Life Insurance Corporation of India

INSURANCE PREMIUM CALCULATOR

Insurance Terms
DATE OF BIRTH (DD-MM-YYY 5/31/1986
LOAN AMOUNT * ₹ 600,000.00
LOAN TERM (In yrs) * 5
INSURANCE SCHEME * GCLI
Result & Summary
AGE OF THE BORROWER (in Y 38 yrs
PREMIUM (in Rs.) 4,140.00
SERVICE TAX (in Rs.) 745.20
TOTAL (in Rs.) 4,885.00
INSURANCE FACTOR 6.90
Designed By : S.Nag, BM(P&GS),Agartala Hub
ENROLLMENT FORM & CUSTOMER COPY DETAILS
1. NAME OF THE BRANCH ammmm
2. DATE OF ENTRY (DD-MM-YYYY) 9/21/2018
3. NAME OF THE BORROWER / INSURED Mr.
4. NAME OF THE FATHER / HUSBAND Mr.
5. RESIDENTIAL ADDRESS

6. SAVINGS A/C NO. 8029012111896

7. LOAN A/C NO. 8029302805656
8. MOBILE NO. 9774213303
9. NOMINEE NAME Mrs.
10. NOMINEE RELATIONSHIP MOTHER
11. NAME OF THE CO-BORROWER-1 (IF ANY) Mr.
12. NAME OF THE CO-BORROWER-2 (IF ANY) SELECT
13. GMRA UNIQUE ID GMRA1463217
14. TYPE OF LOAN HBL
IF OTHERS, PLEASE SPECIFY THE TYPE
15. RATE OF INTEREST 11.00%
16. POLICY TERM (in years) 15
17. LOAN PERIOD (in months) 60 m
18. LOAN AMOUNT ₹ 600,
19. LOAN EMI ₹ 13,
20. DATE OF BIRTH 5/3
21. SCHEME OPTED FOR
22. TABULAR FACTOR
23. INSURANCE PREMIUM ₹ 4,
24. SERVICE TAX @ 15% ₹
25. TOTAL PREMIUM AMOUNT ₹ 4,
OPY DETAILS

13
13
10

60 months
₹ 600,000.00
₹ 13,045.00
5/31/1986
GCLI
6.90
₹ 4,140.00
₹ 745.20
₹ 4,885.00
 Consent Letter for LIC’s Single Premium Group Insurance
(UIN: 512N298V01) Annexure-V

(For Lender-Borrower Groups)

The Branch Manager For office use only
Tripura Gramin Bank Date of Entry : 9/21/2018
ammmm Branch GMRA Unique ID : GMRA1463217
(note during Finacle entry)
LIC ID :
Sir/Madam, (to be obtained from HO)
Re: Application for membership of GCLI/SPGI/UWP group insurance scheme

1. I, Sri/Smt. availing a HBL loan from

your institution, obtained a sanction for availing the same loan, hereby give my consent to become a member of the Life Insurance
Corporation of India Group Credit Life / Single Premium Group Insurance/ UWP Group Insurance Scheme (Strike out whichever is not
applicable), which will be administered by Tripura Gramin Bank Lender as Master Policy Holder.

My details are as below:

Name of Applicant (Borrower) (in capitals):

Date of Birth : 5/31/1986 (DD-MM-YYYY)
Age (nearer Birthday) as on date: 38 years (more than six month will be taken as 1 year)
Loan Availed / Outstanding as on date: Rs. 600,000.00 EMI Rs. 13,045.00
Rate of Interest: 11.00% Loan Term : 5 years.

Single Premium Amount Calculation:

i. Scheme Opted for: GCLI (GCLI <5-35yrs; Rs. 4Lac to no limit AND SPGI<2-7yrs;Rs. 5000 to 10lac
AND UWP < 1 yr; Rs.5000 to 25000)
ii. Total Sum assured: Rs. 600,000.00 (reducing/fixed) Policy Term: 15 years

iii. Tabular factor per thousand as per scheme: 6.9 (select from right table)
iv
. a) Single Premium : Rs. 4,140.00
b) Service tax @15% : Rs. 745.20

v. Total Payable amount : Rs. 4,885.00

** For UWP net payable premium is Rs.100/- including service tax

I hereby authorise you to debit my Loan / SB account No. 8029012111896 a sum of. Rs. 4,885.00
with your ammmm branch towards the one time single premium.

* Please include the premium amount as part of the housing loan amount and fix up the Equated Monthly Instalments(EMIs)
accordingly and debit the premium to my housing loan account. (Option for new housing loan members only)
* - Strike out which ever is not applicable.

3. I agree that in the event of my unfortunate demise during the pendency of the loan, Life Insurance Corporation of India
(Corporation) will be sole authority to consider the claim. Corporation may settle the claim amount as per their rules to the
extent of the outstanding loan balance as on the date of death, in favour of the Lender. These benefits will be utilized
towards the liquidation of the loan amount under the housing loan provided by the Lender. In the event of any surplus
arising out of the benefits settled by Corporation after liquidating the outstanding amount,I nominate
who is my MOTHER (relationship) as the
nominee to receive such surplus amount.
4. I agree to pay the full premium at inception even though the full loan amount will be disbursed by the Lender only in
phases.
5
5. I agree to abide by the terms and conditions of the above scheme.

6. I agree to your conveying the above particulars regarding my admission into the group insurance scheme to LIC of India.

7. Declaration : I, hereby declare that I am in sound

health and amnot suffering or have suffered from any critical illness or condition requiring medical treatment, as on date. (The applicants
should not have suffered or be suffering from cancer, AIDS, condition requiring open chest surgery, history of typical chest pain, kidney
failure, brain stroke or paralysis, hypertension, diabetes/raised blood sugar, liver failure, mental illness or having undergone a major
organ transplantation such as heart, lung liver or kidney. If the applicant had suffered or is suffering from any of the above critical illness,
he/she is not eligible to join the scheme). Corporation will be within its rights to repudiate the claim in case the information given by me
in this regard is found to be untrue.

I, also hereby declare that the above statements are true in all respects and that I agree and declare that the above information shall
form the basis for admission to the above scheme and that if any information is found to be untrue, my membership to the scheme shall
be treated as cancelled from my date of joining the scheme and all claims to any benefit in virtue hereof shall be subject to the
provisions of Section 45 of the Insurance Laws (Amendment) Act, 2015 as amended from time to time.

Dated at ammmm on the 21th of September/18

Signature of the applicant (Borrower):

Name of the applicant (Borrower) :
Father’s/Husband’s name :
Residential Address :

Telephone/Mobile No. : 9774213303

I certify that I have read and understood the contents of the above form. I certify that the contents of this form have been fully
explained to me by and I have understood the significance of the
contract.

Witness :
Signature :
Name & Address :
Signature or thumb impression of the applicant (Borrower)

To be filled in case of thumb impression / vernacular signature:

I hereby declare that I have explained the above contents of this form to the applicants in language and I have
truthfully recorded the information given by the applicant. I also declare that the applicant has suffixed / affixed the
thumb impression above after fully understanding the contents thereof.

Signature of the declarant :

Name :
Residential Address :
Residential Phone No. :
Mobile No. :

No Objection Certificate from co-borrowers (if any):

I / We, 1. 2.
donot have any objection to
a) Joining the Single Premium Group Insurance Scheme mentioned above and
b) One time single premium being debited to the loan Account.
Name of the co-borrower Signature of the co-borrower

Name of the co-borrower Signature of the co-borrower

 TRIPURA GRAMIN BANK
HEAD OFFICE: ABHOYNAGAR, AGARTALA, WEST TRIPURA
ammmm BRANCH

(This copy is required during claim of the insurance)

To

Re: Certification of insurance under Group insurance scheme of LICI

Madam/Sir,

We have rececived your consent letter for insurance for your Loan Account No. 8029302805656
and we have deducted Rs. 4,885.00
as premium including service tax.

Name of the Scheme : GCLI

Sum assured: Rs. 600,000.00

(SA is reduced balance of a completed year as per credit schedule of the loan)

Term of insurance: 15 years

Nominee Name :
GMRA unique Id : GMRA1463217
Enrollment to the scheme will be finalised by LICI.
Eligible for claim after 45 days upto end of term. Claim is subjected to other terms and conditions as
set by insurer from time to time.
In case of claim, settled amount is not related to outstanding balance of the loan.
Other terms and conditions, Operational Guidelines etc are as circulated by Life Insurance Corporaton
of India in accordance with IRDA guidelines

Authorised Bank Official

Tripura Gramin Bank
TERM 5 6 7 8 9 10 11 12 13
18 4.90 5.70 6.45 7.20 7.95 8.70 9.40 10.10 10.75
19 5.00 5.80 6.55 7.30 8.05 8.80 9.50 10.20 10.90
20 5.05 5.85 6.65 7.40 8.15 8.90 9.60 10.30 11.00
21 5.10 5.90 6.70 7.45 8.20 8.95 9.70 10.40 11.10
22 5.15 5.95 6.75 7.50 8.30 9.00 9.75 10.50 11.20
23 5.20 6.00 6.80 7.55 8.35 9.10 9.80 10.55 11.30
24 5.20 6.00 6.80 7.60 8.40 9.15 9.90 10.65 11.35
25 5.25 6.05 6.85 7.65 8.45 9.20 9.95 10.75 11.50
26 5.25 6.10 6.90 7.70 8.50 9.30 10.05 10.85 11.60
27 5.30 6.15 6.95 7.75 8.60 9.40 10.20 11.00 11.80
28 5.35 6.20 7.05 7.85 8.70 9.50 10.35 11.15 12.00
29 5.40 6.25 7.10 7.95 8.80 9.65 10.50 11.35 12.20
30 5.45 6.35 7.20 8.10 9.00 9.85 10.75 11.60 12.50
31 5.55 6.45 7.35 8.25 9.15 10.10 11.00 11.90 12.85
32 5.65 6.60 7.50 8.45 9.40 10.35 11.30 12.25 13.25
33 5.80 6.75 7.70 8.70 9.65 10.65 11.65 12.70 13.70
34 5.95 6.95 7.95 8.95 10.00 11.05 12.10 13.15 14.25
35 6.15 7.15 8.20 9.30 10.35 11.45 12.60 13.70 14.90
36 6.35 7.45 8.55 9.65 10.80 11.95 13.15 14.35 15.65
37 6.60 7.75 8.90 10.10 11.30 12.55 13.80 15.10 16.50
38 6.90 8.10 9.30 10.55 11.85 13.20 14.55 16.00 17.45
39 7.20 8.50 9.80 11.15 12.50 13.95 15.45 16.95 18.55
40 7.60 8.95 10.35 11.80 13.30 14.85 16.45 18.10 19.80
41 8.00 9.50 11.00 12.55 14.15 15.85 17.55 19.35 21.25
42 8.55 10.10 11.70 13.40 15.15 17.00 18.85 20.80 22.80
43 9.10 10.80 12.55 14.40 16.30 18.25 20.30 22.40 24.60
44 9.80 11.60 13.55 15.50 17.60 19.70 21.95 24.20 26.55
45 10.55 12.55 14.65 16.80 19.00 21.35 23.70 26.15 28.70
46 11.40 13.60 15.85 18.20 20.60 23.10 25.65 28.30 31.00
47 12.40 14.75 17.20 19.70 22.30 25.00 27.75 30.60 33.45
48 13.45 16.00 18.65 21.35 24.15 27.05 30.00 33.05 36.10
49 14.60 17.35 20.20 23.15 26.15 29.25 32.40 35.60 38.90
50 15.80 18.80 21.85 25.00 28.20 31.50 34.90 38.35 41.85
51 17.10 20.30 23.55 26.95 30.40 33.90 37.50 41.20 44.95
52 18.45 21.85 25.35 28.95 32.65 36.40 40.25 44.15 48.20
53 19.85 23.50 27.25 31.05 35.00 39.00 43.10 47.30
54 21.25 25.15 29.15 33.25 37.45 41.75 46.10
55 22.75 26.90 31.20 35.55 40.05 44.60
56 24.35 28.75 33.30 38.00 42.75
57 26.00 30.70 35.60 40.55
58 27.75 32.80 38.00
59 29.65 35.05
60 31.70
 14 15 16 17 18 19 20 21 22 23
11.45 12.10 12.75 13.35 14.00 14.60 15.20 15.80 16.40 16.95
11.55 12.25 12.90 13.55 14.15 14.80 15.40 16.00 16.60 17.20
11.70 12.35 13.00 13.65 14.30 14.95 15.60 16.20 16.85 17.45
11.80 12.45 13.15 13.80 14.45 15.10 15.75 16.40 17.05 17.70
11.90 12.60 13.25 13.95 14.60 15.30 15.95 16.65 17.30 17.95
12.00 12.70 13.40 14.10 14.80 15.50 16.15 16.85 17.55 18.25
12.10 12.85 13.55 14.25 15.00 15.70 16.40 17.15 17.85 18.60
12.25 12.95 13.70 14.45 15.2 15.95 16.70 17.45 18.25 19.00
12.40 13.15 13.90 14.70 15.45 16.25 17.05 17.85 18.65 19.45
12.55 13.35 14.15 14.95 15.80 16.60 17.45 18.30 19.15 20.00
12.80 13.65 14.45 15.30 16.15 17.00 17.90 18.80 19.70 20.65
13.05 13.95 14.80 15.70 16.60 17.50 18.45 19.40 20.40 21.40
13.40 14.30 15.25 16.15 17.15 18.10 19.10 20.15 21.20 22.25
13.80 14.75 15.70 16.70 17.75 18.80 19.85 20.95 22.10 23.25
14.25 15.25 16.30 17.35 18.45 19.60 20.75 21.90 23.15 24.40
14.75 15.85 16.95 18.10 19.30 20.50 21.75 23.00 24.35 25.70
15.40 16.55 17.75 18.95 20.25 21.55 22.90 24.25 25.70 27.15
16.10 17.35 18.65 19.95 21.35 22.75 24.20 25.65 27.20 28.75
16.95 18.30 19.65 21.10 22.55 24.10 25.65 27.25 28.90 30.55
17.90 19.35 20.85 22.35 23.95 25.60 27.30 29.00 30.75 32.55
18.95 20.55 22.15 23.80 25.55 27.30 29.10 30.95 32.85 34.75
20.20 21.90 23.65 25.45 27.30 29.20 31.10 33.10 35.10 37.15
21.60 23.40 25.30 27.25 29.25 31.25 33.35 35.45 37.60 39.80
23.15 25.15 27.15 29.25 31.40 33.55 35.80 38.05 40.35 42.70
24.90 27.00 29.20 31.45 33.75 36.05 38.45 40.90 43.35 45.85
26.80 29.10 31.45 33.85 36.30 38.80 41.35 43.95 46.55
28.95 31.40 33.90 36.50 39.10 41.80 44.50 47.25
31.25 33.90 36.60 39.35 42.15 45.00 47.90
33.75 36.55 39.45 42.40 45.35 48.40
36.45 39.45 42.50 45.65 48.85
39.25 42.50 45.75 49.10
42.30 45.70 49.20
45.45 49.10
48.80
 24 25 26 27 28 29 30 31 32 33
17.55 18.15 18.70 19.30 19.85 20.45 21.00 21.60 22.20 22.80
17.80 18.40 19.00 19.60 20.20 20.80 21.45 22.05 22.70 23.30
18.05 18.70 19.30 19.95 20.60 21.20 21.85 22.55 23.20 23.90
18.35 19.00 19.65 20.30 20.95 21.65 22.35 23.05 23.75 24.50
18.65 19.30 20.00 20.70 21.40 22.15 22.85 23.60 24.40 25.15
18.95 19.70 20.40 21.15 21.90 22.70 23.45 24.25 25.10 25.90
19.35 20.10 20.90 21.65 22.50 23.30 24.15 25.00 25.85 26.75
19.80 20.60 21.45 22.25 23.15 24.00 24.90 25.85 26.75 27.70
20.30 21.20 22.05 22.95 23.90 24.80 25.80 26.75 27.75 28.80
20.90 21.85 22.80 23.75 24.75 25.75 26.80 27.85 28.90 30.00
21.65 22.60 23.65 24.65 25.75 26.85 27.90 29.05 30.20 31.35
22.45 23.50 24.60 25.70 26.85 28.10 29.20 30.40 31.60 32.85
23.40 24.55 25.70 26.90 28.10 29.55 30.60 31.90 33.20 34.55
24.45 25.70 26.95 28.25 29.55 31.15 32.20 33.60 35.00 36.40
25.70 27.00 28.35 29.75 31.15 32.90 34.00 35.45 36.95 38.45
27.05 28.50 29.95 31.40 32.90 34.85 35.95 37.55 39.10
28.60 30.15 31.70 33.25 34.85 37.00 38.15 39.80
30.35 31.95 33.65 35.30 37.00 39.40 40.50
32.25 34.00 35.75 37.55 39.40 42.00
34.40 36.25 38.15 40.05 42.00
36.70 38.70 40.70 42.75
39.25 41.40 43.55
42.05 44.30
45.10
 34 35
23.40 24.05
24.00 24.65
24.60 25.30
25.25 26.00
25.95 26.75
26.75 27.65
27.65 28.60
28.70 29.65
29.85 30.90
31.10 32.20
32.55 33.75
34.10 35.40
35.90 37.25
37.85
AGE /
2 3 4 5 6 7
TERM
18 3.40 4.80 6.15 7.50 8.75 10.00
19 3.50 4.95 6.30 7.65 8.95 10.15
20 3.60 5.05 6.45 7.80 9.10 10.30
21 3.65 5.10 6.55 7.90 9.20 10.45
22 3.70 5.20 6.60 7.95 9.30 10.55
23 3.75 5.25 6.65 8.05 9.35 10.60
24 3.75 5.25 6.70 8.10 9.40 10.70
25 3.80 5.30 6.75 8.15 9.50 10.80
26 3.80 5.35 6.80 8.20 9.60 10.95
27 3.85 5.35 6.85 8.30 9.70 11.10
28 3.85 5.45 6.95 8.45 9.85 11.30
29 3.90 5.50 7.05 8.60 10.05 11.55
30 3.95 5.60 7.20 8.75 10.30 11.85
31 4.05 5.70 7.35 9.00 10.60 12.20
32 4.10 5.85 7.55 9.25 10.95 12.65
33 4.25 6.05 7.80 9.60 11.35 13.15
34 4.35 5.25 8.10 10.00 11.85 13.75
35 4.50 5.50 8.45 10.45 12.45 14.45
36 4.70 6.80 8.85 10.95 13.10 15.25
37 4.90 7.10 9.35 11.60 13.85 16.20
38 5.15 7.50 9.85 12.30 14.75 17.25
39 5.45 7.95 10.50 13.10 15.75 18.50
40 5.80 8.45 11.20 14.00 16.90 19.90
41 6.15 9.05 12.05 15.10 18.25 21.55
42 6.60 9.75 13.00 16.35 19.85 23.45
43 7.10 10.55 14.10 17.80 21.60 25.60
44 7.70 11.45 15.35 19.40 23.65 28.00
45 8.35 12.50 16.80 21.30 25.90 30.70
46 9.15 13.70 18.45 23.35 28.45 33.65
47 10.05 15.05 20.30 25.65 31.20 36.90
48 11.00 16.55 22.30 28.15 34.20 40.30
49 12.10 18.20 24.45 30.85 37.35 43.95
50 13.25 19.90 26.70 33.65 40.70 47.75
51 14.50 21.75 29.10 36.60 44.15 51.75
52 15.80 23.65 31.60 39.65 47.75 55.85
53 17.15 25.65 34.20 42.80 51.45 60.15
54 18.55 27.70 36.85 46.10 55.35 64.60
55 19.95 29.80 39.65 49.50 59.40 69.80
56 21.45 32.00 42.55 53.10 63.70 74.25
57 23.05 34.30 45.60 56.90 68.25 79.60
58 24.70 36.80 48.90 61.00 73.15 85.30
59 26.45 39.40 52.40 65.45 78.45 0.00
60 28.35 42.30 56.25 70.25 0.00 0.00