Signature Not Verified: Speed Post BNPL Code-TN/SP/BNPL/54/CO/18 BPC, Anna Road, Chennai-02

Date: - 21-09-2021
Speed Post
BNPL Code-TN/SP/BNPL/54/CO/18
BPC, Anna Road,Chennai-02
jG / 3k i&#d<>e*/=k
7012461250 EB813596115IN
To,
Mr. Lingesh T
Member ID : 655932948
Thippeswamy
Police bar line, Door no 117
Master Policy No : 70000018311
G Block, Chitradurha
CHITRADURGA
Product Name : SBI Life - RiNn Raksha
KARNATAKA 577501
Contact Details : 7892422517
UIN : 111N078V03
Father's Name : T Lingesh
Dear Mr. Lingesh T,
We welcome you to 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 wide range of products which cater to most of your life insurance needs. We have
enclosed the Certificate of Insurance & First Premium Receipt along with copy of Membership Form signed by you in this booklet. You are requested to refer
to the Certificate of Insurance for details on the insurance contract. Kindly check all details and make sure that it is kept safely.
This is a group credit life insurance plan, which provides protection on death of the life assured during the term of the policy. The benefit under the
policy helps in repayment of the outstanding loan.
Please note this is a Single Premium premium payment insurance cover. NA
For any information/ clarification, please contact:
1. Your local SBI Life service branch:

BANGALORE RPC
SBI Life Insurance Co. Ltd., 1st Floor, #119,J.P.Arcade,5 TH Main,Sri Puttanna Chetty Road,Chamrajpet,Bangalore-560018.
2. APPAJI PARISAR, SITE NO. 1278, 5TH BLOC STADIUM ROAD, CHITRADURGA DISTT. CHITRADURGA, KARNATAKA
CHITRADURGA KARNATAKA 577501
3. Call us toll free at our customer service helpline 18002679090 or email us at info@sbilife.co.in. You can also visit us at www.sbilife.co.in
4. All your servicing requests should be submitted to your local SBI Life service branch as mentioned above or nearest SBI Life branch only.
Free Look Option

You can review the terms and conditions of the insurance contract within 15 days from the date of receipt of this Certificate of Insurance. In case you are not
satisfied or disagree with any of the terms and conditions, you have the option to return the Certificate of Insurance stating the reasons for your objection.
Any such request should come through the Master Policyholder.
Your request for cancellation of the insurance contract under the free look option must reach our SBI Life office within a period of 15 days as mentioned
above.
We always look forward to be your preferred Life Insurance Company for all your Life Insurance needs.
Yours truly,
Authorised Signatory
New Business Processing Signature Not Verified
This Policy Document is digitally signed for SBI Life Insurance
Signer: Saubhick Sengupta

Date: Tuesday,Sep 21 2021 03:05 PM
Location: Navi Mumbai
Reason:
Policy Encryption
489/1173 Page 1 of 36 PolicyNo. 7012461250 256/387

489/1173 Page 2 of 36 PolicyNo. 7012461250 256/387
SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111 COI No. 70484841408
CIN: L99999MH2000PLC129113
SBI Life - RiNn Raksha (UIN: 111N078V03)

Group Non-Linked Non-Participating Credit Life Insurance Plan
Certificate of Insurance
jG / 3k
7012461250
BANGALORE RPC/ 00/ STATE BANK OF INDIA /PRASHANTNAGAR

CHITRADURGA/63082
Member : Mr. Lingesh T

Address : Thippeswamy
Police bar line, Door no 117
G Block, Chitradurha
CHITRADURGA
KARNATAKA-577501
Contact Number : 7892422517
Schedule of Benefits
Scheme & Life Assured Details t
Life Insurance Cover Details
Scheme Type : Voluntary Initial Sum Assured : Rs. 2000000.00 /-
Please refer schedule of outstanding
COI Issuance Date : 17-09-2021 Death benefit sum assured :
loan, enclosed herewith
Master Policyholder : STATE BANK OF INDIA Insurance Cover Start Date : 17-09-2021
Insurance Cover End Date : 17-09-2044
Master Policy No. : 70000018311
Interest Cover Rate : 8.49 %
Membership Form No. : 7012461250
Policy Term : 276 Months
Member ID : 655932948 Entire Outstanding Loan Amount
Loan Share to be covered :
check
Membership Form Date : 15-09-2021 Option chosen : NA
Life Assured Name : Mr. Lingesh T Name of Nominee : Lakshmamma T
Date of Birth : 21-02-1975 Date of Birth of Nominee : 01-06-1980

Relationship of Nominee to Life
: Spouse
Assured
Name of Appointee : NA
Date of Birth of Appointee : NA
Relationship with Nominee : NA
Master Policy holder to the extend of
Claim payable to :
the Outstanding loan amount
Loan Details Premium Details

Type of borrower : Single Plan Type : Rinn Raksha Series IIISP
Loan Account No. : 40443379926 Premium Payment Mode : Single Premium
Loan Category : RINN HL Premium Payment Term : Single
Date of First Disbursement : 15-09-2021 Due Date Of Last Premium :
Loan Amount : `2000000 /- Premium Amount : `127380.00/-
Loan Term : 276 Month's Applicable Tax : `22928.00 /-
Moratorium Period : 12 month With Interest Total Amount : `150308.00/-
Current Loan Interest Rate : 8.49 %
Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
Toll free number: 18002679090 Email:info@sbilife.co.in , Website : www.sbilife.co.in
510
489/1173 Page 3 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
SBI Life Insurance Company Limited is pleased to acknowledge that Mr. Lingesh T, having his/her loan account with STATE BANK OF INDIA has joined ‘SBI Life -
RiNn Raksha’ plan under which the borrowers are provided life cover for the Sum Assured as per the Sum Assured schedule mentioned in the Annexure, subject to
the terms and conditions contained in the Master Policy Document.
A summary of the key features of the Plan are given overleaf. Please note that this is merely a summary of the terms and conditions of the Plan and that the insurance
cover is strictly governed by the terms and conditions of the Master Policy issued to the Master Policyholder.
Free Look Option:

Where the scheme type is voluntary/ contributory in nature, you can review the terms and conditions of the insurance contract, within 15 days from the date of
receipt of this Certificate of Insurance. In case you are not satisfied or disagree with any of the terms and conditions, you have the option to return the Certificate of
Insurance stating the reason(s) in a letter for objection.
On such cancellation of the member policy, the premium amount will be refunded by us after deducting (i) proportionate risk premium and proportionate taxes &
cess, (ii) expenses incurred towards medical examinations carried out, if any and (iii) expenses towards stamp duty. The Insurance covers granted to the members, if
any, shall automatically be cancelled.
In case if the master policy is cancelled under free look period, the master policyholder shall inform the members about the cancellation of the insurance cover and
the Certificates of Insurance issued, if any, shall automatically stand cancelled.
Certificates of Insurance for all co-borrowers need to be submitted.
We request you to read this Certificate of Insurance (COI) carefully. If you find any errors, please return your Certificate of Insurance (COI) for effecting corrections.
SBI Life Insurance Co. Ltd.
Toll free number: 18002679090 Email:info@sbilife.co.in , Website : www.sbilife.
510
489/1173 Page 4 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
Annexure
Table of Sum Assured Benefits
Sum Assured Sum Assured

Sr No. Month As Sr No. Month As
On Each Month On Each Month
0 17/09/2021 to 16/10/2021 2000000.00 1 17/10/2021 to 16/11/2021 2000000.00
2 17/11/2021 to 16/12/2021 2000000.00 3 17/12/2021 to 16/01/2022 2000000.00
4 17/01/2022 to 16/02/2022 2000000.00 5 17/02/2022 to 16/03/2022 2000000.00
6 17/03/2022 to 16/04/2022 2000000.00 7 17/04/2022 to 16/05/2022 2000000.00
8 17/05/2022 to 16/06/2022 2000000.00 9 17/06/2022 to 16/07/2022 2000000.00
10 17/07/2022 to 16/08/2022 2000000.00 11 17/08/2022 to 16/09/2022 2000000.00
12 17/09/2022 to 16/10/2022 2000000.00 13 17/10/2022 to 16/11/2022 1997395.00
14 17/11/2022 to 16/12/2022 1994771.00 15 17/12/2022 to 16/01/2023 1992129.00
16 17/01/2023 to 16/02/2023 1989468.00 17 17/02/2023 to 16/03/2023 1986788.00
18 17/03/2023 to 16/04/2023 1984089.00 19 17/04/2023 to 16/05/2023 1981371.00
20 17/05/2023 to 16/06/2023 1978634.00 21 17/06/2023 to 16/07/2023 1975878.00
22 17/07/2023 to 16/08/2023 1973102.00 23 17/08/2023 to 16/09/2023 1970307.00
24 17/09/2023 to 16/10/2023 1967492.00 25 17/10/2023 to 16/11/2023 1964657.00
26 17/11/2023 to 16/12/2023 1961802.00 27 17/12/2023 to 16/01/2024 1958927.00
28 17/01/2024 to 16/02/2024 1956031.00 29 17/02/2024 to 16/03/2024 1953115.00
30 17/03/2024 to 16/04/2024 1950178.00 31 17/04/2024 to 16/05/2024 1947220.00
32 17/05/2024 to 16/06/2024 1944241.00 33 17/06/2024 to 16/07/2024 1941241.00
34 17/07/2024 to 16/08/2024 1938220.00 35 17/08/2024 to 16/09/2024 1935178.00
36 17/09/2024 to 16/10/2024 1932114.00 37 17/10/2024 to 16/11/2024 1929029.00
38 17/11/2024 to 16/12/2024 1925922.00 39 17/12/2024 to 16/01/2025 1922793.00
40 17/01/2025 to 16/02/2025 1919642.00 41 17/02/2025 to 16/03/2025 1916468.00
42 17/03/2025 to 16/04/2025 1913272.00 43 17/04/2025 to 16/05/2025 1910053.00
44 17/05/2025 to 16/06/2025 1906811.00 45 17/06/2025 to 16/07/2025 1903547.00
46 17/07/2025 to 16/08/2025 1900259.00 47 17/08/2025 to 16/09/2025 1896948.00
48 17/09/2025 to 16/10/2025 1893614.00 49 17/10/2025 to 16/11/2025 1890256.00
50 17/11/2025 to 16/12/2025 1886874.00 51 17/12/2025 to 16/01/2026 1883469.00
52 17/01/2026 to 16/02/2026 1880039.00 53 17/02/2026 to 16/03/2026 1876585.00
54 17/03/2026 to 16/04/2026 1873107.00 55 17/04/2026 to 16/05/2026 1869604.00
56 17/05/2026 to 16/06/2026 1866076.00 57 17/06/2026 to 16/07/2026 1862523.00
58 17/07/2026 to 16/08/2026 1858945.00 59 17/08/2026 to 16/09/2026 1855342.00
60 17/09/2026 to 16/10/2026 1851713.00 61 17/10/2026 to 16/11/2026 1848059.00
62 17/11/2026 to 16/12/2026 1844379.00 63 17/12/2026 to 16/01/2027 1840673.00
64 17/01/2027 to 16/02/2027 1836941.00 65 17/02/2027 to 16/03/2027 1833182.00
66 17/03/2027 to 16/04/2027 1829397.00 67 17/04/2027 to 16/05/2027 1825585.00
68 17/05/2027 to 16/06/2027 1821746.00 69 17/06/2027 to 16/07/2027 1817880.00
70 17/07/2027 to 16/08/2027 1813986.00 71 17/08/2027 to 16/09/2027 1810065.00
72 17/09/2027 to 16/10/2027 1806116.00 73 17/10/2027 to 16/11/2027 1802139.00
74 17/11/2027 to 16/12/2027 1798134.00 75 17/12/2027 to 16/01/2028 1794101.00
76 17/01/2028 to 16/02/2028 1790039.00 77 17/02/2028 to 16/03/2028 1785948.00
78 17/03/2028 to 16/04/2028 1781828.00 79 17/04/2028 to 16/05/2028 1777679.00
80 17/05/2028 to 16/06/2028 1773501.00 81 17/06/2028 to 16/07/2028 1769293.00
82 17/07/2028 to 16/08/2028 1765056.00 83 17/08/2028 to 16/09/2028 1760789.00
84 17/09/2028 to 16/10/2028 1756491.00 85 17/10/2028 to 16/11/2028 1752163.00
86 17/11/2028 to 16/12/2028 1747804.00 87 17/12/2028 to 16/01/2029 1743415.00
88 17/01/2029 to 16/02/2029 1738995.00 89 17/02/2029 to 16/03/2029 1734543.00
510
489/1173 Page 5 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
Annexure

90 17/03/2029 to 16/04/2029 1730060.00 91 17/04/2029 to 16/05/2029 1725545.00
92 17/05/2029 to 16/06/2029 1720998.00 93 17/06/2029 to 16/07/2029 1716419.00
94 17/07/2029 to 16/08/2029 1711808.00 95 17/08/2029 to 16/09/2029 1707164.00
96 17/09/2029 to 16/10/2029 1702487.00 97 17/10/2029 to 16/11/2029 1697777.00
98 17/11/2029 to 16/12/2029 1693034.00 99 17/12/2029 to 16/01/2030 1688257.00
100 17/01/2030 to 16/02/2030 1683446.00 101 17/02/2030 to 16/03/2030 1678601.00
102 17/03/2030 to 16/04/2030 1673722.00 103 17/04/2030 to 16/05/2030 1668808.00
104 17/05/2030 to 16/06/2030 1663860.00 105 17/06/2030 to 16/07/2030 1658877.00
106 17/07/2030 to 16/08/2030 1653858.00 107 17/08/2030 to 16/09/2030 1648804.00
108 17/09/2030 to 16/10/2030 1643714.00 109 17/10/2030 to 16/11/2030 1638588.00
110 17/11/2030 to 16/12/2030 1633426.00 111 17/12/2030 to 16/01/2031 1628227.00
112 17/01/2031 to 16/02/2031 1622992.00 113 17/02/2031 to 16/03/2031 1617720.00
114 17/03/2031 to 16/04/2031 1612410.00 115 17/04/2031 to 16/05/2031 1607063.00
116 17/05/2031 to 16/06/2031 1601678.00 117 17/06/2031 to 16/07/2031 1596255.00
118 17/07/2031 to 16/08/2031 1590793.00 119 17/08/2031 to 16/09/2031 1585293.00
120 17/09/2031 to 16/10/2031 1579754.00 121 17/10/2031 to 16/11/2031 1574176.00
122 17/11/2031 to 16/12/2031 1568558.00 123 17/12/2031 to 16/01/2032 1562900.00
124 17/01/2032 to 16/02/2032 1557202.00 125 17/02/2032 to 16/03/2032 1551464.00
126 17/03/2032 to 16/04/2032 1545685.00 127 17/04/2032 to 16/05/2032 1539866.00
128 17/05/2032 to 16/06/2032 1534005.00 129 17/06/2032 to 16/07/2032 1528103.00
130 17/07/2032 to 16/08/2032 1522159.00 131 17/08/2032 to 16/09/2032 1516173.00
132 17/09/2032 to 16/10/2032 1510145.00 133 17/10/2032 to 16/11/2032 1504074.00
134 17/11/2032 to 16/12/2032 1497960.00 135 17/12/2032 to 16/01/2033 1491803.00
136 17/01/2033 to 16/02/2033 1485602.00 137 17/02/2033 to 16/03/2033 1479358.00
138 17/03/2033 to 16/04/2033 1473069.00 139 17/04/2033 to 16/05/2033 1466736.00
140 17/05/2033 to 16/06/2033 1460358.00 141 17/06/2033 to 16/07/2033 1453935.00
142 17/07/2033 to 16/08/2033 1447466.00 143 17/08/2033 to 16/09/2033 1440952.00
144 17/09/2033 to 16/10/2033 1434392.00 145 17/10/2033 to 16/11/2033 1427785.00
146 17/11/2033 to 16/12/2033 1421131.00 147 17/12/2033 to 16/01/2034 1414430.00
148 17/01/2034 to 16/02/2034 1407682.00 149 17/02/2034 to 16/03/2034 1400886.00
150 17/03/2034 to 16/04/2034 1394042.00 151 17/04/2034 to 16/05/2034 1387150.00
152 17/05/2034 to 16/06/2034 1380209.00 153 17/06/2034 to 16/07/2034 1373219.00
154 17/07/2034 to 16/08/2034 1366179.00 155 17/08/2034 to 16/09/2034 1359090.00
156 17/09/2034 to 16/10/2034 1351950.00 157 17/10/2034 to 16/11/2034 1344760.00
158 17/11/2034 to 16/12/2034 1337519.00 159 17/12/2034 to 16/01/2035 1330227.00
160 17/01/2035 to 16/02/2035 1322883.00 161 17/02/2035 to 16/03/2035 1315487.00
162 17/03/2035 to 16/04/2035 1308039.00 163 17/04/2035 to 16/05/2035 1300538.00
164 17/05/2035 to 16/06/2035 1292984.00 165 17/06/2035 to 16/07/2035 1285377.00
166 17/07/2035 to 16/08/2035 1277716.00 167 17/08/2035 to 16/09/2035 1270001.00
168 17/09/2035 to 16/10/2035 1262231.00 169 17/10/2035 to 16/11/2035 1254406.00
170 17/11/2035 to 16/12/2035 1246526.00 171 17/12/2035 to 16/01/2036 1238590.00
172 17/01/2036 to 16/02/2036 1230598.00 173 17/02/2036 to 16/03/2036 1222549.00
174 17/03/2036 to 16/04/2036 1214443.00 175 17/04/2036 to 16/05/2036 1206280.00
176 17/05/2036 to 16/06/2036 1198059.00 177 17/06/2036 to 16/07/2036 1189780.00
178 17/07/2036 to 16/08/2036 1181443.00 179 17/08/2036 to 16/09/2036 1173047.00
510
489/1173 Page 6 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
Annexure

180 17/09/2036 to 16/10/2036 1164591.00 181 17/10/2036 to 16/11/2036 1156075.00
182 17/11/2036 to 16/12/2036 1147499.00 183 17/12/2036 to 16/01/2037 1138862.00
184 17/01/2037 to 16/02/2037 1130164.00 185 17/02/2037 to 16/03/2037 1121405.00
186 17/03/2037 to 16/04/2037 1112584.00 187 17/04/2037 to 16/05/2037 1103700.00
188 17/05/2037 to 16/06/2037 1094754.00 189 17/06/2037 to 16/07/2037 1085744.00
190 17/07/2037 to 16/08/2037 1076671.00 191 17/08/2037 to 16/09/2037 1067533.00
192 17/09/2037 to 16/10/2037 1058331.00 193 17/10/2037 to 16/11/2037 1049064.00
194 17/11/2037 to 16/12/2037 1039731.00 195 17/12/2037 to 16/01/2038 1030332.00
196 17/01/2038 to 16/02/2038 1020866.00 197 17/02/2038 to 16/03/2038 1011334.00
198 17/03/2038 to 16/04/2038 1001734.00 199 17/04/2038 to 16/05/2038 992066.00
200 17/05/2038 to 16/06/2038 982330.00 201 17/06/2038 to 16/07/2038 972525.00
202 17/07/2038 to 16/08/2038 962650.00 203 17/08/2038 to 16/09/2038 952706.00
204 17/09/2038 to 16/10/2038 942691.00 205 17/10/2038 to 16/11/2038 932605.00
206 17/11/2038 to 16/12/2038 922448.00 207 17/12/2038 to 16/01/2039 912219.00
208 17/01/2039 to 16/02/2039 901918.00 209 17/02/2039 to 16/03/2039 891544.00
210 17/03/2039 to 16/04/2039 881097.00 211 17/04/2039 to 16/05/2039 870576.00
212 17/05/2039 to 16/06/2039 859980.00 213 17/06/2039 to 16/07/2039 849309.00
214 17/07/2039 to 16/08/2039 838563.00 215 17/08/2039 to 16/09/2039 827741.00
216 17/09/2039 to 16/10/2039 816842.00 217 17/10/2039 to 16/11/2039 805866.00
218 17/11/2039 to 16/12/2039 794812.00 219 17/12/2039 to 16/01/2040 783680.00
220 17/01/2040 to 16/02/2040 772469.00 221 17/02/2040 to 16/03/2040 761179.00
222 17/03/2040 to 16/04/2040 749809.00 223 17/04/2040 to 16/05/2040 738359.00
224 17/05/2040 to 16/06/2040 726828.00 225 17/06/2040 to 16/07/2040 715215.00
226 17/07/2040 to 16/08/2040 703520.00 227 17/08/2040 to 16/09/2040 691742.00
228 17/09/2040 to 16/10/2040 679881.00 229 17/10/2040 to 16/11/2040 667936.00
230 17/11/2040 to 16/12/2040 655907.00 231 17/12/2040 to 16/01/2041 643792.00
232 17/01/2041 to 16/02/2041 631592.00 233 17/02/2041 to 16/03/2041 619305.00
234 17/03/2041 to 16/04/2041 606931.00 235 17/04/2041 to 16/05/2041 594470.00
236 17/05/2041 to 16/06/2041 581921.00 237 17/06/2041 to 16/07/2041 569283.00
238 17/07/2041 to 16/08/2041 556556.00 239 17/08/2041 to 16/09/2041 543739.00
240 17/09/2041 to 16/10/2041 530831.00 241 17/10/2041 to 16/11/2041 517832.00
242 17/11/2041 to 16/12/2041 504741.00 243 17/12/2041 to 16/01/2042 491557.00
244 17/01/2042 to 16/02/2042 478280.00 245 17/02/2042 to 16/03/2042 464909.00
246 17/03/2042 to 16/04/2042 451443.00 247 17/04/2042 to 16/05/2042 437882.00
248 17/05/2042 to 16/06/2042 424225.00 249 17/06/2042 to 16/07/2042 410471.00
250 17/07/2042 to 16/08/2042 396620.00 251 17/08/2042 to 16/09/2042 382671.00
252 17/09/2042 to 16/10/2042 368623.00 253 17/10/2042 to 16/11/2042 354476.00
254 17/11/2042 to 16/12/2042 340229.00 255 17/12/2042 to 16/01/2043 325881.00
256 17/01/2043 to 16/02/2043 311431.00 257 17/02/2043 to 16/03/2043 296879.00
258 17/03/2043 to 16/04/2043 282224.00 259 17/04/2043 to 16/05/2043 267466.00
260 17/05/2043 to 16/06/2043 252603.00 261 17/06/2043 to 16/07/2043 237635.00
262 17/07/2043 to 16/08/2043 222561.00 263 17/08/2043 to 16/09/2043 207380.00
264 17/09/2043 to 16/10/2043 192092.00 265 17/10/2043 to 16/11/2043 176696.00
266 17/11/2043 to 16/12/2043 161191.00 267 17/12/2043 to 16/01/2044 145576.00
268 17/01/2044 to 16/02/2044 129851.00 269 17/02/2044 to 16/03/2044 114015.00
510
489/1173 Page 7 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
Annexure

270 17/03/2044 to 16/04/2044 98067.00 271 17/04/2044 to 16/05/2044 82006.00
272 17/05/2044 to 16/06/2044 65831.00 273 17/06/2044 to 16/07/2044 49542.00
274 17/07/2044 to 16/08/2044 33137.00 275 17/08/2044 to 16/09/2044 16616.00
276 17/09/2044 to 16/10/2044 0.00
510
489/1173 Page 8 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
TERMS & CONDITIONS OF YOUR INSURANCE COVER
1. Insurance company means SBI Life Insurance Company Limited.
2. Master Policyholder is the Financial Institution or the Bank which has entered into a contract with the Insurance Company for providing
insurance cover to its members.
3. Member is a Primary Borrower, Co-Borrower or an Account Holder with the Master Policyholder.
4. Life Assured is the Member on whose life the insurance cover is granted.
5. Insurance Cover Start Date is the date of communication of underwriting acceptance of proposal or the date of receipt of premium
(including extra premium, if any) whichever is later.
6. Insurance Cover End Date is the date on which the insurance cover on the life of the member ceases.
7. Current Loan Interest Rate is the rate currently applicable to the member on the loan. This rate is used in deciding the appropriate Interest
Cover Rate.
8. Interest Cover Rate is the fixed interest rate used for generating the sum assured schedule. It may vary from the Current Loan Interest Rate.
9. Policy Term is the period, in months, during which the policy benefits are payable in respect of the member.
10. Initial Sum Assured is the Sum Assured at the start of the insurance cover and as mentioned in schedule.
11. Sum Assured Schedule (as mentioned in the annexure) is the decreasing insurance cover schedule generated using the following:
I. Insurance Cover Start Date
II. Interest Cover Rate
III. Policy Term
IV. Initial Sum Assured
V. Moratorium Period, if opted, with / without interest payment
This Sum Assured Schedule may differ from the Loan Repayment Schedule provided by your Master Policyholder for the loan borrowed.
12. Single Premium is the premium payable once at the policy commencement date.
13. Limited Premium Payment Term is where the premium payment period is limited compared to the policy term and the premiums are paid at
regular intervals like yearly, half-yearly, etc.
14. Premium Payment Term is the period, in years, over which premiums are payable.
15. Premium Payment Mode is the frequency of premium payment.
16. Premium Renewal Date is the date on which the renewal premium becomes due.
17. Grace Period is the period, in days, from the premium renewal date during which premium should be paid, which is 15 days for monthly
premium payment mode and 30 days for other premium payment modes. If the premium is not paid within the grace period, the insurance
cover lapses. However, in case of any claim under the cover during the grace period and the Company finds it payable, the outstanding
premiums shall be recovered from the claim.
18. Taxes are payable on premium at the rate prevailing at the time of payment of premium/s. Taxes include service tax/ cess/ GST and/ or any
other statutory levy/ duty/ surcharge as notified by Central and/ or State Government from time to time as per provisions of the prevalent
tax laws.
19. We, Us, Our means SBI Life Insurance Company Limited or its successors.
20. You, Your means the member who is availing insurance cover from Us.
21. Policy Benefits include the following:
510
489/1173 Page 9 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
I. Death Benefit:
In the event of death of the life assured during the policy term, the sum assured applicable for the month and year of death, as per the sum
assured schedule (as mentioned in the annexure) is payable, provided all premiums due up to the date of death have been fully paid. The
death benefit will be payable irrespective of the actual outstanding loan amount or the amount outstanding as per the loan repayment
schedule.
II. Maturity Benefit: No maturity benefit is available under this plan.
III. Surrender Benefit: You may request for surrender of the insurance cover in writing at any point of time after first policy year, provided at
least first policy year’s premiums are paid. If premiums are not paid for full one year, no surrender value shall be payable. The Surrender
Value (SV) available under this plan is
SV = (50% x Premium(s) paid) x (Unexpired term / Total term)
a. A Special Surrender Value (SSV) may be available at the time of surrender. The higher of the SSV and SV will be payable.
b. Surrender Benefit is payable only if SV or SSV is at least Rs. 250/-.
c. In the event of death of the life assured after submission of surrender request but before payment of benefit, we will pay the death
benefit to the nominee or the legal heir, if the claim is otherwise payable.
IV. Paid-up Benefits: If the insurance cover lapses due to non-payment of due premiums, paid-up value will be available at any point of time
after the first year of cover, provided at least first policy year’s premiums are paid in full.
a. In the event of the death of the life assured, the paid up sum assured payable will be:
Paid up Sum Assured = (Number of premiums paid / Number of premiums payable) * Sum Assured as on Date of death as per sum
assured schedule.
b. If the paid-up policy is surrendered on request, surrender value payable will be:
Surrender Value = (50% x Premium(s) paid) x (Unexpired term / Total term)
V. Payment of Surrender/ Paid-up Benefits:

a. Premium(s) considered for calculation of Surrender/ Paid-up Benefit will exclude the below components:
i. Extra premium charged for non-standard age proof or health extra or any other extra premium(s)
ii. Premium paid for Gold option or Platinum option, where applicable
iii. Applicable Taxes
b. For calculation of the above benefits:
i. Term will be measured in completed policy months.
ii. Unexpired Term would be total policy term in months less completed number of policy months as on date of surrender.
22. Exclusions
I. Suicide claim exclusion: If the life assured commits suicide, within 12 Months from the insurance cover start date, the sum assured benefit
will not be payable. Only 80% of the total premium(s) paid (net of taxes & cess) till date of death would be refunded without interest,
provided the member policy is in force.
In case the life assured commits suicide, within 12 months from the date of revival of the insurance cover, the higher of the surrender value
as on the date of suicide or 80% of the total premiums paid (net of taxes & cess) till date of death, without interest will be payable, provided
the member policy is in force.
II. Premium(s) considered for payment of benefits under section 21 will exclude the below components:
a. Extra premium charged for non-standard age proof or health extra or any other extra premium(s)
b. Premium paid for Gold option or Platinum option, where applicable
c. Applicable Taxes
23. Revival
If the insurance cover lapses due to non-payment of renewal premium, the insurance cover can be revived within a period of five years from
the date of first unpaid premium by paying all the outstanding premiums along with interest. The interest rate applicable will be Repo Rate as
st
on 1 April of the financial year in which the revival is effected + 250 basis points, compounded half-yearly. Revival facility will be allowed
only during the term of the cover.
Revival is subject to underwriting as per the Company’s Board approved underwriting policy. The Company reserves the right to accept (on
such terms and conditions stipulated by the Company) or reject the revival of a lapsed cover. The revival will be effective only after the same
is communicated in writing by the Company to the Group Member.
24. Termination of Cover

24.1. Insurance cover under this plan shall cease on the earliest of the following dates:
24.1.1. on the expiry of the policy term, or
24.1.2. on death of the insured member, or
24.1.3. the date on which the member reaches the maximum cover ceasing age, or
24.1.4. the date on which surrender value is paid, if payable, or
510
489/1173 Page 10 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
24.1.5. the date of payment on free-look cancellation, or

24.1.6. the date of termination of the cover at the request of the member, or
24.1.7. the date on which the grace period ends in case if premiums due are not paid, where the insurance cover has not
acquired any paid up value, or
24.1.8. on termination of cover at the behest of the member, or
24.2. In case insurance cover is granted to each of the co-borrowers for the entire outstanding loan and death benefit is paid on the death
of any one of them, the cover of surviving co-borrower(s) will cease automatically and the applicable surrender value, if any, will be
paid.
25. Free-look Period

25.1. Where the scheme is voluntary/ contributory in nature, you can review the terms and conditions of the insurance contract, within 15
days from the date of receipt of this Certificate of Insurance. In case you are not satisfied or disagree with any of the terms and
conditions, you have the option to return the Certificate of Insurance stating the reasons for objection. Any such request should come
through the Master Policyholder. The premium amount after deducting (i) proportionate risk premium and proportionate taxes, (ii)
expenses incurred towards medical examinations carried out, if any and (iii) expenses towards stamp duty; will be refunded by us.
Certificates of Insurance for all co-borrowers need to be submitted.
26. Nomination
I. You may, when effecting the insurance cover, or at any time before the cover term ends; nominate a person to whom the money secured by
the insurance cover shall be paid in the event of death of the life assured.
II. If the nominee is a minor, you may appoint a person, competent to contract as an appointee in the manner laid down by us, to receive the
money secured by the insurance cover in the event of death of the life assured during the minority of the nominee.
III. You may cancel or change the existing nomination at any time during the course of the policy term.
IV. Your nomination should be registered in our records so as to make it binding on us.
V. For complete details about nomination, please refer to Section 39 of the Insurance Act, 1938, as amended from time to time.
[For simplified version of provisions of Section 39 of the Insurance Act, 1938; please refer Annexure I]
27. Assignment
Assignment is not allowed under your insurance cover.
28. Non-disclosure
I. We have issued your insurance cover based on the statements/ responses in the membership form, personal statement, medical reports and
any other documents that are submitted to us.
II. If we find that any of this information is inaccurate or false or you have withheld any material information or in case of fraud, we shall
declare your insurance cover null and void subject to Section 45 of the Insurance Act, 1938, as amended from time to time.
III. We will not pay any benefits and the insurance cover shall be cancelled immediately by paying amount as per provisions of Section 45 of the
Insurance Act, 1938, as amended from time to time.
IV. If we repudiate a claim, we may pay the amount as per provisions of Section 45 of the Insurance Act, 1938; to the life assured or his/ her
nominee/ beneficiary.
[For simplified version of the provisions of Section 45 of the Insurance Act, 1938, please refer Annexure II]
29. Mis-statement of Age

If we find that your correct age is different from that mentioned in the membership form, we will check your eligibility for the insurance
cover as on the cover start date. If the age stated by you is incorrect and if you are:
I. Eligible,
a. If the correct age is found to be higher, you will have to pay the difference in premiums along with interest based on company’s
prevalent norms, which may change from time to time.
b. If you do not pay the difference in premiums and applicable interest, we will terminate your insurance cover by paying you the
surrender value, if any.
c. If the correct age is found to be lower, we will refund the difference in premiums, without interest.
II. Not eligible,
a. We will terminate your insurance cover by paying you the surrender value, if any.
30. Pre-closure of Loan

I. If you choose to repay the loan at faster pace by making repayments over and above the terms agreed with the Master Policy Holder, the
benefits payable in case of a death will continue to be as per the sum assured schedule (as mentioned in the annexure).
II. If you repay the entire outstanding loan amount before the end of the policy term, you can choose either to:
a. surrender your insurance cover under this plan and avail of surrender benefits, if any, OR
b. continue with your insurance cover under this plan. In case of death, benefits will be payable as per the sum assured schedule.
31. Cancellation of Loan

If your loan is cancelled or not taken up after sanction and the premium(s) has been remitted, you can request for cancellation of insurance
cover under this plan. Such a request should come through the Master Policy Holder within 90 days from issuance of this Certificate of
Insurance. Upon receipt of such a request, we will refund 90% of the premium(s) paid excluding taxes and cess after deducting expenses
incurred towards stamp duty. You have to submit the original Certificates of Insurance.
510
489/1173 Page 11 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
32. Co-Borrowers
I. You have the option to cover co-borrowers, where applicable, at a later date as per the terms and conditions defined by the Master
Policyholder.
II. You can add a maximum of two co-borrowers subject to terms and conditions defined by the Master Policyholder.
III. If the membership forms of co-borrowers are received later, then the rebate would be applicable only to the co-borrowers.
IV. If the initial sum assured for each borrower is equal to entire outstanding loan amount, then:
a. Claim is payable only on first death amongst the co-borrowers during the policy term
b. Where the claim is admitted on death of any of the co-borrowers during policy term, we will pay the death benefit for the deceased
borrower. On payment of this death benefit, the insurance cover for the surviving borrower(s) will be terminated by payment of
surrender value, if any.
c. Where the claim is rejected/ repudiated, we will not pay any benefit for the deceased borrower. The insurance cover for the surviving
borrower(s) will continue till the end of the policy term, provided all due premium(s) are paid. The surviving borrower(s) can surrender
their insurance cover at any point in time.
d. In case of simultaneous death of more than one borrower, we will pay the death benefit only in respect of one borrower. It will be
presumed that the younger member survives the elder member. The surrender value, if any, will be paid with respect to the life/lives
assured where death benefit has not been paid.
V. If the initial sum assured for each borrower is equal to [limited to] his/ her respective share of loan amount, then:
a. Claim is payable on all deaths during the policy term
b. Where the claim is admitted on death of any of the co-borrowers during the policy term, we will pay the death benefit for the deceased
borrower as per the sum assured schedule provided in his/ her COI. The insurance cover for the surviving borrower(s) will continue till
the end of the policy term, provided all due premium(s) are paid. The surviving borrower(s) can surrender their insurance cover at any
point in time.
c. Where the claim is rejected/ repudiated for any reason whatsoever, we will not pay any benefit for the deceased borrower. The
insurance cover for the surviving borrower(s) will continue till the end of the policy term, provided all due premium(s) are paid. The
surviving borrower(s) can surrender their insurance cover at any point in time.
33. Top up Loans: If you choose to increase your overall loan limit by borrowing additional monies from the Master Policy Holder through top up,
you may avail of insurance facility for the additional value of the loan as well. We will treat such loans as new loans with corresponding
schedules. Separate premiums would be applicable on this additional loan based on your age as on date of such an application and would be
further subject to underwriting.
34. Loan repayment installment defaults: This plan does not cover any increase in outstanding loan amount as a result of loan repayment
installment defaults on your part.
35. Loans: No loans are available against this policy.
36. Communication
I. Any notice, information or instruction to the Company must be in writing and delivered to the address intimated by the Company to the
Master Policyholder which is currently: Policy Servicing Department, SBI Life Insurance Company Limited, 7th Level (D Wing) & 8th Level,
Seawoods Grand Central,Tower 2, Plot No. R-1, Sector 40, Seawoods, Nerul Node, Navi Mumbai - 400 706, Dist. Thane, Maharashtra. The
Company may change the address stated above and intimate the Master Policyholder of such change by suitable means. Any
communication, information or instruction from the Company to the Master Policyholder shall be mailed to the address of the Master
Policyholder provided or to the changed address as intimated to the Company in writing.
II. It is important that you keep us informed of change in your communication address, if any.
37. Grievance Redressal Procedure

I. In case you have any query or complaint/grievance, you may approach any of our offices
II. You can also call us on our toll-free number 1800 267 9090 (between 9:00 AM and 9:00 PM).
III. If you are not satisfied with the decision or have not received any response within 10 business days, you maywrite to us at:

Head - Client Relationship
7th Level (D Wing) & 8th Level, Seawoods Grand Central,
Tower 2, Plot No. R-1, Sector 40, Seawoods, Nerul Node,
Navi Mumbai - 400 706, Dist. Thane, Maharashtra
Telephone No: 022- 6645 6785.
Email Id: info@sbilife.co.in

IV. In case you are not satisfied with our decision and the issue pertains to Rule 13 of Insurance Ombudsman Rule, 2017, you may approach the
Insurance Ombudsman. You can make the complaint to the Ombudsman as per provision 13 of the said rules. The relevant provisions have
been mentioned in the section “Relevant Satutes”
V. The addresses of the Insurance Ombudsman and the Insurance Ombudsman Rules, 2017, are available on the website of IRDAI,
http://www.irdaindia.org and in our website http://www.sbilife.co.in. The address of the ombudsman at Mumbai is:
510
489/1173 Page 12 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
Office of the Insurance Ombudsman

3rd Floor, Jeevan Seva Annexe, S.V. Road, Santa Cruz (W), Mumbai – 400 054.
Telephone No.: +91 – 22 – 2610 6552 / 2610 6960; Fax No. : +91 – 22 – 2610 6052; E-mail: bimalokpal.mumbai@ecoi.co.in
VI. We have also enclosed a list of addresses of insurance ombudsmen

VII. In case the complaint is not fully attended by us within 15 days of lodging the complaint through our Grievance Redressal Mechanism;
you may escalate the complaint to IRDAI through the Integrated Grievance Management System (IGMS) website:
http://www.igms.irda.gov.in or contact IRDAI approach the Grievance Cell of the Insurance Regulatory and Development Authority
of India (IRDAI) on the following contact details: IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: 155255 / 1800 4254 732
Email ID: complaints@irda.gov.in
VIII. The postal address for communication for complaints by paper is as follows: Consumer Affairs Department, Insurance Regulatory and
Development Authority of India, SY No 115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad – 500 032
38. Claims Process

I. A claim, death, must be notified to us through the Master Policyholder in writing within 3 months of the date of occurrence of the event
along with a copy of the original death certificate (only in case of a death claim) to the nearest SBI Life Office or SBI Life Insurance Co. Ltd,
Claims Department, 7th Level (D Wing) & 8th Level, Seawoods Grand Central, Tower 2, Plot No. R-1, Sector 40, Seawoods, Nerul Node, Navi
Mumbai - 400 706, Dist. Thane, Maharashtra However, without prejudice, in case of delay in intimation or submission of claim documents
beyond the stipulated period in the policy document or in the Statutes, We, at our sole discretion, may condone such delay and examine the
admissibility or otherwise of the claim, if such delay is proved to be for reasons beyond the control of the nominee/claimant.
II. If we find that any of the information provided in the membership form and related documents is inaccurate or false or if you have withheld
any material information, or in case of fraud, we shall have the right to decline the claim subject to provisions of section 45 of the Insurance
Act, 1938, as amended from time to time
III. A claim must be made by notice in writing to the insurance company in the format supplied by the insurance company.
a. The primary documents normally required for processing a death claim are:
i. Original Death Certificate from Municipal/Local authorities
ii. Claim form duly filled in
iii. Certificate from the attending physician along with hospital reports, if any
iv. Police panchnama, and FIR copy / Postmortem Report/ Coroner’s Verdict, where applicable
IV. A claim shall be subject to such other requirements as stipulated by the insurance company and the legal title of the claimant.
V. If found admissible, we will pay the claim as per the authorisation provided by you.
a. In case you have authorised SBI Life to pay the claim proceeds to the Master Policyholder to the extent of the outstanding loan
amount, we will:
i. Pay the claim proceeds to the extent of the outstanding loan amount as on the date of occurrence of the insured event to the
Master Policyholder.
ii. Pay any amount in excess of the outstanding loan amount to the life insured / nominee/ beneficiary / legal heir as the case may
be.
iii. This arrangement is allowed only where the Master Policy Holder is a lender-borrower entity regulated by the Reserve Bank of
India (RBI) or the National Housing Board or the National Minority Development Finance Corporation and its State Channelizing
Agencies or any other entity that meets the eligibility criteria specified in the applicable regulations from time to time.
b. In case you have not authorised SBI Life to pay the claim proceeds to the Master Policyholder, we will:
i. pay the entire claim proceeds to the nominee/ beneficiary / legal heir as the case may be, in case of a death claim
c. We will make the claim payment, to the extent applicable; in the name of the life assured or his/ her nominee/ beneficiary / legal heir
even if the cheque is sent to the Master Policyholder for administrative convenience or through any other electronic mode of
payment to the specific bank account of the life assured.
VI. In a scenario where the due premium has been paid by you to the master policyholder and an acknowledgement or receipt for the premium
is being received by you, but the premium has not been remitted by the master policyholder to us within the grace period. If a claim occurs
subsequently, we shall honour the claim provided the claim is otherwise admissible and payable. However, this will be subject to submission
of relevant documents by the master policyholder to us to our satisfaction, proving that the due premiums have been paid by the insured
member to the master policyholder. For e.g., in a scheme where the premium is being borne by the member, we will need an
acknowledgement /receipt proving that the premium has been paid by the insured member. Further, the claim amount would be settled only
after remittance of due premium to us
39. Discontinuance of the Master Policy

The Master Policyholder has the right to terminate or surrender the master policy at any given time by giving 3 months notice. Under such
circumstances, existing group members will be given an option to continue the insurance cover. In case the group member opts to continue
the insurance cover, then the future premiums, if any, would need to be paid by the group member as and when due. In case the group
member doesn’t want to continue the insurance cover he/she can surrender the policy.
40. Section 41 of the Insurance Act, 1938; as amended from time to time:
I. 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 the commission 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:
II. Any person making default in complying with the provisions of this section shall be liable to a penalty which may extend to ten lakh rupees.
510
489/1173 Page 13 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
41. Section 45 of the Insurance Act, 1938, as amended from time to time:
[For simplified version of the provisions of Section 45, please refer Annexure II.]
42. Rule 13 of Ombudsman Rules, 2017
i. The Ombudsman may receive and consider complaints or disputes relating to:
a. delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance Regulatory and Development
Authority of India Act, 1999;
b. any partial or total repudiation of claims by the life insurer, General insurer or the health insurer;
c. disputes over premium paid or payable in terms of insurance policy;
d. misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
e. legal construction of insurance policies in so far as the dispute relates to claim;
f. policy servicing related grievances against insurers and their agents and intermediaries;
g. issuance of life insurance policy, general insurance policy including health insurance policy which is not inconformity with the proposal
form submitted by the proposer;
h. non-issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance; and
i. any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or
instructions issued by the IRDAI from time to time or the terms and conditions of the policy contract, in so far as they relate to issues
mentioned at clauses (a) to (f)
II. The Ombudsman shall act as counsellor and mediator relating to matters specified in sub-rule (1) provided there is written consent of the
parties to the dispute.
III. The Ombudsman shall be precluded from handling any matter if he is an interested party or having conflict of interest.
IV. The Central Government or as the case may be, the IRDAI may, at any time refer any complaint or dispute relating to insurance matters
specified in sub-rule (1), to the Insurance Ombudsman and such complaint or dispute shall be entertained by the Insurance Ombudsman and
be dealt with as if it is a complaint made under Rule 14.
43. Rule 14 of Ombudsman Rules, 2017
I. Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing
to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential
address or place of residence of the complainant is located.
II. The complaint shall be in writing, duly signed by the complainant or through his legal heirs, nominee or assignee and shall state clearly the
name and address of the complainant, the name of the branch or office of the insurer against whom the complaint is made, the facts giving
rise to complaint, supported by documents, the nature and extent of the loss caused to the complainant and the relief sought from the
Insurance Ombudsman.
III. No complaint to the Ombudsman shall lie unless –
a. The complainant makes a written representation to the insurer named in the complaint and
i. Either the insurer had rejected the complaint; or
ii. the complainant had not received any reply within a period of one month after the insurer received his representation; or
iii. the complainant is not satisfied with the reply given to him by the insurer
b. the complaint is made within one year
i. after the order of the insurer rejecting the representation is received; or
ii. after receipt of decision of the insurer which is not to the satisfaction of the complainant;
iii. after expiry of a period of one month from the date of sending the written representation to the insurer if the insurer named fails
to furnish reply to the complainant
IV. The Ombudsman shall be empowered to condone the delay in such cases as he may consider necessary, after calling for objections of the
insurer against the proposed condonation and after recording reasons for condoning the delay and in case the delay is condoned, the date of
condonation of delay shall be deemed to be the date of filing of the complaint, for further proceedings under these rules.
V. No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before
or disposed of by any court or consumer forum or arbitrator.
44. Protection of Policyholders’ Interest

The IRDAI (Protection of Policyholders’ Interests) Regulations, 2017, provide for protection of the interest of the policyholders. The provisions
of this regulation will be applicable and subject to the prevailing law, as amended from time to time.
510
489/1173 Page 14 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
Annexure I
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 by Insurance Laws
(Amendment) Act, 2015. The extant provisions in this regard are as follows:
01. 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.
02. 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 is to be laid down by the insurer.
03. Nomination can be made at any time before the maturity of the policy.
04. 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.
05. 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.
06. 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.
07. Fee to be paid to the insurer for registering change or cancellation of a nomination can be specified by the Authority through Regulations.
08. 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.
09. 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 Laws (Amendment) Ordinance, 2014 (i.e. 26.12.2014).
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 Laws (Ordinance) 2014, 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 Laws (Amendment) Act, 2015 and only a simplified version prepared
for general information. Policy Holders are advised to refer to Original Ordinance Gazette Notification dated March 23, 2015 for complete and
accurate details.]
510
489/1173 Page 15 of 36 PolicyNo. 7012461250 256/387

CIN: L99999MH2000PLC129113
Annexure II
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, as amended by Insurance Laws
(Amendment) Act, 2015 are as follows:
01. 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.
02. 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.
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 such decision is based.
03. 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.
04. 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.
05. 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.
06. 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.
07. 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.
08. 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.
09. 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 Laws (Amendment) Act, 2015 and only a simplified version prepared
for general information. Policy Holders are advised to refer to Original Ordinance Gazette Notification dated March 23, 2015 for complete and
accurate details]
510
489/1173 Page 16 of 36 PolicyNo. 7012461250 256/387

ADDRESSES OF OMBUDSMAN CENTRES
Office of the Contact Details Jurisdiction of Office
Ombudsman Union Territory, District)
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Gujarat,
Tilak Marg, Relief Road,
AHMEDABAD Dadra & Nagar Haveli,
Ahmedabad – 380 001.
Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@ecoi.co.in
Jeevan Soudha Building,PID No. 57-27-N-
19
Ground Floor, 19/19, 24th Main Road,
BENGALURU Karnataka.
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@ecoi.co.in
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
BHOPAL Near New Market, Madhya Pradesh
Bhopal – 462 003. Chattisgarh.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@ecoi.co.in
62, Forest park,
Bhubneshwar – 751 009.
BHUBANESHWAR Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@ecoi.co.in
S.C.O. No. 101, 102 & 103, 2nd Floor, Punjab,
Batra Building, Sector 17 – D, Haryana,
CHANDIGARH Chandigarh – 160 017. Himachal Pradesh,
Tel.: 0172 - 2706196 / 2706468 Jammu & Kashmir,
Fax: 0172 - 2708274 Chandigarh.
Email: bimalokpal.chandigarh@ecoi.co.in
Fatima Akhtar Court, 4th Floor, 453,
Tamil Nadu,
Anna Salai, Teynampet,
Pondicherry Town and
CHENNAI CHENNAI – 600 018.
Karaikal (which are part of
Tel.: 044 - 24333668 / 24335284
Pondicherry).
Fax: 044 - 24333664
Email: bimalokpal.chennai@ecoi.co.in
2/2 A, Universal Insurance Building,
Asaf Ali Road,
DELHI New Delhi – 110 002. Delhi.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@ecoi.co.in
Office of the Insurance Ombudsman, Assam,

Jeevan Nivesh, 5th Floor, Meghalaya,
Nr. Panbazar over bridge, S.S. Road, Manipur,
GUWAHATI
Guwahati – 781001(ASSAM). Mizoram,
Tel.: 0361 - 2632204 / 2602205 Arunachal Pradesh,
Email: bimalokpal.guwahati@ecoi.co.in Nagaland and Tripura.
489/1173 Page 17 of 36 PolicyNo. 7012461250 256/387

6-2-46, 1st floor, "Moin Court",
Lane Opp. Saleem Function Palace, Andhra Pradesh,
A. C. Guards, Lakdi-Ka-Pool, Telangana,
HYDERABAD
Hyderabad - 500 004. Yanam and
Tel.: 040 - 67504123 / 23312122 part of Territory of Pondicherry.
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@ecoi.co.in
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
JAIPUR Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: Bimalokpal.jaipur@ecoi.co.in
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road, Kerala,
ERNAKULAM Ernakulam - 682 015. Lakshadweep,
Tel.: 0484 - 2358759 / 2359338 Mahe-a part of Pondicherry.
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@ecoi.co.in
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue, West Bengal,
KOLKATA KOLKATA - 700 072. Sikkim,
Tel.: 033 - 22124339 / 22124340 Andaman & Nicobar Islands.
Fax : 033 - 22124341
Email: bimalokpal.kolkata@ecoi.co.in
Office of the Insurance Ombudsman, Districts of Uttar Pradesh :
6th Floor, Jeevan Bhawan, Phase-II, Laitpur, Jhansi, Mahoba,
Nawal Kishore Road, Hazratganj, Hamirpur, Banda, Chitrakoot,
Lucknow - 226 001. Allahabad, Mirzapur, Sonbhabdra,
Tel.: 0522 - 2231330 / 2231331 Fatehpur, Pratapgarh,
Fax: 0522 - 2231310 Jaunpur,Varanasi, Gazipur, Jalaun,
Email: bimalokpal.lucknow@ecoi.co.in Kanpur, Lucknow, Unnao, Sitapur,
Lakhimpur, Bahraich, Barabanki,
LUCKNOW
Raebareli, Sravasti, Gonda,
Faizabad, Amethi, Kaushambi,
Balrampur, Basti, Ambedkarnagar,
Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh,
Kushinagar, Gorkhpur, Deoria,
Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar.
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Goa,
Mumbai - 400 054.
MUMBAI Mumbai Metropolitan Region
Tel.: 022 - 26106552 / 26106960
excluding Navi Mumbai & Thane.
Fax: 022 - 26106052
Email: bimalokpal.mumbai@ecoi.co.in
Office of the Insurance Ombudsman, State of Uttaranchal and the

Bhagwan Sahai Palace following Districts of Uttar
4th Floor, Main Road, Pradesh:
NOIDA Naya Bans, Sector 15, Agra, Aligarh, Bagpat, Bareilly,
Distt: Gautam Buddh Nagar, Bijnor, Budaun, Bulandshehar,
U.P-201301. Etah, Kanooj, Mainpuri, Mathura,
Tel.: 0120-2514250 / 2514252 / 2514253 Meerut, Moradabad,
489/1173 Page 18 of 36 PolicyNo. 7012461250 256/387

Email: bimalokpal.noida@ecoi.co.in Muzaffarnagar, Oraiyya, Pilibhit,
Etawah, Farrukhabad, Firozbad,
Gautambodhanagar, Ghaziabad,
Hardoi, Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj,
Sambhal, Amroha, Hathras,
Kanshiramnagar, Saharanpur.
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road,
Bihar,
PATNA Bahadurpur,
Jharkhand.
Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@ecoi.co.in
Jeevan Darshan Bldg., 3rd Floor,
Maharashtra,
C.T.S. No.s. 195 to 198,
Area of Navi Mumbai and Thane
PUNE N.C. Kelkar Road, Narayan Peth,
excluding Mumbai Metropolitan
Pune – 411 030.
Region.
Tel.: 020-41312555
Email: bimalokpal.pune@ecoi.co.in
489/1173 Page 19 of 36 PolicyNo. 7012461250 256/387

489/1173 Page 20 of 36 PolicyNo. 7012461250 256/387
CIN: L99999MH2000PLC129113
First Premium Receipt cum Tax Invoice
Group Member ID: 7003072108
Membership form No : 7012461250

Loan Account No : 40443379926
Master Policy 70000018311 Sourcing Branch : TUK-TUMKUR

Master Policy holder name STATE BANK OF INDIA Sourcing Branch address : APPAJI PARISAR, SITE NO. 1278,
5TH BLOC STADIUM ROAD,
Customer Name Mr. Lingesh T
CHITRADURGA DISTT.
Thippeswamy CHITRADURGA, KARNATAKA
CHITRADURGA KARNATAKA
Police bar line, Door no 117 577501
G Block, Chitradurha GSTIN SBI : 29AAFCS2530P1ZX
CHITRADURGA
Invoice No :
KARNATAKA - 577501
Invoice date : 17-09-2021
Contact Number 7892422517
GSTIN Customer NA
Place of Supply KARNATAKA
State Code 29
Premium Payment Mode Single Product :SBI Life RiNn Raksha
Insurance Cover Start Date 17-09-2021 UIN :111N078V03
HSN Code :997132
HSN description :Life Insurance Services
Initial Sum Assured `2000000.00 /- Total Amount Received : `150308.00 /-
Payment Method EFT - Debit by Voucher Premium Amount : ` 127380.00/-
Taxable Value : ` 127380.00/-
State/UT GST-9% : ` 11464.00 /-

Whether the tax is payable on reverse charge basis or not :- No
Central GST-9% : ` 11464.00 /-
Amount of Total GST : `22928.00 /-
Total Premium Amount : `150308.00 /-
Next premium due on : NA

Amount of Initial/First Premium paid
: ` 150308.00 /-
Rupees Rupees One Lakh Fifty Thousand Three Hundred Eight Only
Received the amount as above.
Note: In case of any discrepancies, you are kindly requested to inform us immediately. Call us toll free at our customer service helpline 1800 267 9090
No interest is payable on excess payments, if any, made by the member.
"Premium paid under this policy is eligible for tax rebates under section 80C of the Income Tax Act, 1961, as applicable.
"Goods & Service Tax (GST)/ Cess and/or any other statutory levy/ duty/surcharge, at the rate notified by the Central Government/ State Government
/ Union Territories of India from time to time, shall be levied on premium /charges (as applicable) as per the provisions of the prevalent tax laws."
As per GOI notification, GST has been levied on your insurance policy @18% on premium or charges. (or as applicable) w.e.f 01.07.2017.
In the case of endowment policy, the taxable value is 25% of the premium for first year and 12.5% for second & subsequent year. For single premium
annuity policy, the taxable value is 10% of the premium. Please refer SBI Life website for details."
This premium receipt is issued subject to realization of cheque/ draft

The Consolidated Revenue stamp duty paid vide Letter of Authorisation No. CSD/280/2021/1030 dated 16 Mar, 2021 issued by Pradhan Mudrank
Karyalay.
SBI Life Insurance Co. Ltd.
510 Toll free number: 18002679090 Email:info@sbilife.co.in , Website : www.sbilife.co.in
489/1173 Page 21 of 36 PolicyNo. 7012461250 256/387
489/1173 Page 22 of 36 PolicyNo. 7012461250 256/387
SBI Life Insurance Co. Ltd Corporate Office: 'Natraj', M.V. Road and Western Express, Highway Junction,
Andheri (East),Mumbai 400069. Regn No. 111
Website: www.sbilife.co.in | Email: info@sbilife.co.in | CIN: L99999MH2000PLC129113. Toll Free: 1800 267 9090 (Between 9.00 am & 9.00 pm)
Benefit Illustration for SBI LIFE - Rinn Raksha (UIN: 111N078V03)
Quotation Number OL7000000621321915092021055407 Proposer Name Mr. Lingesh T
Home Loan
Loan Type Home Loan J & K Resident No
Staff/Non-Staff Non-Staff
Loan Details
Loan Amount to be covered (Rs) 2000000 Cover Term ( in months) 276
Interest Rates Range Between 06.00% to 08.49% Cover Interest Rate 8.49 %
Moratorium Option Chosen Yes Moratorium Period ( input in 12

months)
Interest Payment during Yes Co-borrower Option Only Primary Borrower

Moratorium Period
Primary borrower Age 45 Option 1
Premium Paid By Self Paid Premium Frequency Single
Premium Details First Borrower
Basic Premium (Rs) 127380
Co-Borrower Rebate 0%
Total First Year Premium Exclusive of Applicable Tax (Rs.) 127380
Applicable Tax (Rs.) 22928
Total First Year Premium Inclusive of Applicable Tax (Rs.) 150308
Initial Sum Assured (Loan Amount to be covered including Premium and Applicable 2000000
Tax)(Rs)
Medical Requirements CHQ
Authenticated via OTP shared for proposal no. 7012461250 on 15-09-2021 18:05:40 PM
489/1173 Page 23 of 36 PolicyNo. 7012461250 256/387

One Premium Installment
Premium inclusive of Applicable Tax payable for all borrowers (Rs.) 127380
Applicable Tax (Rs.) 22928
Premium inclusive of Applicable Tax payable for all borrowers (Rs.) 150308
I, Mr. Lingesh T having received the information with respect to the above, have understood the above statement before entering into the
contract.
This document is eSigned by Mr. Lingesh T
Marketing official's
Place :Chitradurga Date :15-9-2021 (Employee code- 6213219)

Name of Employee- K Thilak Raj
Authenticated by Id & Password
489/1173 Page 24 of 36 PolicyNo. 7012461250 256/387

Form Number 7012461250
Loan Account Number 40443379926
SBI Life - RiNn Raksha Membership Form

SBI LIFE INSURANCE COMPANY LTD.
Registered & Corporate Office: Natraj, M.V. Road & Western Express Highway Junction, Andheri (East), Mumbai - 400 069.
IRDAI Registration no. 111.
website: www.sbilife.co.in | Email: info@sbilife.co.in | CIN: L99999MH2000PLC129113 | Toll Free: 1800 267 9090 (Between 9:00 AM & 9:00
PM)
Instruction for filling the form for applying insurance on life of borrower(member to be insured)
1. INSURANCE IS A CONTRACT OF UTMOST GOOD FAITH WHICH REQUIRES YOU TO DISCLOSE ALL REQUIRED INFORMATION TRUTHFULLY. PLEASE ENSURE THAT
INFORMATION FURNISHED IN THE MEMBERSHIP FORM IS TRUE TO THE BEST OF YOUR KNOWLEDGE. IN CASE SOMEONE ELSE(YOUR AGENT,BANK BRANCH
ETC.)HAS COMPLETED THE MEMBERSHIP FORM ON YOUR BEHALF,PLEASE APPRECIATE THAT THE OWNERSHIP OF THE INFORMATION PROVIDED IS STILL
ENTIRELY YOURS, HENCE ENSURE THE CORRECTNESS OF THE INFORMATION BEFORE YOU SIGN THE MEMBERSHIP FORM.
IF ANY INFORMATION (E.G AGE, HEALTH/MEDICAL)IS SUBSEQENTLY FOUND UNTRUE OR FOUND UNTRUE AT THE TIME OF THE CLAIM, WE MAY DECLINE THE
CLAIM
2. SBI Life branches and its sales teams are not authorised to collect cash from its customers.
1. MASTER POLICY HOLDER DETAILS
MPH Name STATE BANK OF INDIA Master Policy No. 70000018311
Bank Code 00 Branch Code (Sourcing) 41178
RACPC Code 63082 Branch Name PRASHANTNAGAR

CHITRADURGA
OSF Code NA
Code 1 6192270 Code 2 6213219
Code 3 6192270 Code 4 NA
Code 5 NA Code 6 44201
2. MEMBERS DETAILS
Name Mr. Lingesh T
Father's/Proposer Name T Lingesh
Date of Birth 21-02-1975 Date of Birth of Father/Proposer 21-02-1975
Relationship of the Proposer With the Member Son
Age Proof(Please attach copy of Age Proof) Pancard
PAN* ACHPL0088L
I do not have a PAN Card and have submitted Form 60 No
*Please provide PAN number or submit Form 60 if the annualized premium under this proposal exceeds Rs 50000/-
Occupation Salaried
Name of the Employer and Designation District reserve police
Business Organisation's or Company's Name and Nature of Bussiness or Head Constable

Profession:
Address S/O, Thippeswamy, Police bar line, Door no 117, G Block,

Chitradurha-CHITRADURGA, 577501, KARNATAKA
Mobile No 7892422517 Email Id
Telephone No(Home) NA Telephone No(Office) NA
70.ver.10-07/18 MF 1
489/1173 Page 25 of 36 PolicyNo. 7012461250 256/387

Are You State Bank Group/BNPP Staff Member No
IF YES, state PF Number NA
Are you a Non Resident Indian (NRI)? No
If YES, state Country of Residence: India
3. NOMINEE DETAILS
Name Mrs. Lakshmamma T
Date of Birth 01-06-1980
Relationship with Member Spouse
Address Thippeswamy, Police bar line, Door no 117, G Block, Chitradurha-

CHITRADURGA, 577501, KARNATAKA
In case of more than one nominee, please provide details in the requisite annexure.
4. APPOINTEE DETAILS (If Nominee is a Minor)
Name NA
Date of Birth NA
Relationship with Nominee NA
Signature of Appointee
5. MEDICAL QUESTIONNAIRE:- In case where insurance is proposed on Minor Life, the answers should relate to medical status of Minor Life to be Assured
Important :Please read this section fully and give correct details.
Height 172.72 Cms Weight 60 Kgs
i. Have you consulted any doctor for surgical operations or have been hospitalised for any disorder other than minor No
cough,cold or flu during the last 5 years?
ii. Have you ever had any illness/injury, major surgical operation or received any treatment for any medical condition No
for a continuous period of more than 14 days? (Except for minor cough, cold, flu, appendicitis & typhoid)
iii. Have you ever suffered from / been treated / hospitalized for or diagnosed to have -
(a) Diabetes, raised blood sugar or No (b) Chest pain, heart attack, heart No
high blood pressure disease or any other disorder of the
circulatory system.
(c) Stroke, paralysis, disorder of No (d) HIV infection, AIDS No

the brain/nervous system.
(e) Cancer, tumor, growth or cyst No (f) Any genitourinary or kidney No

of any kind disorder, Hepatitis B/C or any
other liver disease
(g) Any digestive disorder (ulcer, colitis etc), any disease of the gall bladder, spleen, any blood disorder, disorder of any No
other gland (e.g. Thyroid etc) or any musculoskeletal disorder
(h) Asthma, Tuberculosis, No (i) Mental, psychiatric or nervous No

Pneumonia, or any other disease of disorder
the lung.
(iv) Have you suffered from any other disease not mentioned above? No
(v) Are you at present taking any medication, or on any special diet or on any treatment? No
(vi) Has a proposal for Life Insurance, ever been declined, postponed, withdrawn or accepted at extra premium? No
(vii) Have you had or have been advised to undergo any of the following tests or investigations? No
70.ver.10-07/18 MF 2
489/1173 Page 26 of 36 PolicyNo. 7012461250 256/387

(IF Yes, Please Select which of the following and provide reason for NA
undergoing the tests) Ultra Sonograpghy,CT Scan/MRI,Biopsy,Coronary
Angiography
viii. a) Do you consume more than 10 cigarettes / bidis per day or chew more than 5 pouches of tobacco per day? No
b) Do you consume more than 2 pegs of alcohol per day in any form? No
If Yes Please Provide the type of alcohol and daily quantity consumed
Type NA Quantity per day(In ml) NA
c) Do you use or have you used any narcotics / any other drugs? No
{If answer to any of the question (i) to (viii) are Yes please give full particulars below with details and also attach necessary documents such as medical
history, diagnosis, when it happened, treatment taken, names of medications, tests done, results of tests. }
Section 41 of the Insurance Act, 1938, as amended from time to time.
(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 the commission 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 on his 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 such acceptance the insurance agent satisfies
the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
(2) Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakh rupees.
Extract of Section 45 of the Insurance Act 1938, as amended from time to time
No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of policy. A policy of life
insurance may be called in question at anytime within three years from the date of the policy, on the ground of fraud or on the ground that any statement
of or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of
which the policy was issued or revived or rider issued. The insurer shall have to communicate in writing to the insured or the legal representatives or
nominees or assignees of the insured, the grounds and materials on which such decision is based.
No insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the mis-statement or suppression of material fact was
true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis-statement or suppression are
within the knowledge of the insurer. In case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive.
In case of repudiation of the policy on the ground of misstatement or suppression of a material fact, and not on the grounds of fraud, the premiums
collected on the policy till the date of repudiation shall be paid.
Nothing in this section shall prevent 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 in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the
proposal.
For complete details of the section and the definition of 'date of policy', please refer Section 45 of the Insurance Act 1938.
I hereby agree that this form including this declaration shall for the basis for the issuance of the proposed insurance plan; all information has been
provided with full understanding and knowledge and the information is complete and true to the best of my knowledge.
Signature of Member or Proposer(In case Member is a Minor)
Signature of the Witness (Employee code- 6213219)

Place :Chitradurga Date :15-09-2021
Name Mr. Lingesh T

6. LOAN DETAILS
Loan Amount/Outstanding Loan 2000000 EMI Payable Rs. : 14624

Amount Rs.*:
Date of First Disbursement 15-09-2021
70.ver.10-07/18 MF 3
489/1173 Page 27 of 36 PolicyNo. 7012461250 256/387

Loan Term(Months): 276 Loan Interest Rate(%) 8.49 Loan Category/ Type Home Loan
Study/ Course duration NA
Moratorium Period Yes Moratorium Period(Months) 12
If Yes, please Select With Interest payment
Have you availed Loan insurance cover from SBI Life in the last two No
years
If Yes, please give the Loan Account Number NA In case there are more loan accounts, then please provide
information in a seperate sheet in the given format.
*In loans where the entire loan amount is not disbursed, the loan sanctioned amount will be covered
7. INSURANCE PLAN DETAILS
Loan Amount to be covered for the 2000000 Cover Term(Months) 276

applicant/Initial Sum Assured Rs. :
Note: Initial Sum Assured cannot exceed 120% of the outstanding loan amount or a limit prescribed by the scheme rules. Where the co-borrower is covered for their respective share, the Total Initial
Sum Assured for all Co-borrowers cannot exceed the above limit
Interest Cover Rate(%)** 8.49 Premium Payment Mode*^ Single
Premium Payment Term(PPT)(only for LP)(Years)*^ Single
Premium Payment Option Self Paid (Please fill section 9C(2))
Additional Option Details*^ : NA Rider chosen, if any NA

Option chosen, if any
*(i)Primium Payment Modes available under this plan are-Single, Yearly, Half-Yearly, Quarterly and Monthly. (ii)Premium Payment Terms available under this plan are - 5 years and 10 years.(iii)
Options available under this plan are- Gold Option and Platinum Option(iv)Rider available under this plan-Accidental Total & Permanent Disability Benefit
^All products features under this plan have been chosen by the Master Policy holder in his capacity as the group administrator. Only features chosen by the Master Policy holder are avialable to you,
based on eligibility. You can choose from the options/features made available to you by the Master Policy holder. Please refer the Sales Brouchure for complete details of product features.
**The rate on which the Sum Assured schedule is based. This is as per the understanding between MPH & member.
8. CO-BORROWERS
Co-borrowers to be covered? NA
Each Co-Borrower to be covered for@ NA
Name of Co-Borrower 1: NA
Loan Amount NA Membership Form NA Relationship with NA

Covered/Initial Sum No: Primary Applicant:
Assured Rs.

Assured Rs.
@All product features under this plan have been chosen by the Master Policy Holder in his capacity as the Group Administrator. Only features chosen by the Master Policy Holder are available to you
based on eligibility. You can choose from the options/features made available to you by the Master Policy Holder. Please refer the Sales Brochure for complete details of product features.
9. PREMIUM PAYMENT DETAILS AND DIRECT DEBIT MANDATE
9A. PREMIUM PAYMENT DETAILS
Premium Payable Rs. 127380 Applicable Tax Rs. 22928 Draft Amount Rs. 150308
Draft Number: NA EFT Transaction ID: NA Draft/EFT Date NA
I Mr. Lingesh T hereby certify that the loan amount and details mentioned in section 6 & 7 are correct and loan amount has been
sanctioned according to the extant Credit Appraisal Norms and Procedures being followed by us.
Further, I certify that Life to be Assured is: Sole Borrower
9B. BANK ACCOUNT DETAILS OF PROPOSER/LIFE TO BE ASSURED(MANDATORY)
Account no### 39494179790
70.ver.10-07/18 MF 4
489/1173 Page 28 of 36 PolicyNo. 7012461250 256/387

A/C Type Saving

Bank Name STATE BANK OF INDIA Bank Branch Name PRASHANTNAGAR
CHITRADURGA
For State Bank Group Branches, please provide
Bank Code 00 Bank Branch Code 41178
Name of the A/C Holder Mr Lingesh T
MICR Code* 577006505 IFSC Code* SBIN0041178
I declare that the information given above is true and correct, I shall not hold SBI Life responsible for non-credit of payout or refund, if any , due to any reason including but not limited to
incorrect/incomplete information. I hereby authorise SBI Life to directly credit payout/refund, if any. to the above mentioned account.
###Valid Resident Indian Account. *Please submit cancelled cheque with pre-printed account holder name along with the membership form
9C. DIRECT DEBIT MANDATE

1) Where Premium is Paid Through Additional Loan From Bank/Lending Institution
I authorise my account to be debited for renewal premium(for State Bank Group) favouring SBI Life on due date.
Bank Code NA Branch Code NA Loan Plus Account NA

No:(for State Bank
Group Only)
2) For Self Paid Option (Where Member Makes Premium Payment Out of His Own Saving Bank Account)
I authorise my account number, as mentioned above in section 9B to be debited for renewel premium favouring SBI Life on due date
I have attached ECS Mandate copy along with the form. Yes
Signature of Member or Proposer(In case

Member is a Minor)
Signature of Authorised Representative of Bank/Financial Institution with (Employee code- 6213219)

Name and Designation Name of Employee- K Thilak Raj
Date 15-09-2021 Place Chitradurga
10. DECLARATION CUM AUTHORISATION
1. I would like to become a member of SBI Life - RiNn Raksha Group Insurance Plan for borrowers of Master Policyholder. I hereby declare and certify
that all the terms and conditions of the Life Insurance Cover have been thoroughly explained to me and I have fully understood the same.
2. I have understood the terms and conditions of the Plan and agree to abide the same and join the Plan for Life Insurance Cover for the duration of the
loan as per the prevailing EMI schedule.
3. I undertake to furnish any other personal details that the Proposer/ Master Policyholder/ SBI Life may require with regard to my Life Insurance Cover
under the Group Life Insurance Plan and authorise the Proposer/Master Policyholder to communicate any change in regards to my Life Insurance Cover.
4. I understand that the grant of the loan will be assessed independently of Life Insurance Cover which is optional.
5. I hereby understand and agree that no Life Insurance Cover will commence until the risk is accepted and requisite premium has been remitted to SBI
Life by the Master Policyholder and SBI Life conveys its written acceptance of this application for Life Insurance Cover. I further understand and agree
that Life Insurance Cover provided to me shall be governed by the Master Policy Contract issued in favour of the Master Policyholder. Notwithstanding
the provision of any law, usage, custom or convention for the time being in force prohibiting any doctor, hospital and/or employer from divulging any
knowledge or information about me concerning my health, employment on the grounds of secrecy. I, my heirs, executors, administrator or any other
person or persons having interest of any kind whatsoever in the Life Insurance Cover provided to me, hereby agree that such authority, having such
knowledge or information, shall at anytime be at liberty to divulge any such knowledge or information to the Company.
• I hereby agree that this form including the details of loan and cover and options chosen by me as above are correct and complete shall form the basis of
my admission into the Group Insurance Plan. I also understand that once the cover is accepted any alteration in these information shall not be feasible or
permissible.
• I hereby authorise SBI Life to pay directly to the Master Policyholder such portion of claim proceeds payable equal to the Outstanding Loan Balance
amount owed by me to the Master Policyholder on the date of occurence of the insured event. The balance claim amount, if any, shall be payable to my
70.ver.10-07/18 MF 5
489/1173 Page 29 of 36 PolicyNo. 7012461250 256/387

nominee/ beneficiary (as applicable).
• Note: (1) The claim should be found admissible by SBI Life. (2) In case there is no outstanding loan balance owed to the Master Policyholder, this
authorisation shall be deemed to be lapsed, ineffective, unenforceable and invalid from the date of settlement of my outstanding dues to the Master
Policyholder.

Member is a Minor)
Date :15-09-2021
11. ADDITIONAL DECLARATION WHEN THE MEMBERSHIP FORM IS FILLED BY PERSON OTHER THAN THE MEMBER/MEMBER SIGNS IN A
VERNACULAR LANGUAGE/MEMBER IS ILLITERATE
I hereby declare that I have read out and explained the contents of Membership Form and all other documents incidental to availing the Group Insurance
Plan from SBI Life to the Member and that he/she said that he/she had understood the same and that he/she agrees to abide by all the terms and conditions
of the same. I hereby declare that I have fully explained to the Member that the statements contained in this form shall be the basis for the Life Insurance
Cover and that if any untrue statement is contained herein, no benefit shall be payable by the SBI Life. I hereby declare that I have explained the contents
of this form to the Member in kannada Language, that I have truly and correctly recorded the details and statements given by the Member and that the
Member has affixed his/her signature/thumb impression on the Membership Form in my presence, after fully understanding the contents thereof.

Member is a Minor)
Signature of person making the declaration (Employee code- 6213219)

Date 15-09-2021
Name Mr. Lingesh T
Address Chitradurga
70.ver.10-07/18 MF 6
489/1173 Page 30 of 36 PolicyNo. 7012461250 256/387

Loan Account Number 40443379926
SBI Life - RiNn Raksha Membership Form

SBI LIFE INSURANCE COMPANY LTD.
Registered & Corporate Office: Natraj, M.V. Road & Western Express Highway Junction, Andheri (East), Mumbai - 400 069.
IRDAI Registration no. 111.
website: www.sbilife.co.in | Email: info@sbilife.co.in | CIN: L99999MH2000PLC129113 | Toll Free: 1800 267 9090 (Between 9:00 AM & 9:00
PM)
Instruction for filling the form for applying insurance on life of borrower(member to be insured)
1. INSURANCE IS A CONTRACT OF UTMOST GOOD FAITH WHICH REQUIRES YOU TO DISCLOSE ALL REQUIRED INFORMATION TRUTHFULLY. PLEASE ENSURE THAT
INFORMATION FURNISHED IN THE MEMBERSHIP FORM IS TRUE TO THE BEST OF YOUR KNOWLEDGE. IN CASE SOMEONE ELSE(YOUR AGENT,BANK BRANCH
ETC.)HAS COMPLETED THE MEMBERSHIP FORM ON YOUR BEHALF,PLEASE APPRECIATE THAT THE OWNERSHIP OF THE INFORMATION PROVIDED IS STILL
ENTIRELY YOURS, HENCE ENSURE THE CORRECTNESS OF THE INFORMATION BEFORE YOU SIGN THE MEMBERSHIP FORM.
IF ANY INFORMATION (E.G AGE, HEALTH/MEDICAL)IS SUBSEQENTLY FOUND UNTRUE OR FOUND UNTRUE AT THE TIME OF THE CLAIM, WE MAY DECLINE THE
CLAIM
2. SBI Life branches and its sales teams are not authorised to collect cash from its customers.
1. MASTER POLICY HOLDER DETAILS
MPH Name STATE BANK OF INDIA Master Policy No. 70000018311
Bank Code 00 Branch Code (Sourcing) 41178
RACPC Code 63082 Branch Name PRASHANTNAGAR

CHITRADURGA
OSF Code NA
Code 1 6192270 Code 2 6213219
Code 3 6192270 Code 4 NA
Code 5 NA Code 6 44201
2. MEMBERS DETAILS
Name Mr. Lingesh T
Father's/Proposer Name T Lingesh
Date of Birth 21-02-1975 Date of Birth of Father/Proposer 21-02-1975
Relationship of the Proposer With the Member Son
Age Proof(Please attach copy of Age Proof) Pancard
PAN* ACHPL0088L
I do not have a PAN Card and have submitted Form 60 No
*Please provide PAN number or submit Form 60 if the annualized premium under this proposal exceeds Rs 50000/-
Occupation Salaried
Name of the Employer and Designation District reserve police
Business Organisation's or Company's Name and Nature of Bussiness or Head Constable

Profession:

Mobile No 7892422517 Email Id
Telephone No(Home) NA Telephone No(Office) NA
70.ver.10-07/18 MF 1
489/1173 Page 31 of 36 PolicyNo. 7012461250 256/387

Are You State Bank Group/BNPP Staff Member No
IF YES, state PF Number NA
Are you a Non Resident Indian (NRI)? No
If YES, state Country of Residence: India
3. NOMINEE DETAILS
Name Mrs. Lakshmamma T
Date of Birth 01-06-1980
Relationship with Member Spouse
Address Thippeswamy, Police bar line, Door no 117, G Block, Chitradurha-

CHITRADURGA, 577501, KARNATAKA
In case of more than one nominee, please provide details in the requisite annexure.
4. APPOINTEE DETAILS (If Nominee is a Minor)
Name NA
Date of Birth NA
Relationship with Nominee NA
Signature of Appointee
5. MEDICAL QUESTIONNAIRE:- In case where insurance is proposed on Minor Life, the answers should relate to medical status of Minor Life to be Assured
Important :Please read this section fully and give correct details.
Height 172.72 Cms Weight 60 Kgs
i. Have you consulted any doctor for surgical operations or have been hospitalised for any disorder other than minor No
cough,cold or flu during the last 5 years?
ii. Have you ever had any illness/injury, major surgical operation or received any treatment for any medical condition No
for a continuous period of more than 14 days? (Except for minor cough, cold, flu, appendicitis & typhoid)
iii. Have you ever suffered from / been treated / hospitalized for or diagnosed to have -
(a) Diabetes, raised blood sugar or No (b) Chest pain, heart attack, heart No
high blood pressure disease or any other disorder of the
circulatory system.
(c) Stroke, paralysis, disorder of No (d) HIV infection, AIDS No

the brain/nervous system.
(e) Cancer, tumor, growth or cyst No (f) Any genitourinary or kidney No

of any kind disorder, Hepatitis B/C or any
other liver disease
(g) Any digestive disorder (ulcer, colitis etc), any disease of the gall bladder, spleen, any blood disorder, disorder of any No
other gland (e.g. Thyroid etc) or any musculoskeletal disorder
(h) Asthma, Tuberculosis, No (i) Mental, psychiatric or nervous No

Pneumonia, or any other disease of disorder
the lung.
(iv) Have you suffered from any other disease not mentioned above? No
(v) Are you at present taking any medication, or on any special diet or on any treatment? No
(vi) Has a proposal for Life Insurance, ever been declined, postponed, withdrawn or accepted at extra premium? No
(vii) Have you had or have been advised to undergo any of the following tests or investigations? No
70.ver.10-07/18 MF 2
489/1173 Page 32 of 36 PolicyNo. 7012461250 256/387

(IF Yes, Please Select which of the following and provide reason for NA
undergoing the tests) Ultra Sonograpghy,CT Scan/MRI,Biopsy,Coronary
Angiography
viii. a) Do you consume more than 10 cigarettes / bidis per day or chew more than 5 pouches of tobacco per day? No
b) Do you consume more than 2 pegs of alcohol per day in any form? No
If Yes Please Provide the type of alcohol and daily quantity consumed
Type NA Quantity per day(In ml) NA
c) Do you use or have you used any narcotics / any other drugs? No
{If answer to any of the question (i) to (viii) are Yes please give full particulars below with details and also attach necessary documents such as medical
history, diagnosis, when it happened, treatment taken, names of medications, tests done, results of tests. }
Section 41 of the Insurance Act, 1938, as amended from time to time.
(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 the commission 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 on his 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 such acceptance the insurance agent satisfies
the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
(2) Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakh rupees.
Extract of Section 45 of the Insurance Act 1938, as amended from time to time
No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of policy. A policy of life
insurance may be called in question at anytime within three years from the date of the policy, on the ground of fraud or on the ground that any statement
of or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of
which the policy was issued or revived or rider issued. The insurer shall have to communicate in writing to the insured or the legal representatives or
nominees or assignees of the insured, the grounds and materials on which such decision is based.
No insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the mis-statement or suppression of material fact was
true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis-statement or suppression are
within the knowledge of the insurer. In case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive.
In case of repudiation of the policy on the ground of misstatement or suppression of a material fact, and not on the grounds of fraud, the premiums
collected on the policy till the date of repudiation shall be paid.
Nothing in this section shall prevent 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 in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the
proposal.
For complete details of the section and the definition of 'date of policy', please refer Section 45 of the Insurance Act 1938.
I hereby agree that this form including this declaration shall for the basis for the issuance of the proposed insurance plan; all information has been
provided with full understanding and knowledge and the information is complete and true to the best of my knowledge.
Signature of Member or Proposer(In case Member is a Minor)
Signature of the Witness (Employee code- 6213219)

Place :Chitradurga Date :15-09-2021
Name Mr. Lingesh T

6. LOAN DETAILS
Loan Amount/Outstanding Loan 2000000 EMI Payable Rs. : 14624

Amount Rs.*:
Date of First Disbursement 15-09-2021
70.ver.10-07/18 MF 3
489/1173 Page 33 of 36 PolicyNo. 7012461250 256/387

Loan Term(Months): 276 Loan Interest Rate(%) 8.49 Loan Category/ Type Home Loan
Study/ Course duration NA
Moratorium Period Yes Moratorium Period(Months) 12
If Yes, please Select With Interest payment
Have you availed Loan insurance cover from SBI Life in the last two No
years
If Yes, please give the Loan Account Number NA In case there are more loan accounts, then please provide
information in a seperate sheet in the given format.
*In loans where the entire loan amount is not disbursed, the loan sanctioned amount will be covered
7. INSURANCE PLAN DETAILS
Loan Amount to be covered for the 2000000 Cover Term(Months) 276

applicant/Initial Sum Assured Rs. :
Note: Initial Sum Assured cannot exceed 120% of the outstanding loan amount or a limit prescribed by the scheme rules. Where the co-borrower is covered for their respective share, the Total Initial
Sum Assured for all Co-borrowers cannot exceed the above limit
Interest Cover Rate(%)** 8.49 Premium Payment Mode*^ Single
Premium Payment Term(PPT)(only for LP)(Years)*^ Single
Premium Payment Option Self Paid (Please fill section 9C(2))
Additional Option Details*^ : NA Rider chosen, if any NA

Option chosen, if any
*(i)Primium Payment Modes available under this plan are-Single, Yearly, Half-Yearly, Quarterly and Monthly. (ii)Premium Payment Terms available under this plan are - 5 years and 10 years.(iii)
Options available under this plan are- Gold Option and Platinum Option(iv)Rider available under this plan-Accidental Total & Permanent Disability Benefit
^All products features under this plan have been chosen by the Master Policy holder in his capacity as the group administrator. Only features chosen by the Master Policy holder are avialable to you,
based on eligibility. You can choose from the options/features made available to you by the Master Policy holder. Please refer the Sales Brouchure for complete details of product features.
**The rate on which the Sum Assured schedule is based. This is as per the understanding between MPH & member.
8. CO-BORROWERS
Co-borrowers to be covered? NA
Each Co-Borrower to be covered for@ NA

Assured Rs.

Assured Rs.
@All product features under this plan have been chosen by the Master Policy Holder in his capacity as the Group Administrator. Only features chosen by the Master Policy Holder are available to you
based on eligibility. You can choose from the options/features made available to you by the Master Policy Holder. Please refer the Sales Brochure for complete details of product features.
9. PREMIUM PAYMENT DETAILS AND DIRECT DEBIT MANDATE
9A. PREMIUM PAYMENT DETAILS
Premium Payable Rs. 127380 Applicable Tax Rs. 22928 Draft Amount Rs. 150308
Draft Number: NA EFT Transaction ID: NA Draft/EFT Date NA
I Mr. Lingesh T hereby certify that the loan amount and details mentioned in section 6 & 7 are correct and loan amount has been
sanctioned according to the extant Credit Appraisal Norms and Procedures being followed by us.
Further, I certify that Life to be Assured is: Sole Borrower
9B. BANK ACCOUNT DETAILS OF PROPOSER/LIFE TO BE ASSURED(MANDATORY)
Account no### 39494179790
70.ver.10-07/18 MF 4
489/1173 Page 34 of 36 PolicyNo. 7012461250 256/387

A/C Type Saving

Bank Name STATE BANK OF INDIA Bank Branch Name PRASHANTNAGAR
CHITRADURGA
For State Bank Group Branches, please provide
Bank Code 00 Bank Branch Code 41178
Name of the A/C Holder Mr Lingesh T
MICR Code* 577006505 IFSC Code* SBIN0041178
I declare that the information given above is true and correct, I shall not hold SBI Life responsible for non-credit of payout or refund, if any , due to any reason including but not limited to
incorrect/incomplete information. I hereby authorise SBI Life to directly credit payout/refund, if any. to the above mentioned account.
###Valid Resident Indian Account. *Please submit cancelled cheque with pre-printed account holder name along with the membership form
9C. DIRECT DEBIT MANDATE

1) Where Premium is Paid Through Additional Loan From Bank/Lending Institution
I authorise my account to be debited for renewal premium(for State Bank Group) favouring SBI Life on due date.
Bank Code NA Branch Code NA Loan Plus Account NA

No:(for State Bank
Group Only)
2) For Self Paid Option (Where Member Makes Premium Payment Out of His Own Saving Bank Account)
I authorise my account number, as mentioned above in section 9B to be debited for renewel premium favouring SBI Life on due date
I have attached ECS Mandate copy along with the form. Yes

Member is a Minor)
Signature of Authorised Representative of Bank/Financial Institution with (Employee code- 6213219)

Name and Designation Name of Employee- K Thilak Raj
Date 15-09-2021 Place Chitradurga
10. DECLARATION CUM AUTHORISATION
1. I would like to become a member of SBI Life - RiNn Raksha Group Insurance Plan for borrowers of Master Policyholder. I hereby declare and certify
that all the terms and conditions of the Life Insurance Cover have been thoroughly explained to me and I have fully understood the same.
2. I have understood the terms and conditions of the Plan and agree to abide the same and join the Plan for Life Insurance Cover for the duration of the
loan as per the prevailing EMI schedule.
3. I undertake to furnish any other personal details that the Proposer/ Master Policyholder/ SBI Life may require with regard to my Life Insurance Cover
under the Group Life Insurance Plan and authorise the Proposer/Master Policyholder to communicate any change in regards to my Life Insurance Cover.
4. I understand that the grant of the loan will be assessed independently of Life Insurance Cover which is optional.
5. I hereby understand and agree that no Life Insurance Cover will commence until the risk is accepted and requisite premium has been remitted to SBI
Life by the Master Policyholder and SBI Life conveys its written acceptance of this application for Life Insurance Cover. I further understand and agree
that Life Insurance Cover provided to me shall be governed by the Master Policy Contract issued in favour of the Master Policyholder. Notwithstanding
the provision of any law, usage, custom or convention for the time being in force prohibiting any doctor, hospital and/or employer from divulging any
knowledge or information about me concerning my health, employment on the grounds of secrecy. I, my heirs, executors, administrator or any other
person or persons having interest of any kind whatsoever in the Life Insurance Cover provided to me, hereby agree that such authority, having such
knowledge or information, shall at anytime be at liberty to divulge any such knowledge or information to the Company.
• I hereby agree that this form including the details of loan and cover and options chosen by me as above are correct and complete shall form the basis of
my admission into the Group Insurance Plan. I also understand that once the cover is accepted any alteration in these information shall not be feasible or
permissible.
• I hereby authorise SBI Life to pay directly to the Master Policyholder such portion of claim proceeds payable equal to the Outstanding Loan Balance
amount owed by me to the Master Policyholder on the date of occurence of the insured event. The balance claim amount, if any, shall be payable to my
70.ver.10-07/18 MF 5
489/1173 Page 35 of 36 PolicyNo. 7012461250 256/387

nominee/ beneficiary (as applicable).
• Note: (1) The claim should be found admissible by SBI Life. (2) In case there is no outstanding loan balance owed to the Master Policyholder, this
authorisation shall be deemed to be lapsed, ineffective, unenforceable and invalid from the date of settlement of my outstanding dues to the Master
Policyholder.

Member is a Minor)
Date :15-09-2021
11. ADDITIONAL DECLARATION WHEN THE MEMBERSHIP FORM IS FILLED BY PERSON OTHER THAN THE MEMBER/MEMBER SIGNS IN A
VERNACULAR LANGUAGE/MEMBER IS ILLITERATE
I hereby declare that I have read out and explained the contents of Membership Form and all other documents incidental to availing the Group Insurance
Plan from SBI Life to the Member and that he/she said that he/she had understood the same and that he/she agrees to abide by all the terms and conditions
of the same. I hereby declare that I have fully explained to the Member that the statements contained in this form shall be the basis for the Life Insurance
Cover and that if any untrue statement is contained herein, no benefit shall be payable by the SBI Life. I hereby declare that I have explained the contents
of this form to the Member in kannada Language, that I have truly and correctly recorded the details and statements given by the Member and that the
Member has affixed his/her signature/thumb impression on the Membership Form in my presence, after fully understanding the contents thereof.

Member is a Minor)
Signature of person making the declaration (Employee code- 6213219)

Date 15-09-2021
Name Mr. Lingesh T
Address Chitradurga
70.ver.10-07/18 MF 6
489/1173 Page 36 of 36 PolicyNo. 7012461250 256/387

Signature Not Verified: Speed Post BNPL Code-TN/SP/BNPL/54/CO/18 BPC, Anna Road, Chennai-02

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Signature Not Verified: Speed Post BNPL Code-TN/SP/BNPL/54/CO/18 BPC, Anna Road, Chennai-02

Uploaded by

Copyright:

Available Formats

Date: - 21-09-2021

Dear Mr. Lingesh T,

Please note this is a Single Premium premium payment insurance cover. NA

For any information/ clarification, please contact:

1. Your local SBI Life service branch:

Free Look Option

Signer: Saubhick Sengupta

489/1173 Page 1 of 36 PolicyNo. 7012461250 256/387

SBI Life - RiNn Raksha (UIN: 111N078V03)

BANGALORE RPC/ 00/ STATE BANK OF INDIA /PRASHANTNAGAR

Member : Mr. Lingesh T

Date of Birth : 21-02-1975 Date of Birth of Nominee : 01-06-1980

Loan Details Premium Details

489/1173 Page 3 of 36 PolicyNo. 7012461250 256/387

Free Look Option:

Certificates of Insurance for all co-borrowers need to be submitted.

489/1173 Page 4 of 36 PolicyNo. 7012461250 256/387

Sum Assured Sum Assured

489/1173 Page 5 of 36 PolicyNo. 7012461250 256/387

Sum Assured Sum Assured

489/1173 Page 6 of 36 PolicyNo. 7012461250 256/387

Sum Assured Sum Assured

489/1173 Page 7 of 36 PolicyNo. 7012461250 256/387

Sum Assured Sum Assured

489/1173 Page 8 of 36 PolicyNo. 7012461250 256/387

TERMS & CONDITIONS OF YOUR INSURANCE COVER

1. Insurance company means SBI Life Insurance Company Limited.

15. Premium Payment Mode is the frequency of premium payment.

21. Policy Benefits include the following:

489/1173 Page 9 of 36 PolicyNo. 7012461250 256/387

II. Maturity Benefit: No maturity benefit is available under this plan.

V. Payment of Surrender/ Paid-up Benefits:

24. Termination of Cover

489/1173 Page 10 of 36 PolicyNo. 7012461250 256/387

24.1.5. the date of payment on free-look cancellation, or

25. Free-look Period

29. Mis-statement of Age

30. Pre-closure of Loan

31. Cancellation of Loan

489/1173 Page 11 of 36 PolicyNo. 7012461250 256/387

35. Loans: No loans are available against this policy.

37. Grievance Redressal Procedure

SBI Life Insurance Company Limited

Email Id: info@sbilife.co.in

489/1173 Page 12 of 36 PolicyNo. 7012461250 256/387

Office of the Insurance Ombudsman

VI. We have also enclosed a list of addresses of insurance ombudsmen

38. Claims Process

39. Discontinuance of the Master Policy

489/1173 Page 13 of 36 PolicyNo. 7012461250 256/387

42. Rule 13 of Ombudsman Rules, 2017

43. Rule 14 of Ombudsman Rules, 2017

44. Protection of Policyholders’ Interest

489/1173 Page 14 of 36 PolicyNo. 7012461250 256/387

489/1173 Page 15 of 36 PolicyNo. 7012461250 256/387

489/1173 Page 16 of 36 PolicyNo. 7012461250 256/387

Office of the Insurance Ombudsman, Assam,

489/1173 Page 17 of 36 PolicyNo. 7012461250 256/387

Office of the Insurance Ombudsman, State of Uttaranchal and the

489/1173 Page 18 of 36 PolicyNo. 7012461250 256/387

489/1173 Page 19 of 36 PolicyNo. 7012461250 256/387

Membership form No : 7012461250