.

GROUP LOAN INSURANCE POLICY

. .
. Policy / Certificate No : 0000000039765159
. . Customer ID : 0000000075504694
Name : Mr SUDAONG MOG . Policy Issue Date : 29/06/2024
Address : ,KALMA BAIKHORA, Period of Insurance : From : 20/06/2024 12:55
SANTIR BAZAR,Baikhora, To: 19/06/2026 23:59
South Tripura,South Tripura, Intermediary Name & code : Sbi Santirbazar Adb 6487,
Tripura,799144, 0009122
India. Intermediary Contact Number :
Contact No : +91-9862784137 Loan Account No : 42965522949
Email Id : sudaong@gmail.com Name and Address of : SBI,SANTIR BAZAR
Financial Institution
Dear Mr. SUDAONG MOG .,

Welcome to the SBI General Family. Trust is the foundation of any financial transaction; and a loan is no exception. The entire concept of a loan rests
on good faith - the premise being the loan will be returned on time. However, what if a borrower is unable to return a loan in full due to illness,
accident .

We are hereby enclosing the following documents pertaining to your policy that outline the details of risk and cover as proposed by you.
• The Key Feature • Policy schedule • QR Code for Policy Wording

This is where SBI General's Group Loan Insurance Policy can assist you. Designed to reduce financial burden of borrowers, this policy pays off the
loan in case the borrowers face any unfortunate events or accidents. Critical illness and Personal Accident are the two events covered by this policy.

We request you to verify and confirm that these documents are in order. Please ensure safety of these documents as they form part of our contract
with you. For all your future correspondence with us, kindly quote your Customer ID and Policy No mentioned above. In case of any queries or
suggestions, please do not hesitate to get in touch with us. You can contact us at customer.care@sbigeneral.in or call our Customer Care Number
1800-102-1111.We look forward to a continuing and mutually beneficial relationship.
KEY FEATURE
Details mentioned under are indicated and not exhaustive, for complete details, please refer policy wordings.
Key Benefits of the Policy • Protect both borrowers and lenders in case loan can’t be returned due to
unforeseeable circumstances.
• Personal accident cover with critical illness and hospital admission benefit.
• Policy can be issued for a minimum tenure of 6 months to maximum tenure of 5
years. If the scope of covers includes
Critical illness, the minimum tenure will be 1 year.
• No exit age.
• Tax saving under 80D (If applicable)
• Free look period of 30 days. (Only on first policy)
• Sum Insured available on fixed or reducing basis
What is covered in this Policy? SBI General's Group Loan Insurance Policy offers the following covers -
• Personal Accident
• Critical Illness
• Admission Benefit - Accidental Hospitalization
• Section I : Personal Accident:This Section Covers:
• Accidental Death
• Permanent Total Disability
• Funeral Expenses
Table of Benefits for Permanent Total Disability:
Table Of Benefits
Permanent Total Disability % of Sum Insured
Both Hands or Both Feet 100%
Sight of Both Eyes 100%
One Hand and One Foot 100%
Either Hand or Foot and Sight of One Eye 100%
Speech and Hearing in Both Ears 100%
Either Hand or Foot 50%
Sight of One Eye 50%
Speech or Hearing in Both Ears 50%
Hearing in One Ear 25%
Thumb and Index Finger of Same Hand 25%

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 SBI-Platinum

• Section ll:Critical lllness:

This section Provided the coverage against the 15 Critical Illnesses Listed below:
• Cancer of specific severity
• Myocardial Infarction (First Heart Attack of Specific Severity)
• Open Chest CABG
• Open Heart Replacement or Repair of Heart Valves
• Coma of Specified Severity
• Kidney Failure Requiring Regular Dialysis
• Stroke Resulting in Permanent Symptoms
• Major Organ/ Bone Marrow Transplant
• Permanent Paralysis of Limbs
• Multiple Sclerosis with Persisting Symptoms
• Blindness
• Primary (Idiopathic) Pulmonary Hypertension
• Aorta Graft Surgery
• Benign Brain Tumor
• Motor Neurone Disease with Permanent Symptoms
Incidental Benefit:
If claim is accepted under Section II. Critical Illness then additional amount towards
incidental expenses as lumpsum payment is payable.
• Section lll:Admission Benefit - Accidental Hospitalization
• 3 EMIs payable if the insured is hospitalized for minimum period of 48 hours
due to accidental Injury.
What is Not covered in this • Exclusion:
Policy? • Any Pre-existing condition, or its related conditions arising from it will 48 months from the date
of inception of policy except any condition as a result of accident.
• Breach of law with criminal intent
• self-destruction or self-inflicted injury, attempted suicide or suicide.
• Nuclear perils; ionising radiations
• Participation in an actual or attempted felony, riot, crime, misdemeanour, or civil commotion
• Specific Exclusions:
Specific Exclusions Applicable to SECTION I:
• Payment of compensation in respect of death arising from or resulting directly from any Illness
to any Insured.
• Specific Exclusions Applicable to SECTION II:
• Any Critical Illness or covered Disease/Illness/Sickness of which, the signs or symptoms first
occurred within ninety (90) days following the first risk inception date. This 90 days period shall
not be applicable on renewals to the extent of sum insured under the previous policy.
• Any Critical Illness resulting from a physical condition which existed prior to first risk inception
date which was not disclosed.
• Any claim under for any Insured if the Insured does not survive a period of at least 28 days after
the date of occurrence Insured Event.
• Specific Exclusion applicable to SECTION III:
• Any stay in Hospital for an Illness or Injury due to Accident without undertaking any treatment.
• Aesthetic treatment, cosmetic surgery and plastic surgery unless necessitated due to Accident or
as a part of any Injury.
• Any admission for any dental treatment except any dental Surgery or facial reconstruction being
performed under Emergency Care due to an Accident.
• Hospitalization for the sole purpose of traction, physiotherapy or any ailment for which
Hospitalization is not warranted due to advancement in medical technology.
• Any treatment taken for Domiciliary Hospitalization.
#This is an indicative list of exclusions, please refer policy wording for detail list

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Age Limit • Minimum entry age is 18 years & Maximum entry age is 65 years
• You will be allowed a free look period of at least 30 days from the date of receipt of the
Free look provision policy to review the term and conditions
of the policy and to return the same if not acceptable.
Cancellation • The policy may be cancelled by us after giving you a 15-day notice period by recorded
delivery. This can be done in cases of misrepresentation, fraud or non-disclosure of
material facts. Premium will not be refunded in such cases.
• You can choose to cancel the policy, giving us a 15-day notice period by recorded
delivery. This provided there is no claim under the policy. The insured shall be entitled
for premium refund at the company’s Short Period Scale provided in table below.
Length of time Policy in force Refund of
(% of Annual Premium)
Premium
Up to 1 month 75%
Up to 3 months 50%
Up to 6 months 25%
Exceeding 6 Months 0%

Note: This document contains brief information about the key features of the Product. The same shall not be construed as terms and
conditions of the Policy or oart there of.For detailed terms and conditions governing the Policy, please read all parts of the policy document. In
case of any conflict between the information given in the Key Features document and the terms and conditions of the policy document,the
terms and conditions of the Policy document shall prevail.

Your's Sincerely,

Authorized Signature

POLICY SCHEDULE
Important Note: 1) The Validity of this Certificate of Insurance cum Schedule is subject to realization of the premium cheque. 2) This insurance
policy cover is valid subject to Warranties, Terms and Conditions of the policy.

Policy Servicing Office: Ground Floor,Sriram Plaza,Kerchoumuhani,T G Road, Agartala, Ramnagar, Tripura - 799002,India

Insured Name : Mr SUDAONG MOG . Policy Servicing Branch : Agartala

Group Policy Holders Name
Proposers Name
Date of Birth
Previous policy number if any
PAN/Form 60/61
Date of First Policy
Type of Cover Opted -
ReducingBalance/ Fixed Sum
Insured
Intermediary Address
Appointee (Name &
Relationship), if Nominee is
minor
Address Proof
Names of Co-Borrowers 1
: State Bank of India and Loan
Policy / Certificate Number : 0000000039765159
Borrowers
Period of Insurance : From : 20/06/2024 12:55
: Mr SUDAONG MOG .
To: 19/06/2026 23:59
: 09/08/1984 Group Policy Number : SBI-P-20062024
: Type of Loan : Personal Loan -
: Out Standing Loan Amount : 196,500.00
: 20/06/2024 Equated Monthly Installment : 11,320.00
: Fixed Nominee Name : TITAL MOG .
: Age : 26
: , Relationship : Spouse
: KALMA BAIKHORA,SANTIR GSTIN No :
BAZAR,Baikhora,South
Tripura,South
Tripura,Tripura,India-799144
: SUDAONG MOG .

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 Summary Particulars of Scope of Cover
Details of the Insured along with the Benefits (as per table below)
Sum Insured(To be equally apportioned in case
Section Coverage
of CoBorrowers)
a)Death of the Insured Person on account of an
Accident
Section I Personal Accident : Rs.196,500.00
b)Permanent Total Disablement of the Insured
Person on account ofAccident;
Funeral expenses including
transporting the mortal remains of
Additional Benefit:
the Insured Person from the place Rs.20,000.00
Funeral Expenses
of the Accident or the Hospital to
his residence.
1. Cancer of specific severity
2. Myocardial Infarction (First Heart Attack of
SpecificSeverity)
3. Open Chest CABG
4. Open Heart Replacement or Repair of Heart
Valves
5. Coma of Specified Severity
6. Kidney Failure Requiring Regular Dialysis
7. Stroke Resulting in Permanent Symptoms
8. Major Organ/ Bone Marrow Transplant
Section II Critical Illness : Rs.196,500.00
9. Permanent Paralysis of Limbs
10. Multiple Sclerosis with Persisting
Symptoms
11. Blindness
12. Primary (Idiopathic) Pulmonary
Section III: Admission Benefit-Accidental Hypertension
Hospitalization due to accidental injury for
13. Aorta Graft Surgery 11,320.00
Hospitalization minimum period of 48 Hours
14. Benign Brain Tumor
15. Motor Neurone Disease with Permanent
Symptoms
Lumpsum amount of Rs. 1 Lakh to
Optional
dependent spouse/children or
BenefitBenefit:Incidental Rs.100,000.00
Dependent Parents (if unmarried)
Benefit:
on diagnosis of named critical illnesses
Section III: Admission Benefit-Accidental Hospitalization due to accidental injury for
Rs.11,320.00 per month for 3 months
Hospitalization minimum period of 48 Hours

Addtional Condition - In the event the Sum Insured as appearing against Section I, II & III of the Schedule of the Policy is less than the total of the
actual Loan disbursed upto the date of the occurrence of the Insured Event, then the Amortization Schedule shall be calculated as if the actual Loan
disbursed was equivalent to the Sum Insured. This clause will not apply to Section I and II, if Sum Insured is opted on Fixed Basis

Waiting Periods applicable to different Sections

Section III. Admission Benefit Accidental
Section I. Personal Accident Section II. Critical Illness
Hospitalization
No Waiting Period First 90 days Waiting Period No Waiting Period
Survival Period - 28 days

Additional Conditions, Exclusions, Warranties: Coverage subject to the following additional Conditions and Clauses / Endorsements / Warranties
with reference to the Section that it is applicable to
1. Sum Insured Basis_Fixed
2. Sum Insured Basis_Reducing
3. Survival Period
4. Waiting Period

Additional Conditions, Exclusions, Warranties: Coverage subject to the following additional Conditions and Clauses / Endorsements / Warranties
with reference to the Section that it is applicable to

Insured Person Name Pre-Existing Conditions Special Exclusions Additional Loading if any
SUDAONG MOG . NA NA NA

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Premium Computation
PREMIUM DETAILS
Net Premium 4,233.39
IGST/(SGST/UTGST+CGST)/J&K GST whichever applicable 762.02
Gross Premium 4,995.00
P.S. If premium through cheque,the policy is void ab-initio in case of dishonour of cheque. Consolidated Stamp Duty Rs 0.5 /- paid towards
Insurance Policy Stamps vide Order No.LOA/ENF-2/CSD/21/2024/(Validity Period Dt.25/03/2024 to Dt.24/03/2026)/1609 Date:- 06/03/2024
Dated: 29/06/2024 of General Stamp Office,Mumbai.
For Complete Coverage & Policy Wording. Kindly visit our website - www.sbigeneral.in or pls refer policy document shared with you digitally

Scan to view Customer Details and Proposal Form

For and on behalf of SBI General Insurance

Date : 29/06/2024 Digitally signed by

VISHWANATHAN
Place : Agartala SUBRAMANIAN
Date: 2024.06.29 10:50:04
Authorized Signature

IMPORTANT NOTE
1. All otherterms, conditions as per attached policy wordings.
2. In case of payment by cheque, in the event of dishonor of cheque for any reason whatsover, insurance cover provided under this
document automatically stands cancelled from the irrespective of whether a separate communication is sent or not.
3. Please refer the claims settlements & Grievance Redressal procedure document attached herein for ready references
4. SBIGI does not accept Cash for Premium Payment against the Policy
5. Receipt subject to realization of instrument submitted.
6. Kindly refer the policy document for time of commencement of cover

Declaration
As part of the Go Green initiative, we’ll be issuing this policy in digital mode on your registered mobile number and e-mail ID. We save a tree
when we issue an e-policy. A policy document sent electronically is as valid as a physical policy contract document. Date of delivery of the policy
document is reckoned for the purpose of examining free look request. However, if you need a physical copy of the policy document, please send
SMS “PRINT <Policy Number>” to 561612 from your registered mobile number.

INTIMATING A CLAIM
For Intimating a Claim with us please contact us through the following channels:
Phone: 1800 210 3366 / 1800 210 6366
Email: sbig.health@sbigeneral.in
Facsmile: +91 20 49334525
CLAIM SETTLEMENT
The company will settle the claim under this policy within 30 days from the date if receipt of last necessary document required for assessing the
claim in the event that the company decides to reject a claim made under this Policy, the Company shall do so within a period of thirty days of the
Survey Report or additional Survey report, as the case may be, in accordance with the provision of Protection of Policyholder's Interest Regulations
2017.
GREIVANCES
Redressal of Grievances

Stage 1
If you are dissatisfied with the resolution provided above or for lack of response, you may write to
head.customercare@sbigeneral.in We will look into the matter and decide the same expeditiously within 14
days from the date of receipt of your complaint.
For Senior Citizens: Senior Citizens can reach us at seniorcitizengrievances@sbigeneral.in; Toll Free - 1800 22
1111 / 1800 102 1111 Monday to Saturday (8 am - 8 pm)
Scan the QR code for Terms &
Stage 2
conditions , Key Feature and
In case, you are not satisfied with the decision/resolution communicated by the above office, or have not
Ombudsman List
received any response within 14 days, you may send your Appeal addressed to the Chairman of the Grievance
Redressal Committee at : gro@sbigeneral.in. or contact at: 022-42412070

Address: Grievance Redressal Officer, 9th Floor, A & B Wing, Fulcrum Building, Sahar Road, Andheri (East),
Mumbai 400 099
List of Grievance Redressal Officers at Branch:
https://content.sbigeneral.in/uploads/0449cac1bcd144bbb160d3f6b714fbbd.pdf/

Stage 3
In case, you are not satisfied with the decision/resolution communicated by the above office, or have not
received any response within 14 days, you may Register your complaint with IRDAI on the below given link
https://bimabharosa.irdai.gov.in/Home/Home

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Stage 4
If your grievance remains unresolved from the date of filing your first complaint or is partially resolved, you may
approach the Insurance Ombudsman falling in your jurisdiction for Redressal of your Grievance. The details of
the Insurance Ombudsman can be accessed at https://www.cioins.co.in/Ombudsman

If Your issue remains unresolved You may approach IRDAI by calling on the Toll-Free no. 155255 or You can
register an online complaint on the website http://igms.irda.gov.in

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 PREMIUM CERTIFICATE
(Applicable only for Section II. Critical Illness) Premium certificate for the purpose of deduction under section 80 - (D) of Income Tax (Amendment)
Act, 1986 . Tax benefits are subject to change in tax laws
This is to certify that Mr SUDAONG MOG . has paid Rs 4023.99 towards the premium for Health Insurance for the period from 20/06/2024 12:55
To 19/06/2026 23:59
Policy Number: 0000000039765159
Date: 20/06/2024
Place: Agartala

Authorized Signature

Important Note:
Insurance is a contract of Utmost Good Faith requiring the Insured not only to disclose all information related to his health and which has a bearing
on the acceptance or rejection of the Proposal by the Insurer and also not to suppress any factual information in response to the questions in the
Proposal form. Please examine this Policy including its attached Schedules / Annexure if any. In the event of any discrepancy, contact the office of
the Insurer immediately, it being noted that this Policy shall be otherwise considered as being entirely in order. In case of payment by cheque, in the
event of dishonor of cheque for any reason whatsoever, insurance provided under this document automatically stands cancelled from the inception
of the Policy irrespective of whether a separate communication is sent or not. All terms, conditions and exclusions as per standard Policy wordings
attached with this Schedule

PREMIUM RECEIPT
Branch Office Address: Reference No: 000055219568
SBI General Insurance Company Limited. OF Receipt No: 41342161
Ground Floor, Sriram Plaza, Kerchoumuhani, T G Road, Agartala, Date: 29/06/2024
Ramnagar, Tripura - 799002, India
Branch Code: 00103
Party/Depositor ID: 0000000075504694
Received with thanks from SUDAONG MOG .
an amount of Rs. 4,995.00 (Rupees Four Thousand Nine Hundred and Ninety Five)
by EFT
No: 393158737
Dated : 19/06/2024
Drawn on Bank : STATE BANK
OF INDIA
Branch:
Party ID Quote/Policy/Claim No. Name of Party Amount(Rs.)
0000000075504694 0000000039765159 SUDAONG MOG . 4,995.00

TOTAL 4,995.00

For and on behalf of

SBI General Insurance Co. Ltd.

Authorized Signatory

Eb

Disclaimer: SBI General Insurance Company Limited, Corporate & Registered Office: Fulcrum Building, 9th Floor, A & B Wing, Sahar Road, Andheri (East), Mumbai -
400099. | For more details on the risk factors, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before conducting a sale. | For SBI
General Insurance Company Limited IRDAI Reg. No. 144 dated 15/12/2009 | CIN:U66000MH2009PLC190546 | SBI Logo displayed belongs to State Bank of India and
used by SBI General Insurance Company Limited under license |Group Loan Insurance Policy,UIN: SBIPAGP24073V022324 | SBI General Insurance and SBI are separate
legal entities and SBI is working as Corporate Agent of the company for sourcing of insurance products.
Call (Toll Free) 1800 102 1111 | www.sbigeneral.in
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 GST INVOICE
GST Invoice No: 108975218 GST Invoice Date: 29/06/2024
GST No. (SBI
16AAMCS8857L1ZF SBI General State Tripura
General)
SBI General Branch SBI General Insurance Company Limited
Address: Ground Floor, Sriram Plaza, Kerchoumuhani, T G Road, Agartala, Ramnagar, Tripura - 799002, India
Details of Policy Holder:
Name: SUDAONG MOG .
,KALMA BAIKHORA,SANTIR BAZAR,Baikhora,South Tripura,South Tripura,Tripura,799144,
Address:
India.
Policy Holder State Tripura
GST IN/Unique No Policy Number 0000000039765159
Insurance HSN Code Premium KFC CGST SGST/ UTGST IGST
Product (without Rate Amount Rate Amount Rate Amount Rate Amount
Name Taxes)
Group Loan
4,233.39 1% 0.00 9.00% 381.01 9.00% 381.01 0.00% 0.00
Insurance

Total Invoice
Value (In 4,995.00
Figures)

Taxes Applicable 762.02 Authorized Signatory

“I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate
turnover notified under sub-rule (4) of rule 48, we are not required to prepare e-invoice in view of exemption provided to insurance companies
under Notification no. 13/2020-Central Tax dated March 21, 2020"

Disclaimer: SBI General Insurance Company Limited, Corporate & Registered Office: Fulcrum Building, 9th Floor, A & B Wing, Sahar Road, Andheri (East), Mumbai -
400099. | For more details on the risk factors, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before conducting a sale. | For SBI
General Insurance Company Limited IRDAI Reg. No. 144 dated 15/12/2009 | CIN:U66000MH2009PLC190546 | SBI Logo displayed belongs to State Bank of India and
used by SBI General Insurance Company Limited under license |Group Loan Insurance Policy,UIN: SBIPAGP24073V022324 | SBI General Insurance and SBI are separate
legal entities and SBI is working as Corporate Agent of the company for sourcing of insurance products.
Call (Toll Free) 1800 102 1111 | www.sbigeneral.in
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