STATE BANK OF INDIA

Pradhan Mantri Suraksha Bima Yojana (PMSBY)

Group Personal Accident Insurance Scheme
Master Policy
: 240600422399999901 Branch Code : 784
Number
Details of Insured
Bank Account
Insured Name : PATHI NAGENDRA : 41449260747
Number
H NO: 1-34 RAMALAYAM STREET MARIPALLE
Insured Address : ALLAGADDA KURNOOL DISTRICT Mobile No. :

Date of Birth : 23­10­2004 Gender : Male

Aadhaar No. : E­mail :
PAN No. : Customer ID : 90231879452

Certificate Details
Master Policy
Certificate Number : SBISB14171202320250240844 : 240600422399999901
Number

Insured Address : H NO: 1-34 RAMALAYAM STREET MARIPALLE Mobile No. :

ALLAGADDA KURNOOL DISTRICT
Coverage Start
: 10­05­2023 Name of Nominee : P NAGARAJU
Date
Coverage end Nominee
: 30­04­2024 19:21:29 : FATHER
Date Relationship
Date of Certificate : 10­05­2023

Premium Service Tax Frequency of Premium Total (Rs.) Rupees (in words) Credit Advice No. & Date
20.00 NA ANNUAL 20.00 RUPEES TWENTY ONLY SBISB14171202320250240844, 10­05­2023

Details of the coverages under the Policy: INDIVIDUAL

Sum
Coverages
Assured
Accidental Death Rs 2 Lakhs
Total and irrecoverable loss of both eyes or loss of use of both hands or feet or loss of sight of one eye and loss of use of one hand or
Rs 2 Lakhs
foot due to accident
Total and irrecoverable loss of sight of one eye or loss of use of one hand or foot due to accident Rs 1 Lakh

This is to certify that the above member is covered under the scheme of insurance effected under the above master policy. Insurance benefits are
available to the member subject to the conditions specified in the policy documents.

This is a computer generated document and does not require any signature

Note : 1) This certificate is primarily issued to create awareness about insurance affected in the life of the member. It does not confer any legal rights on
the nominee/or any other person to claim the benefits under the policy. The benefits will be payable only to the authorised person specified in the policy
and subject to the fulfilment of the conditions specified therein. 2) For informing about lodging of claims under the Scheme, please contact the bank.