should Grant a written acknowledgement of receipt of
notice. Such notice shall be conclusive evidence against the insurer of duly receiving the notice.
8.If the insurer maintains one or more places of business, such notices shall be delivered only at the
place where the policy is being serviced.
9.The insurer may accept or decline to act upon any transfer or assignment or endorsement, if it has
sufficient reasons to believe that it is
a.not bonafide or
b.not in the interest of the policyholder or
c.not in public interest or
d.is for the purpose of trading of the insurance policy.
10.Before refusing to act upon endorsement, the Insurer should record the reasons in writing and
communicate the same in writing to Policyholder within 30 days from the date of policyholder giving a
notice of transfer or assignment.
11.In case of refusal to act upon the endorsement by the Insurer, any person aggrieved by the refusal
may prefer a claim to IRDAI within 30 days of receipt of the refusal letter from the Insurer.
12.The priority of claims of persons interested in an insurance policy would depend on the date on
which the notices of assignment or transfer is delivered to the insurer; where there are more than one
instruments of transfer or assignment, the priority will depend on dates of delivery of such notices.
Any dispute in this regard as to priority should be referred to Authority.
13.Every assignment or transfer shall be deemed to be absolute assignment or transfer and the assignee
or transferee shall be deemed to be absolute assignee or transferee, except
a.where assignment or transfer is subject to terms and conditions of transfer or assignment OR
b.where the transfer or assignment is made upon condition that
i.the proceeds under the policy shall become payable to policyholder or nominee(s) in the event of
assignee or transferee dying before the insured OR
ii.the insured surviving the term of the policy Such conditional assignee will not be entitled to
obtain a loan on policy or surrender the policy. This provision will prevail notwithstanding any law
or custom having force of law which is contrary to the above position.
14.In other cases, the insurer shall, subject to terms and conditions of assignment, recognize the
transferee or assignee named in the notice as the absolute transferee or assignee and such person
a.shall be subject to all liabilities and equities to which the transferor or assignor was subject to
at the date of transfer or assignment and
b.may institute any proceedings in relation to the policy
c.obtain loan under the policy or surrender the policy without obtaining the consent of the transferor
or assignor or making him a party to the proceedings
15.Any rights and remedies of an assignee or transferee of a life insurance policy under an assignment
or transfer effected before commencement of the Insurance Act, 1938 as amended from time to time shall
not be affected by this section.

[Disclaimer: This is not a comprehensive list of amendments of Insurance Act 1938 and only a
simplified version prepared for general information. Policy Holders are advised to refer to Original
Ordinance Gazette Notification dated December 26, 2014 for complete and accurate details.]

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
 Annexure - 2

Section 39 - Nomination by policyholder

Nomination of a life insurance Policy is as below in accordance with Section 39 of the Insurance Act,
1938 as amended from time to time. The extant provisions in this regard are as follows:
1. The policyholder of a life insurance on his own life may nominate a person or persons to whom money
secured by the policy shall be paid in the event of his death.
2. Where the nominee is a minor, the policyholder may appoint any person to receive the money secured
by the policy in the event of policyholder’s death during the minority of the nominee. The manner of
appointment to be laid down by the insurer.
3. Nomination can be made at any time before the maturity of the policy.
4. Nomination may be incorporated in the text of the policy itself or may be endorsed on the policy
communicated to the insurer and can be registered by the insurer in the records relating to the
policy.
5. Nomination can be cancelled or changed at any time before policy matures, by an endorsement or a
further endorsement or a will as the case may be.
6. A notice in writing of Change or Cancellation of nomination must be delivered to the insurer for
the insurer to be liable to such nominee. Otherwise, insurer will not be liable if a bonafide payment
is made to the person named in the text of the policy or in the registered records of the insurer.
7.Fee to be paid to the insurer for registering change or cancellation of a nomination can be
specified by the Authority through Regulations.
8. On receipt of notice with fee, the insurer should grant a written acknowledgement to the
policyholder of having registered a nomination or cancellation or change thereof.
9. A transfer or assignment made in accordance with Section 38 shall automatically cancel the
nomination except in case of assignment to the insurer or other transferee or assignee for purpose of
loan or against security or its reassignment after repayment. In such case, the nomination will not
get cancelled to the extent of insurer’s or transferee’s or assignee’s interest in the policy. The
nomination will get revived on repayment of the loan.
10.The right of any creditor to be paid out of the proceeds of any policy of life insurance shall not
be affected by the nomination.
11.In case of nomination by policyholder whose life is insured, if the nominees die before the
policyholder, the proceeds are payable to policyholder or his heirs or legal representatives or holder
of succession certificate.
12.In case nominee(s) survive the person whose life is insured, the amount secured by the policy shall
be paid to such survivor(s).
13.Where the policyholder whose life is insured nominates his
a.parents or
b.spouse or
c.children or
d.spouse and children
e.or any of them
the nominees are beneficially entitled to the amount payable by the insurer to the policyholder
unless it is proved that policyholder could not have conferred such beneficial title on the nominee
having regard to the nature of his title.
14.If nominee(s) die after the policyholder but before his share of the amount secured under the
policy is paid, the share of the expired nominee(s) shall be payable to the heirs or legal
representative of the nominee or holder of succession certificate of such nominee(s).
15.The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance policies
maturing for payment after the commencement of Insurance Act 1938 as amended from time to time.
16.If policyholder dies after maturity but the proceeds and benefit of the policy has not been paid to
him because of his death, his nominee(s) shall be entitled to the proceeds and benefit of the policy.
17.The provisions of Section 39 are not applicable to any life insurance policy to which Section 6 of
Married Women’s Property Act, 1874 applies or has at any time applied except where before or after
Insurance Act 1938 as amended from time to time, a nomination is made in favor of spouse or children
or spouse and children whether or not on the face of the policy it is mentioned that it is made under
Section 39. Where nomination is intended to be made to spouse or children or spouse and children under
Section 6 of MWP Act, it should be specifically mentioned on the policy. In such a case only, the
provisions of Section 39 will not apply.

[Disclaimer: This is not a comprehensive list of amendments of Insurance Act 1938 and only a
simplified version prepared for general information. Policy Holders are advised to refer to Original
Ordinance Gazette Notification dated December 26, 2014 for complete and accurate details.]

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
 Annexure - 3

Section 45 – Policy shall not be called in question on the ground of mis-statement after three years

Provisions regarding policy not being called into question in terms of Section 45 of the Insurance
Act, 1938, amended from time to time are as follows:
1.No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3
yrs from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
2.On the ground of fraud, a policy of Life Insurance may be called in question within 3 years from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
3.Fraud means any of the following acts committed by insured or by his agent, with the intent to
deceive the insurer or to induce the insurer to issue a life insurance policy:
a. The suggestion, as a fact of that which is not true and which the insured does not believe to be
true;
b. The active concealment of a fact by the insured having knowledge or belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be fraudulent.
4.Mere silence is not fraud unless, depending on circumstances of the case, it is the duty of the
insured or his agent keeping silence to speak or silence is in itself equivalent to speak.
5.No Insurer shall repudiate a life insurance Policy on the ground of Fraud, if the Insured /
beneficiary can prove that the misstatement was true to the best of his knowledge and there was no
deliberate intention to suppress the fact or that such mis-statement of or suppression of material
fact are within the knowledge of the insurer. Onus of disproving is upon the policyholder, if alive,
or beneficiaries.
6.Life insurance Policy can be called in question within 3 years on the ground that any statement of
or suppression of a fact material to expectancy of life of the insured was incorrectly made in the
proposal or other document basis which policy was issued or revived or rider issued. For this, the
insurer should communicate in writing to the insured or legal representative or nominee or assignees
of insured, as applicable, mentioning the ground and materials on which decision to repudiate the
policy of life insurance is based.
7.In case repudiation is on ground of mis-statement and not on fraud, the premium collected on policy
till the date of repudiation shall be paid to the insured or legal representative or nominee or
assignees of insured, within a period of 90 days from the date of repudiation.
8.Fact shall not be considered material unless it has a direct bearing on the risk undertaken by the
insurer. The onus is on insurer to show that if the insurer had been aware of the said fact, no life
insurance policy would have been issued to the insured.
9.The insurer can call for proof of age at any time if he is entitled to do so and no policy shall be
deemed to be called in question merely because the terms of the policy are adjusted on subsequent
proof of age of life insured. So, this Section will not be applicable for questioning age or
adjustment based on proof of age submitted subsequently.

[Disclaimer: This is not a comprehensive list of amendments of Insurance Act 1938 and only a
simplified version prepared for general information. Policy Holders are advised to refer to Original
Ordinance Gazette Notification dated December 26, 2014 for complete and accurate details].

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018
 Sum Assured Schedule
Name of the borrower's Initial Sum Type of Loan Policy Tenure Moratorium Period Moratorium Option
Assured (Years) (Months)

MR GAURI SHANKAR Verma 190000.00 SLS - Others 5 0 N

Loan

Year Month Sum Assured Year Month Sum Assured Year Month Sum Assured Year Month Sum Assured
1 1 190000.00 2 1 159836.59 3 1 126182.72 4 1 88634.45
1 2 187610.60 2 2 157170.70 3 2 123208.33 4 2 85315.87
1 3 185199.30 2 3 154480.37 3 3 120206.68 4 3 81966.88
1 4 182765.90 2 4 151765.38 3 4 117177.51 4 4 78587.18
1 5 180310.20 2 5 149025.50 3 5 114120.58 4 5 75176.50
1 6 177831.98 2 6 146260.51 3 6 111035.63 4 6 71734.56
1 7 175331.05 2 7 143470.17 3 7 107922.39 4 7 68261.06
1 8 172807.19 2 8 140654.25 3 8 104780.62 4 8 64755.73
1 9 170260.19 2 9 137812.52 3 9 101610.05 4 9 61218.26
1 10 167689.85 2 10 134944.75 3 10 98410.41 4 10 57648.37
1 11 165095.95 2 11 132050.68 3 11 95181.45 4 11 54045.75
1 12 162478.27 2 12 129130.08 3 12 91922.89 4 12 50410.11

Year Month Sum Assured

5 1 46741.15
5 2 43038.55
5 3 39302.01
5 4 35531.21
5 5 31725.86
5 6 27885.62
5 7 24010.17
5 8 20099.21
5 9 16152.39
5 10 12169.39
5 11 8149.88
5 12 4093.53
 STAR UNION DAI-ICHI LIFE INSURANCE COMPANY LIMITED

PREMIUM RECEIPT

Name of Main Member: MR GAURI SHANKAR Verma

COI No. MR001022-1867400

Application No. 510014877

Basic Premium 1771.00

GST 318.78

Premium Received 2089.78

We hereby confirm that the amount of Rs 2089.78/- has been received towards the single premium under
SLS - OTHERS LOAN Plan.

Tax Benefit:
The premiums paid towards this policy is eligible for tax benefits under Section 80 C of the Income
Tax Act, 1961, which is subject to change from time to time.

Signed for and on behalf of Star Union Dai-ichi Life Insurance Limited at Navi Mumbai on 28/01/2020

Authorized signatory

142N073V01
SLS - OTHERS LOAN

UIN: 142N073V01
Certificate of Insurance SUD Life Sampoorna Loan Suraksha
Date of Modification – 28.09.2018