 011-551 43 29, 011-554 67 49,  12836  011-553 66 24, Addis Ababa, Ethiopia

Group Life Assurance Policy No. 0100/GTN0/XXXX/XX22

WHEREAS the Policy Owner and each Member named in the Schedule below have applied in writing to NILE
INSURANCE COMPANY (S.C.) (hereinafter called the Company) for the Assurance hereinafter contained, and
WHEREAS the Policy Owner/Member and the Company have agreed that the written statements made by the Policy
Owner and by Members in the Proposal and Declaration(s) or in any other written documents be the bases of the
Assurance applied for by the Policy Owner/Member,
Now, in consideration of the foregoing, the Company by this Life Assurance Policy (hereinafter called the Policy) do
agree to pay the benefits, but without interest, to the person(s) to whom the same is payable in terms of the said Schedule,

SUBJECT HOWEVER TO:

the submission by the said person(s) to the Company of proof satisfactory to the Company that an event giving rise to a
claim specified in the Policy has happened and that the benefit(s) have become payable as set out in the Schedule,
the Submission by the said person(s) of proof of their entitlement, the submission by said person(s) of proof of the
correctness of the date of birth, sex and occupation of the Member as stated in the Proposal and Declaration(s) and any
other document(s) the Company may require, and the Terms and Conditions printed in the pages following the Schedule
and in every endorsement made or to be made by the Company which shall be deemed part of the Policy.

THE SCHEDULE
Plan of Assurance : Group Yearly Renewable Term
Policy Owner :
Members : Employees of the Policy Owner
Sum Assured (Birr) : months salary
Premium (Birr) : ( )
annually for the first year of insurance, renewal premiums to be agreed.
Date of Effect :
Period of Assurance : From to

TERMS AND CONDITIONS

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 Group Policy No. 0100GTNR4/0001/0101
1. UTMOST GOOD FAITH
In issuing this Policy the Company has relied on the
statements made by the Policy Owner/Member in the
Proposal and Declaration, Questionnaire or Medical
Report, if any, or any other written document, all of which
together with this policy form the entire contract. The
Company assumes these statements are true and complete
to the best of the knowledge and belief of those who made
them. If anything averted in such document(s) be untrue,
2. ELIGIBILITY
2.1 Full-time, permanent Member of the Policy Owner,
who are less than sixty-five years old, is actively at work on
the Date of Effect, has been absent (if
any) from any work through sickness or disablement for
not more than two weeks per year during the previous
three years shall be eligible for the Assurance provided
hereunder immediately.
2.2 Subsequent new Members shall be eligible as from the
date and month coinciding with the Anniversary
immediately following their Membership with the Policy
3. PAYMENT OF PREMIUM
3.1 This Policy has been issued in consideration of payment
of the first premium or first installment thereof and of the
subsequent premiums as stated in the Schedule of the
Policy or any endorsements and receipt of same by the
Company. Each premium is payable to the Company at the
Company’s Office where this Policy has been served or to
such other person(s) whom the Company may from time to
time appoint for this purpose, the Policy Owner bearing any
remittance charges.
3.2 A Grace Period of one calendar month is allowed for
payment of renewal premium in respect of each Member
for this Policy. Provided the Company has invited for the
payment of renewal premiums prior to or during the Grace
Period, if any premium or installment thereof in respect of
4. INFORMATION TO BE FURNISHED
4.1 The Policy Owner shall upon request immediately
forward to the Company information that may be deemed
necessary to the evaluate eligibility of Member(s) for the
Assurance as may reasonably be considered to have a
bearing on the administration of the Assurance and on
tq245rthe determination of premium rates. Such
information will be attached to any requisition for provision
of Assurance cover and will form part of this policy. Such
records of the Policy Owner as have a bearing on the
Assurance shall also be open for inspection by the
Company at any reasonable time.
4.2 Written notice with full particulars sufficient to identify
the Member and covering the occurrence, character and
extent of the Loss for which claim is made must be given to
the Company within thirty days after the date of the
occurrence of such Loss. In the event of death due to
or if this Policy be obtained through the
withholding or misrepresenting of any material fact, or
if the Member become of intemperate habits,
or make any false statements in support of a
claim, then the Policy shall be void and all
premiums in respect thereof shall be forfeited to the
Company.
Owner becoming on a regular, full-time and permanent
basis.
2.3 The Company shall issue to the Policy Owner
endorsement(s) setting forth whether or not the Assurance
applied for in respect of Member(s) has/have been granted
and on what terms and conditions. The Assurance cover
provided by the Company is subject to payment of the
required premium.
any one Member is not paid on the due date or within the
Grace Period, the Assurance under this Policy shall end
without the issue of summons or any other formality. The
Policy Owner shall however be liable to the Company for
the payment of a pro-rata premium for the time the Policy
was in force during such grace period.
3.3 Premium in respect of a new Member shall be paid
immediately the Company accepts such new entrant for
Assurance. No Grace Period is given for such new entrant.
The premium shall be a due proportion of the premium for
the Policy year then current calculated as from the date he
is accepted by the Company.
Accident, immediate notice thereof must be given to the
Company.
4.3. The Company upon receipt of such notice will furnish
forms to be filled in with the particulars of the loss. The
forms must be completed and returned to the Company
with any other proof of loss, if any, within ninety days after
the notification of a claim for which the Company is liable.
4.4. The Company shall have the right and opportunity to
examine the Member and/or records in respect of the
Member in respect of whom a claim has been lodged when
and so often as it may reasonably require during a claim
hereunder is kept pending final decision. Also the
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Company shall have the right and opportunity to make an
autopsy in case of death.
5. PAYMENT OF ASSURANCE BENEFITS
5.1 The benefits under this Policy shall become payable
after proof satisfactory to the Company have been
furnished free of expense to the Company that benefit (s)
have become payable as provided for in this policy and
provided that premiums have been paid as called for in the
Schedule.
5.2 Indemnity for death of a Member will be paid to the
Policy Owner, who in turn will pay same to the proper
beneficiary(ies) surviving the Member or hold on trust with
power to pay the proper beneficiary(ies) or to the estate of
6. DEATH COMPENSATIONS
6.1 In the event of death of a Member while this Policy is
in full force or within the Grace Period allowed due to an
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the Member; should there be other claimants for such
benefits, it shall be the sole responsibility of the Policy
Owner to deal with such representations, and it is hereby
understood and agreed by the Policy Owner that the
Company is absolved from any and all liabilities arising
therefrom. All other payments under this Policy are payable
to the Member.
5.3 Before paying all such proceeds, however, the
Company will deduct any amount due to the Company.
unexcluded/unexpected cause the amount payable in death
compensation shall be the Sum Assured in respect of such
member.
.
 7. LIMITATIONS AND EXCEPTIONS
7.1. Age: The premium for this Policy having been invasion, acts of foreign enemies, hostilities, civil war,
calculated based on the Member’s age as declared in the rebellion, revolution, insurrection, military or usurped
Proposal and Declaration, if no satisfactory proof of age had power, etc. The sum payable by the Company shall be
been submitted to the Company and the age declared is limited to return of the premiums received in respect of the
found to be understated while the Member is alive, then the said Member, exclusive of any extra premiums less any
accumulated difference in premium from the Date of Effect amount due to the Company.
of Assurance to date will be paid retroactively with interest 7.7. Judicial Sentence: If the Member’s death is caused as a
at the then applicable rates. If this understatement is consequence of judicial sentence of death penalty the
discovered after the death of the Member, any amount that Company’s liability shall be limited to return of the
would be payable under this Policy shall be reduced to such premiums received in respect of the said Member, exclusive
a sum as shall bear the same ratio to the full sum as the rate of any extra premiums less any amount due to the Company.
of premium actually paid shall bear to the rate of premium
that would have been charged for the Policy at the correct
age. If the Member’s age at entry is such as would have
made him uninsurable according to the practice in force at
the date such Member joined this Assurance Scheme, then
such practice will apply and premiums paid to then will be
refunded, without interest and after deduction of charges and
expenses incurred by the Company.
7.2. Suicide: If a Member commits suicide, (while sane or
insane, normal or abnormal) within two years from the Date
of Effect or date of reinstatement of his/her Assurance
coverage under this Policy, the amount payable shall be
equal to the premium paid for the then current period of
Assurance.
7.3. Beneficiary Killing Member: If a beneficiary murders
the Member or is directly or indirectly responsible for the
death of the Member, this beneficiary will not be entitled to
the proceeds of this Policy.
7.4. Misrepresentation: The Company shall be free from
all obligations under this Policy if at any time it is found that
there has been any willful or fraudulent misrepresentation on
the part of the Policy Owner or the Member in which event
all money paid to and/or payable by the Company shall be
forfeited.
7.5 Occupation: If a Member, without notifying to and
obtaining the consent of the Company in writing, enters into
or be engaged in military, naval or auxiliary services or
adopts any hazardous occupation or engages in aviation
(except as a fare-paying passenger in an aircraft of a duly
recognized and regular air service operating to and from
recognized airports) the amount payable under this Policy
shall be limited to a face amount that the premium paid
would have purchased for the new occupation. If the new
occupation is uninsurable under the Company's underwriting
rules, the sum payable shall be limited to a return of total
premium received, exclusive of any extra premiums and
after deduction of charges and expenses incurred by the
Company, for the then current period of Assurance.
7.6. War and War-Like Operations: This Policy shall
cover time of peace the death of the Member resulting from
the repression of a riot, a sedition or an insurrection or from
a civil commotion provided the Member is not taking part
directly or indirectly in the events described. However, the
aviation risks of military or air force service are not covered.
If war be declared and the Member dies as a direct or
indirect result of any war and war-like operations such as
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 8. RENEWAL AND REINSTATEMENT
8.1 This Policy may be renewed with the consent of the
reinstated without production of evidence of insurability.
Company from term to term by the payment of the premium
For requests to reinstate a policy which has been lapsed for
in advance at the Company’s premium rate in force at time
more than ninety days the Company may require in respect
of renewal. If, at the expiration of the Grace Period, any
of all or some Members evidence of insurability including
premium due and payable under this Policy shall not have
good health satisfactory to the Company at no expense to the
been paid then the Assurance will end
Company. Such reinstatement shall however cover only
8.2 Upon written application to the Company within ninety
Loss that may be sustained thereafter.
days after default in premium payment, this Policy may be

9. TERMINATION AND/OR AMENDMENT

9.1 The full Assurance of each Member shall automatically
terminate:
a) if the Member ceases to be actively engaged in any
work of the Policy Owner on a regular, full-time and
permanent basis,
b) if this Policy is terminated or if premium is not paid
when due or within the grace period, or
c) on the anniversary date of Policy nearest to the
sixty-fifth birthday of the Member.
The Company can terminate or amend the contents of this
Policy or amend the premiums at any Anniversary date.
This Policy may also be amended upon written request made
by the Policy Owner and agreement by the Company.
Termination of this Policy by the Policy Owner or by the
Company shall be without prejudice to any claim arising
prior to such termination.

10. DOCUMENTS BINDING UPON THE COMPANY

The Company is bound only by documents bearing the binding upon the Company, nor to make or accept
signature of the General Manager of the Company or such engagements for or on behalf of the Company, nor to give
other person or persons holding authority for that purpose. interpretations of contracts binding upon the Company.
No agent has the power to make or change any contracts

11. DUTIES AND CHARGES

All stamp and other duties imposed by no matter what part of the Sum Assured or the premiums, shall be borne by
authority, and whether upon the Assurance, the Policy or the Policy Owner.
endorsements, and whether calculated upon the whole or a

12. CURRENCY AND JURISDICTION

All moneys payable in respect of this Policy whether by or and the Policy shall be construed and take effect according
to the Company shall be payable in the currency of Ethiopia to the laws of Ethiopia.

13. LEGAL PROCEEDINGS

No action at law or in equity shall be brought to recover on
brought within two years from the expiration of the
this Policy prior to the expiration of sixty days after proof of
time within which proof of Loss is required by the
Loss has been filed in accordance with the requirements of
Policy.
this Policy nor shall such action be brought at all unless
th
Signed in Addis Ababa on this day of , 2022 .

___________________________
for and on behalf of
NILE INSURANCE COMPANY (S.C.)

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