Date: - 12-01-2024

Speed Post
BNPL Code-CCU-064-049
MBC,Bidhan Nagar,CC Block

jGV^Ck i&8d@Pe*/ k

7013308593 EW663031779IN
97/180_East_780

To,
Mr. Pijush Rana
Member ID : 630531542
BAGNAN
N D BLOCK BERABERIA PASCHIM NR ADARSHA SCHOOL
Master Policy No : 70000018311
HOWRAH
WEST BENGAL 711303
Product Name : SBI Life - RiNn Raksha
Contact Details : 9732869691
Father's Name : Kartick Chandra Rana
UIN : 111N078V03

Dear Mr. Pijush Rana,

We welcome you to the SBI Life family and thank you for your trust in our products.

Joining SBI Life family will give you access to best customer service and wide range of products which cater to most of your life insurance needs. We have
enclosed the Certificate of Insurance & First Premium Receipt along with copy of Membership Form signed by you in this booklet. You are requested to refer
to the Certificate of Insurance for details on the insurance contract. Kindly check all details and make sure that it is kept safely.

This is a group credit life insurance plan, which provides protection on death of the life assured during the term of the policy. The benefit under the
policy helps in repayment of the outstanding loan.

Please note this is a Single Premium premium payment insurance cover. NA

For any information/ clarification, please contact:

1. Your local SBI Life service branch:

SBI LIFE INSURANCE CO LTD 168, GROUND FLOOR, GT ROAD SOUTH PANCHWATI APARTMENT, HOWRAH WEST BENGAL India
711102

2. SBI Thalia SBI Thalia P.S. AMTA HOWRAH HOWRAH WEST BENGAL 711401

3. Call us toll free at our customer service helpline 18002679090 or email us at [email protected]. You can also visit us at www.sbilife.co.in

4. All your servicing requests should be submitted to your local SBI Life service branch as mentioned above or nearest SBI Life branch only.

Free Look Option

You can review the terms and conditions of the insurance contract within 15 days from the date of receipt of this Certificate of Insurance. In case you are not
satisfied or disagree with any of the terms and conditions, you have the option to return the Certificate of Insurance stating the reasons for your objection.
Any such request should come through the Master Policyholder.

Your request for cancellation of the insurance contract under the free look option must reach our SBI Life office within a period of 15 days as mentioned
above.

We always look forward to be your preferred Life Insurance Company for all your Life Insurance needs.

Yours truly,

Authorised Signatory
New Business Processing

Signature Not Verified

This Policy Document is digitally signed for SBI Life Insurance

Signer: Gannavarapu Adinarayana Prasad Rao

Date: Friday,Jan 12 2024 05:19 PM
Location: Navi Mumbai
Reason:
Policy Encryption

97/180_East_780 Page 1 of 28 PolicyNo. 7013308593

97/180_East_780 Page 2 of 28 PolicyNo. 7013308593
 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

SBI Life - RiNn Raksha (UIN: 111N078V03)

Group Non-Linked Non-Participating Credit Life Insurance Plan
Certificate of Insurance
jGV^Ck

7013308593

BENGAL RO/ 00/ STATE BANK OF INDIA /Thalia/64100

Member : Mr. Pijush Rana

Address : BAGNAN
N D BLOCK BERABERIA PASCHIM NR ADARSHA SCHOOL

HOWRAH
WEST BENGAL-711303
Contact Number : 9732869691

Schedule of Benefits
Scheme & Life Assured Details t
Life Insurance Cover Details
Scheme Type : Voluntary Initial Sum Assured : Rs. 1872556.00 /-
Please refer schedule of outstanding
COI Issuance Date : 11-01-2024 Death benefit sum assured :
loan, enclosed herewith
Master Policyholder : STATE BANK OF INDIA Insurance Cover Start Date : 11-01-2024
Insurance Cover End Date : 11-01-2036
Master Policy No. : 70000018311
Interest Cover Rate : Between 8.50% to 11.50%
Membership Form No. : 7013308593
Policy Term : 144 Months
Member ID : 630531542 Entire Outstanding Loan Amount
Loan Share to be covered :
check
Membership Form Date : 10-01-2024 Option chosen : NA
Life Assured Name : Mr. Pijush Rana Name of Nominee : Moumita Rana

Date of Birth : 21-12-1975 Date of Birth of Nominee : 08-06-1985

Relationship of Nominee to Life
: Wife
Assured
Name of Appointee : NA
Date of Birth of Appointee : NA
Relationship with Nominee : NA
Master Policy holder to the extend of
Claim payable to :
the Outstanding loan amount

Loan Details Premium Details

Type of borrower : Single Plan Type : Rinn Raksha Series IIISP
Loan Account No. : 42603308677 Premium Payment Mode : Single Premium
Loan Category : RINN HL Premium Payment Term : Single
Date of First Disbursement : 10-01-2024 Due Date Of Last Premium :
Loan Amount : `1800000 /- Premium Amount : `61488.00/-
Loan Term : 144 Month's Applicable Tax : `11068.00 /-
Moratorium Period : NA Total Amount : `72556.00/-
Current Loan Interest Rate : 8.60 %

653
Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

97/180_East_780 Page 3 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

SBI Life Insurance Company Limited is pleased to acknowledge that Mr. Pijush Rana, having his/her loan account with STATE BANK OF INDIA has joined ‘SBI Life
- RiNn Raksha’ plan under which the borrowers are provided life cover for the Sum Assured as per the Sum Assured schedule mentioned in the Annexure, subject to
the terms and conditions contained in the Master Policy Document.

A summary of the key features of the Plan are given overleaf. Please note that this is merely a summary of the terms and conditions of the Plan and that the insurance
cover is strictly governed by the terms and conditions of the Master Policy issued to the Master Policyholder.

Free Look Option:

Where the scheme type is voluntary/ contributory in nature, you can review the terms and conditions of the insurance contract, within 15 days from the date of
receipt of this Certificate of Insurance. In case you are not satisfied or disagree with any of the terms and conditions, you have the option to return the Certificate of
Insurance stating the reason(s) in a letter for objection.

On such cancellation of the member policy, the premium amount will be refunded by us after deducting (i) proportionate risk premium and proportionate taxes &
cess, (ii) expenses incurred towards medical examinations carried out, if any and (iii) expenses towards stamp duty. The Insurance covers granted to the members, if
any, shall automatically be cancelled.

In case if the master policy is cancelled under free look period, the master policyholder shall inform the members about the cancellation of the insurance cover and
the Certificates of Insurance issued, if any, shall automatically stand cancelled.

Certificates of Insurance for all co-borrowers need to be submitted.

We request you to read this Certificate of Insurance (COI) carefully. If you find any errors, please return your Certificate of Insurance (COI) for effecting corrections.

Authorised Signatory
Prasad Rao
VP - New Business (Operations)

653
Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.

97/180_East_780 Page 4 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004
Annexure
Table of Sum Assured Benefits

Sum Assured Sum Assured

Sr No. Month As Sr No. Month As
On Each Month On Each Month
0 11/01/2024 to 10/02/2024 1872556.00 1 11/02/2024 to 10/03/2024 1866471.00
2 11/03/2024 to 10/04/2024 1860327.00 3 11/04/2024 to 10/05/2024 1854124.00
4 11/05/2024 to 10/06/2024 1847862.00 5 11/06/2024 to 10/07/2024 1841540.00
6 11/07/2024 to 10/08/2024 1835157.00 7 11/08/2024 to 10/09/2024 1828713.00
8 11/09/2024 to 10/10/2024 1822207.00 9 11/10/2024 to 10/11/2024 1815639.00
10 11/11/2024 to 10/12/2024 1809008.00 11 11/12/2024 to 10/01/2025 1802314.00
12 11/01/2025 to 10/02/2025 1795555.00 13 11/02/2025 to 10/03/2025 1788732.00
14 11/03/2025 to 10/04/2025 1781843.00 15 11/04/2025 to 10/05/2025 1774888.00
16 11/05/2025 to 10/06/2025 1767867.00 17 11/06/2025 to 10/07/2025 1760778.00
18 11/07/2025 to 10/08/2025 1753621.00 19 11/08/2025 to 10/09/2025 1746396.00
20 11/09/2025 to 10/10/2025 1739101.00 21 11/10/2025 to 10/11/2025 1731737.00
22 11/11/2025 to 10/12/2025 1724302.00 23 11/12/2025 to 10/01/2026 1716796.00
24 11/01/2026 to 10/02/2026 1709218.00 25 11/02/2026 to 10/03/2026 1701567.00
26 11/03/2026 to 10/04/2026 1693843.00 27 11/04/2026 to 10/05/2026 1686045.00
28 11/05/2026 to 10/06/2026 1678172.00 29 11/06/2026 to 10/07/2026 1670224.00
30 11/07/2026 to 10/08/2026 1662199.00 31 11/08/2026 to 10/09/2026 1654098.00
32 11/09/2026 to 10/10/2026 1645919.00 33 11/10/2026 to 10/11/2026 1637662.00
34 11/11/2026 to 10/12/2026 1629325.00 35 11/12/2026 to 10/01/2027 1620909.00
36 11/01/2027 to 10/02/2027 1612412.00 37 11/02/2027 to 10/03/2027 1603833.00
38 11/03/2027 to 10/04/2027 1595172.00 39 11/04/2027 to 10/05/2027 1586428.00
40 11/05/2027 to 10/06/2027 1577600.00 41 11/06/2027 to 10/07/2027 1568688.00
42 11/07/2027 to 10/08/2027 1559690.00 43 11/08/2027 to 10/09/2027 1550606.00
44 11/09/2027 to 10/10/2027 1541435.00 45 11/10/2027 to 10/11/2027 1532176.00
46 11/11/2027 to 10/12/2027 1522829.00 47 11/12/2027 to 10/01/2028 1513392.00
48 11/01/2028 to 10/02/2028 1503865.00 49 11/02/2028 to 10/03/2028 1494246.00
50 11/03/2028 to 10/04/2028 1484535.00 51 11/04/2028 to 10/05/2028 1474731.00
52 11/05/2028 to 10/06/2028 1464833.00 53 11/06/2028 to 10/07/2028 1454840.00
54 11/07/2028 to 10/08/2028 1444751.00 55 11/08/2028 to 10/09/2028 1434566.00
56 11/09/2028 to 10/10/2028 1424283.00 57 11/10/2028 to 10/11/2028 1413902.00
58 11/11/2028 to 10/12/2028 1403421.00 59 11/12/2028 to 10/01/2029 1392840.00
60 11/01/2029 to 10/02/2029 1382157.00 61 11/02/2029 to 10/03/2029 1371372.00
62 11/03/2029 to 10/04/2029 1360484.00 63 11/04/2029 to 10/05/2029 1349491.00
64 11/05/2029 to 10/06/2029 1338393.00 65 11/06/2029 to 10/07/2029 1327188.00
66 11/07/2029 to 10/08/2029 1315876.00 67 11/08/2029 to 10/09/2029 1304456.00
68 11/09/2029 to 10/10/2029 1292926.00 69 11/10/2029 to 10/11/2029 1281286.00
70 11/11/2029 to 10/12/2029 1269534.00 71 11/12/2029 to 10/01/2030 1257670.00
72 11/01/2030 to 10/02/2030 1245692.00 73 11/02/2030 to 10/03/2030 1233599.00
74 11/03/2030 to 10/04/2030 1221390.00 75 11/04/2030 to 10/05/2030 1209064.00
76 11/05/2030 to 10/06/2030 1196620.00 77 11/06/2030 to 10/07/2030 1184057.00
78 11/07/2030 to 10/08/2030 1171373.00 79 11/08/2030 to 10/09/2030 1158568.00
80 11/09/2030 to 10/10/2030 1145640.00 81 11/10/2030 to 10/11/2030 1132588.00
82 11/11/2030 to 10/12/2030 1119411.00 83 11/12/2030 to 10/01/2031 1106108.00
84 11/01/2031 to 10/02/2031 1092677.00 85 11/02/2031 to 10/03/2031 1079118.00
86 11/03/2031 to 10/04/2031 1065429.00 87 11/04/2031 to 10/05/2031 1051609.00
88 11/05/2031 to 10/06/2031 1037656.00 89 11/06/2031 to 10/07/2031 1023569.00

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653 Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

97/180_East_780 Page 5 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004
Annexure
Table of Sum Assured Benefits

Sum Assured Sum Assured

Sr No. Month As Sr No. Month As
On Each Month On Each Month
90 11/07/2031 to 10/08/2031 1009347.00 91 11/08/2031 to 10/09/2031 994989.00
92 11/09/2031 to 10/10/2031 980493.00 93 11/10/2031 to 10/11/2031 965859.00
94 11/11/2031 to 10/12/2031 951084.00 95 11/12/2031 to 10/01/2032 936168.00
96 11/01/2032 to 10/02/2032 921109.00 97 11/02/2032 to 10/03/2032 905905.00
98 11/03/2032 to 10/04/2032 890556.00 99 11/04/2032 to 10/05/2032 875060.00
100 11/05/2032 to 10/06/2032 859415.00 101 11/06/2032 to 10/07/2032 843620.00
102 11/07/2032 to 10/08/2032 827674.00 103 11/08/2032 to 10/09/2032 811575.00
104 11/09/2032 to 10/10/2032 795322.00 105 11/10/2032 to 10/11/2032 778913.00
106 11/11/2032 to 10/12/2032 762347.00 107 11/12/2032 to 10/01/2033 745622.00
108 11/01/2033 to 10/02/2033 728737.00 109 11/02/2033 to 10/03/2033 711690.00
110 11/03/2033 to 10/04/2033 694480.00 111 11/04/2033 to 10/05/2033 677105.00
112 11/05/2033 to 10/06/2033 659563.00 113 11/06/2033 to 10/07/2033 641853.00
114 11/07/2033 to 10/08/2033 623973.00 115 11/08/2033 to 10/09/2033 605922.00
116 11/09/2033 to 10/10/2033 587698.00 117 11/10/2033 to 10/11/2033 569299.00
118 11/11/2033 to 10/12/2033 550724.00 119 11/12/2033 to 10/01/2034 531971.00
120 11/01/2034 to 10/02/2034 513038.00 121 11/02/2034 to 10/03/2034 493924.00
122 11/03/2034 to 10/04/2034 474627.00 123 11/04/2034 to 10/05/2034 455145.00
124 11/05/2034 to 10/06/2034 435476.00 125 11/06/2034 to 10/07/2034 415618.00
126 11/07/2034 to 10/08/2034 395570.00 127 11/08/2034 to 10/09/2034 375330.00
128 11/09/2034 to 10/10/2034 354896.00 129 11/10/2034 to 10/11/2034 334266.00
130 11/11/2034 to 10/12/2034 313439.00 131 11/12/2034 to 10/01/2035 292412.00
132 11/01/2035 to 10/02/2035 271183.00 133 11/02/2035 to 10/03/2035 249751.00
134 11/03/2035 to 10/04/2035 228114.00 135 11/04/2035 to 10/05/2035 206269.00
136 11/05/2035 to 10/06/2035 184215.00 137 11/06/2035 to 10/07/2035 161950.00
138 11/07/2035 to 10/08/2035 139471.00 139 11/08/2035 to 10/09/2035 116777.00
140 11/09/2035 to 10/10/2035 93865.00 141 11/10/2035 to 10/11/2035 70734.00
142 11/11/2035 to 10/12/2035 47381.00 143 11/12/2035 to 10/01/2036 23804.00
144 11/01/2036 to 10/02/2036 0.00

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653 Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

97/180_East_780 Page 6 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004
TERMS & CONDITIONS OF YOUR INSURANCE COVER

1. Insurance company means SBI Life Insurance Company Limited.

2. Master Policyholder is the Financial Institution or the Bank which has entered into a contract with the Insurance Company for providing
insurance cover to its members.

3. Member is a Primary Borrower, Co‐Borrower or an Account Holder with the Master Policyholder.

4. Life Assured is the Member on whose life the insurance cover is granted.

5. Insurance Cover Start Date is the date of communication of underwriting acceptance of proposal or the date of receipt of premium
(including extra premium, if any) whichever is later.

6. Insurance Cover End Date is the date on which the insurance cover on the life of the member ceases.

7. Current Loan Interest Rate is the rate currently applicable to the member on the loan. This rate is used in deciding the appropriate Interest
Cover Rate.

8. Interest Cover Rate is the fixed interest rate used for generating the sum assured schedule. It may vary from the Current Loan Interest Rate.

9. Policy Term is the period, in months, during which the policy benefits are payable in respect of the member.

10. Initial Sum Assured is the Sum Assured at the start of the insurance cover and as mentioned in schedule.

11. Sum Assured Schedule (as mentioned in the annexure) is the decreasing insurance cover schedule generated using the following:
I. Insurance Cover Start Date
II. Interest Cover Rate
III. Policy Term
IV. Initial Sum Assured
V. Moratorium Period, if opted, with / without interest payment
This Sum Assured Schedule may differ from the Loan Repayment Schedule provided by your Master Policyholder for the loan borrowed.

12. Single Premium is the premium payable once at the policy commencement date.

13. Limited Premium Payment Term is where the premium payment period is limited compared to the policy term and the premiums are paid at
regular intervals like yearly, half‐yearly, etc.

14. Premium Payment Term is the period, in years, over which premiums are payable.

15. Premium Payment Mode is the frequency of premium payment.

16. Premium Renewal Date is the date on which the renewal premium becomes due.

17. Grace Period is the period, in days, from the premium renewal date during which premium should be paid, which is 15 days for monthly
premium payment mode and 30 days for other premium payment modes. If the premium is not paid within the grace period, the insurance
cover lapses. However, in case of any claim under the cover during the grace period and the Company finds it payable, the outstanding
premiums shall be recovered from the claim.

18. Taxes are payable on premium at the rate prevailing at the time of payment of premium/s. Taxes include service tax/ cess/ GST and/ or any
other statutory levy/ duty/ surcharge as notified by Central and/ or State Government from time to time as per provisions of the prevalent
tax laws.

19. We, Us, Our means SBI Life Insurance Company Limited or its successors.

20. You, Your means the member who is availing insurance cover from Us.

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

97/180_East_780 Page 7 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

21. Policy Benefits include the following:

I. Death Benefit:
<<In the event of death of the life assured during the policy term, the sum assured applicable for the month and year of death, as per the
sum assured schedule (as mentioned in the annexure) is payable, provided all premiums due up to the date of death have been fully paid.
The death benefit will be payable irrespective of the actual outstanding loan amount or the amount outstanding as per the loan repayment
schedule.>>

II. Maturity Benefit: No maturity benefit is available under this plan.

III. Surrender Benefit: You may request for surrender of the insurance cover in writing at any point of time after first policy year, provided at
least first policy year’s premiums are paid. If premiums are not paid for full one year, no surrender value shall be payable. The Surrender
Value (SV) available under this plan is
SV = (50% x Premium(s) paid) x (Unexpired term / Total term)
a. A Special Surrender Value (SSV) may be available at the time of surrender. The higher of the SSV and SV will be payable.
b. Surrender Benefit is payable only if SV or SSV is at least Rs. 250/‐.
c. In the event of death of the life assured after submission of surrender request but before payment of benefit, we will pay the death
benefit to the nominee or the legal heir, if the claim is otherwise payable.

IV. Paid‐up Benefits: If the insurance cover lapses due to non‐payment of due premiums, paid‐up value will be available at any point of time
after the first year of cover, provided at least first policy year’s premiums are paid in full.
a. In the event of the death of the life assured, the paid‐up sum assured payable will be:
Paid up Sum Assured = (Number of premiums paid / Number of premiums payable) * Sum Assured as on Date of death as per sum
assured schedule.
b. If the paid‐up policy is surrendered on request, surrender value payable will be:
Surrender Value = (50% x Premium(s) paid) x (Unexpired term / Total term)

V. Payment of Surrender/ Paid‐up Benefits:

a. Premium(s) considered for calculation of Surrender/ Paid‐up Benefit will exclude the below components:
i. Extra premium charged for non‐standard age proof or health extra or any other extra premium(s)
ii. Premium paid for Gold option or Platinum option, where applicable
iii. Applicable Taxes
b. For calculation of the above benefits:
i. Term will be measured in completed policy months.
ii. Unexpired Term would be total policy term in months less completed number of policy months as on date of surrender.
<<

22. Exclusions
I. Suicide claim exclusion: If the life assured commits suicide, whether sane or insane, within 12 Months from the insurance cover start date,
the sum assured benefit will not be payable. Only 80% of the total premium(s) paid (net of taxes & cess) till date of death would be refunded
without interest, provided the member policy is in force.
In case the life assured commits suicide, whether sane or insane, within 12 months from the date of revival of the insurance cover, the higher
of the surrender value as on the date of suicide or 80% of the total premiums paid (net of taxes & cess) till date of death, without interest will
be payable, provided the member policy is in force.
II. Premium(s) considered for payment of benefits under section 21 will exclude the below components:
a. Extra premium charged for non‐standard age proof or health extra or any other extra premium(s)
b. Premium paid for Gold option or Platinum option, where applicable
c. Applicable Taxes
<<

23. Revival
If the insurance cover lapses due to non‐payment of renewal premium, the insurance cover can be revived within a period of five years from
the date of first unpaid premium by paying all the outstanding premiums along with interest. The interest rate applicable will be Repo Rate as
on 1st April of the financial year in which the revival is effected + 250 basis points, compounded half‐yearly. Revival facility will be allowed
only during the term of the cover.
Revival is subject to underwriting as per the Company’s Board approved underwriting policy. The Company reserves the right to accept (on
such terms and conditions stipulated by the Company) or reject the revival of a lapsed cover. The revival will be effective only after the same
is communicated in writing by the Company to the Group Member.

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

97/180_East_780 Page 8 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

24. Termination of Cover

24.1. Insurance cover under this plan shall cease on the earliest of the following dates:
24.1.1. on the expiry of the policy term, or
24.1.2. on death of the insured member, or
24.1.3. the date on which the member reaches the maximum cover ceasing age, or
24.1.4. the date on which surrender value is paid, if payable, or
24.1.5. the date of payment on free‐look cancellation, or
24.1.6. the date of termination of the cover at the request of the member, or
24.1.7. the date on which the grace period ends in case if premiums due are not paid, where the insurance cover has not
acquired any paid‐up value, or
24.1.8. on termination of cover at the behest of the member, or

24.2. In case insurance cover is granted to each of the co‐borrowers for the entire outstanding loan and death benefit is paid on the death
of any one of them, the cover of surviving co‐borrower(s) will cease automatically and the applicable surrender value, if any, will be
paid.

25. Free‐look Period

25.1. Where the scheme is voluntary/ contributory in nature, you can review the terms and conditions of the insurance contract, within 15
days from the date of receipt of this Certificate of Insurance. In case you are not satisfied or disagree with any of the terms and
conditions, you have the option to return the Certificate of Insurance stating the reasons for objection. Any such request should come
through the Master Policyholder. The premium amount after deducting (i) proportionate risk premium and proportionate taxes, (ii)
expenses incurred towards medical examinations carried out, if any and (iii) expenses towards stamp duty; will be refunded by us.
Certificates of Insurance for all co‐borrowers need to be submitted.

26. Nomination
I. You may, when effecting the insurance cover, or at any time before the cover term ends; nominate a person to whom the money secured by
the insurance cover shall be paid in the event of death of the life assured.
II. If the nominee is a minor, you may appoint a person, competent to contract as an appointee in the manner laid down by us, to receive the
money secured by the insurance cover in the event of death of the life assured during the minority of the nominee.
III. You may cancel or change the existing nomination at any time during the course of the policy term.
IV. Your nomination should be registered in our records so as to make it binding on us.
V. For complete details about nomination, please refer to Section 39 of the Insurance Act, 1938, as amended from time to time.
[For simplified version of provisions of Section 39 of the Insurance Act, 1938; please refer Annexure I]

27. Assignment
Assignment is not allowed under your insurance cover.

28. Non‐disclosure
I. We have issued your insurance cover based on the statements/ responses in the membership form, personal statement, medical reports and
any other documents that are submitted to us.
II. If we find that any of this information is inaccurate or false or you have withheld any material information or in case of fraud, we shall
declare your insurance cover null and void subject to Section 45 of the Insurance Act, 1938, as amended from time to time.
III. We will not pay any benefits and the insurance cover shall be cancelled immediately by paying amount as per provisions of Section 45 of the
Insurance Act, 1938, as amended from time to time.
IV. If we repudiate a claim, we may pay the amount as per provisions of Section 45 of the Insurance Act, 1938; to the life assured or his/ her
nominee/ beneficiary.
[For simplified version of the provisions of Section 45 of the Insurance Act, 1938, please refer Annexure II]

29. Mis‐statement of Age

If we find that your correct age is different from that mentioned in the membership form, we will check your eligibility for the insurance
cover as on the cover start date. If the age stated by you is incorrect and if you are:
I. Eligible,
a. If the correct age is found to be higher, you will have to pay the difference in premiums along with interest based on company’s
prevalent norms, which may change from time to time.
b. If you do not pay the difference in premiums and applicable interest, we will terminate your insurance cover by paying you the
surrender value, if any.
c. If the correct age is found to be lower, we will refund the difference in premiums, without interest.
II. Not eligible,
a. We will terminate your insurance cover by paying you the surrender value, if any.

30. Pre‐closure of Loan

I. If you choose to repay the loan at faster pace by making repayments over and above the terms agreed with the Master Policy Holder, the
benefits payable in case of a death will continue to be as per the sum assured schedule (as mentioned in the annexure).

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

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 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

II. If you repay the entire outstanding loan amount before the end of the policy term, you can choose either to:
a. surrender your insurance cover under this plan and avail of surrender benefits, if any, OR
b. continue with your insurance cover under this plan. In case of death, benefits will be payable as per the sum assured schedule.

31. Cancellation of Loan

If your loan is cancelled or not taken up after sanction and the premium(s) has been remitted, you can request for cancellation of insurance
cover under this plan. Such a request should come through the Master Policy Holder within 90 days from issuance of this Certificate of
Insurance. Upon receipt of such a request, we will refund 90% of the premium(s) paid excluding taxes and cess after deducting expenses
incurred towards stamp duty. You have to submit the original Certificates of Insurance.

32. Co‐Borrowers
I. You have the option to cover co‐borrowers, where applicable, at a later date as per the terms and conditions defined by the Master
Policyholder.
II. You can add a maximum of two co‐borrowers subject to terms and conditions defined by the Master Policyholder.
III. If the membership forms of co‐borrowers are received later, then the rebate would be applicable only to the co‐borrowers.
IV. If the initial sum assured for each borrower is equal to entire outstanding loan amount, then:
a. Claim is payable only on first death amongst the co‐borrowers during the policy term
b. Where the claim is admitted on death of any of the co‐borrowers during policy term, we will pay the death benefit for the deceased
borrower. On payment of this death benefit, the insurance cover for the surviving borrower(s) will be terminated by payment of
surrender value, if any.
c. Where the claim is rejected/ repudiated, we will not pay any benefit for the deceased borrower. The insurance cover for the surviving
borrower(s) will continue till the end of the policy term, provided all due premium(s) are paid. The surviving borrower(s) can surrender
their insurance cover at any point in time.
d. In case of simultaneous death of more than one borrower, we will pay the death benefit only in respect of one borrower. It will be
presumed that the younger member survives the elder member. The surrender value, if any, will be paid with respect to the life/lives
assured where death benefit has not been paid.
V. If the initial sum assured for each borrower is equal to [limited to] his/ her respective share of loan amount, then:
a. Claim is payable on all deaths during the policy term
b. Where the claim is admitted on death of any of the co‐borrowers during the policy term, we will pay the death benefit for the deceased
borrower as per the sum assured schedule provided in his/ her COI. The insurance cover for the surviving borrower(s) will continue till
the end of the policy term, provided all due premium(s) are paid. The surviving borrower(s) can surrender their insurance cover at any
point in time.
c. Where the claim is rejected/ repudiated for any reason whatsoever, we will not pay any benefit for the deceased borrower. The
insurance cover for the surviving borrower(s) will continue till the end of the policy term, provided all due premium(s) are paid. The
surviving borrower(s) can surrender their insurance cover at any point in time.

33. Top up Loans: If you choose to increase your overall loan limit by borrowing additional monies from the Master Policy Holder through top up,
you may avail of insurance facility for the additional value of the loan as well. We will treat such loans as new loans with corresponding
schedules. Separate premiums would be applicable on this additional loan based on your age as on date of such an application and would be
further subject to underwriting.

34. Loan repayment installment defaults: This plan does not cover any increase in outstanding loan amount as a result of loan repayment
installment defaults on your part.

35. Loans: No loans are available against this policy.

36. Communication
I. Any notice, information or instruction to the Company must be in writing and delivered to the address intimated by the Company to the
Master Policyholder which is currently: Policy Servicing Department, SBI Life Insurance Company Limited, 7th Level (D Wing) & 8th Level,
Seawoods Grand Central, Tower 2, Plot No. R‐1, Sector 40, Seawoods, Nerul Node, Navi Mumbai ‐ 400 706, Dist. Thane, Maharashtra. The
Company may change the address stated above and intimate the Master Policyholder of such change by suitable means. Any communication,
information or instruction from the Company to the Master Policyholder shall be mailed to the address of the Master Policyholder provided
or to the changed address as intimated to the Company in writing.
II. It is important that you keep us informed of change in your communication address, if any.

37. Grievance Redressal Procedure

I. If you have any query, complaint or grievance, you may approach any of our offices.
II. You can also call us on our toll‐free number 1800 267 9090 (9 AM and 9 PM and these timings are subject to change).
III. You can also send an email to us on [email protected]
IV. If you are not satisfied with the decision or have not received any response within 15 days, you may write to us at:

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

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 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

Head ‐ Client Relationship

SBI Life Insurance Company Limited
Central Processing Centre,
7th Level (D Wing) & 8th Level,
Seawoods Grand Central,
Tower 2, Plot No. R‐1, Sector 40,
Seawoods, Nerul Node,
Navi Mumbai ‐ 400 706, Dist. Thane
Telephone No: +91 ‐22‐ 6645 6785
E‐mail Id: [email protected]

V. In case the complaint is not fully attended by us within 15 days of lodging the complaint through our Grievance Redressal Mechanism; you
may escalate the complaint to IRDAI through the Bima Bharosa Portal (IRDAI): https://bimabharosa.irdai.gov.in/ or contact IRDAI
Grievance Call Centre on toll‐free number : 155255 / 1800 4254 732 or alternatively you may send an email on [email protected]

VI. The postal address of IRDAI for communication for complaints by paper is as follows: Policyholders’ Protection Grievance Redressal
Department, Insurance Regulatory and Development Authority of India, SY No 115/1, Financial district, Nanakramguda, Gachibowli,
Hyderabad – 500032.

VII. In case you are not satisfied with our decision or not received a response within 30 days from the date of filing your complaints with us and
the issue pertains to Rule 13 and 14(3) of Insurance Ombudsman Rules, 2017, you may approach the Insurance Ombudsman. You can make
the complaint to the Ombudsman as per provision 13 and 14(3) of the said rules. The relevant provisions have been mentioned in the section
“Relevant Statutes”.

VIII. The address of the Insurance Ombudsman and the Insurance Ombudsman Rules, 2017, are, available on the website of IRDAI,
https://www.irdai.gov.in and in our website http://www. sbilife.co.in The address of the ombudsman at Mumbai is:
Office of the Insurance Ombudsman
3rd Floor, Jeevan Seva Annexe,
S.V. Road, Santa Cruz (W),
Mumbai – 400 054.
Telephone No.: +91 – 22 – 69038821/23/24/25/26/27/28/29/30/31
Fax No. : +91 – 22 – 2610 6052
E‐mail : [email protected]

IX. We have also enclosed a list of addresses of insurance ombudsmen in Annexure III for reference.

38. Claims Process

I. A claim, death, must be notified to us through the Master Policyholder in writing within 3 months of the date of occurrence of the event
along with a copy of the original death certificate (only in case of a death claim) to the nearest SBI Life Office or SBI Life Insurance Co. Ltd,
Claims Department, 7th Level (D Wing) & 8th Level, Seawoods Grand Central, Tower 2, Plot No. R‐1, Sector 40, Seawoods, Nerul Node, Navi
Mumbai ‐ 400 706, Dist. Thane, Maharashtra However, without prejudice, in case of delay in intimation or submission of claim documents
beyond the stipulated period in the policy document or in the Statutes, We, at our sole discretion, may condone such delay and examine the
admissibility or otherwise of the claim, if such delay is proved to be for reasons beyond the control of the nominee/claimant.
II. If we find that any of the information provided in the membership form and related documents is inaccurate or false or if you have withheld
any material information, or in case of fraud, we shall have the right to decline the claim subject to provisions of section 45 of the Insurance
Act, 1938, as amended from time to time
III. A claim must be made by notice in writing to the insurance company in the format supplied by the insurance company.
a. The primary documents normally required for processing a death claim are:
i. Original Death Certificate from Municipal/Local authorities
ii. Claim form duly filled in
iii. Certificate from the attending physician along with hospital reports, if any
iv. Police panchnama, and FIR copy / Post mortem Report/ Coroner’s Verdict, where applicable
IV. A claim shall be subject to such other requirements as stipulated by the insurance company and the legal title of the claimant.
V. If found admissible, we will pay the claim as per the authorisation provided by you.
a. In case you have authorised SBI Life to pay the claim proceeds to the Master Policyholder to the extent of the outstanding loan
amount, we will:
i. Pay the claim proceeds to the extent of the outstanding loan amount as on the date of occurrence of the insured event to the
Master Policyholder.

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

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 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

ii. Pay any amount in excess of the outstanding loan amount to the life insured / nominee/ beneficiary / legal heir as the case may
be.
iii. This arrangement is allowed only where the Master Policy Holder is a lender‐borrower entity regulated by the Reserve Bank of
India (RBI) or the National Housing Board or the National Minority Development Finance Corporation and its State Channelizing
Agencies or any other entity that meets the eligibility criteria specified in the applicable regulations from time to time.
b. In case you have not authorised SBI Life to pay the claim proceeds to the Master Policyholder, we will:
i. pay the entire claim proceeds to the nominee/ beneficiary / legal heir as the case may be, in case of a death claim
c. We will make the claim payment, to the extent applicable; in the name of the life assured or his/ her nominee/ beneficiary / legal heir
even if the cheque is sent to the Master Policyholder for administrative convenience or through any other electronic mode of
payment to the specific bank account of the life assured.
VI. In a scenario where the due premium has been paid by you to the master policyholder and an acknowledgement or receipt for the premium
is being received by you, but the premium has not been remitted by the master policyholder to us within the grace period. If a claim occurs
subsequently, we shall honour the claim provided the claim is otherwise admissible and payable. However, this will be subject to submission
of relevant documents by the master policyholder to us to our satisfaction, proving that the due premiums have been paid by the insured
member to the master policyholder. For e.g., in a scheme where the premium is being borne by the member, we will need an
acknowledgement /receipt proving that the premium has been paid by the insured member. Further, the claim amount would be settled only
after remittance of due premium to us

39. Discontinuance of the Master Policy

The Master Policyholder has the right to terminate or surrender the master policy at any given time by giving 3 months’ notice. Under such
circumstances, existing group members will be given an option to continue the insurance cover. In case the group member opts to continue
the insurance cover, then the future premiums, if any, would need to be paid by the group member as and when due. In case the group
member doesn’t want to continue the insurance cover he/she can surrender the policy.

40. Section 41 of the Insurance Act, 1938; as amended from time to time:
I. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take 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:
II. Any person making default in complying with the provisions of this section shall be liable to a penalty which may extend to ten lakh rupees.

41. Section 45 of the Insurance Act, 1938, as amended from time to time:
[For simplified version of the provisions of Section 45, please refer Annexure II.]

42. Rule 13 of Ombudsman Rules, 2017

i. The Ombudsman may receive and consider complaints or disputes relating to:
a. delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance Regulatory and Development
Authority of India Act, 1999;
b. any partial or total repudiation of claims by the life insurer, General insurer or the health insurer;
c. disputes over premium paid or payable in terms of insurance policy;
d. misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
e. legal construction of insurance policies in so far as the dispute relates to claim;
f. policy servicing related grievances against insurers and their agents and intermediaries;
g. issuance of life insurance policy, general insurance policy including health insurance policy which is not inconformity with the proposal
form submitted by the proposer;
h. non‐issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance; and
i. any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or
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 at clauses (a) to (f)
II. The Ombudsman shall act as counsellor and mediator relating to matters specified in sub‐rule (1) provided there is written consent of the
parties to the dispute.
III. The Ombudsman shall be precluded from handling any matter if he is an interested party or having conflict of interest.
IV. The Central Government or as the case may be, the IRDAI may, at any time refer any complaint or dispute relating to insurance matters
specified in sub‐rule (1), to the Insurance Ombudsman and such complaint or dispute shall be entertained by the Insurance Ombudsman and
be dealt with as if it is a complaint made under Rule 14.

43. Rule 14 of Ombudsman Rules, 2017

I. Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing
to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential
address or place of residence of the complainant is located.
II. The complaint shall be 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

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

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 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

rise to complaint, supported by documents, the nature and extent of the loss caused to the complainant and the relief sought from the
Insurance Ombudsman.
III. No complaint to the Ombudsman shall lie unless –
a. The complainant makes a written representation to the insurer named in the complaint and
i. Either the insurer had rejected the complaint; or
ii. the complainant had not received any reply within a period of one month after the insurer received his representation; or
iii. the complainant is not satisfied with the reply given to him by the insurer
b. the complaint is made within one year
i. after the order of the insurer rejecting the representation is received; or
ii. after receipt of decision of the insurer which is not to the satisfaction of the complainant;
iii. after expiry of a period of one month from the date of sending the written representation to the insurer if the insurer named fails
to furnish reply to the complainant
IV. The Ombudsman shall be empowered to condone the delay in such cases as he may consider necessary, after calling for objections of the
insurer against the proposed condonation and after recording reasons for condoning the delay and in case the delay is condoned, the date of
condonation of delay shall be deemed to be the date of filing of the complaint, for further proceedings under these rules.
V. No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before
or disposed of by any court or consumer forum or arbitrator.

44. Protection of Policyholders’ Interest

The IRDAI (Protection of Policyholders’ Interests) Regulations, 2017, provide for protection of the interest of the policyholders. The provisions
of this regulation will be applicable and subject to the prevailing law, as amended from time to time.

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

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 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

Annexure I
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 is 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 insured 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) Ordinance, 2014 (i.e. 26.12.2014).
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 (Ordinance) 2014, a nomination is made in favor 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 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. Policy Holders are advised to refer to Original Ordinance Gazette Notification dated March 23, 2015 for complete and
accurate details.]

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

97/180_East_780 Page 14 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004

Annexure II

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 insured 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 insured 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 insured does not believe to be true;
b. The active concealment of a fact by the insured 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 insured 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 Insured / 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 insured 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 insured 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 insured 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.

09. The insurer can call 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 are adjusted on subsequent proof of age of life insured. So, this Section will not be applicable for questioning
age or adjustment based on proof of age submitted subsequently.

[Disclaimer: This is not a comprehensive list of amendments of Insurance Laws (Amendment) Act, 2015 and only a simplified version prepared
for general information. Policy Holders are advised to refer to Original Ordinance Gazette Notification dated March 23, 2015 for complete and
accurate details]

Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
653
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

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 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113

Annexure III

List of Ombudsman Centres with Address

Contact Details
Office of the Jurisdiction of Office
Ombudsman Union Territory, District)

Office of the Insurance Ombudsman,

Jeevan Prakash Building, 6th floor,
Gujarat,
Tilak Marg, Relief Road,
AHMEDABAD Dadra & Nagar Haveli,
Ahmedabad – 380 001.
Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: [email protected]

Office of the Insurance Ombudsman,

Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
BENGALURU JP Nagar, Ist Phase, Karnataka.
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: [email protected]

Office of the Insurance Ombudsman,

Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
BHOPAL Near New Market, Madhya Pradesh
Bhopal – 462 003. Chattisgarh.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: [email protected]

Office of the Insurance Ombudsman,

62, Forest park,
Bhubneshwar – 751 009.
BHUBANESHWAR Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: [email protected]

Office of the Insurance Ombudsman,

S.C.O. No. 101, 102 & 103, 2nd Floor, Punjab,
Haryana(excluding Gurugram, Faridabad,
Batra Building, Sector 17 – D,
Sonepat and Bahadurgarh)
CHANDIGARH Chandigarh – 160 017.
Himachal Pradesh, Union Territories of
Tel.: 0172 - 2706196 / 2706468
Jammu & Kashmir,
Fax: 0172 - 2708274
Ladakh & Chandigarh.
Email: [email protected]

Office of the Insurance Ombudsman,

Tamil Nadu,
CHENNAI Fatima Akhtar Court, 4th Floor, 453,
Tamil Nadu
Anna Salai, Teynampet,
PuducherryTown and
CHENNAI – 600 018.

97/180_East_780 Page 17 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113

Tel.: 044 - 24333668 / 24335284 Karaikal (which are part of Puducherry).

Fax: 044 - 24333664
Email: [email protected]

Office of the Insurance Ombudsman,

2/2 A, Universal Insurance Building,
Asaf Ali Road, Delhi &
New Delhi – 110 002. Following Districts of Haryana -
DELHI
Tel.: 011 - 23232481/23213504 Gurugram, Faridabad, Sonepat &
Email: [email protected] Bahadurgarh.

Office of the Insurance Ombudsman, Assam,

Jeevan Nivesh, 5th Floor, Meghalaya,
Nr. Panbazar over bridge, S.S. Road, Manipur,
GUWAHATI
Guwahati – 781001(ASSAM). Mizoram,
Tel.: 0361 - 2632204 / 2602205 Arunachal Pradesh,
Email: [email protected] Nagaland and Tripura.

Office of the Insurance Ombudsman,

6-2-46, 1st floor, "Moin Court",
Lane Opp. Saleem Function Palace, Andhra Pradesh,
A. C. Guards, Lakdi-Ka-Pool, Telangana,
HYDERABAD
Hyderabad - 500 004. Yanam and
Tel.: 040 - 23312122 part of Union Territory of Puducherry.
Fax: 040 - 23376599
Email: [email protected]

Office of the Insurance Ombudsman,

Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
JAIPUR Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: [email protected]

Office of the Insurance Ombudsman,

2nd Floor, Pulinat Bldg.,
Kerala,
Opp. Cochin Shipyard, M. G. Road,
Lakshadweep,
ERNAKULAM Ernakulam - 682 015.
Mahe-a part of Union Territory of
Tel.: 0484 - 2358759 / 2359338
Puducherry..
Fax: 0484 - 2359336
Email: [email protected]

Office of the Insurance Ombudsman,

Hindustan Bldg. Annexe, 4th Floor, West Bengal,
KOLKATA 4, C.R. Avenue, Sikkim,
KOLKATA - 700 072. Andaman & Nicobar Islands.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341

97/180_East_780 Page 18 of 28 PolicyNo. 7013308593

 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113

Email: [email protected]

Office of the Insurance Ombudsman, Districts of Uttar Pradesh :Lalitpur, Jhansi,

6th Floor, Jeevan Bhawan, Phase-II, Mahoba, Hamirpur, Banda, Chitrakoot,
Nawal Kishore Road, Hazratganj, Allahabad, Mirzapur, Sonbhabdra, Fatehpur,
Lucknow - 226 001. Pratapgarh, Jaunpur,Varanasi, Gazipur,
Tel.: 0522 - 2231330 / 2231331 Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Fax: 0522 - 2231310 Lakhimpur, Bahraich, Barabanki, Raebareli,
LUCKNOW
Email: [email protected] Sravasti, Gonda, Faizabad, Amethi,
Kaushambi, Balrampur, Basti,
Ambedkarnagar, Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur, Chandauli,
Ballia, Sidharathnagar.

Office of the Insurance Ombudsman,

3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Goa,
Tel.: 022 -
MUMBAI Mumbai Metropolitan Region
69038821/23/24/25/26/27/28/28/29/30/31
excluding Navi Mumbai & Thane.
Fax: 022 - 26106052
Email: [email protected]

Office of the Insurance Ombudsman, State of Uttaranchal and the following

Bhagwan Sahai Palace Districts of Uttar Pradesh:
4th Floor, Main Road, Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun,
Naya Bans, Sector 15, Bulandshehar, Etah, Kanooj, Mainpuri,
Distt: Gautam Buddh Nagar, Mathura, Meerut, Moradabad,
NOIDA
U.P-201301. Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Tel.: 0120- 2514252 / 2514253 Farrukhabad, Firozbad, Gautambodhanagar,
Email: [email protected] Ghaziabad, Hardoi, Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj, Sambhal, Amroha,
Hathras, Kanshiramnagar, Saharanpur.

Office of the Insurance Ombudsman,

2nd Floor, Lalit Bhawan,

Bihar,
PATNA Bailey Road,
Jharkhand.
Patna 800 001.
Tel.: 0612-2547068
Email: [email protected]

Office of the Insurance Ombudsman,

Jeevan Darshan Bldg., 3rd Floor, Maharashtra,
PUNE C.T.S. No.s. 195 to 198, Area of Navi Mumbai and Thane
N.C. Kelkar Road, Narayan Peth, excluding Mumbai Metropolitan Region.
Pune – 411 030.
Tel.: 020-41312555

97/180_East_780 Page 19 of 28 PolicyNo. 7013308593

97/180_East_780 Page 20 of 28 PolicyNo. 7013308593
 SBI Life Insurance Company Limited
Regulated by IRDAI | Registration Number 111
CIN: L99999MH2000PLC129113 COI No. 70768939004
First Premium Receipt cum Tax Invoice
Group Member ID: 7003724293
Membership form No : 7013308593
Loan Account No : 42603308677

Master Policy 70000018311 Sourcing Branch : HWA-KOLKATA 2

Master Policy holder name STATE BANK OF INDIA Sourcing Branch address : SBI Thalia SBI Thalia P.S. AMTA
HOWRAH HOWRAH WEST
Customer Name Mr. Pijush Rana
BENGAL 711401
BAGNAN
N D BLOCK BERABERIA PASCHIM
NR ADARSHA SCHOOL GSTIN SBI : 19AAFCS2530P1ZY

Invoice No : WBI012400128010
HOWRAH
Invoice date : 11-01-2024
WEST BENGAL - 711303
Contact Number 9732869691
GSTIN Customer NA
Place of Supply WEST BENGAL
State Code 19
Premium Payment Mode Single Product :SBI Life RiNn Raksha

Insurance Cover Start Date 11-01-2024 UIN :111N078V03

HSN Code :997132

HSN description :Life Insurance Services

Initial Sum Assured `1872556.00 /- Total Amount Received : `72556.00 /-

Payment Method EFT - Debit by Voucher Premium Amount : ` 61488.00/-

Taxable Value : ` 61488.00/-

Integrated GST-18% : ` 0.00 /-

Whether the tax is payable on reverse charge basis or not :- No
State/UT GST-9% : ` 5534.00 /-

Central GST-9% : ` 5534.00 /-

Amount of Total GST : `11068.00 /-

Total Premium Amount : `72556.00 /-

Next premium due on : NA

Amount of Initial/First Premium paid
: ` 72556.00 /-
Rupees Rupees Seventy Two Thousand Five Hundred Fifty Six Only
Received the amount as above.
Note: In case of any discrepancies, you are kindly requested to inform us immediately. Call us toll free at our customer service helpline 1800 267 9090
No interest is payable on excess payments, if any, made by the member.
"Premium paid under this policy is eligible for tax rebates under section 80C of the Income Tax Act, 1961, as applicable.
"Goods & Service Tax (GST)/ Cess and/or any other statutory levy/ duty/surcharge, at the rate notified by the Central Government/ State Government
/ Union Territories of India from time to time, shall be levied on premium /charges (as applicable) as per the provisions of the prevalent tax laws."
As per GOI notification, GST has been levied on your insurance policy @18% on premium or charges. (or as applicable) w.e.f 01.07.2017.
In the case of endowment policy, the taxable value is 25% of the premium for first year and 12.5% for second & subsequent year. For single premium
annuity policy, the taxable value is 10% of the premium. Please refer SBI Life website for details."
This premium receipt is issued subject to realization of cheque/ draft
The Consolidated Revenue stamp duty paid vide Letter of Authorisation No. CSD/10/2023/4753 dated 23 Nov, 2023 issued by Pradhan Mudrank
Karyalay.

Authorised Signatory
New Business Processing

653
Corporate Office & Registered Office: ‘Natraj’, M. V. Road & Western Express Highway Junction, Andheri (E), Mumbai – 400 069.
Toll free number: 18002679090 Email:[email protected] , Website : www.sbilife.co.in

97/180_East_780 Page 21 of 28 PolicyNo. 7013308593

97/180_East_780 Page 22 of 28 PolicyNo. 7013308593
 Form Number 7013308593

Loan Account Number 42603308677

SBI Life - RiNn Raksha Membership Form(UIN: 111N078V03)
SBI LIFE INSURANCE COMPANY LTD.
Registered & Corporate Office: SBI Life Insurance Co. Ltd, Natraj, M.V. Road & Western Express Highway Junction, Andheri (East), Mumbai
- 400 069.IRDAI Registration no. 111.
website: www.sbilife.co.in | Email: [email protected] | CIN: L99999MH2000PLC129113 | Toll Free: 1800 267 9090 (Between 9:00 AM & 9:00
PM)
Instruction for filling the form for applying insurance on life borrower(member to be insured)
1. INSURANCE IS A CONTRACT OF UTMOST GOOD FAITH WHICH REQUIRES YOU TO DISCLOSE ALL REQUIRED INFORMATION TRUTHFULLY. PLEASE ENSURE THAT
INFORMATION FURNISHED IN THE MEMBERSHIP FORM IS TRUE TO THE BEST OF YOUR KNOWLEDGE. IN CASE SOMEONE ELSE(YOUR AGENT,BANK BRANCH
ETC.)HAS COMPLETED THE MEMBERSHIP FORM ON YOUR BEHALF,PLEASE APPRECIATE THAT THE OWNERSHIP OF THE INFORMATION PROVIDED IS STILL
ENTIRELY YOURS, HENCE ENSURE THE CORRECTNESS OF THE INFORMATION BEFORE YOU SIGN THE MEMBERSHIP FORM.
IF ANY INFORMATION (E.G AGE, HEALTH/MEDICAL)IS SUBSEQENTLY FOUND UNTRUE AT THE TIME OF THE CLAIM, WE MAY DECLINE THE CLAIM

2. SBI Life branches and its sales teams are not authorised to collect cash from its customers.

1. MASTER POLICY HOLDERS DETAILS

MPH Name STATE BANK OF INDIA Master Policy No. 70000018311

Bank Code 00 Branch Code 8923

RACPC Code 64100 Branch Name Thalia

OSF Code 64100

Code 1 4592166 Code 2 5115914

Code 3 4212045 Code 4 5061709

Code 5 42950 Code 6

2. MEMBER DETAILS

Name Mr. PIJUSH RANA

Father's/Proposer Name KARTICK CHANDRA RANA

Date of Birth(As Per Bank 21/12/1975 Date of Birth of Father/Proposer

Records)

Relationship of the Proposer With the Member

Age Proof(Please attach copy of Age Proof) Pancard

PAN* AGVPR6102K

I do not have a PAN Card and have submitted Form 60 No

*Please provide PAN number or submit Form 60 if the annualized premium under this proposal exceeds Rs 50000/-

Occupation Salaried

Name of the Employer and Designation WBSEDCL ASST ENGINEER

Business Organisation's or Company's Name and Nature of Bussiness or

Profession:

Address BAGNAN N D BLOCK BERABERIA PASCHIM NR ADARSHA

SCHOOL HOWRAH 711303 WEST BENGAL

Mobile No 9732869691 Email Id [email protected]

Telephone No(Home)

Are You State Bank Group/BNPP Staff members? No

Are you a Non Resident Indian (NRI)? No

3. NOMINEE DETAILS

Nominee Name Mrs. MOUMITA RANA

70.ver.11-01-20 MF 1

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 Form Number 7013308593

Date of Birth 08/06/1985

Relationship with the Proposer Wife

Address BAGNAN N D BLOCK BERABERIA PASCHIM NR ADARSHA

SCHOOL HOWRAH 711303 WEST BENGAL

In case of more than one nominee, please provide details in the requisite annexure.

4. APPOINTEE DETAILS (If nominee is a minor, details of an Appointee to be provided)

Appointee Name

Date of Birth

Relationship with Nominee

5. MEDICAL QUESTIONNAIRE:- In case where insurance is proposed on Minor Life, the answers should relate medical status of Minor Life to be Assured

Important: Please read this section fully and give correct details.

Height(In feet, inches) 182.88 Cms Weight(In Kgs) 82 Kgs

i. Have you consulted any doctor for surgical operations or have been hospitalised for any disorder other than minor No
cough,cold or flu during the last 5 years?

ii. Have you ever had any illness/injury, major surgical operation or received any treatment for any medical condition No
for a continuous period of more than 14 days? (Except for minor cough, cold, flu, appendicitis & typhoid)

iii. Have you ever suffered from / been treated / hospitalized for or diagnosed to have -

(a) Diabetes, raised blood sugar or No (b) Chest pain, heart attack, heart No
high blood pressure disease or any other disorder of the
circulatory system.

(c) Stroke, paralysis, disorder of No (d) HIV infection, AIDS No

the brain/nervous system.

(e) Cancer, tumor, growth or cyst No (f) Any genitourinary or kidney No

of any kind disorder, Hepatitis B/C or any
other liver disease

(g) Any digestive disorder (ulcer, colitis etc), any disease of the gall bladder, spleen, any blood disorder, disorder of any No
other gland (e.g. Thyroid etc) or any musculoskeletal disorder

(h) Asthma, Tuberculosis, No (i) Mental, psychiatric or nervous No

Pneumonia, or any other disease of disorder
the lung.

(iv) Have you suffered from any other disease not mentioned above? No

(v) Are you at present taking any medication, or on any special diet or on any treatment? No

(vi) Has a proposal for Life Insurance, ever been declined, postponed, withdrawn or accepted at extra premium? No

(vii) Have you had or have been advised to undergo any of the following tests or investigations? No

IF Yes, Please Select which of the following and provide reason for NA
undergoing the tests
Ultra Sonograpghy,CT Scan/MRI,Biopsy,Coronary Angiography

viii. a) Do you consume more than 10 cigarettes / bidis per day or chew more than 5 pouches of tobacco per day? No

b) Do you consume more than 2 pegs of alcohol per day in any form? No
If Yes Please Provide the type of alcohol and daily quantity consumed.

Type Quantity per day

c) Do you use or have you used any narcotics / any other drugs? No

ix. FOR FEMALE LIFE ONLY

a) Are yor pregnant?

How many months pregnant?

b) Have you suffered from any gynaecological problems or illness related to breasts, uterus or ovary?

{If answer to any of the question (i) to (ix) are Yes please give full particular below with details and also attach necessary documents such as medical
history, diagnosis, when it happened, treatment taken, names of medications, tests done, results of tests. }

Section 41 of the Insurance Act, 1938, as amended from time to time.

70.ver.11-01-20 MF 2

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 Form Number 7013308593

(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 prospectus 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.

Extract of Section 45 of the Insurance Act 1938, as amended from time to time
No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy. A policy of life
insurance may be called into question at anytime within three years from the date of policy, on the ground of fraud or on the ground that any statement of
or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which
the policy was issued or revived or rider issued. The insurer shall have to communicate in writing to the insured or legal representatives or nominees or
assignees of the insured, the grounds and materials on which such decision is based.
No insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the mis-statement or suppression of material fact was
true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis-statement or suppression are
within the knowledge of the insurer. In case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive.
In case of repudiation of the policy on the ground of misstatement or suppression of a material fact and not on the grounds of fraud, the premiums
collected on the policy till the date of repudiation shall be paid.
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 are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the
proposal.
For complete details of the section and the definition of 'date of policy', please refer Section 45 of the Insurance Act 1938, as amended from time to time.
I hereby agree that this form including this declaration shall for the basis for the issuance of the proposed insurance plan; all information has been
provided with full understanding and knowledge and the information is complete and true to the best of my knowledge.
Name of Member or Proposer(in case Member is a Minor) Mr. PIJUSH RANA

Place :UTTARPARA Date :10/01/2024

Name of Witness (Bank Staff PF no- 5890519)
Name of Bank Staff- Saikat Bagal
Authenticated by Id & Password
Address UTTARPARA

6. LOAN DETAILS

Loan Amount/Outstanding Loan 1800000 EMI Payable : 20081

Amount *:

Date of First Disbursement 10/01/2024

Loan Term(Months): 144 Loan Interest Rate(%) 8.60 Loan Category/ Type Home Loan

Moratorium Period No Moratorium Period(Months) 0

Have you availed Loan insurance cover from SBI Life in the last two No
years

*In loans where the entire loan amount is not disbursed, the loan sanctioned amount will be covered

7. INSURANCE PLAN DETAILS

Loan Amount to be covered for the 1800000 Cover Term(Months) 144

applicant/Initial Sum Assured :

Note: Initial Sum Assured cannot exceed 120% of the outstanding loan amount or a limit prescribed by the scheme rules. Where the co-borrower is covered for their respective share, the Total Initial
Sum Assured for all Co-borrowers cannot exceed the above limit

Interest Cover Rate(%)** 11.50 Premium Payment Mode#@ Single

Premium Payment Term(PPT)(only for LP)(Years)#@ Single

Premium Payment Option Additional Loan from Bank/Lending Institution (Please fill section
9C(1))

Additional Option Details#@

(i)Primium Payment Modes available under this plan are-Single, Yearly, Half-Yearly and Monthly. (ii)Premium Payment Terms available under this plan are - 5 years and 10 years.(iii) Options
available under this plan are- Gold Option and Platinum Option

All products features under this plan have been chosen by the Master Policy holder in his capacity as the group administrator. Only features chosen by the Master Policy holder are avialable to you,
based on eligibility. You can choose from the option/features made available to you by the Master Policy holder. Please refer the Sales Brouchure for complete details of product features.

**The rate on which the Sum Assured schedule is based. This is as per the understanding between MPH & member.

9. PREMIUM PAYMENT DETAILS AND DIRECT DEBIT MANDATE

9A. PREMIUM PAYMENT DETAILS

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 Form Number 7013308593

Premium Payable 61488 Applicable Taxes 11068 Draft Amount 72556

Draft Number: EFT Transaction ID: Draft/EFT Date

I Saikat Bagal hereby certify that the loan amount and details mentioned in section 6 & 7 are correct and loan amount has been sanctioned
according to the extant Credit Appraisal Norms and Procedures being followed by us,

Further, I certify that Life to be Assured is: Sole Borrower

9B. BANK ACCOUNT DETAILS OF PROPOSER/LIFE TO BE ASSURED(MANDATORY)

Account no### 31640633944

A/C Type Savings

Bank Name STATE BANK OF INDIA Bank Branch Name Thalia
For State Group Branches, please provide

Bank Code 00 Bank Branch Code 8923

Name of the A/C Holder PIJUSH RANA

MICR Code* 700002527 IFSC Code* SBIN0008923

I declare that the information given above is true and correct, I shall not hold SBI Life responsible for non-credit of payout, if any , due to any reason including but not limited to incorrect/incomplete
information. I hereby authorise SBI Life to directly credit payout/refund, if any. to the above mentioned account.

###Valid Resident Indian Account. *Please submit cancelled cheque with pre-printed account holder name along with the membership form

9C. DIRECT DEBIT MANDATE

1) Where Premium is Paid Through Additional Loan From Bank/Lending Institution

I authorise my account to be debited for renewal premium(for State Bank Group) favouring SBI Life on due date.

Bank Code 00 Branch Code 8923 Loan Plus Account 42603338817

No:(for State Bank
Group Only)

Name of Member or Proposer(in case Member is a Minor) Mr. PIJUSH RANA

Name of Authorised Representative of Bank/Financial Institution with (Bank Staff PF no- 5890519)
Name and Designation Name of Bank Staff- Saikat Bagal
Authenticated by Id & Password
Date 10/01/2024 Place UTTARPARA

10. DECLARATION CUM AUTHORISATION

1. I would like to become a member of SBI Life - RiNn Raksha Group Insurance Plan for borrowers of Master Policyholder. I hereby declare and certify
that all the terms and conditions of the Life Insurance Cover have been thoroughly explained to me and I have fully understood the same.

2. I have understood the terms and conditions of the Plan and agree to abide the same and join the Plan for Life Insurance Cover for the duration of the
loan as per the prevailing EMI schedule.

3. I undertake to furnish any other personal details that the Proposer/ Master Policyholder/ SBI Life may require with regard to my Life Insurance Cover
under the Group Life Insurance Plan and authorise the Proposer/Master Policyholder to communicate any change in regards to my Life Insurance Cover.

4. I understand that the grant of the loan will be assessed independently of Life Insurance Cover.

5. I hereby understand and agree that no Life Insurance Cover will commence until the risk is accepted and requisite premium has been remitted to SBI
Life by the Master Policyholder and SBI Life conveys its written acceptance of this application for Life Insurance Cover. I further understand and agree
that Life Insurance Cover provided to me shall be governed by the Master Policy Contract issued in favour of the Master Policyholder. Notwithstanding
the provision of any law, usage, custom or convention for the time being in force prohibiting any doctor, hospital and/or employer from divulging any
knowledge or information, shall at anytime be at liberty to divulge any such knowledge or information to the Company.

• I hereby agree that this form including the details of loan and cover and options chosen by me as above are correct and complete shall form the basis of
my admission into the Group Insurance Plan. I also understand that once the cover is accepted any alteration in these information shall not be feasible or
permissible.

• I hereby authorise SBI Life to pay directly to the Master Policyholder such portion of claim proceeds payable equal to the Outstanding Loan Balance
amount owed by me to the Master Policyholder on the date of occurence of the insured event. The balance claim amount, if any, shall be payable to my
nominee/ beneficiary (as applicable).

• Note: (1) The claim should be found admissible by SBI Life. (2) In case there is no outstanding loan balance owed to the Master Policyholder, this
authorisation shall be deemed to be lapsed, ineffective, unenforceable and invalid from the date of settlement of my outstanding dues to the Master
Policyholder.

Name of Member or Proposer(in case Member is a Minor) Mr. PIJUSH RANA

70.ver.11-01-20 MF 4

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 Form Number 7013308593

Date 10/01/2024

11. ADDITIONAL DECLARATION WHEN THE MEMBERSHIP FORM IS FILLED BY PERSON OTHER THAN THE MEMBER/MEMBER SIGNS IN A
VERNACULAR LANGUAGE/MEMBER IS ILLITERATE

• I hereby declare that I have read out and explained the contents of Membership Form and all other documents incidental to availing the Group Insurance
Plan from SBI Life to the Member and that he/she said that he/she had understood the same. I hereby declare that I have fully explained to the Member
that the statements contained in this form shall be the basis for the Life Insurance Cover and that if any untrue statement is contained herein, no benefit
shall be payable by the SBI Life. I hereby declare that I have explained the contents of this form to the Member in ENGLISH Language, that I have
truly and correctly recorded the details and statements given by the Member and that the Member has affixed his/her signature/thumb impression on the
Membership Form in my presence, after fully understanding the contents thereof.
Name of Person Making Declaration (Bank Staff PF no- 5890519)
Name of Bank Staff- Saikat Bagal
Authenticated by Id & Password
Name of Member or Proposer(in case Member is a Minor) Mr. PIJUSH RANA

Date 10/01/2024

Address UTTARPARA

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Page 28 of 28 PolicyNo. 7013308593