Riiag #as ster Gor Porm Life Insurance Corporation of India s.. an anand {FSTABLISHED BY THE LIFE INSURANCE CORPORATION ACT, 356) JEEVAN ANAND (WITH PROFITS) (WITH ACCIDENT BENEFIT) ‘THE LIFE INSURANCE CORPORATION OF INDIA (hareinalter called “the Corporation’) having received a Proposal and Declaration, and the first premium from the Proposer and the Life Assured named in the Schedule and the said Proposal and Declaration withthe statements contained and referred to therein having been agreed to by the said proposer and the Corporation as the basis of tis assurance do by this policy agree, in considera- tion of and subject to the due receipt of the subsequent premiums as Set out in the Schedule, to pay the Sum assured together with such further sum as may be allocated by way of Bonus, but without interest atthe office of the Corporation where this Policy is serviced, fo the person of persons to whom the same is payable in terms of the said Schedule, on proot to the satisfaction of the Corporation of the Sum Assured having become payable os ‘set out in the Schedule, ofthe tile ofthe said person or persons claiming payment and ofthe corractness of the age of the Life Assured stated in the Proposal Itnot previously admitted. ‘And its hereby declared that ths Poly of Assurance shal be subject tothe Conditions and Privileges printed on ‘the back hereot, and that the following Schedule and every endorsement placed on the Policy by the Corporation shall be deemed part of the Policy. 108 DIVISIONAL OFFICE ¥MADURAL SCHEDULE SATTUR BRANCH gtAREHOFFEEY ‘ie Dae POUCY Ho Tbe eget Irate sane Pru : S| pram Paybie Propo! No.8 Date aot Conancement | $0 rama Ps ot ae ry 744910884 149 | soeeeo |zech | 1s86s.00 3934 28/e8/2007 | 15 1s Maly 29/08/2007 Nominee under Section 39 ofthe Insurance Act, 1938 e lv_SRINTVASAN Father [DaeotBith O65 06 /1¥%4 ‘Name and Adgross of Proposer and Life Assured [Age of ie Assured 2.3 IS MOHANRAI (ENGINEER), ls/0.SRT.V.SRINIVASAN, encreeenoreccay VENKATACHALAPURAN- (POST), SATTUR~ (TK )VIRUDHUNAGAR-O1ST. eee eee 626203 28/02/2022 1.0m Ue asses sawing Sur Acsurstopter the rear yng tm wh scoued bos 2.0 tle Asueds doa Sum Assure ger Payers tobe made and ers. on he ‘leo erdottesnuned wh scovestens ageing wi ry aro be nace, Prom Payog Tem 3.0 bbe Asreds coat Sum Assad ‘tere ed of he pls Prau Pye “The Proposer oc his Asso: Noes de Sec 39 of nszareg Ado Prong Exes oe CAR SiR Ta PBENSEMENT OF FLSk: | Acrnistaios PAAR aves who should ‘ecu raesertnon os Esta ried othe mans payable ure is Pay ka ay Cour any Sl or econo Union ota Pend dng wc prion pay Tite spl dl ol Las Paes rus doa ot he Lt Ase, ‘es when promum 208 On We epdated e cate Au anal Roe: ‘Signed on behall fhe Corporlion at he above mented Branch Ofc, whose adarass ls ghen below and to wnich any ‘ommunteaton relating to the poly shouldbe adcressec 40 a 209) eicutonnoanan wasan q ay é brand SATTUR [MADURAI OVw} ae a fAgn: 00/5774x dev: eo7as7s AgstGmUnANSYIoer, C0442 Table No, 48CONDITIONS AND PRIVILEGES WITHIN REFFRRED TO 1. Proof of Age ‘Tho promiums having neon calGulated on the age ofthe Lie Assured as declared in Proposal, in case the age ig found figner than such age, wou preutice 10 the Corporation's other rights and remedies, including those under the insurance Act, 1338, fe premium shal be payable in such cease atthe rate calculated on ine Sum Assured for tho comect ‘92 at enicy, and the Assured shall pay to the Corporation the Accumulated diference between the premiums forthe correct ‘age and the onginal Premiums, from the commencement of he Poly up 0 the date of such payinent wath intorest at such rate ‘as may be prevaing at tho ime ol payment provided, Nowever, that case the Life Assured continues Ia gay the premium at the sates shown herein, and aiso does not pay the above mentioned accumulated debt, the accumulated diference between the premium for (ha coxect age and the original premium from the commencement of this Policy up ta the date fn which the Poly Dacomes a claim, with inerest on each instalment of such ference at such rate as may be prevaling altho time of claim, shal accrue and be treated as a debt due by the Assured agamst tne said Policy and wall be ceductes ‘rom the Poicy moneys payabie on the Policy becoming a claim, Proves further that he Assured conect age at enty is such 1s would have mado him uninsurable uncer the Gause oF tore. fof assurance spacited the said Schedule hereto the clause fof terms shat stand allared to such 25 are granted by the Corporation according to the practice in ferce at fe commence: ment ofthis Assurance 2, Payment of Premiums : A grace period of ane meth but not less than 20 days will 06 allowed for payment of yoaly, hat ‘yearly oF quarterly promiums and 15 days, for monthly prem luns If death occurs whin this period and belore the payment ofthe premiue then due, the policy wil still be vakd and the Sum Assured shall be paid atte deduction ofthe said premium as aso tho unpaid premums faling due bolore the ned annwver sary ofthe Pole. the premium & not paid before the expiry of ‘he days of grave, the poicy lapses. tthe Potcy has not tapsed and te ctaim is acmited in case of eam under a Policy where the mode ot payment of premium is ‘other than year, unpacl premiums, i any, laling due betore the next Poly anniversary shall be deducted from the claim amount 3. Revival of Discontinued tics : I the Pobey has lapsed, 1 may be revived Gucing tre Ie time of the Lite Assured, but botore tne end ofthe premium paying ferm and within a period of 5 years from the dae ofthe fist unpaid premium, on submis- ‘sn of proof of continued insurabity 19 the sabstaction of he Corporation and tho payment of al the arrears of premium tegetner wih intrest at Such vale as may be provailng at he time of tne payment. The Corporation reserves the right 12 ‘accept or decine the revival of iecontied pokey. The revival lof the ciscontinued paicy shal take elec only alter the same Is _2pp10vee by the Corporation and s spectcaly communicated tote Lite Assured ‘4Nomforteiture Regulations: ater at eas thee ul years pleroums have beer pan respect oft Poly. ary subs0- {ue promur be nol duly pad this Poy shal ot be wholy ‘ort, ute Sur Assured Lt shale reduced 0 sch a sum {pard up vave as shalt bear the same rato to tha hal Sum ‘Assured the number a! premiums actually past stall bear to {ne ial rumverctginaly stipulated form the Potey, promdad such recuced sume rot (ess than Fs. 250 The Poy 80 reduced shall Ihereatter be. tree trom aN abilty” lor payment ol tne watunnonioned premium. On poly becoming ald up ne Special Provsion wi cease 0 apply. It shall rot be nied 0 partepare in nur pris, but exsing vested bonis addvons, any. wil main atacned 10 the reduced paid up potey Notwithstanding wnat is above statea, after at ea8t tha full years’ pramume have beet par, in respect ofthis Policy, any subsequent premum be not duly paid in the event of the death of the Lite Aecured wihin six months fe the due date of the fist unpatd premium, the Pony “e638 wil be paid as if the Poley had remained in tu foe after deduction of fa) Me pro- ‘ium oF premiums unpad wits itorest thereon to the date of ‘oeah on the samo terms 8 tor revival of the poley ‘duang such penod, and 1b) the unpaid premiums fling due before te nex anniversary ofthe Posey. [Notwithstanding wha is above stated, i after atleast fv fi years’ premiums have been paid in respect of this policy, any subsoquent premium be not duty pai, in the event ofthe death ofthe Lie Assured with 12 months from the due data of te fist urpais premiuin, tre Foley moneys willbe paid ag f the Policy nad remained in ful force after deduction of a) the premium or premiums 02 ren to the date of death on tha same c= Naat of the potoy du ing such period ac} ih) hw! entum’s aling due Betore {ho nx anniversary ofthe Hy, 5. Forfeiture in certain eve-ve :" 2 premiums shallot, be duly paid or in case any coretinn nerein contained oF ‘endorsed hereon shale cartavened, ct wy case itis found tat [any untrue er incorec’slateriens i contained inthe proposal, personal slalemont. declareion and cennected documenis of any mato worst on Is vatREIs, TEN and i every Such ‘case bul subjec tothe provisions of Section 45 of he Insurance ‘Acl, 1938, wherever apolicatte, this policy shal be ord and al Claims to any benoit, m vrive neteo! shall cease and dete:ming land all moneys, thal ‘ava been paid in consequence heret shall belang (9 the Cureoraten, excepting always wn So far as ral is provided in terms ofthe Privieges herein contained or may be lawily granted by “ne Corporation 6. Suicide : The Policy shal be void ie Lite Assured commis sulede (whether sane of mane atthe lima) at anytime On oF ater the date on wtich the risk under the Policy has com ‘enced but tetere the expiry of one year ftom the date of the commencement of risk unser ths poley ang the Corporation wil fot, entertain ary claicm by vrlue of this poley excent to the fexdont of a third patty’ Gonalde beneficial mtorest acquired in the policy lor valuable consideration of which notice has been given ia writing to the branch were the policy is being presen serviced {whete the Paicy cecords ave Kept atleast one cal ‘dar month prox to dean 7. Guaranteed Surrencer Value : The polly can be ‘Surendered for cash afer the premiums have been paid for at least 3 years The minimum surrander value alowable under tis policy 1S equal to 20 per cent of the total amount of the ‘within menvones premiums oad excluding the promiume for the fist year and a! exra presaums andor aditional premiums for ‘Aceldept Benelt trat may have Been pad. The cash valuo of ‘any existing vestes Guarantees addivons wl also be allowed, 8. Loans : Provises the lity has acqured a paid-up value, loans are granted suéiret tothe folowing terms and concions \winin he Surtendar vale ofthe palicy for such amounts and an Such furher ters and castors as the Corporation may Wx from me to hme are cutiae’ ra the production of salistactory tie: u) The Poicy shal oe assigned sbsolutely to and had by the Corparation as secunty for tne repayment of advance(s) and of the mtovest terson (i) Imerest on the acwanceds) shail 8€ paid compounding halt-yeary 9 ae, v38 99 he rte to be spactied by the Corporation wien tne teutive advance 1s made, the fst payment ef interest lv ha msde on the next Poby anniversary (ron the dato six rcnths Beir tno next Poly anniversary whichever smmediately ichows the dala on whyeh the relative advance 1s mado an! every hall year theroatter Interest is Charged for a minimum: period of so months (ii) Te Corpor ‘ss rad tees fr repayment ofthe ‘advarce(s) wth ites rerest uy gag 3 months notes. tn the event o ale tc cpa, Yh oa) when required oF fo pay interest on the ds G35 +s horn above mantionad of wit 80 days afer secr: a-date respectively the poly shal beheld without the necass:y of any “ove berg given, tobe foreted 0 the Corporation and the Corporation shall be entitled to apply the surender valve allaable respect ol he poly in payment ‘of the advances} crt sees liv) At tne end cl sie premas paying term or on earlier death, the Corporation shai Secces eat Yo deduet the amount of om paw'en theract whieh is outstanding, who 5) maneys, 8. Assignments and Nominatione : Notice of assignment ot ominaion should be submited fer registaton to the affce of the Corporation, vinera ths poley is serviced, In registring an assignment o: nomination the Coiperaton does aot accep! any responsibity 0° express ary opinion 2s ta fs valid or leat tect410, Accident Beneft: i at ary time when this Policy sin force forthe fi sum assured, the Lie Assited. below the expiry of the period for which premium is payable or ‘efoe whe potcy ‘anniversary 09 wich the age noarer birthday of the Ue Assured i 70, phichover is earlier, invaved in an accident resuting i etc permanent dsabity as hereinatier deinen cr death and the same is. proved 10 the satstaction of the Corporation, the Corporation agrees in the ease of {) Disabitty to the Lile Assured = 6) to pay in menthiy iestaliment spread over 19 years as adaiona sum equal to the ‘Sum Assured under this Potcy If tie Poicy becomes a clam Delors the expiy of the seid period of 10 years, the csabliy Deneitinstaimanis which have not allen due wit be pad along ‘it the cain, (i 0 waive the payment of future premiums. ‘The maximum aggregate limit of assurance under al! policies taken under the plan on the same ita te which the ben: ‘ht () and (8) above apply soall not in any event exceod Fs 50,00 000. ‘The waWer of prémium shail extinguish a options under this policy except as 10 such assurances, i! any. a8 exceeds the ‘aximum Hit ot As. 50,00,000 ard which may have been wept In force by contnued payment! premiums and the benotis covered by (b ofthe clause, ‘The disabisty above reer to must be asabiy which is the resuitof an accident and must be tata and permanent an such that thee is nether then aoe at any time thereatter any work, occupation or protession that the Lile Assured can ever Suflenty do of fofow to earn or obtain ary wages, compara tion or prot. Accidental injuras whic independent of al other causes and wihio 180 cays trom tne appening of such ‘ecidan, resuit io the iracoverable toss of the enti sight of both eyes or inthe amputation of both hands at oF abave the ‘wrists o inthe amputation of both feet ator above ankles, oF in the amputation of one hand at or above the wns! and one foot ator above the ankle, shall also be deemed To constute such satay Immediately alter the happening of ne disability, tl pariculars thereo! must be given in wrtng to the office of the ‘Corporation where ths Poicy is seraced togetner wit the then caress and wheteabouts of the Ue Assured and winin 18D days after ine happening ofthe disabilty there must be ven to ‘he serving Daisional Otize / Branen Otte o te Corporation in the manner required by it proof of disability satisfactory tothe Corporation and without any expense to the Corporation and thereatter simiar roo! must be gven as and when requted by the Corporation, of the continuance of such dsabiiy. Any Magical Examiner rominatod by the Corporation shail be lowed to examine in person at ihe Lilo Assured in spect of ‘any dsabaty claimed in such manner and at such tres belore andlor afer the disabity ie accepted by te Corporaton as the Corporation may require In the event of ts bang ascovored at any time tat a claim Under this clause naz bean wrongly admited, a premiums faling due ater the Corporation's imation to that affect shall be paid on due dates and urthar al prenwums fo which waiver was wrongly claimed and all instalments of addgional sum _26sured vnicn have been paid shall be paid to the Corporation Ione lump sum wrth ncerest at such rate as may be provating atthe te of payment as i! no Gisablty hac occurred, ting when (1 Tha benefits avaiable under the pokey sna stand reduced as ithe poicy has been discontinued as on the date from which premiums have been waived onthe payrvent of the Bt sta ‘ment ofthe additonal sum aesived, whichever is eaver ard. i) Theinstelmenis of additonal Sum Assured already paid shall be treated as a debt agains the sac Policy and shal be deduct ‘9d with interest at such rate as ay be prevailing at the tee of payment from the proceeds ofthe Policy () Death ofthe Life Assured : to pay an aadtonal sum equal to the Sum Assured under this ofc, fhe Life Assured sha sustain any basSy uty resuting Solely and deectly fiom the ‘ccident, caused by outward. violent and wssbie means and ‘such injury shall within 180 days of ts occurence solely, directly and indepandetly of al ether causes resus the death fof the tilp Assured Homever, such addtional sum payable = respect of tis potcy shall nat exceee Ps, $000,000 The Corporation shal not be Kale to pay the addtional sum ‘efered in (a) or (b) above, i the eisabiy or te dat ofthe Lie Assixes sat ()) be caused by intentional se nut. eempted suede, insan- hy or mmoraty oF whist the Lie Assured i under the iene clintoreating quer, crag or narcote, or (i tane place as a result of accident ile the Lite Assured is ‘engaged in aviation of aeronautes nny capac olner than ‘rat of a fare paying, par-paying or non-paying passenger in any sicerah whieh i authorised by the relevant requations to ‘arty such passengers and tying belween established aero: drome. the Lie Assured having at hat time no cuties on boars the acral o requiing descent therelrom: er i) be caused by injuries resuling from no's, vi commotion, rebelion, war (whelher wor be aeciared or not ‘evas..7 hunting, mouniangeting steaplechasing oF racing 0 fry koe oF iy vase fom the Life Assured commiting any breach of aw () ange from employment of the Me Assured ia the armed ‘occas oF miltary service cf any couniry at wa (whetner war be eciated ot rt) The ena Proriv forthe benelt wil not be requied io Be ca ater al emume under ts pokey have been pat of or are fale the potty anniversary on wisch the age nearer Bt day ot the ie agsured is 7o yoars wrichover i earhor 11, Participation in Profits : The Poly shall caricipate profs ct ime vin Prof Assurance Patcies” at Suh 7ates as Fay bo ueciawd by the corporaton provites the potcy m kept in force Sy payment of premums for = period of st least tee years (except in case of Single Premium) The simie Feversicnary Bon ses shal be doclarey as at 31st March ery ‘ear and wil ronan attached to he Poly. Such bonures 4 thet cast vai, #any, sal be pak along wth the aim woe? te Poe cease 2 paricgte Fr profits wespectn 0 Dolcy has acqured paid up valve (reduces sum assure: Torinal Bonusos may alse be aecared unter the Pale we wil De dayabie at atu, 12. Norral Requitoment fo 3 elaim : The notrat dooumen's \whien te aimont shal submit whale fogging tho cia nc Of death of the Poicyhalder shall be ‘he cam forms, os prescabed by he corporation, asompeniee vith anginal 8c\"y Secumans, roa! of tive, proot of death, froot oF accent Gisabity, mecical eatment prior ty tie Geath. employes cereale whenever is applicable, {0 the satislacton oh ‘Corporation ihe ige s ot admitted unde! tne Poicy, the pat ‘ot age at ho Lie Assured shall also Be subsnted inate ihe Policy suis ite a matuity calm oF case of surrender ofthe Poiey the Lile Assured shal sabmnt the es charge form along with orginal Policy documenl besites 00) of age, the age i not aomitiod caries, Note: in case you have any complaint ‘approach Grievance Redrossal Ofcer asdross is a8 uncer. grievance, yas may Ombudsr-an whose ADRESS OF GRIEVANCE REDRESSAL OFFICER Morkowg Managor LUG. of inte Onisiorat Otiee Sel, acura: 625 0C2 ADDRESS OF OMBUDSMAN Insurance Omousman “Fame Aldhar Court ‘ih Poor, 312, New No, 453, Anca Sal oynampet, Chennai - 600 018EILIC Gfe Insurance Corporation of India Consolidated StampDuty paid vide GO RtNo.649,CT&R/29.a% ‘SPACE FOR ENDORSEMENTS ay YOU ARE REQUESTED TO EXAMINE THIS POLICY, AND IF ANY MISTAKE BE FOUND ‘THEREIN, TO RETURN IT IMMEDIATELY FOR CORRECTION