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Mr.

Sagar Karande
1A 2006 Dreams Complex
L.B.S Marg
Bhandup west
Mumbai 400078
Maharashtra

12th February 2015

Dear Mr. Sagar Karande,


Subject: Change in Acceptance Terms
Proposal No.: 17338454
Life to be Assured: Mr. Sagar Karande 74494600
Thank you for choosing HDFC Standard Life for your insurance policy. We now have all the
information we require to decide how much you need to pay to enjoy the benefits of your policy.
At HDFC Standard Life we have a policy of offering the best value for money at all times. We base
our standard premium rates on all our customers being in good health. We have taken into
account all the facts that you provided on your application plus the information given to us,
wherever required, by the medical profession to assess your application. To be fair to all our
customers, sometimes we need to ask for an extra premium and in other cases we can't give
cover at all.
For your proposal, we have proposed change in terms of acceptance on financial grounds and
Urine cotinine positive.
For your cover details please see the table below:
Plan: HDFC Life Click 2 Protect Plus
Periodicity of premium payments: Annual
Term of policy: 30 years
Benefit

Cover

Sum to be
Assured
(Rs.)

Standard
Premium
(Rs.)

Income Benefit

5,000,000

10,429.00

0.00

10,429.00

Income Plus Opt.-Incr.Incm(MB)

50,000

0.00

0.00

0.00

10,429.00

0.00

10,429.00

Total

Extra
Premium
(Rs.)

Total
Premium
(Rs.)

A - Accepted by us
D - Declined
R - Accepted with extra Premium
We have enclosed a new illustration of benefits that indicates the effect that these changes might
have on the benefits of your policy.
Amount in Rs.
Total premium
Add: Service Tax & Education Cess
Less: Amount already paid
Excess Amount

Amount in Rs.
10,429.00

1,289.00
14,670.00
2,952.00

Please note that we have reduced the Sum Assured as indicated above.
To take up your cover, simply fill in the attached consent form and send it to us within 30 days
from the date of this letter. We will then send your policy document and confirm to you that you are
covered. In case you have opted for ECS/SI mode of payment kindly provide a fresh ECS/SI
mandate along with the consent letter. We will then send your policy document and confirm to you
that you are covered.

Please note that until we have these we cannot cover you for insurance of Rs. 5,000,000/- so it is
important to get back to us at the earliest.
If you choose not to take up the cover please tick the box marked 'I do not accept the revised
terms' and we will refund your money, without any interest.
We look forward to hearing from you.
Yours sincerely

Operations Department
For HDFC Standard Life Insurance Company

Encl.: As above

cc:
Mr. Self Sourced Business X 00399206
Corporate Office
Maharashtra
400001

CONSENT LETTER
HDFC SL Corporate Office
12th & 13th Flr Lodha Excelus
Apollo Mills Compound
NM Joshi Marg Mahalaxmi
Mumbai 400011
Maharashtra
Dear Sir / Madam,
Subject: Your letter dated 12th February 2015 under Proposal No. 17338454
Life to be Assured: Mr. Sagar Karande 74494600
With reference to your aforesaid letter, I/We have read and fully understood the revised terms
offered to me and have ticked the relevant box reflecting my decision.
The revised cover details as proposed by you are as follows:
Plan: HDFC Life Click 2 Protect Plus
Periodicity of premium payments: Annual
Term of policy: 30 years
Benefit

Cover

Sum to be
Assured
(Rs.)

Standard
Premium
(Rs.)

Income Benefit

5,000,000

10,429.00

0.00

10,429.00

Income Plus Opt.-Incr.Incm(MB)

50,000

0.00

0.00

0.00

10,429.00

0.00

10,429.00

Total
Amount in Rs.
Total premium
Add: Service Tax & Education Cess
Less: Amount already paid
Excess Amount

Extra
Premium
(Rs.)

Total
Premium
(Rs.)

Amount in Rs.
10,429.00

1,289.00
14,670.00
2,952.00

I/We hereby confirm that I/We have read the terms and conditions mentioned in this letter.
(Choose One)

I/We accept the same.


I/We do not accept the same.
Signature__________________________
Mr. Sagar Karande
Date : ______________

Place : ______________