,  
,

MU01 C197802357 BD 236/1738 BROK DSP Non Term_NonEIA

December 9, 2020
KHUSHBU SHISHODIYA
30 AZAD MOHALLA
BIJAINAGAR
AJMER
AJMER
AJMER 305624
RAJASTHAN INDIA
M- 9825516237
1.Part A
Dear KHUSHBU SHISHODIYA,

Thank you for choosing Us for your insurance needs. Tata AIA Life is committed to give you world-class products and
professional service.

We take great pleasure in presenting Your Policy document. Please check your personal details and the Policy provisions
carefully. Should you have any queries, please contact your agent or contact us at the address mentioned below. You can
also reach us via email at customercare@tataaia.com or call our helpline number 1860-266-9966 (Local charges apply).

Agent Name: BLUECHIP INSURANCE BROKING PRIVATE LTD

Agency Code: 004000629
Agent Contact details: 25787046 / srinivasan@bluechipindia.co.in

In order to provide better service, We request you to intimate us in the event of any change in the address of the
Policyholder or the Nominee.

If you are not satisfied with the terms & conditions/features of the Policy and benefits stated in the Benefit Illustration,
you have the right to cancel the Policy by providing a written notice to the Company stating objections/reasons and
receive the refund of all premiums paid without interest after deducting proportionate risk premium, stamp duty
and medical examination cost along with applicable taxes, cesses and levies which have been incurred for issuing the
Policy. Such notice must be signed by you and received directly by the Company within 15 days from the date of receipt
of the Policy document by you or person authorized by you. The said period of 15 days shall stand extended to 30 days,
if the Policy is sourced through electronic or distance marketing mode, which includes solicitation through any means of
communication other than in person.

If you notice any mistake on examination of the Policy, please return the Policy to the Company immediately for
correction.

At Tata AIA Life, we believe that life inspires us to think ahead. Our insurance solutions are therefore designed to be a
step ahead, thus giving you an advantage to adapt to tomorrow’s changes, starting today.

We look forward to a long and cherished relationship with you.

Best wishes,
For and on behalf of
Tata AIA Life Insurance Company Limited

Naveen Tahilyani
CEO & Managing Director
Authorised Signatory

Policy Servicing Branch : 1st Flr,Simran Cntr,30/H Parsi, Panchayat Mrg,Andheri-E,Mumbai - 400093
Tata AIA Life Insurance Company Ltd (IRDA of India Regn.No.110) (CIN - U66010MH2000PLC128403)
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.
C197802357 Page 1 of 32
"The Stamp duty of (`) 110/-(Rupees One Hundred And Ten only) paid vide MUDRANK 2004/4125/CR 690/M-1
Dated 31.12.2004, CSD/127/2020/1984 dated 28/09/2020"

(Signature)
Proper Officer

Tata AIA Life Insurance Diamond Savings Plan

Tata AIA Life Insurance Company Limited

LIFE INSURED: KHUSHBU SHISHODIYA

POLICY NUMBER: C197802357

BRANCH CODE: MU01

1.1. Policy Terms and Conditions and Privileges within referred to

This Policy is the evidence of the contract between Tata AIA Life Insurance Company Limited and the Policyholder
referred to below.

PREAMBLE

Tata AIA Life Insurance Company Limited (“the Company”) having received a Proposal Form and other related
documents with Declaration thereto and initial premium from the Policyholder hereby issues Tata AIA Life Insurance
Diamond Savings Plan. The Company under this Policy; does agree in consideration and subject to Policy conditions
to pay the benefits under the Policy on the happening of a insured event, while the Policy is in-force. The basic
Insurance plan provided under this Policy, with its amount of coverage and Premium is specified on the Policy
Schedule. Entitlement to benefits, conditions for payment and other Policy details are also set out inside. This Policy is
subject to term and conditions mentioned herein below and endorsements if any.

Executed and signed by us on the Date of Commencement of this Policy as stated in the Policy Schedule.

Signature valid
Signed by: KUMARESH
Date:
Location:

Registrar Managing Director and CEO

This is a system generated document requiring no physical signature.

C197802357 Page 2 of 32
 POLICY SCHEDULE

Tata AIA Life Insurance Diamond Savings Plan (110N133V02)

THIS SCHEDULE MUST BE READ WITH THE ACCOMPANYING POLICY DOCUMENT AND IS PART OF THE LIFE INSURANCE CONTRACT

Personal Details
Name of Policyholder : KHUSHBU SHISHODIYA Name of Life Insured : KHUSHBU SHISHODIYA
Address of Policyholder : 30 AZAD MOHALLA Address of Life Insured : N/A
BIJAINAGAR N/A
AJMER N/A
AJMER N/A
N/A
AJMER N/A
305624 N/A
RAJASTHAN
INDIA
Client ID of Policyholder : 283701191 Client ID of Life Insured : 283701191
Date of Birth of Policyholder : 15/07/1984 Date of Birth of Life Insured : 15/07/1984
Age at entry of Policyholder : 36 Age at entry of Life Insured : 36
Gender : Female Age Admitted : YES
Gender : Female

Policy Details
Policy Number : C197802357 Policy Term : 15 years
Date of Commencement of Policy : 02/12/2020 Premium Paying Term : 5 years
Date of Commencement of Risk : 02/12/2020 Mode of Premium Payment : Annual
Date of Maturity of Policy : 02/12/2035 Annualised Premium (Excl. taxes) Rs. : 50000.00
Premium Due Date (s) : 02/12 of every year Modal Premium (Excl. taxes) Rs. : 50000.00
Applicable Taxes, Cessess and Levies Rs. : 2,250.00
Total Modal Premium (Incl. taxes) Rs. : 52250.00

Base Plan/Rider Name Sum Assured Modal Premium Date of Maturity Due Date of Last Policy Premium
(Rs.) (Incl. taxes) (Rs.) of Policy Premium Payment Term Payment Term
(Years) (Years)
Tata AIA Life Insurance
Diamond Savings Plan 5,50,000.00 52250 2035/12/02 2024/12/02 15 5
(110N133V02)

Benefit Payable
Maturity Benefit As per clause 3.1.2 of Part C
Survival Benefit As per clause 3.1.1 of Part C
Death Benefit As per clause 3.1.4 of Part C

Nominee details (under section 39 of the Insurance Act 1938)

Name of the Nominee (s) Relationship with Life Insured Age Nomination %
VISHAL SHISHODIA Spouse 38 100.00

Appointee Details (Applicable in case the Nominee is a minor)

Name of the Appointee (s) Relationship with nominee Age
NA NA NA

For and on behalf of

Tata AIA Life Insurance Company Limited

Naveen Tahilyani
CEO & Managing Director
Authorised Signatory

On examination of the Policy, if you notice any mistake, please return the Policy to the Company immediately for correction.

C197802357 Page 3 of 32
OTHER ENDORSEMENTS

C197802357 Page 4 of 32
 Policy Document - Tata AIA Life Insurance Diamond Savings Plan
Key Benefits:

Provided the Policy is in force and all due Premiums have been paid, the following
Survival Benefit shall be paid:

Guaranteed Income: A Guaranteed Income, as a percentage of the Assured Benefit,

shall be paid as follows:
Premium
Policy Term Income
Payment Guaranteed Income (p.a.)
(years) Commencement
Survival Term (years)
Benefit 5 15 10% of Assured Benefit End of Policy Year 6
5 20 7.50% of Assured Benefit End of Policy Year 6
6 15 15% of Assured Benefit End of Policy Year 7
8 18 20% of Assured Benefit End of Policy Year 9
12 25 25% of Assured Benefit End of Policy Year 13

The above benefit shall be paid till the Date of Maturity of Policy or till death of Life
Insured, whichever is earlier.
Provided the Policy is in force and all due Premiums have been paid the following
Maturity Benefit shall be paid:

(i) Sum Assured on Maturity which is equal to last Guaranteed Income instalment
Maturity payable on maturity; plus
Benefit (ii) Vested Compound Reversionary Bonus, if any, plus
(iii) Terminal Bonus, if any,

The Compound Reversionary Bonus and Terminal Bonus will be based on Company’s
performance and are not guaranteed.

In the event of death of Life Insured during the Policy Term provided the policy is in
force, We shall pay:

 Sum Assured on Death; plus

 Compound Reversionary Bonus, if any; plus
 Terminal Bonus, if any.

Death This total amount will be subject to a minimum of 105% of total Premiums received up
Benefit to the date of death.
Where,
The ‘Sum Assured on Death’ shall be the highest of the following:
a) 11 times Annualised Premium;
b) Sum Assured on Maturity;
c) Absolute amount assured to be paid on death;

The Policy will terminate on payment of death benefit and no other benefit under the
Policy shall be payable.

Page 1 of 1
Date of filing: 30/03/2017
Date of Modification: 06/09/2019
Final Policy Document Date: 06/09/2019

C197802357 Page 5 of 32
 2. PART B
Tata AIA Life Insurance Diamond Savings Plan is a Limited
Premium Paying Non-Linked, Participating Individual Life
Insurance Savings Plan.
2.1. Basic definitions
“Age” means age as on the last birthday; i.e. the age of the Life Insured in
completed years as on Date of Commencement of Policy and is as shown
in the Policy Schedule.
“Annual Premium” means an amount specified in the Policy Schedule,
which is payable under annual premium payment mode, excluding Extra
Premium, if any and excluding applicable taxes, cesses and levies if any.
“Annualised Premium”shall be the premium payable in a year chosen by
the Policyholder, excluding the taxes, rider premiums, Extra Premiums and
loadings for Modal Premiums, if any, as specified in the Policy Schedule.
“Assured Benefit” is an amount dependent on the Age, Policy Term and
Premium Payment Term and shall be as below:
Assured Benefit = Annualised Premium x 1000 / Premium Rate per 1000
Assured Benefit (As per Annexure 1).
All the benefits payable under the plan are as a % of Assured Benefit.
“Claimant” means the person entitled to receive the Policy benefits and
includes the Policyholder, the nominee, the assignee, the legal heir, the
legal representative(s) or the holder(s) of succession certificate as the case
may be;
“Compound Reversionary Bonus” means the bonus(es) payable by Us
in accordance with Clause 3.1.3 of Part C, if declared by Us.
“Date of Commencement of Policy” is the date when We issue the
Policy and is mentioned on the Policy Schedule.
“Date of Commencement of Risk” means the date on which the risk
under the Policy, if opted for, comes into effect and is as specified in the
Policy Schedule. The Date of Commencement of Risk cover shall depend
on the age of the Life Insured as on the Date of Commencement of Policy.
“Date of Maturity of Policy” means the date specified in the Policy
Schedule on which the Policy Term expires.
“Extra Premium” means an additional amount mentioned in the Policy
Schedule and charged by Us, as per Our Underwriting Policy, which is
determined on the basis of disclosures made by You in the Proposal Form
or any other information received by Us including medical examination
report of the Life Insured.
“Free look” means a period of 15 days (30 days if the Policy is sourced
through distance marketing modes) from the date of receipt of the Policy,
to review the terms and conditions of the Policy, where if You disagree to
any of those terms and conditions, You have the option to return the Policy
stating the reasons for objection. Upon return, the Policy will terminate
forthwith and all rights, benefits and interests under the Policy will cease
immediately. You shall be entitled to a refund of the premium received by
Us after deducting the proportionate risk premium for the period of cover,
charges of stamp duty paid and the expenses incurred by Us on medical
examinations, if any.
“Grace Period” means a period of 15 (Fifteen) days from the due date of the
unpaid Premium for monthly premium payment mode and 30 (Thirty) days
from the due date of unpaid Premium for all other premium payment modes.
“Guaranteed Income” means an amount which depends on the
combination of chosen Premium Payment Term and Policy Term and shall
commence as below:
Premium Policy
Payment Term Guaranteed Income
Term (years) (years) Income (p.a.) Commencement
5 15 10% of Assured Benefit End of Policy Year 6
5 20 7.50% of Assured Benefit End of Policy Year 6
6 15 15% of Assured Benefit End of Policy Year 7
8 18 20% of Assured Benefit End of Policy Year 9
12 25 25% of Assured Benefit End of Policy Year 13
Guaranteed Income shall be paid till Date of Maturity of Policy or till death
of Life Insured, whichever is earlier.
“Guaranteed Surrender Value” shall be the minimum Surrender Value
computed in accordance with Clause 4.5.1. of Part D, which is guaranteed
by Us. The Guaranteed Surrender Value will be determined in the Policy
Year in which the Surrender is effected.
IRDA of India Regn no. 110
C2019-34
“Lapsed Policy” means a Policy which has not acquired the Surrender
Value and where the due Premium has not been received till the expiry of
the Grace Period.
“Life Insured” means the person whose life is insured or assured under
the Policy and is shown in the Policy Schedule.
“IRDAI” means the Insurance Regulatory and Development Authority
of India.
“Nominee” means the person or persons nominated under Section 39 of
the Insurance Act, 1938, as amended from time to time, to receive the
admissible benefits, in the event of death of the Life Insured.
“Policy” means the contract of insurance entered into between You and
Us as evidenced by this document, the Proposal Form, the Policy
Schedule and any additional information/document(s) provided to Us in
respect of the Proposal Form along with any written instructions from You
subject to Our acceptance of the same and any endorsement issued by
Us.
“Policy Anniversary” refers to the annual anniversary of the Date of
Commencement of Policy.
“Policy Schedule” means the policy schedule and any endorsements
attached to and forming part of the Policy and if any updated Schedule is
issued, then, the Schedule latest in time.
“Policy Term” means the term of the Policy as specified in the Schedule.
“Policy Year” means a period of 12 (Twelve) months commencing from
the Date of Commencement of Policy and every Policy Anniversary
thereafter.
“Premium” means the amount specified in the Policy Schedule, payable
by you, by the due dates to secure the benefits under the Policy, excluding
applicable tax or other taxes, surcharge, cessess or levies, if any.
“Premium Payment Term” means the term as specified in the Schedule,
during which the Premium is payable.
“Proposal Form” means the form filled in and completed by You for the
purpose of obtaining insurance coverage under the Policy;
“Revival Period” means a period of 5 (Five) years from the due date of the
first unpaid Premium.
“Special Surrender Value” means the Special Surrender Value
computed in accordance with Clause 4.5.1 of Part D.
"Special Surrender Value Factors” are factors determined by Us in
consultation with and approved by the IRDAI to compute the Special
Surrender Value, which can be revised by Us on the basis of Our experience
from time to time in consultation with and approval of the IRDAI.
“Sum Assured on Maturity” shall refers to the amount of benefit which
is guaranteed to be paid on Date of Maturity of Policy, and shall be equal
to the last Guaranteed Income instalment payable on the Date of Maturity
of Policy.
“Surrender” means complete withdrawal/ termination of the entire Policy.
“Surrender Value” means an amount payable on Surrender of this Policy,
which will be the higher of the Guaranteed Surrender Value or the Special
Surrender Value;
“Terminal Bonus” means the bonus(es) payable by Us in accordance
with Clause 3.1.3 of Part C, if declared by Us .
“Total Premiums Paid" means amount equal to the total Premiums paid
excluding any Extra Premiums, any rider premiums and taxes, if any.
“Underwriting Policy” means our then prevailing Underwriting Policy as
approved by Our board of directors;
“We”, “Us”, “Our” or “Company” refers to Tata AIA Life Insurance
Company Limited.
“You” or “Your” means the Policyholder of this Policy as named in the
Policy Schedule
Whenever the context requires, the masculine form shall apply to feminine
and singular terms shall include the plural.
3. PART C
3.1. Benefits
3.1.1. Survival Benefit
We shall pay Guaranteed Income provided the Policy is in force and all due
Premiums have been paid. The Guaranteed Income shall be paid till the
Date of Maturity of Policy or till death of the Life Insured, whichever is
earlier.
C197802357 Page 6 of 32
3.1.2. Maturity Benefit
We shall pay the sum total of following benefits where Life Insured survives
on the Maturity Date of the Policy provided the Policy is in force and all due
Premiums have been paid:
• Sum Assured on Maturity which is equal to last Guaranteed Income
instalment payable on maturity plus
• Vested Compound Reversionary Bonus, if any; plus
• Terminal Bonus, if any.
3.1.3. Bonus
Bonus(es) may be declared by Us depending upon the surplus generated
in the participating fund over the Policy Term. You shall be eligible to
receive the following, Bonus(es) on death of Life Insured or on Surrender
or Date of Maturity of the Policy, whichever is earlier:
• Compound Reversionary Bonus - Compound Reversionary Bonus
will accrue annually starting from first Policy Anniversary. Compound
Reversionary Bonus shall be a percentage of the Assured Benefit and
vested Compound Reversionary Bonus
• Terminal Bonus – Terminal Bonus shall be a percentage of the
Assured Benefit and shall be paid subject to the following:
- At least 4 year full Annual Premiums have been paid, where
Premium Payment Term is 5 or 6 years;
- At least 5 year full Annual Premiums have been paid, where
Premium Payment Term is 8 years; or
- At least 7 years full Annual Premiums have been paid, where
Premium Payment Term is 12 years.
Compound Reversionary Bonus and Terminal Bonus will be based on
Company’s performance and are not guaranteed.
3.1.4. Death Benefit
On death of the Life Insured during the Policy Term, provided the Policy is
in force, We shall pay the Claimant:
• Sum Assured on Death; plus
• Vested Compound Reversionary Bonus, if any; plus
• Terminal Bonus, if any.
This total amount will be subject to a minimum of 105% of the total
Premiums received up to the date of death.
“Sum Assured on Death” means the absolute amount of benefit which
is guaranteed to be paid on death of the Life Insured and shall be highest
of the following:
• An amount equal to 11 times of the Annualised Premium
• Absolute amount assured to be paid on death
• Sum Assured on Maturity
“Basic Sum Assured” is defined as 11 times the Annualised Premium.
The interim bonus, if any, shall be payable in case of termination of policies
due to death before the next policy anniversary.
3.1.5. Premium details
3.1.5.1. Plan change / Conversion option
Plan change / Conversion is not allowed under this Policy
3.1.5.2. Payment
• You can pay Premium at any of Our offices or through our website
www.tataaia.com or by any other means, as informed by Us. Any
Premium paid by You will be deemed to have been received by Us
only after the same has been realized and credited to Our bank
account.
• Collection of advance premium shall be allowed within the same
financial year for the Premium due in that financial year. However,
where the Premium due in one financial year is being collected in
advance in earlier financial year, the Company may collect the same
for a maximum period of three months in advance of the due date of
the Premium.
• The Premium so collected in advance shall only be adjusted on the
due date of the Premium.
3.1.5.3. Change of frequency of premium payment
You may change the frequency of Premium payments by written request.
Subject to our minimum premium requirements, premiums may be paid
on Annual, Half- yearly, Quarterly or Monthly mode at the Premium rates
applicable on the Issue Date. Alteration in the frequency of Premium
payment may lead to a change in the Premium.
No alterations are permissible under the Policy except change in
frequency of Premium payment.
IRDA of India Regn no. 110
C2019-34
3.1.5.4. Default
After payment of the first premium, failure to pay a subsequent Premium
on or before its due date will constitute a default in Premium payment.
3.1.5.5. Grace period
The Premium is due and payable by the due date as mentioned in the
Policy Schedule. If the Premium is not paid by the due date, you may pay
the same during the Grace Period without any interest. The Policy will
remain in-force during this period. If the full Premium for the first 2 Policy
Years remains unpaid at the end of their grace period, the Policy shall
lapse from the due date of the first unpaid Premium.
3.1.5.6. Deduction of premium at claim
If a claim is payable under this Policy, any balance of the premiums due for
the full Policy year in which death occurs shall be deducted from the
proceeds payable under the Policy.
3.1.6. Payment of benefits
• The benefit under the Policy shall be payable to the Claimant.
• Once the benefits under this Policy are paid to a Claimant, the same
shall constitute a valid discharge of Our liability under this Policy.
3.1.7. Change in address of Policyholder or Nominee
In order to provide better service, We request you to intimate us in the
event of any change in the address of the Policyholder or the Nominee.
4. PART D
4.1. Free look period
If the Policyholder is not satisfied with the terms & conditions/ features of
the Policy, the Policyholder has the right to cancel the Policy by providing
written notice to the Company stating objections/reasons and receive a
refund of all premiums paid without interest after deducting a)
Proportionate Risk Premium for the period of cover, b) Stamp duty
charges and medical examination costs (including applicable taxes,
cesses and levies) which have been incurred for issuing the Policy. Such
notice must be signed by the Policyholder and received directly by the
Company within 15 days after the Policyholder receives the Policy
document. The said period of 15 days shall stand extended to 30 days, if
the Policy is sourced through distance marketing i.e. other than in person.
The Proportionate Risk Premium will be determined as under:
Sum Assured on Death multiplied by (Mortality rate) multiplied by (number
of days for the period on cover divided by 365)
4.2. Lapsation of Policy
The coverage under a Lapsed Policy ceases from the due date of first
unpaid Premium and benefits, if any, shall cease immediately and
automatically.
4.3. Revival
If a premium is in default beyond the Grace Period and subject to the
Policy not having been surrendered, it may be revived, in accordance
with Underwriting Policy within Revival Period but before the Date of
Maturity of Policy, subject to: (i) Your written application for revival; (ii)
production of Insured’s current health certificate and other evidence of
insurability subject to Our satisfaction; and (iii) payment of all overdue
Premiums with interest.
Any evidence of insurability requested at the time of revival will be based
on the prevailing Underwriting Policy.
The applicable interest rate for revival is determined using the SBI
domestic term deposit rate for tenure ‘1 year to 455 days’, plus 2%. Any
alteration in the formula will be subject to prior approval of IRDAI. The
interest rate applicable as on 1st April 2017, is 8.90% p.a. [i.e. SBI
interest rate of 6.90% (which rate may be revised from time to time) + 2%]
and applicable taxes, cesses and levies, compounding annually.
Upon revival, the benefits of the Policy shall be restored with effect from
the date of revival.
4.4. Loan
You may apply for a loan up to 80% of Surrender Value provided the Policy
acquires Surrender Value. On availing loan, the Policy must be assigned to
us. The Policyholder shall be liable to pay interest on the loan as below:
• Daily interest shall accrue on loan at the prevailing SBI domestic term
deposit interest rate for tenure 1 year to 455 days’ + 2%. This formula
will be reviewed annually and only altered subject to prior approval of
IRDAI. The interest rate applicable as on 1st April 2017, is 8.90% p.a.
[i.e. SBI interest rate of 6.90% (which rate may be revised from time to
time) + 2%] and applicable taxes, cesses and levies, compounding
annually;
C197802357 Page 7 of 32
• Interest shall be payable on each Policy Anniversary after the loan
date and until the loan is repaid;
• Any unpaid interest shall be added to the principal loan and bear
interest at the same rate. At any time while this Policy is in-force, You
may repay the principal and accrued interest, or any part of the loan;
• When the loan with accrued interest exceeds the Surrender Value, the
Policy will become void. This shall not be applicable, in case of the
Premium Paying Policies or Reduced Paid- up policies.
4.5. Non forfeiture provisions
4.5.1. Surrender Benefit:
The Policy may be surrendered at any point during the Policy Term but it
shall acquire a Surrender Value only if at least first 2 full years’ premiums
have been paid, wherein:
Guaranteed Surrender Value (GSV) is equal to
GSV Factor for premium multiplied by all the premiums paid (excluding
Extra Premiums and modal loading) plus (vested Compound Reversionary
Bonus x GSV factor for Compound Reversionary Bonus) minus Total
Guaranteed Income already paid, if any.
Guaranteed Surrender Value factor will be as applicable at the time of
Surrender and are as per table annexed as Annexure 2 herein. The
Guaranteed Surrender Value Factors vary according to the Policy Term and
Policy year of Surrender.
Special Surrender Value (SSV) is equal to
SSV Factor multiplied by (No. of Premiums paid) divided by (No of
Premiums payable, during the entire Premium Payment Term) multiplied by
(Sum of all Guaranteed Income pay outs) minus Guaranteed Income pay
outs already made, if any, plus vested Compound Reversionary Bonus, if
any, plus Terminal Bonus, if any
The interim bonus becomes payable in case of surrenders before the next
Policy Anniversary.
The SSV Factors vary according to the Policy Term and Policy Year of
Surrender. The Company may review this SSV factor from time to time
based on the experience and any change in SSV factors will be subject to
prior approval of IRDAI.
SSV factor will be as applicable at the time of Surrender and are as per
table annexed as Annexure – B herein.
4.5.2. Reduced Paid-up:
If at least first 2 full years’ Premiums have been paid and subsequent
Premiums remain unpaid provided the Policy has not been surrendered,
the Policy will be converted into a Reduced Paid-up Policy by default.
Reduced Paid-up policy is a default non forfeiture benefit. Reduced
Paid-Up Policy, shall continue as Reduced Paid-up Policy unless revived
within five years from the due date of first unpaid premium. Such Reduced
Paid-up Policies can be revived within five years from the due date of first
unpaid Premium by payment of all due premiums together with interest as
mentioned in Clause 4.3 (“Revival”) of Part D.Once the Policy becomes
Reduced Paid-up, the Policy shall not be entitled to any further Bonuses.
“Reduced Paid Up Factor” shall be equal to (Number of Premiums paid)
divided by (Number of Premiums Payable during the entire premium
payment term)
In case of Reduced Paid-up policies, the benefit shall be payable as under:
a. Survival Benefit:
The reduced Guaranteed Income, as mentioned below, shall continue
to be payable as scheduled:
Premium Policy
Payment Term Reduced Guaranteed Income (p.a.)
Term (years) (years)
5 15 10% of Assured Benefit x Reduced Paid up factor
5 20 7.50% of Assured Benefit x Reduced Paid up factor
6 15 15% of Assured Benefit x Reduced Paid up factor
8 18 20% of Assured Benefit x Reduced Paid up factor
12 25 25% of Assured Benefit x Reduced Paid up factor
b. Maturity Benefit:
Sum Assured on Maturity multiplied by Reduced Paid up factor, along
with vested Compound Reversionary Bonus plus Terminal Bonus, if
any will be paid.
c. Death Benefit
On death of the Life Insured during the Policy Term, an amount equal
to Sum Assured on Death multiplied by Reduced Paid up factor along
IRDA of India Regn no. 110
C2019-34
with vested Compound Reversionary Bonus, if any, plus Terminal
Bonus, if any,will be paid.
d. Surrender benefit
The policy may be surrendered at any point during the Policy Term but
it shall acquire a Surrender Value only if at least first 2 full years’
premiums have been paid.
Guaranteed Surrender Value = (Total premiums paid multiplied by
GSV factor for Premium) plus (vested Compound Reversionary Bonus
multiplied by GSV factor for Compound Reversionary Bonus) minus
Total Guaranteed Income already paid, if any.
Special Surrender Value = SSV Factor multiplied by (No. of Premiums
paid) divided by (No of Premiums payable, during the entire Premium
Payment Term) multiplied by
(Sum of all Guaranteed Income pay outs) minus income pay outs
already made, if any plus vested Compound Reversionary Bonus, if
any plus Terminal Bonus, if any}
The interim bonus, if any, shall be payable in case of termination
policies due to surrender before the next Policy Anniversary.
5. PART E
Not Applicable for this Product
6. PART F
6.1. Policy Contract
This Policy Contract is issued on the basis of the details provided by you in
the Proposal Form and the declaration signed by you, on receipt of the
required premium amount and any attached endorsement given at the time
of issuing this Policy. The Policy, proposal for it, the Policy Schedule and any
attached endorsements constitute the entire contract. The terms and
conditions of this Policy cannot be changed or waived except by
endorsement duly signed by our authorized officer. Your Policy consists of the
basic Insurance plan and any endorsements which may be attached to it.
6.2. Fraud, Misrepresentation and Forfeiture
Your Policy is based on the application and declaration which you have
made to us and other information provided by you/on your behalf.
However, in case of fraud and mis-representation by you we shall
immediately cancel the Policy by paying Surrender Value, if any, subject to
the fraud or misrepresentation being established by Us in accordance with
Section 45 of the Insurance Act, 1938.
The simplified version of the provisions of Section 45 of the Insurance Act,
1938 is enclosed in Annexure 5 for reference.
6.3 Suicide
In case of death due to suicide within 12 months from the Date of
Commencement of Risk under the Policy or from the date of revival of the
Policy, as applicable, the Claimant shall be entitled to at least 80% of the
Total Premiums Paid till the date of death or the surrender value available
as on the date of death whichever is higher, provided the Policy is in force.
6.4. Misstatement of Age and Gender
Declaration of the correct Age and/ or gender of the Life Insured is
important for Our underwriting process and calculation of premiums
payable under the Policy. If the Age and/or gender declared in the
Proposal Form is found to be incorrect at any time during the Policy Term
or at the time of claim, We may revise the premium with interest and/or
applicable benefits payable under the Policy in accordance with the
premium and benefits that would have been payable, if the correct Age
and/ or gender would have made the Life Insured eligible to be covered
under the Policy on the Date of Commencement. If at the correct
age/gender the Insured is not insurable under this Policy pursuant to our
Underwriting Policy, the Policy/Rider shall be void-ab-initio and the
Company will refund the total premiums paid without interest after
deducting all charges incurred by the Company under the Policy/Rider.
6.5. Nomination
Nomination allowed as per provisions of Section 39 of the Insurance Act
1938 as amended from time to time. The simplified version of the
provisions of Section 39 is enclosed in Annexure 4 for reference.
6.6. Assignment
Assignment shall be as per provisions of Section 38 of the Insurance Act
1938 as amended from time to time. The simplified version of the Section
38 is enclosed in Annexure 3 for reference.
6.7. Policy on the life of a Minor
Where Life Insured is a minor, the Policy shall automatically vest unto the
C197802357 Page 8 of 32
Life Insured on his attaining majority. following documents:
6.8. Currency and place of payment Type of Claim Requirement
All amounts payable either to or by Us will be paid in the Indian currency. Such a) Claim Forms
amounts will be paid by a negotiable bank draft or cheque drawn on a bank • Part I: Application Form for Death Claim
or NEFT (National Electronic Funds Transfer) or electronic clearing systems. (Claimant's Statement) along with NEFT form
6.9. Loss of Policy document • Part II: Physician's Statement - to be filled by
last attending physician
If the Policy document is lost or destroyed, then at the request of the
Policyholder, the Company, will issue a duplicate Policy document duly b) Death Certificate
endorsed to show that it is issued following the loss or destruction of the Death c) Medical Records (Admission Notes,
original Policy document. Upon the issue of the duplicate Policy (all causes of death Discharge/Death Summary, Indoor Case
document, the original Policy document immediately and automatically other than the Papers, Test Reports etc)
ceases to have any validity. The Company will charge a fee of Rs. 250 Accidental Death) d) Original Policy document
along with the applicable tax and surcharge/cess, for the issuance of a e) Claimant's Photo ID with age proof &
duplicate Policy document. The Policyholder has to also submit an relationship with the Life Insured along with
Indemnity Bond executed on appropriate Stamp paper along with a Policy Address proof of the claimant and Cancelled
Lost Declaration. These charges are subject to revision by the Company cheque with name and account number printed
from time to time. or cancelled cheque with copy of Bank
6.10. Freedom from restrictions Passbook / Bank Statement
If no nomination - Proof of legal title to the claim
Unless otherwise specified, this Policy is free from any restrictions upon
proceeds (e.g. legal succession paper)
the Life Insured as to travel or occupation.
f) Postmortem report (Autopsy report) & Chemical
6.11. Policyholder’s Right:
If Death due to Viscera report - if performed
To exercise your rights or options, under this Policy, You should follow the Accident (to be g) All Police Papers – Panchnama, Inquest, First
procedures stated in this Policy. If you want to change your Nominee, submitted in Information Report (FIR) and Final Investigation
change an address or exercise any other options under the Policy, You addition to the Report
shall do so only using the forms prescribed for each purpose which are above)
available with your financial advisor, from our local office or can be h) Newspaper cutting / Photographs of the
accident - if available
downloaded from our website www.tataaia.com.
6.12. Taxes NOTE:
Applicable taxes, cesses and levies are payable on life Insurance premium • In case the claim warrants any additional requirement, the Company
reserves the right to call for the same.
as per the applicable laws. All applicable taxes, duties, surcharge, cesses
or levies, as may be imposed by Government or any statutory authority • Notification of claim & submission of the claim requirements does not
from time to time, on the premiums payable and benefits secured under mean admission of the claim liability by the Company.
Policy, shall be borne and paid by the Policyholder. The benefits and 6.17. Claims Intimation Process
liabilities under the Policy are subject to prevailing tax laws. If any Mentioned below is a list of various mediums through which Claimant can
imposition (tax or otherwise) is levied by any statutory or administrative contact us.
body under the Policy, We reserve the right to claim the same from You.
a. Online at www.tataaia.com
Alternatively, We have the right to deduct the amount from the benefits
payable by Us under the Policy. b. Email - customercare@tataaia.com
c. Call our helpline number 1-860-266-9966 (local charges apply)
Tax benefits and liabilities under the Policy are subject to prevailing tax
laws. Tax laws and the benefits arising thereunder are subject to change. d. Walk into any of the Company branch office
You are advised to seek an opinion of Your tax advisor in relation to the tax e. Write directly to us on following address:
benefits and liabilities applicable to You. Tata AIA Life Insurance Company Limited
B - Wing, 9th Floor, I-Think Techno Campus, Behind TCS, Pokhran
6.13. Change in Basic Sum Assured Road No.2, Close to Eastern Express Highway, Thane (West) – 400
Increase / Decrease in Basic Sum Assured is not allowed in this Policy. 607, Maharashtra.
6.18. Governing Law And Jurisdiction
6.14. Termination of Policy:
The Policy will be governed by and enforced in accordance with the laws
This Policy will terminate upon the happening of any of the following events: of India. The competent courts in India will have exclusive jurisdiction in all
1. On the date of acceptance of Freelook request. matters and causes arising out of the Policy.
2. On the date of payment of the death claim in accordance with the 7. PART G
provisions of this Policy;
3. On the expiry of the Revival Period, if the Lapsed Policy has not been CONSUMER INFORMATION
revived; POLICYHOLDER'S SERVICING
4. On the date of payment of surrender benefit of this Policy; or With regards to any query or issue related to the Policy, the Policyholder
5. On the Date of Maturity of Policy. can contact the Company through the following service avenues:
6.15. Claims • Contact your Tata AIA Life Agent / Distributor
All cases of death must be notified to us in writing within 90 days of • Call our helpline number 1-860-266-9966 (local charges apply)
occurrence of death. We may condone delay on merit for delayed claims • E-mail us at customercare@tataaia.com
where the reason for delay is proved to be for reasons beyond the control • Visit the nearest Tata AIA Life branch or CAMS Service Center
of the Claimant.
• Log on to Online Customer Portal by visiting www.tataaia.com
Please note that all death claims will be payable to the nominee/legal heir
of the Life Insured. • Write to Us at: Tata AIA Life Insurance Company Limited
B- Wing, 9th Floor, I-Think Techno Campus, Behind TCS, Pokhran
Filing Proof of Claim - Unless otherwise specified, duly filled in requisite
Road No.2, Close to Eastern Express Highway, Thane (West) – 400
forms along with proof of loss shall be furnished to us, at the claimant’s
607, Maharashtra.
expenses, within 90 days from the date the Insured event happens. A list
of documents required in general, is attached to the Policy. However, GRIEVANCE REDRESSAL PROCEDURE
submission of such documents, forms or other proof shall not be 1) Resolution of Grievances
construed as an admission of liabilities by the Company and we reserve
right to request additional proof and/or documents in support. Customers can register their grievances through Multiple Service
Avenues:
6.16. Claims requirements • Call our helpline number 1-860-266-9966 (local charges apply)
6.16.1. Death claims requirements • Email us at life.complaints@tataaia.com
For processing the claim request under this Policy, we will require the • Login to online Policy account on www.tataaia.com

IRDA of India Regn no. 110

C2019-34
C197802357 Page 9 of 32
• SMS SERVICE to 58888 to receive a call back from our Customer
Service Representative
• Visit any of the nearest Tata AIA Life branches or CAMS Service
Centers
• Contact your Tata AIA Life Agent / Distributor
• Write to us on the following address:
Grievance Redressal Department
Tata AIA Life Insurance Company Limited
B- Wing, 9th Floor, I-Think Techno Campus, Behind TCS, Pokhran
Road No.2, Close to Eastern Express Highway, Thane (West) – 400
607, Maharashtra.
- We shall acknowledge a customer's grievance within 3 business days
by providing the customer with the name of the Grievance Redressal
Executive who is responsible to handle the grievance.
- We shall provide the customer with an equitable resolution within 2
weeks of receipt of the grievance.
- In case customer wishes to contact us during the course of the
assessment, they can contact us at any of the above mentioned touch
points.
- All Tata AIA Life branches have a Grievance Redressal Officer who
can be contacted for any support during the grievance redressal
process.
2) Escalation Mechanism
In case customers are not satisfied with the decision of the above
offices, or has not received any response within the stipulated
timelines, they may contact the following officials for resolution:
• 1st level of Escalation: Senior Manager - Customer Service
• 2nd level of Escalation: Head - Customer Service
• 3rd level of Escalation: Grievance Redressal Officer (GRO)
For escalations, customers can email to
head.customerservice@tataaia.com or write to –
Tata AIA Life Insurance Company Limited,
B-Wing, 9th Floor, I-Think Techno Campus, Behind TCS, Pokhran Road
No.2, Close to Eastern Express Highway, Thane (West) - 400 607,
Maharashtra
We request our customers to follow the escalation mechanism in case of
non-receipt of response or unsatisfactory response from the concerned
persons mentioned above.
If you are not satisfied with the response or do not receive a response from
us within 15 days, you may 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 (or)
1800 4254 732
- Send an e-mail to Email ID: complaints@irda.gov.in
- Make use of IRDAI's online portal - Integrated Grievance Management
System (IGMS): Register and monitor your complaint at
igms.irda.gov.in
Address for communication for complaints by fax/paper:
General Manager
Consumer Affairs Department - Grievance Redressal Cell
Insurance Regulatory and Development Authority of India
Sy. No. 115/1, Financial District,
Nanakramguda, Gachibowli,
Hyderabad – 500032, Telangana.
3) Insurance Ombudsman:
Where the redressal provided by the Company is not satisfactory despite
the escalation above, the customer may represent the case to the
Ombudsman for Redressal of the grievance, if it pertains to the following:
- Delay in settlement of claim
- Partial or total rejection of claim
- Dispute with regard to premium
- Misrepresentation of policy terms and conditions
- Legal construction of the policy in so far as dispute related to claim
- Grievance relating to policy servicing
- Issuance of policy which is not in conformity with proposal form
- Non- issuance of your insurance document and
- Any other matter resulting from the violation of provisions of the
Insurance Act, 1938 or the regulations, circulars, guidelines or
IRDA of India Regn no. 110
C2019-34
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 hereinabove.
Please refer to our website www.tataaia.com for further details in this regard.
The list of Ombudsman address is attached as Annexure - A
The complaint should be made 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 the
complaint, supported by documents, the nature and extent of the loss
caused to the complainant and the relief sought from the Insurance
Ombudsman. As per provision 14(3) of the Insurance Ombudsman Rules,
2017, the complaint to the Ombudsman can be made, within a period of
one year provided it is not simultaneously under any litigation:
• Only if the grievance has been rejected by the Grievance Redressal
Machinery of the Insurer; or
• the complainant had not received any reply within a period of one
month after the Insurer received his representation; or
• the complainant is not satisfied with the reply given to him by the insurer.
ANNEXURE – A
NAMES OF OMBUDSMAN AND ADDRESSES OF
OMBUDSMAN CENTRES
AHMEDABAD - Office of the Insurance Ombudsman, Jeevan Prakash
Building, 6th floor, Tilak Marg, Relief Road, Ahmedabad - 380 001. Tel.:
079 - 25501201/02/05/06, Email: bimalokpal.ahmedabad@ecoi.co.in,
(Jurisdiction: Gujarat, Dadra & Nagar Haveli, Daman and Diu).
BENGALURU - Office of the Insurance Ombudsman, Jeevan Soudha
Building, PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP
Nagar, Ist Phase, Bengaluru - 560 078. Tel.: 080 - 26652048/26652049,
Email: bimalokpal.bengaluru@ecoi.co.in, (Jurisdiction: Karnataka).
BHOPAL - Office of the Insurance Ombudsman, Janak Vihar Complex,
2nd Floor, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal -
462 003. Tel.: 0755 - 2769201/ 2769202, Fax: 0755 - 2769203, Email:
bimalokpal.bhopal@ecoi.co.in, (Jurisdiction: Madhya Pradesh,
Chattisgarh). BHUBANESHWAR - Office of the Insurance Ombudsman,
62, Forest park, Bhubneshwar – 751 009. Tel.: 0674 - 2596461/2596455,
Fax: 0674 - 2596429, Email: bimalokpal.bhubaneswar@ecoi.co.in,
(Jurisdiction: Orissa). CHANDIGARH - Office of the Insurance
Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building,
Sector 17 - D, Chandigarh - 160 017. Tel.: 0172 - 2706196/2706468, Fax:
0172 - 2708274, Email: bimalokpal.chandigarh@ecoi.co.in, (Jurisdiction:
Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir, Chandigarh).
CHENNAI - Office of the Insurance Ombudsman, Fatima Akhtar Court,
4th Floor, 453, Anna Salai, Teynampet, Chennai - 600 018. Tel.: 044 -
24333668/ 24335284, Fax: 044 - 24333664, Email:
bimalokpal.chennai@ecoi.co.in, (Jurisdiction: Tamil Nadu, Pondicherry
Town and Karaikal {which are part of Pondicherry}). DELHI - Office of the
Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali
Road, New Delhi - 110 002. Tel.: 011 - 23232481 / 23213504, Email:
bimalokpal.delhi@ecoi.co.in, (Jurisdiction: Delhi). ERNAKULAM - Office
of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin
Shipyard, M. G. Road, Ernakulam - 682 015. Tel.: 0484 - 2358759/
2359338, Fax: 0484 - 2359336, Email: bimalokpal.ernakulam@ecoi.co.in,
(Jurisdiction: Kerala, Lakshadweep, Mahe-a part of Pondicherry).
GUWAHATI - Office of the Insurance Ombudsman, Jeevan Nivesh, 5th
Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati - 781001(ASSAM).
Tel.: 0361 - 2132204 / 2132205, Fax: 0361 - 2732937, Email:
bimalokpal.guwahati@ecoi.co.in, (Jurisdiction: Assam, Meghalaya,
Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura).
HYDERABAD - Office of the Insurance Ombudsman, 6-2-46, 1st floor,
Moin Court, Lane Opp. Saleem Function Palace, A. C. Guards,
Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 - 67504123/23312122,
Fax: 040 - 23376599, Email: bimalokpal.hyderabad@ecoi.co.in,
(Jurisdiction: Andhra Pradesh, Telangana, Yanam and part of Territory of
Pondicherry). JAIPUR - Office of the Insurance Ombudsman, Jeevan
Nidhi - II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005. Tel.: 0141
- 2740363, Email: bimalokpal.jaipur@ecoi.co.in, (Jurisdiction: Rajasthan).
KOLKATA - Office of the Insurance Ombudsman, Hindustan Bldg.
Annexe, 4th Floor, 4, C.R. Avenue, Kolkata - 700 072. Tel.: 033 -
22124339 / 22124340, Fax : 033 - 22124341, Email:
bimalokpal.kolkata@ecoi.co.in, (Jurisdiction: West Bengal, Sikkim,
Andaman & Nicobar Islands). LUCKNOW - Office of the Insurance
Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road,
Hazratganj, Lucknow - 226 001. Tel.: 0522 - 2231330/2231331, Fax:
0522 - 2231310, Email: bimalokpal.lucknow@ecoi.co.in, (Jurisdiction:
Districts of Uttar Pradesh: Laitpur, Jhansi, Mahoba, Hamirpur, Banda,
Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
Jaunpur, Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad,
Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur,
Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria,
C197802357 Page 10 of 32
Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar). MUMBAI - Office of Age PPT 5 / PPT 5 / PPT 6 / PPT 8 / PPT 12 /
the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, PPT/PT* PT 15* PT 20* PT 15* PT 18* PT 25*
Santacruz (W), Mumbai - 400 054. Tel.: 022 - 26106552/26106960, Fax:
022 - 26106052, Email: bimalokpal.mumbai@ecoi.co.in, (Jurisdiction: 40 240.64 337.83 267.65 278.04 302
Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane). 41 241.71 342.11 269.13 279.31 303.66
NOIDA - Office of the Insurance Ombudsman, Bhagwan Sahai Palace, 42 242.94 345.93 270.74 280.69 305.52
4th Floor, Main Road, Naya Bans, Sector 15, Dist: Gautam Buddh Nagar, 43 244.32 350.8 272.5 282.2 307.6
U.P-201301. Tel.: 0120 - 2514250 / 2514252 / 2514253, Email:
bimalokpal.noida@ecoi.co.in, (Jurisdiction: State of Uttaranchal and the 44 245.87 354.3 274.42 283.87 309.91
following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, 45 247.61 356.86 276.51 285.71 312.5
Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut, 46 249.17 360.08 278.24 287.49 315.38
Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad,
Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, 47 250.95 362.94 280.16 289.48 318.6
Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, 48 252.98 366.02 282.3 291.7 322.18
Saharanpur). PATNA - Office of the Insurance Ombudsman, 1st Floor, 49 254.08 368.78 284.7 294.17 326.18
Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna 800 006.
Tel.: 0612-2680952, Email: bimalokpal.patna@ecoi.co.in, (Jurisdiction: 50 255.45 372.44 286.71 296.93 330.62
Bihar, Jharkhand). PUNE - Office of the Insurance Ombudsman, Jeevan 51 255.91 375.89 289.02 300.46 334.72
Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, 52 256.66 379.78 291.65 304.21 339.06
Narayan Peth, Pune - 411 030. Tel.: 020 - 41312555, Email: 53 257.75 382.87 294.39 308.04 343.36
bimalokpal.pune@ecoi.co.in, (Jurisdiction: Maharashtra, Area of Navi
Mumbai and Thane excluding Mumbai Metropolitan Region). 54 259.24 387.16 296.41 312.34 346.4
55 259.88 390.04 298.88 314.97 350.65
For further information or latest updated list of Ombudsman Office
addresses, kindly visit the IRDA of India website 56 NA NA NA 316.98 356.95
http://www.policyholder.gov.in/ - Ombudsman / List of Insurance 57 NA NA NA 319.12 363.51
Ombudsmen OR our website www.tataaia.com 58 NA NA NA 321.46 370.39
ANNEXURE 1 59 NA NA NA 323.27 374.56
Premium Rate per 1,000 Assured Benefit: 60 NA NA NA 324.53 379.75
Age PPT 5 / PPT 5 / PPT 6 / PPT 8 / PPT 12 / *PPT – Premium Payment Term / PT – Policy Term
PPT/PT* PT 15* PT 20* PT 15* PT 18* PT 25*
0 0 320.19 0 270.41 287.54 ANNEXURE 2
1 0 318.51 0 269.64 286.96 Surrender Value Factors:
2 0 317.11 0 268.99 286.47 Guaranteed Surrender Value (GSV) and Special Surrender Value (SSV)
factors are as under:
3 233.33 316.08 257.95 268.52 286.13 Company has the right to review the basis for calculating the SSV factors
4 232.85 315.32 257.56 268.19 285.88 from time to time based on the experience and will be subject to prior
approval of IRDAI.
5 232.52 314.77 257.3 267.97 285.72
Guaranteed Surrender Value factor
6 232.31 314.35 257.14 267.81 285.63
Guaranteed Surrender Value factor for Total Premiums Paid:
7 232.18 314.06 257.06 267.72 285.58
8 232.11 313.84 257.03 267.68 285.57 Year of surrender/Policy Term 15 18 20 25
9 232.08 313.68 257.04 267.68 285.62 1 0% 0% 0% 0%
10 232.09 313.57 257.09 267.7 285.69 2 30% 30% 30% 30%
11 232.12 313.5 257.15 267.74 285.78 3 35% 35% 35% 35%
12 232.16 313.45 257.23 267.8 285.9 4 50% 50% 50% 50%
13 232.19 313.41 257.3 267.86 286.03 5 50% 50% 50% 50%
14 232.23 313.38 257.37 267.93 286.17 6 50% 50% 50% 50%
15 232.25 313.36 257.44 267.99 286.32 7 50% 50% 50% 50%
16 232.27 313.36 257.5 268.06 286.47 8 56% 54% 53% 52%
17 232.28 313.37 257.55 268.12 286.64 9 61% 58% 57% 55%
18 232.28 313.4 257.6 268.18 286.82 10 67% 62% 60% 57%
19 232.28 313.46 257.65 268.25 287.01 11 73% 66% 63% 59%
20 232.29 313.56 257.69 268.32 287.23 12 79% 70% 67% 62%
21 232.3 313.71 257.75 268.4 287.47 13 84% 74% 70% 64%
22 232.33 313.93 257.81 268.48 287.74 14 90% 78% 73% 66%
23 232.37 314.23 257.89 268.59 288.05 15 90% 82% 77% 69%
24 232.44 314.64 257.99 268.72 288.4 16 - 86% 80% 71%
25 232.54 315.15 258.12 268.87 288.8 17 - 90% 83% 74%
26 232.67 315.8 258.28 269.05 289.25 18 - 90% 87% 76%
27 232.84 316.61 258.46 269.27 289.75 19 - - 90% 78%
28 233.06 317.61 258.7 269.54 290.3 20 - - 90% 81%
29 233.34 318.81 258.98 269.85 290.91 21 - - - 83%
30 233.68 320.24 259.32 270.23 291.57 22 - - - 85%
31 234.1 321.91 259.72 270.67 292.29 23 - - - 88%
32 234.6 323.84 260.19 271.17 293.07 24 - - - 90%
33 235.2 326.06 260.76 271.75 293.89 25 - - - 90%
34 235.91 328.57 261.41 272.4 294.78
35 236.73 331.37 262.16 273.13 295.74
36 237.73 331.66 263.03 273.95 296.77
37 238.27 333.27 264 274.84 297.9
38 238.92 335.37 265.1 275.81 299.13
39 239.71 336.23 266.31 276.88 300.49

IRDA of India Regn no. 110

C2019-34
C197802357 Page 11 of 32
Guaranteed Surrender Value factor for Vested Compound 02. An Assignment may be effected in a Policy by an endorsement upon
Reversionary Bonus: the Policy itself or by a separate instrument under notice to the Insurer.
Year of surrender/Policy Term 15 18 20 25 03. The instrument of assignment should indicate the fact of transfer or
assignment and the reasons for the assignment or transfer,
1 0% 0% 0% 0%
antecedents of the assignee and terms on which assignment is made.
2 17% 14% 12% 7%
04. The assignment must be signed by the transferor or assignor or duly
3 18% 15% 13% 8% authorized agent and attested by at least one witness.
4 19% 16% 14% 9%
05. The transfer of assignment shall not be operative as against an
5 20% 17% 15% 10% insurer until a notice in writing of the transfer or assignment and
6 21% 18% 16% 11% either the said endorsement or instrument itself or copy there of
7 22% 19% 17% 12% certified to be correct by both transferor and transferee or their duly
8 23% 20% 18% 13% authorised agents have been delivered to the insurer.
9 24% 21% 19% 14% 06. Fee to be paid for assignment or transfer can be specified by the
Authority through Regulations.
10 25% 22% 20% 15%
11 26% 23% 21% 16% 07. On receipt of notice with fee, the insurer should Grant a written
acknowledgement of receipt of notice. Such notice shall be conclusive
12 27% 24% 22% 17% evidence against the insurer of duly receiving the notice.
13 28% 25% 23% 18%
08. If the insurer maintains one or more places of business, such notices
14 29% 26% 24% 19% shall be delivered only at the place where the Policy is being
15 30% 27% 25% 20% serviced.
16 - 28% 26% 21% 09. The insurer may accept or decline to act upon any transfer or
17 - 29% 27% 22% assignment or endorsement, if it has sufficient reasons to believe that
18 - 30% 28% 23% it is
19 - - 29% 24% a. not bonafide or
20 - - 30% 25% b. not in the interest of the Policyholder or
21 - - - 26% c. not in public interest or
22 - - - 27% d. is for the purpose of trading of the Insurance Policy.
23 - - - 28% 10. Before refusing to act upon endorsement, the Insurer should record
24 - - - 29% the reasons in writing and communicate the same in writing to
25 - - - 30% Policyholder within 30 days from the date of Policyholder giving a
notice of transfer or assignment.
Special Surrender Value Factors 11. In case of refusal to act upon the endorsement by the Insurer, any
The Special Surrender Value Factors vary according to the policy term and person aggrieved by the refusal may prefer a claim to IRDAI within 30
policy year of Surrender. days of receipt of the refusal letter from the Insurer.
Year of surrender/Policy Term 15 18 20 25 12. The priority of claims of persons interested in an Insurance Policy
would depend on the date on which the notices of assignment or
1 0% 0% 0% 0% transfer is delivered to the insurer; where there are more than one
2 47% 40% 36% 27% instruments of transfer or assignment, the priority will depend on
3 50% 43% 38% 29% dates of delivery of such notices. Any dispute in this regard as to
4 53% 45% 40% 30% priority should be referred to Authority.
5 56% 48% 42% 32% 13. Every assignment or transfer shall be deemed to be absolute
6 59% 50% 45% 34% assignment or transfer and the assignee or transferee shall be
deemed to be absolute assignee or transferee, except
7 63% 53% 47% 36%
a. where assignment or transfer is subject to terms and conditions of
8 67% 56% 50% 38%
transfer or assignment OR
9 71% 60% 53% 40%
b. where the transfer or assignment is made upon condition that
10 75% 63% 56% 43%
i. the proceeds under the Policy shall become payable to
11 79% 67% 60% 45%
Policyholder or nominee(s) in the event of assignee or transferee
12 84% 71% 63% 48% dying before the Life Assured OR
13 89% 75% 67% 50% ii. the Life Assured surviving the term of the Policy
14 94% 79% 71% 53%
Such conditional assignee will not be entitled to obtain a loan on Policy or
15 100% 84% 75% 56% surrender the Policy. This provision will prevail notwithstanding any law or
16 - 89% 79% 60% custom having force of law which is contrary to the above position.
17 - 94% 84% 63% 14. In other cases, the insurer shall, subject to terms and conditions of
18 - 100% 89% 67% assignment, recognize the transferee or assignee named in the
19 - - 94% 71% notice as the absolute transferee or assignee and such person
20 - - 100% 75% a. shall be subject to all liabilities and equities to which the transferor
21 - - - 79% or assignor was subject to at the date of transfer or assignment
and
22 - - - 84%
b. may institute any proceedings in relation to the Policy
23 - - - 89%
24 - - - 94% c. obtain loan under the Policy or surrender the Policy without
obtaining the consent of the transferor or assignor or making him
25 - - - 100% a party to the proceedings

ANNEXURE - 2 15. Any rights and remedies of an assignee or transferee of a life

Insurance Policy under an assignment or transfer effected before
A. Section 38 - Assignment and Transfer of Insurance Policies commencement of the Insurance Laws (Amendment) Act, 2015 shall
Assignment or transfer of a Policy should be in accordance with Section not be affected by this section.
38 of the Insurance Act, 1938 as amended by Insurance Laws [Disclaimer: This is not a comprehensive list of amendments of Insurance
(Amendment) Act, 2015.The extant provisions in this regard are as follows: Laws (Amendment) Act, 2015 and only a simplified version prepared for
01. This Policy may be transferred/assigned, wholly or in part, with or general information. Policyholders are advised to refer to Insurance Laws
without consideration. (Amendment) Act, 2015 for complete and accurate details.]
IRDA of India Regn no. 110

C2019-34
C197802357 Page 12 of 32
 ANNEXURE - 3
B. 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 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 Life Assured 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) Act, 2015.
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 (Amendment) Act, 2015., a nomination is made in
favour 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
IRDA of India Regn no. 110
C2019-34
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. Policyholders are advised to refer to Insurance Laws
(Amendment) Act, 2015 for complete and accurate details.]
ANNEXURE - 4
C. 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 Life Assured 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 Life Assured 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
Life Assured does not believe to be true;
b. The active concealment of a fact by the Life Assured 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 Life Assured 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 Life Assured/ 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 Life Assured 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 Life Assured 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 Life Assured 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.
C197802357 Page 13 of 32
09. The insurer can call for proof of age at any time if he is entitled to do that if the insurer had been aware of the said fact, no life Insurance
so and no Policy shall be deemed to be called in question merely Policy would have been issued to the insured.
because the terms of the Policy are adjusted on subsequent proof of 09. The insurer can call for proof of age at any time if he is entitled to do
age of Life Insured. So, this Section will not be applicable for so and no Policy shall be deemed to be called in question merely
questioning age or adjustment based on proof of age submitted because the terms of the Policy are adjusted on subsequent proof of
subsequently. age of Life Insured. So, this Section will not be applicable for
[Disclaimer: This is not a comprehensive list of amendments of Insurance questioning age or adjustment based on proof of age submitted
Laws (Amendment) Act, 2015. and only a simplified version prepared for subsequently.
general information. Policyholders are advised to refer to Insurance Laws [Disclaimer: This is not a comprehensive list of amendments of Insurance
(Amendment) Act, 2015 for complete and accurate details.] Laws (Amendment) Act, 2015. and only a simplified version prepared for
general information. Policyholders are advised to refer to Insurance Laws
ANNEXURE 5
(Amendment) Act, 2015 for complete and accurate details.]
C. 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 Life Assured 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 Life Assured 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
Life Assured does not believe to be true;
b. The active concealment of a fact by the Life Assured 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 Life Assured 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 Life Assured/ 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 Life Assured 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 Life Assured 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 Life Assured 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
IRDA of India Regn no. 110

C2019-34
C197802357 Page 14 of 32
 CLAIM DOCUMENT LIST

Requirements for Hospitalization & Critical
Illness Claim
A Claim Forms
Part I: Application Form for Hospitalization/Critical
Illness Claim (Claimant's Statement) along with
NEFT form
Part II: Confidential Medical Report -to be filled by
attending physician
Requirements for Disability and
Dismemberment Claim
A Claim Forms
Part I: Application Form for
Disability/Dismemberment Claim (Claimant's
Statement) along with NEFT form
Part II: Confidential Medical Report -to be filled by
attending physician
Requirements for Death Claim (all causes of
Death)
A Claim Forms
Part I: Application Form for Death Claim
(Claimant's Statement) along with NEFT form
Part II:Physician's Statement - to be filled by last
attending physician

B Hospital Bills for the confinement.
C Attested True Copy of Indoor Case Papers of the
Hospital
B Attested True Copy of Indoor Case Papers of the B Death Certificate issued by a local government
Hospital body like Municipal Corporation
C Discharge Summary of Present and Past C Medical Records (Admission Notes,
Hospitalizations Discharge/Death Summary, Indoor Case Papers,
Test Reports etc)1

D Discharge Summary of Present and Past D Photo Identity of insured with age and address D Original Policy document
Hospitalizations proof

E Photo Identity of insured with age and address E Bank Details of the claimant – Cancelled cheque
proof (with printed name and account number)/bank
passbook and NEFT Form
E Claimant's Photo ID with age proof & relationship
with the Insured along with Address proof of the
claimant and Cancelled cheque with name and
account number printed or cancelled cheque with
copy of Bank Passbook / Bank Statement

If no nomination - Proof of legal title to the claim

proceeds (e.g. legal succession paper)

F Bank Details of the claimant – Cancelled cheque F Disability Certificate by attending Physician /
(with printed name and account number)/bank Institute for disabled
passbook and NEFT Form
G Certificate of Diagnosis G Rehabilitation Certificate - if applicable

H Medical Examination Certificate (First H Employer’s written confirmation / statement - for

Consultation Notes). Disability claim

I All related clinical Reports pertaining to the claim I All related Medical Examination Reports, e.g. -
event - Laboratory test reports
Laboratory test reports X-Ray / CT Scan / MRI Reports & Plates
X-Ray / CT Scan / MRI Reports & Ultrasonography Report
PlatesUltrasonography Report Clinical / Hospital Reports
Histopathology Report
Clinical / Hospital Reports
Angiography Reports & Plates.
Others (please specify).
J All follow-up Consultation Notes in relation to the J Clinical Photographs showing the injured areas -
hospitalized condition. if available
If Claims is due to accidental causes (submit in If Claims is due to accidental causes (submit in In case of accidental death inaddition to the above
addition to the above) addition to the above). documents, we would require the following
documents –
K All police reports- K All police reports- F Postmortem report (Autopsy report) &
First Information Report First Information Report Chemical Viscera report - if performed
Final Investigation Report Final Investigation Report
G All Police Papers – Panchnama, Inquest, First
Information Report (FIR) and Final Investigation
Report
H Newspaper cutting / Photographs of the accident -
if available

1. This is applicable if insured was in hospital at the time of death or any time prior to the date of death.
• Please submit copies of the following documents certified / attested by the issuing authority. ( Original Seen Verified (OSV) by Branch Personnel will also be accepted) -
o All Police papers – Panchnama, Inquest, First Information Report and Final Investigation Report
o Medical Records (Admission Notes, Discharge/Death Summary, Indoor Case Papers, Test Reports etc)1
o Postmortem report (Autopsy report) & Chemical Viscera report (certified by Police / Magistrate / Court will also be accepted)
• Copies of the other documents to be submitted by self attestation of the claimant

NOTE:
- In case the claim warrants any additional requirement, TATA AIA LIFE reserves the right to call for the same.
- Notification of claim & submission of the claim requirements does not mean admission of the claim liability by the Company.
- No agent is authorized to admit any liabilities on behalf of the Company, nor to alter this list of documents or any claims requirements called for by the Company.

C197802357 Page 15 of 32
 FREQUENTLY ASKED QUESTIONS (FAQs)
1. How can I cancel my policy under Free Look?
 The policy can be cancelled anytime within 15 days from the date of receipt of the policy document. Kindly submit the policy
#
document along with a duly signed letter at any of the Tata AIA Life branches .

2. How can I change the premium payment mode?


#
Please submit a duly signed copy of the Mode change form* at any of the Tata AIA Life branches at least 10 days before the
due date of the policy.
 Please contact the branch or call center for mode changes allowed on your policy

3. How can I make the below mentioned changes in my policy?

- Name change - Address / Contact Number Change
- Ownership Change - Signature Change
- Nominee Change - Basic Plan Change
 Please submit a duly signed copy of the respective change form* along with the documents mentioned in the form at any of the
#
Tata AIA Life branches .

4. Can I opt for automatic premium payment facility on my policy?

 You can avail of any of the following facilities wherein your account / Credit Card will be debited on the due date of your policy.
 ECS - A signed copy of the ECS form* along with a cancelled cheque or copy of cancelled cheque needs to be submitted at
any of the Tata AIA Life branches at least 10 days prior to the due date
 Credit Card – A signed copy of the Credit Card form* along with a copy of Front page of credit card needs to be submitted
at any of the Tata AIA Life branches at least 10 days prior to the due date
 Direct debit – You can avail of Direct Debit facility by providing a copy of an 'ECS & Direct Debit' form* with copy of
cancelled cheque or bank attestation at least 30 days before the due date. To know the list of banks wherein this facility is
available, kindly visit the 'Premium Payment Options' on www.tataaia.com.

5. I have lost my PIP and need a duplicate PIP.

 Please submit a duly signed copy of the Duplicate PIP form* along with the documents mentioned in the form at any of the Tata
#
AIA Life branches .

6. How can I view my policy related details online?

 You can create your online account by logging in to www.tataaia.com and avail of the following benefits –
 Easy access to policy related details (Premium Due Date, NAV, Payment Summary, etc.,)
 Single access for all your policies
 Perform Online ULIP transactions
 Pay Premium Online
 Generate e-statements (Premium Certificates, Unit Statements)
 Raise Service Requests

7. How do I request for a Premium Payment Certificate for my policies?

 You can request for your Premium Certificate through the following modes -
 Online Customer Portal - Kindly logon to your Online Account by visiting www.tataaia.com
 SMS - Kindly SMS the following to 5676799:
 PCT <space> 10 digit policy no <space> email address (in case you wish to receive by email, else will be sent to your
communication address) <space> financial year (yyyy-yyyy format)
 The mobile number from where the SMS has been sent should be registered with the company. In case your mobile number is
not registered, please send the following SMS to 5676799:
REG <space> 10 digit policy no <space> Insured's DOB in DDMMYYYY format <space> Sum Assured
(For Health, Annuity and Pension plans, Sum Assured should be mentioned as '0')
 Email / Call / Branch - Request for the Premium Certificate by sending an email to customercare@tataaia.com or call our
#
helpline number at 1-860-266-9966 (local charges apply) or visit the nearest branch .

8. For my unit linked policy, how can I request for Fund Switch, Premium Redirection & Top-up?
 You can create your online account by logging in to www.tataaia.com and perform Fund Switch, Premium Redirection and Top-
up transactions instantly (or)
 Please submit a duly signed copy of the Fund Allocation, Switch & Top-up form* pertaining to your product at any of the Tata AIA
#
Life branches .
#
For your nearest Tata AIA Life branch, please visit 'Contact Us' section on www.tataaia.com.; * You can download the forms by
visiting 'Customer Services' section on www.tataaia.com

You can also send the forms along with the documents to the below mentioned address –
Policy Owners Services
Tata AIA Life Insurance Company Limited,
B-Wing, 9th Floor, I-Think Techno Campus,
Behind TCS, Pokhran Road No.2,
Close to Eastern Express Highway,
Thane (West) – 400 607, Maharashtra

C197802357 Page 16 of 32
 PROPOSAL FORM

Tata AIA Life Insurance Company Limited.

COMMON PROPOSAL FORM
Kindly Fill the form in CAPITAL and only in blue or black
(For Official Use only)

Proposal Number: C197802357 Branch Code: MU01

Channel: BROKING Campaign Code:

Sub Office Code: BCB0373 RM CAMS Code: 1835314

Agent/Broker/Specified Person/Employee: BlueChip

Code: 1835314 Contact Details: 25787046 License No. & Validity Details: U66010MH2006PTC161904

Customer Relationship No. (For Bancassurance Channel) PAN No.

IMPORTANT GUIDELINES: 1) IN UNIT-LINKED INSURANCE POLICIES (ULIPs), THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. 2)
Insurance is a contract of utmost good faith between the Insurer and the Insured. The Proposer and the Life to be Assured are required to disclose all facts in response to the questions in
this application form. 3) Any cancellation/alteration is to be signed by Proposer/Life to be assured as applicable. 4) KYC documents will be required for all the parties to the contract.

I. GENERIC DETAILS

Is this policy self-proposed? YES. If No, please answer the following details Type of Proposer: Individual

Relation with Life Assured: Self Type of Proposal:

II. ELECTRONIC INSURANCE ACCOUNT (eIA) DETAILS OF THE PROPOSER/POLICYOWNER

If you have an e-Insurance Account (eIA) Number, please provide:

I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Tata AIA Life Insurance Company Ltd. In PHYSICAL FORMAT (Physical
copy would be sent even if proposer opts for electronic format; however, in case proposer has e-Insurance Account, only electronic copy of the Insurance Policy will be provided)
I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Insurance Repository in the Electronic Format as and when applicable.
Please select the name of the Insurance Repository.
CUST PORTAL

III. PRODUCT DETAILS

Unit Linked Sum Policy Premium Paying Premium(Premium is inclusive of applicable taxes, Premium Paying
Base Plan/ Rider (optional) Name
(Yes/No) Assured ( ) Term(Years) Term(Years) cesses & levies ) ( ) Mode

Tata AIA Life Insurance Diamond

No 550000 15 5 52250 ANNUAL
Savings Plan

Kindly DATE BACK my Application to ____ 1. Allowed only as per product specifications 2. Allowed within the same financial year 3. In case of juvenile (less than 1 year) back date is not
allowed. 4. Date Back of policy is allowed only up to the official launch date of the product.
FUND SELECTION DETAILS (To be filled for Unit Linked Products) a. Kindly mention the names of the fund chosen b. Incase you opt for a specific Portfolio Strategy (as available with
individual products), kindly mention the Fund Names or other details as applicable c. Kindly fill in whole numbers in percentage only. Decimals and Fractions not allowed.

Portfolio Strategy
Name of Fund % Allocation
Funds for the chosen Portfolio Strategy (If Applicable )
OR
Debt oriented fund Equity oriented fund

Other Details(if applicable)

IV. PROPOSER / POLICYHOLDER DETAILS (Please fill in details of Life Assured if same as Proposer)

1. Title Ms.

2. Name KHUSHBU SHISHODIYA

3. Father's Name / Spouse Name NAVAL SINGH JAIN

4. Mother's Name SUSHILA DEVI JAIN

5. Maiden Name(For female lives only) KHUSHBU JAIN

6. Gender/Date of Birth Female 15-07-1984

C197802357 Page 17 of 32
7. Which is your Dominant Hand? (Question to be answered only if ADDL Rider is
selected )

8. Marital Status Married

Resident Indian (Nationality) INDIA

Country of Residence : India
9. Nationality (If other than resident Indian, Passport as an age proof is mandatory)
(If country of residence or nationality outside India then FATCA/ CRS-Self Certification Form to be mandatorily
completed)

Residence for Tax purposes in Jurisdiction(s) outside India NO (If 'Yes' then FATCA/ CRS-Self Certification Form to be mandatorily completed)

10. Highest Educational Qualification Graduate

30 AZAD MOHALLA,BIJAINAGAR,AJMER

11. Current Residence Address Landmark: AJMER City: AJMER

State: RAJASTHAN Country: INDIA Pin code: 305624

30 AZAD MOHALLA,BIJAINAGAR

12. Permanent Address Landmark: AJMER City: AJMER

State: RAJASTHAN Country: INDIA Pin code: 305624

13. Address for Communication Current

Residence No: Mobile No: 9825516237

14. Telephone and Email Details E-mail:
SHISHODIA.VISHAL@GMAIL.COM

15. Occupation Class Housewife

a. Name of Organisation /School / College House wife

b. Organisation Type

c. Industry

d. Nature of Work

e. Annual Income ( ) 500000

16. Income Proof

PAN Card
17. Identity Proof (In case of Passport & Driving License please mention expiry date)
AGCPJ6384L

18. Address Proof (Utility bills should not be older than 2 months) Aadhar card UID

AGCPJ6384L (kindly attach copy of Pan card)

19. Permanent Account Number ( PAN ) :
Yes I do have PAN (kindly attach copy of Form 60 duly signed)

20. CKYC No. (If available)

21. Source of Funds

22. Are you a Politically Exposed Person? NO (Definition of PEP: "PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international organisation /in a foreign country.
This would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials, senior executives of state owned corporations, important
political party officials". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity) or through marriage or similar (civil) forms of partnership. Close associates are individuals
closely connected to a PEP, either socially or professionally")

V. LIFE ASSURED DETAILS (Please fill in this section only if Life Assured is different from Proposer)

1. Title

2. Name

3. Maiden Name(For female lives only)

4. Gender/Date of Birth

5. Which is your Dominant Hand? (Question to be answered only if ADDL Rider is

selected )

6. Marital Status

(Nationality)
7. Nationality (If other than resident Indian, Passport as an age proof is mandatory)
Country of Residence

C197802357 Page 18 of 32
8. Highest Educational Qualification

9. Occupation Class

10. Name of Organisation/ School/College

11. Organisation Type

12. Industry

13. Nature of Work

14. Annual Income ( )

15. Income Proof

16. Identity Proof (In case of Passport & Driving License please mention expiry date)
Others :

17. Address Proof (Utility bills should not be older than 2 months)

(kindly attach copy of Pan card)

18. Permanent Account Number (PAN):
(kindly attach copy of Form 60 duly signed)

19. Are you a Politically Exposed Person? (Definition of PEP: "PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international organisation /in a foreign country. This
would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials, senior executives of state owned corporations, important political
party officials". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity) or through marriage or similar (civil) forms of partnership. Close associates are individuals closely
connected to a PEP, either socially or professionally")

VI. HEALTH & LIFESTYLE DETAILS OF THE LIFE ASSURED

1. Nature of Age proof (Non-standard age proof submission will attract extra premium)
PAN Card

2. a) Height (cms or ft) 162 cms b) Weight ( kg or lbs). 59 kgs

PART A: LIFESTYLE DETAILS

1. Are you employed in the Armed Forces, Paramilitary, Police Forces, Fire Brigade or any other similar occupation? NO

2. Is your occupation/your hobbies associated with any specific accident/health hazard or are dangerous in any way (e.g. working with dangerous or corrosive chemicals, explosives,
NO
radiation, working underwater/underground or at height, working in mines, non-commercial flying activities, diving, mountaineering, any form of motorbike/car racing etc.)?

3. Do you intend to live or travel outside India for more than 30 days for reason other than family vacation in next 6 months? NO

4. Have you ever been charge sheeted or convicted of any criminal proceedings or have any criminal case or charge pending against you in any court of law in India or abroad? If Yes,
NO
please provide complete details.

5. Do you consume or have consumed any of the following? Please tick all relevant options and provide details NO

Substance Yes/ Consumed Quantity/ Per Day for Tobacco & Per week for Alcohol No. of If stopped consumption, mention month and year in which
Consumed No As and Narcotics Years last consumed

Tobacco NO

Alcohol NO

Any Narcotics NO

PART B: HEALTH & PERSONAL DETAILS

1. Has any of your insurance application or reinstatement application on life, accident, medical or health, critical illness, or disability ever been declined, postponed or accepted at extra
NO
premium or modified terms?

2. Did you have any loss or Gain of weight of 10 kgs or more in the last six months? NO

3. Do you have any physical deformity / handicap or congenital defect / abnormality? NO

4. Have you ever been advised to and / or have undergone any tests, investigations or surgery or had signs or symptoms of any condition, aliment or injury and / or were advised
NO
treatment for or have been hospitalized for check-up or treatment other than minor flu, cold or influenza?

5. Have you ever been diagnosed with or investigated for any of the following: NO

a. Cardio: High or Low Blood Pressure / Raised Cholesterol / Chest Pain / Palpitation / Rheumatic Fever / Heart Murmur / Shortness of Breath / Heart Attack / Stroke / Any other heart
NO
condition

b. Hormonal: High Blood Sugar/ Diabetes / Thyroid or endocrine disorder / Sugar in Urine / Any other hormonal disorder NO

c. Respiratory: Asthma / Tuberculosis / chronic cough, chronic bronchitis, emphysema, pneumonia / Any other respiratory disorder NO

d. Blood/Cellular: Cancer / Tumor or malignant growth / Leukemia / Anemia / Enlarged lymph nodes/ Any blood disorder NO

e. Digestive/Regulatory: Recurrent indigestion / Gastritis / Stomach or Duodenal Ulcer / Hernia / Jaundice / Disorders of the liver / Cirrhosis and Gastrointestinal System/ Any other
NO
disease

C197802357 Page 19 of 32
 f. Mental/Psychiatric / Neurological ailment: Symptoms or ailment relating to Brain Depression / Anxiety / Brain Disorder or disease / Mental / Psychiatric / Transient ischemic attack
NO
/Parkinson's disease / Multiple Sclerosis / Nervous disorder / Paralysis or Paraplegia / Epilepsy / Any other mental or psychiatric ailment

g. Neural/Skeletal/Muscular: Musculoskeletal disorders such as Arthritis / Recurrent Back Pain / muscular dystrophies/ musculoskeletal deformities/ Slipped disc or any other
disorder of Spine, Joints, Limbs or Leprosy; / Disorders of Eye, Ear, Nose,Throat including defective sight / Disorder of speech or hearing and discharge from ears / Any other NO
disorder

h. Infectious/Contagious: Were you or your spouse ever tested for Hepatitis B or C, HIV /AIDS or any other Sexually Transmitted Disease / Any other disorder NO

i. Genitourinary: Hydrocele / fistula / piles / symptoms or ailment relating to Kidney / Kidney Stones/ Prostate, Urinary System or Reproductive System / Any other disorder NO

6. Have you had/ are having any other illness or impairment not mentioned above? NO

7. Are you presently in good health? YES

8. Has any of your family member (Parents and Siblings) ever been diagnosed with diabetes, Hypertension, Kidney Failure, Cancer, Heart Attack or any Hereditary Disorder before
NO
the age of 60?

9. Have you ever been advised to undergo any surgery or treatment or laboratory investigations (stress ECG, echocardiogram, angiography, MRI/CT scan etc.) by any doctor or
NO
specialist?

10. Have you been off work due to illness for a continuous period of 7 days and above during the last 5 years? NO

11. Female Life Questionnaire

a. Are you now Pregnant? If Yes, kindly state expected delivery date NO

b. Have you undergone any gynecological investigations for illness, internal checkups, breast checks such as mammogram or biopsy? NO

c. Have you ever consulted a doctor because of an irregularity at the breast, vagina, uterus, ovary, fallopian tubes, menstruation, complications during pregnancy or child delivery or
NO
a sexually transmitted disease?

d. Have you suffered from any other disorder of the breast or reproductive organs, abnormal smear test(s) and irregular menses? NO

12. If answer to any of the question above is 'yes', kindly give full details noting the question number (attach relevant copies)
Question No.: Details: Insured:

13. Family Details (Mandatory if the life to insured is Juvenile/Student/Housewife)

Family Details Name Gender (M / F) Date of Birth Occupation Annual Income ( ) Insurance Details (Existing /Applied for)

Father/Husband NA NA NA NA NA NA

First Child / Sibling NA NA NA NA NA NA

Second Child / Sibling NA NA NA NA NA NA

14. Family Details to be filled for Life Assured only Father Mother Brother Sister Spouse

a. If Alive, Health Status NA NA NA NA NA

b. If Deceased, Cause of Death NA NA NA NA NA

c. Age at Death/Current Age NA NA NA NA NA

VII. EXISTING INSURANCE DETAILS

Do you currently hold or have applied for Life Insurance/Pension/Health(Cancer/Cardiac/Critical Illness)/Personal Accident Policies? Y / N If Yes, kindly provide details as
below:

Life Assured Proposer (If Life Assured is Juvenile/Student/Housewife)

Type of Insurance (Life/ Health(Cancer/Cardiac/Critical Illness)/ Company Basic Sum Type of Insurance (Life/ Health(Cancer/Cardiac/Critical Illness)/ Company Basic Sum
Unit Linked /Pension/Personal Accident) Name Assured ( ) Unit Linked /Pension/Personal Accident) Name Assured ( )

VIII. NOMINEE DETAILS (Required only if Proposer & Life Assured are the same)

Name Date of Birth Gender (M/F) Relationship Percentage ( % ) (Do not enter % in decimals & total % should be equal to 100)

Vishal Shishodia 08-04-1982 Male Spouse 100

IX. APPOINTEE DETAILS (Required only if Nominee is less than 18 years of age)

Name Date of Birth Gender (M/F) Relationship

C197802357 Page 20 of 32
X. PAYMENT DETAILS

Premium Payment Method: ONLINE

Name of Credit Card/Debit Card Holder: KHUSHBU SHISHODIYA Credit Card/Debit Card Number
Cheque/DD No. Issuing Bank I.C.I.C.I. BANKLTD. Branch MANJUSAR Amount 50000 Date:
Premium# 50000 + Taxes, cesses & levies 2250 = Total Payment 52250.0 for 0 months initial deposit (To be filled for monthly mode only)
On the first policy/modal anniversary I would like to change the premium payment mode to , subject to policy contract provisions. For Annual/Monthly mode issued policies mode change
shall be accepted only on completion of first policy anniversary. #Premium is exclusive of applicable taxes, cesses & levies. All Premiums are subject to applicable taxes, cesses & levies
which will entirely be borne by the Policyholder and will always be paid by the Policyholder along with the payment of Premium. If any imposition (tax or otherwise) is levied by any statutory
or administrative body under the Policy, Tata AIA Life Insurance Company Limited reserves the right to claim the same from the Policyholder. Alternatively, Tata AIA Life Insurance Company
Limited has the right to deduct the amount from the benefits payable by Us under the Policy. Cheque/DD should be drawn in favor of "Tata AIA Life Insurance Company Ltd. (Proposal No)".
Do not issue blank cheque.
Renewal Payment Mode: NA

XI. Mandatory Bank Account Details:

Please provide below bank details. Bank details provided should be in the name of Proposer. All policy payouts will be made to the below mentioned bank account through electronic transfer
(NEFT). Payout would be in accordance and subject to terms and conditions of the policy.

Name of Account Holder Bank Account No. Bank Name and Branch Account Type IFSC Code

KHUSHBU SHISHODIYA 403301000070 I.C.I.C.I. BANKLTD.,MANJUSAR Saving ICIC0004033

Note: 1. Please provide a cancelled copy of your personalized cheque. If personalized cancelled cheque is not available, attach bank statement showing account holder name, address and
account number. 2. In case of Non-Credit to the given bank account with/without assigning any reason thereof or if the transaction is delayed or not effected at all for any reason of
incomplete information, Tata AIA Life Insurance Co Ltd will not be responsible. 3. Further, the Company reserves the right to use any alternative payout option inspite of opting for Direct
Credit option. 4. If Account type is NRE/NRO then FATCA/CRS-Self Certification Form to be mandatorily completed.

XII. DECLARATION & CONSENT

I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all
respects to the best of my knowledge and that I am authorised to propose on behalf of these other persons (applicable where the proposer and life insured are different).
I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurer and that the policy will come
into force only after full payment of the premium chargeable.
I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before
communication of the risk acceptance by the company.
I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person to be insured/ proposer or from any
past or present employer concerning anything which affects the physical or mental health of the person to be insured/ proposer and seeking information from any insurer to whom an
application for insurance on the person to be insured /proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer (if any) for the sole purpose of underwriting the proposal
and/or claims settlement and with any Governmental and/or Regulatory authority.
I confirm that I have understood the contents of this Proposal Form and I am submitting this Proposal Form with all the details which are true and correct. I have not withheld any material
information or suppressed any fact which are essential for issuance of the policy. I also hereby irrevocably authorize the Company to ascertain all the details from any third parties, as may
be required for assessing the risk.
I agree to undergo all medical tests as determined by the Company for obtaining the policy and I further understand that the Company reserves the right to issue the policy if all the
required criteria are met and in case of any fraud or misrepresentation being established, the insurer shall take action in accordance with Section 45 of the Insurance Act, 1938 as
amended time to time. I understand that the contract will be governed by the provisions of the Insurance Act, 1938 as amended time to time, the IRDA Act, 1999 and the Regulations
framed there under and that the contract will not commence until the Company's written acceptance of this Proposal Form is received. In case of the life to be insured being a minor, I
further declare and affirm that this proposal of insurance is for the benefit of the life to be insured.
Anti-Money Laundering Declaration: I hereby confirm that all premiums will be paid from bonafide sources and no premiums will be paid out of proceeds of crime related to any of the
offence listed in Prevention of Money Laundering Act, 2002. The Company has the right to peruse my financial profile and also agree that the Company has right to cancel the insurance
contract in case I have been found guilty of any of the provisions of any law, directly or indirectly, having relation to the laws governing prevention of money laundering in the country, by
any competent court of law.
I/We understand that in accordance with the IRDAI (Protection of Policyholder's Interests) Regulations, 2017, the insurer is permitted to share policyholder information only with the
statutory authorities.I permit/authorize the Company to collect, store, communicate and process information relating to the Policy/Account and all transactions therein, by the Company
and any of its affiliates or service providers wherever situated including sharing, transfer and disclosure between them or with any entity or entities for the purpose of underwriting,
policyholder servicing and claims; and to the authorities in and/or outside India for compliance with any law or regulation whether domestic or foreign.

Date: 01-12-2020
Place:
Authenticated through OTP on CDF Authenticated through OTP on CDF
Signature/Thumb Impression of Proposer Signature/Thumb impression of Life Assured

I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein, immediately in case
any of the above information is found to be false or untrue or misleading or misrepresenting, before issuance of the proposal. "I, the undersigned confirm that I have verified photocopies of
the proofs submitted along with this proposal form against the originals and certify the same to be true copy".
I declare and confirm that I have carried out necessary suitability analysis while advising this product to the proposer and that the product is suitable to the proposer.

Signature of Agent/ Specified Person/ Broker/ Employee

ACKNOWLEDGEMENT
Tear away portion (To be handed over to the customer)
Proposal Number: ___________________
Dear Customer
We acknowledge receipt of your Cash/Cheque/DD for Rs.______________ by number ______________ dated ___ /___ /___ drawn on _______________ toward' s Initial Deposit. We
request you to kindly verify the details filled in the proposal form before signing the same. Please do insist on Official Receipt issued by Tata AIA Life from your advisor within 2 working days
from submission of this proposal form. In case you do not hear from us or do not receive your policy within 15 days from the date of submission of your proposal, please visit us at
www.tataaia.com or call our helpline number 1860 266 9966 (local charges apply) or email us at customercare@tataaia.com.
This is only acknowledgement slip and not the premium receipt.

C197802357 Page 21 of 32
Agent code Agent name Signature of Agent Date of Acknowledgement

C197802357 Page 22 of 32
 IN CASE ANSWERS TO THE QUESTIONS ARE FILLED IN BY A PERSON OTHER THAN THE PROPOSER OR WHERE THE ANSWERS/SIGNATURE OF THE PROPOSER IS IN
VERNACULAR.
Note: The below must be witnessed by someone other than advisor/employee of the company.
Declaration by Agent/Intermediary of Tata AIA Life Insurance Company Limited
I, _______________________________________ (name) have explained the contents of this proposal to the _________________________________________ (Proposer) in
____________________ (language) and ensured that the contents have been fully understood by him/her. I have accurately recorded the Proposer responses to the information sought in
the proposal form and I have read out the responses to the Proposer and he/she has confirmed that they are correct.

Date: 01-12-2020
Place:

(Signature of the person making the declaration)

Address of the person making the declaration:

Declaration by Proposer/ Life Assured:

I have understood the contents of this proposal explained to me in language and confirm that the responses provided by me are correct.

Date: 01-12-2020 Date: 01-12-2020

Place: Place:
Signature/Thumb Impression of the Proposer Signature/Thumb impression of the Life Assured

(Prohibition of Rebates) 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 out 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. 2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees."
SECTION 45 OF THE INSURANCE ACT, 1938 STATES: 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,
i.e. from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later. A policy of life
insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of
the rider to the policy, whichever is later, on the ground of fraud: Provided that 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. 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 adjusted on subsequent proof that the age of the life insured was incorrectly stated in the
proposal. For further details, please refer to the Insurance Act, as amended from time to time.
Disclaimers: IN CASE OF A ULIP POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. Tata AIA Life Insurance Company Limited is only
the name of the Company and any contract bearing the prefix "Tata AIA Life" is only the name of the contract and does not in any way indicate the quality of the contracts, its future prospects
or returns. Premium paid in ULIP is subject to investment risks associated with capital markets & the NAV of the units may go up or down based on the performance of the funds and factors
influencing capital markets and the insured is responsible for his decision. Past performance is not indicative of future results. For more details on risk factors, terms and conditions please read
sales brochure carefully before concluding a sale.

L&C/Advt/2020/Sep/1211/CAF V2

1. Please carry valid Identity card to the medical examination center wherever applicable. 2. For cash payment, please visit our nearest Tata AIA Life branch. Please do not handover cash to
Agent. If handed over to the agent, the company will not be liable for any loss. 3. In case there is any change in the particulars given above including Life Assured/Proposer's health and/or
medical and/or financial and/or occupational status and/or being charged with and/or arrested for any criminal offence after the date of proposal but before risk acceptance by the company;
please inform the company. 4. Acceptance of premium does not constitute risk commencement. 5. Risk commencement starts after the acceptance of risk by the company. 6. Freelook
Period: If you are not satisfied with the terms & conditions/features of the policy, you have the right to cancel the Policy by providing written notice to the Company and receive the premiums
after deducting a) Proportionate risk premium for theperiod on cover & b) Stamp duty and medical examination costs including applicable taxes, cesses & levies, which have been incurred
for issuing the Policy. Such notice must be signed by you and received directly by the Company within 15 days from the date of receipt of the policy document by you or person authorized by
you. The said period of 15 days shall stand extended to 30 days, if the policy sourced through distance marketing mode which includes solicitation through any means of communication
other than in person. For Unit Linked Life Insurance products, you would receive the non - allocated premiums plus charges levied by cancellation of units plus fund value at the date of
cancellation and after deducting the charges as mentioned in (a) & (b) above.

Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110 CIN: U66010MH2000PLC128403). Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park,
Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under
a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor/ Intermediary or visit Tata AIA Life's nearest branch office or call 1-
860-266-9966 (local charges apply) or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com.

C197802357 Page 23 of 32
 Proposal No: 8812330113653

Name of the Prospect/Policyholder : Ms. KHUSHBU SHISHODIYA Name of the Product : Tata AIA Life Insurance Diamond Savings
Plan
Age (Years) : 36 Gender: Female
Tag Line : Non-Linked Participating Individual Life
Insurance Savings Plan
Name of the Life Assured : Ms. KHUSHBU SHISHODIYA
Unique Identification No.: 110N133V02
Age (Years) : 36 Gender: Female
GST Rate: 4.5%
Policy Term (Years) : 15
I am red I am red
Premium Payment Term (Years) : 5

Amount of Instalment Premium (Rs.) 52250

: I am red I am red

Mode of Payment of Premium : Annual

Assured Benefit : 214611

How to read and understand this benefit illustration?

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rate of interest i.e., 8% p.a. and 4% p.a.
Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. If
your policy offers guaranteed benefits then these will be clearly marked "guaranteed" in the illustration table on this page. If your policy offers variable benefits
then the illustration on this page will show two different rates of assumed future investment returns, of 8% p.a. and 4% p.a. These assumed rates of return are
not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependant on a number of factors including
future investment performance.

Policy Details
Policy Option NA Basic Sum Assured Rs. 550000

Bonus Type Compound Reversionary Bonus Sum Assured on Death (at inception of the policy) Rs. 550000

Rider Details
Rider Name (Benefit Option) UIN Sum Assured (Rs.) Term (Years) Premium Payment Term (Years) Premium without GST (Rs.)

Total Benefit Summary

Benefits @ 4% Benefits @ 8%

Total Guaranteed Income payable (A) 214611 214611

Non-Guaranteed Compound Reversionary Bonus payable at Maturity (B) 0 91692
Non-Guaranteed Terminal Bonus payable at Maturity (C) 64383 90137

Total Benefit (including Guaranteed and Non-Guaranteed Benefits) payable (A + B + C) 278994 396440

Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST (Rs.) 50000 0 50000

Instalment Premium with First year GST (Rs.) 52250 0 52250

Instalment Premium with GST 2nd year onwards (Rs.) 51125 0 51125

C197802357 Page 24 of 32
 (Amount in Rupees)

Total Benefits
Non - Guaranteed Benefits Non - Guaranteed Benefits
Guaranteed Benefits including Guaranteed and Non Guaranteed
@4% p.a. @8% p.a.
Benefits
Maturity Benefit Death Benefit

Single/ Total Total Total Total

Policy Maturity Maturity Death Death
Annualized Survival
Year Benefit, Benefit, Benefit, Benefit,
Premium Guaranteed Benefit Surrender Death Maturity Reversionary Cash Surrender Reversionary Cash Surrender incl incl incl of incl of
Additions (Guaranteed Benefit Benefit Benefit Bonus Bonus Benefit Bonus Bonus Benefit Terminal Terminal Terminal Terminal
income) Bonus, Bonus, Bonus, Bonus,
if any if any if any if any
@4% @8% @4% @8%
(7+8+9) (7+11+12) (6+8+9) (6+11+12)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

1 50000 NA 0 0 550000 0 0 NA 0 5151 NA 0 0 0 550000 550000

2 50000 NA 0 30000 550000 0 0 NA 40347 10425 NA 45247 0 0 550000 555151

3 50000 NA 0 52500 550000 0 0 NA 64383 15826 NA 72296 0 0 550000 560425

4 50000 NA 0 100000 550000 0 0 NA 92133 21356 NA 103451 0 0 550000 565826

5 50000 NA 0 125000 550000 0 0 NA 206713 27020 NA 224248 0 0 552146 573502

6 0 NA 21461 125000 550000 0 0 NA 206391 32819 NA 232085 0 0 704520 735832

7 0 NA 21461 103539 550000 0 0 NA 193343 38757 NA 228576 0 0 685205 728754

8 0 NA 21461 97078 550000 0 0 NA 179737 44838 NA 224157 0 0 663744 719670

9 0 NA 21461 88117 550000 0 0 NA 166087 51065 NA 219104 0 0 646575 712874

10 0 NA 21461 81656 550000 0 0 NA 151301 57441 NA 215306 0 0 633698 708370

11 0 NA 21461 75195 550000 0 0 NA 137330 63970 NA 209906 0 0 622968 708308

12 0 NA 21461 68733 550000 0 0 NA 120783 70656 NA 203570 0 0 616529 708399

13 0 NA 21461 59772 550000 0 0 NA 105052 77502 NA 195040 0 0 607945 706500

14 0 NA 21461 53311 550000 0 0 NA 88763 84513 NA 188379 0 0 603653 704762

15 0 NA 21461 0 550000 0 0 NA 0 91692 NA 0 85844 203290 601507 707481

Note: Annualized premium excludes underwriting extra premium, frequency loadings on premiums, the premium paid towards the riders, if any, and Goods and
Services Tax. Refer Sales literature for explanation of terms used in the illustration.

I _____________________________________(name), have I _____________________________________(name), having received the

explained the premiums and benefits under the product fully to the information with respect to the above, have understood the above statement before
prospect / policyholder. entering into the contract.

Place: i am red
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect/ Policyholder

Unique Reference Number - L&C/Advt/2019/Nov/741

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013
Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license.
For more information, Call the Tata AIA Life Insurance Company Ltd Helpline number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com or
SMS 'LIFE' to 58888

(I)V.87.00/FY2020-2021_Q3/RELEASE 01-10-20/EXPIRY 31-12-2020 01-12-2020,10:37 AM

C197802357 Page 25 of 32
C197802357 Page 26 of 32
C197802357 Page 27 of 32
C197802357 Page 28 of 32
C197802357 Page 29 of 32
C197802357 Page 30 of 32
 FIRST PREMIUM RECEIPT

C197802357
Insured Name : KHUSHBU SHISHODIYA Policy No. : C197802357

Policyowner : KHUSHBU SHISHODIYA Receipt date : 2020/12/02

Name
Agent/Broker code : 004000629
Address :
30 AZAD MOHALLA
Agent/Broker Name : BLUECHIP INSURANCE
BIJAINAGAR
AJMER BROKING PRIVATE LTD
AJMER
AJMER 305624
RAJASTHAN, INDIA Office Code : MU01
Payment Mode : ANNUAL Payment Method : CASH/CHEQUE

Basic Plan Name : Tata AIA Life Insurance Diamond Modal premium : (`) 50000.00
Savings Plan
(110N133V02)
Taxes, Cesses & Levies : (`) 2,250.00

Amount Received : (`)52,250.00 Amount Due : (`) 52250.00

Receipt No. Date Amount (`)

PN0320090 2020/12/01 52,250.00

Next Premium Due on : 2021/12/02

Excess as on Date(if any) : (`) 0.00

Tax benef ts** on life Insurance Policies are available u/s 80C, on Pension u/s 80CCC & Health Policies / Health Riders u/s 80D of
Income tax Act, 1961.
Tax benef t u/s 80D is not available for premium payment in cash.
Tax benef ts u/s 80CCC and 80D are not available for premium payment through automatic loans from Cash Value of the policy if any,
as per the policy provisions

* All taxes, duties, surcharge, cesses or levies, (including but not limited to Taxes, Cesses & Levies and TDS), as may be imposed by Government or any
statutory authority from time to time, on the premiums payable and benifits secure under Policy, Shall beborne and paid by the Policyholder.

Pan Number: AABCT3784C

Category of Service: Life Insurance Service and / or Management of investment under ULIP Services

** Income Tax benef ts would be available as per the prevailing income tax laws, subject to fulf llment of conditions stipulated therein.
Tata AIA Life Insurance Company Ltd. does not assume responsibility on tax implication mentioned anywhere in this document.
Please consult your own tax consultant to know the tax benef ts available to you.

Consolidated Revenue stamp duty paid: Notification No. Mudrank – CSD/179/2019/4939, dated 16th October,
2019 vide receipt number MH006751891201920M dated on 26th September, 2019.

Tata AIA Life Insurance Company Ltd (IRDA of India Regn.No.110) (CIN - U66010MH2000PLC128403)
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.
C197802357 Page 31 of 32
C197802357 Page 32 of 32