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THE LIFE INSURANCE CORPORATION OF INDIA (hereinafter called “the Corporation”) having received a Proposal along with Declaration and the first
premium from the Proposer and the Life Assured named in the Schedule referred to herein below and the said Proposal and Declaration with the
statements contained and referred to therein having been agreed to by the said Proposer and the Corporation as basis of this assurance do by this Policy
agree, in consideration of and subject to the due receipt of the subsequent premiums as set out in the Schedule, to pay the benefits as set out in the
schedule, but without interest, at the Branch Office of the Corporation where this Policy is serviced to the person or persons to whom the same is payable in
terms of the said Schedule, on proof to the satisfaction of the Corporation of the benefits having become payable as set out in the Schedule, of the title of the
said person or persons claiming payment and of the correctness of the age of the Life Assured stated in the Proposal if not previously admitted.
And it is hereby declared that this Policy of Assurance shall be subject to the Conditions and Privileges printed on the back hereof and that the following
Schedule and every endorsement placed on the Policy by the Corporation shall be deemed part of the Policy.

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Nominee under Section 39 of the InsuranceAct, 1938:

And as printed overleaf.


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Signed on behalf of the Corporation at the above-mentioned Branch Office, whose address is given on the last page and to which all communications relating to the policy should be addressed:

Agent's Mobile / Landline Number


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1. On death of the Life Assured before the stipulated Sum Assured on Death shall be payable, which is the highest of Basic Sum Assured or 10
Date of Maturity provided the policy is in full force by times of annualised premium or 105% of all the premiums paid as on date of death.
paying upto-date premiums. The premiums mentioned above exclude service tax, extra premium and Accident Benefit
Rider premium, if any.
Loyalty Addition, if any, shall also be payable if death occurs after completion of 5th policy
year.

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2. On Life Assured surviving the stipulated Date of Basic Sum Assured along with Loyalty Addition, if any, shall be payable.
Maturity provided the policy is in full force by paying
upto-date premiums.

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m an a the premiums shall be payable in such case at the rate calculated on
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wa {jV aIV mh°.~›X policy. The revival of the discontinued policy shall take effect only
n
m ∞{
b grH $
mn wZ: ‡
dV ©Z V ^ r
‡ ^ m dr hm
oJm O ~ {
Z J_ ¤ma
mC g oA Z
w_ m
o{
XV H$a{X̀m after the same is approved by the Corporation and is specifically
O m`oJ m
V W m
{
d {e Ô

$ n g o‡ ÒV m
d / ~ r
{_ V Ï p̀
ä V H$ m
og y{
MV H
$ a {
X̀ mO m
`oJm
. communicated to the Life Assured.

X
˛K ©Q>Z m
d e {
h Vb m
^ a m BS >aH $
mn wZ :‡d V ©Z, `{X B g H
$m M̀ Z {
H $m̀J̀ mh°,Vmo Revival of Accident Benefit Rider, if opted for, will only be considered
along with the revival of the Basic policy and not in isolation.
Cg H $m
_yb n
m ∞{b grHo$ n wZ
: ‡d
V ©Z Ho$gmW h r{
d Mma {
H $m̀O m
`oJ m,A b Jg oZht
.
4. Non-forfeiture Regulations: If less than three years’ premiums
4
.O „ V r g og a
wj m g ~
ßY ß r { Z̀ _ : A J a C ∫ $ nm
{
∞b g r H $
oA V
ß J V
© _ |V rZ d f ©g oH $ _ H $ s have been paid in respect of this policy and any subsequent premium
‡ r {_ ` _ H $m ^ J
wV m Z {H $m̀ J̀ m h °A m a
° { H $
g rA m J m_ r ‡ r { _ ` _ H $ m { Z̀ _ m Z g
w m a ^ J
wV mZ be not duly paid, all the benefits under this policy shall cease after the
Z h t {H $m̀ J̀ m h ,
°V m oB g n m {
∞b g r H $
oA V
ß J V
© g _ Ò V b m ^ ‡ W _ A X Œm ‡ r {_ ` _ H $ s {V{ Wexpiry of grace period from the date of first unpaid premium and
nothing shall be payable.
g o[ a m̀ V̀ A d { Y H $ s g _ m { · H $
o~ m X Ò W { J
V hm
oO m E J
± oA m a
°H $
wN >^ r X̀ o Z h t h mJ
om .
h m b m±{ H $, ` {X B g n m
∞{b g r H o$ A ßV J ©V _ |H$
_ g oH $_ V r Z n yU ©d f m ]H o$‡ r
{ _ ` _H $ m However, if after at least three full years’ premium have been paid in
respect of this policy and any subsequent premiums be not duly paid,
^ wJ V m Z H $ aZ oA m °a { H $g r A Z wdV u ‡ r { _ ` _ H
$ m ^ wJ V mZ {
Z̀ _ m Z wg ma Z H$ a Z oH o$ ~
mX , this policy shall not be wholly void, but shall subsist as a paid-up
h̀ n m ∞{ b g r n yU ©V : A d °Y Z h t h m oJ r , ~p Î H
$ M wH $ V m n m∞{ b g r H o$ Í $ n _ |a h oJ r ._ ybpolicy. The Basic Sum Assured shall be reduced to such a sum, called
~ r _ mH •$ V a m
{ e E og ra m
{e _ |g oH $ _ h m oO m E J r,
{ O g oM wH $ V m ~ r_ mH •$ V a m { e H $ h m O mVm h ° Paid-up Sum Assured and shall bear the same ratio to the Basic Sum
A m °a B g H $m _ yb ~ r _ m H •$ V a m {e g od h r A Z wn mV h moJ m O m od mÒ V { d H $ Í $n g o‡ X Œ m Assured as the number of premiums actually paid shall bear to the
‡ r {_ ` _ m |H $s g ߪ̀ m H $ mn m∞{ b g r _ |_ yb V : Ï `∫ $ ‡ r {_ ` _ m
|H $s H w$b g ߪ̀ m g oh m oJ m . total number of premiums originally stipulated for in the policy.

O h mßE og r n m∞{
b g r ~ r_ m H •$ V a m {e H $ _ h ˛B©h°, C Î b o{I V ‡ r { _ ` _ m |H o$ ^ rV a CZ H o$ The policy so reduced shall thereafter be free from all liabilities for
^ wJ V m Z H o$ {b E g _ Ò V X m{ À̀d m |g o_ w∫ $ h m oJr
, b o{H $ Z d h { Z  >m d •{ ’ H o$ { b E m̀
oΩ ` Z h t payment of the within mentioned premiums, but shall not be entitled
h m oJ r. n m ∞{b g r H o$ ‡ X Œm h m
oZ on a A Z wg yM r _ |CÎ b o{ I V { d e of ‡ m d Y m Z m|H $ m b m J yh
m oZ m for Loyalty Addition. On the policy becoming paid-up the special
provisions mentioned in the schedule will cease to apply. This Paid-
Ò W { J V h m oJ m
.h̀ M wH $V m _ yÎ̀ n [a n ä d V m H$
s { V { W n a m̀O r d Z ~ r { _ V H $
s n yd ©_
•À ` w Up Sum Assured shall be payable on the date of maturity or on Life
h m oZ on a X o` h moJ r . Assured’s prior death.
C n a m o∫ $ H $ W Z H o$ ~ m d O yX , ` {X B g n m ∞{
b g r H o$ A ßV J ©V H $_ g oH $
_ V r Z n yU ©d fm
]H o$ Notwithstanding what is stated above, if atleast 3 full years’ premiums
‡ r {_ ` _ m |H $
m ^ wJ V m Z { H $E O m Z oH o$ ~ m X , { H $
g r A Z wd V u ‡ r {_ ` _ H $m ^ wJ V m Z have been paid in respect of this policy, and any subsequent premium
{
Z̀ _ m Z wg ma Z h t { H $m̀ O m V m h°, V m o‡ W _ A X Œ m ‡ r { _ ` _ H $ s { Z̀ V {V {W g o6 _ m
h H o$ be not duly paid, in the event of the death of the Life Assured within six
^ r V a ~ r { _ V Ï p̀ ä V H $
s _ •À` wh m oZ oH $ s X e m
_ |, {Z Â Z { b { I V H $ m Q >H $ a _ yb ~ r _ m
H •$ V months from the due date of first unpaid premium, Basic Sum
a
m { e H o$ ( H $ ) _ yb ~ r_ m n m ∞{ b g r H o$ V h V A X Œ m ‡ r{ _ ` _ , _ •À ` y{ X Z m ßH $ V H $ „ m̀O H o> Assured will be paid after deduction of (a) the premium or premiums
g m W X o` h m oJ r - C › ht e V m]n a O °g o{ H $ C g g _ ` n m ∞{ b g r _ |n wZ Ö‡ d ©V Z h oV w{ $m̀ for the basic policy unpaid with interest thereon upto the date of
H
death, on the same terms as for revival of the Policy during such
O m V m , A m °a ( I ) _ yb nm ∞{
b g rH o$ V h V A J br n m∞{ b g r d f ©J mR >|H o$ n yd ©A X Œm ‡ r{ _` _ period and (b) the unpaid premiums for the basic policy falling due
H $ m ^ wJ V mZ C g r ‡ H $ m
a {
H $m̀ O mE J m O °g o{ H $
n m ∞{ b g rn yU ©È n g oM m
b ya h r h m o. before the next policy anniversary.
C n a m o∫ $ H $ W Z H o$ ~ m dO yX , ` {X B g n m ∞{b g rH o$ A ßV J ©V H $_ g oH $
_ n mßM n yU ©d fm
]H o$ Notwithstanding what is stated above, if at least five full years'
‡ r {_ ` _ m |H $
m ^ wJ V m Z { H $E O m Z oH o$ ~ m X , { H $
g r A Z wd V u ‡ r {_ ` _ H $m ^ wJV m Z premiums have been paid in respect of this policy, any subsequent
{
Z̀ _ m Z wg ma Z h t { H $m̀ O m V m h °, V m o‡ W _ AX Œ m ‡ r { _ ` _ H $ s { Z̀ V { V { W g o1 2 _ mh premium be not duly paid, in the event of death of the Life Assured
Ho$ ^ r V a ~ r
{ _ V Ï p̀ ä V H $ s _ •À ` wh m oZ oH $ s
X em _ |, { Z ÂZ { b {I V H $ m Q >H $ a _ yb ~ r _ m
H •$ V within 12 months from the due date of first unpaid premium, Basic
a
m { e H o$ ( H $ ) _ yb ~ r_ m n m ∞{ b g r H o$ V h V A X Œ m ‡ r{ _ ` _ , _ •À ` y{ X Z m ßH $ V H $ „ m̀ O H o> Sum Assured will be paid after deduction of (a) the premium or
g m W X o` h moJ r - C › ht e V m]n a O °g o{ H $ C g g _ ` n m ∞{ b g r _ |n wZ Ö‡ d ©V Z h oV w{ $m̀ premiums for the basic policy unpaid with interest thereon upto the
H
date of death, on the same terms as for revival of the Policy during
O m V m , A m °a ( I ) _ yb nm ∞{b g r H o$ V h V A J br n m ∞{b g r d f ©J mR >|H o$ n yd ©A X Œm ‡ r{ _` _ such period and (b) the unpaid premiums for the basic policy falling
H$ m ^ wJ V mZ C g r ‡ H $ m
a {
H $m̀ O mE J m O °g o{ H $
n m ∞{ b g r n yU ©È n g oM m
b ya h r h m o. C n a
m o∫ $ due before the next policy anniversary. In addition to the above,
H
o$ A { V [a ∫ $, { Z  >m d •{
’ , ` { X H $ m oB ©h °, ^ rV ~X o` h m oJ r , ` { X _ •À ` wn m ±M n m
∞{
b g r d f
m]H o$ Loyalty Addition, if any shall also be payable if death occurs after
n yU ©h moZ oH o$ ~ m X h m oV r h°. completion of five policy years.
` o‡ md Y m Z X ˛K ©Q >Z m
d e {
h V b m ^ am B S >a H o$ {b E b m J yZ h t h moV oh ¢, ä m̀ |{H $ C Z H $m H
$ moB © These provisions do not apply to Accident Benefit Rider as they do not
‡ X Œm _ yÎ̀ Z h t h m oV m h °A m °a a mB S >a b m ^ Ò W{
J V h m oO m V oh ¢, A J a n m ∞{ b g r H $ m b mVr V acquire any paid up value and the rider benefits cease to apply, if
p
Ò W { V _ |h °. policy is in lapsed condition.

5
.H
$
a: H
$
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a g {hV,`{XH$
m
B
o ©hm,
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H$
m
ZZ
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oAZ
g
w m
ahm
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Ama
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$aH$
sX
a5. Tax: Taxes including Service Tax, if any, shall be as per the Tax laws
{
ZY
m©{a
VXa
na b m
JyhmJ
or. and the rate of tax shall be as applicable from time to time.
{
ZYm©{
a
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am
|H$
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w maH
$aH$
sa
m {en m {
∞b g
rYm
aH$
¤ m
a
m‡r{
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|n
aX̀
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or
,AJ
a The amount of tax as per the prevailing rates shall be payable by the
C
g‡ r
{
_`__|A{V[a∫$‡r
{_`_E dßX
K
˛ Q© >Zm
{
hVbm^am
BS
>a‡r
{
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em {
_b h
.
¢‡
XŒm policyholder on premiums including extra premiums and Accident
Benefit Rider premiums, if any. The amount of tax paid shall not be
H
$
aH $s
am
{
ena m̀
O
o Z mH$
oA
V
ß J
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$
sJ
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bE{d
Mm
aZh
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O m
EJ
m.
considered for the calculation of benefits payable under the plan.

6
.{
deof n[a
pÒẀm|_
|O „Vr:`{
Xn m∞{
b gr_
|g _
m
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n •
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g reV ©H$
m 6. Forfeiture in Certain Events: In case any condition herein
C
Î bßKZ {
H$m̀
O mV
m h ° m̀nmm̀
Om
V mh°{
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$‡Ò V
m
dn
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WZ,KmofUm contained or endorsed hereon shall be contravened or in case it is
A
m°agß~
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|_|H $m
oB©AgÀ
` m̀
JbVH$WZ
gp
 _{bV h °A WdmH
$m
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mp
À d H$ found that any untrue or incorrect statement is contained in the
proposal, personal statement, declaration and connected documents
O
mZ H$
mar{N
>nm
B©JB©h° h̀ n
m
∞{
bgr {ZaÒVhmoO
m
EJ
r A m
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m∞{
bgrgog
ß~
ß{Y V or any material information is withheld, then and in every such case
{
H
$g r^r bm
^ H
o$g^ r
X mdo~r
_mA{
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1 93
8Ho$AZw¿N >oX 4 5H
o$
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o$ this policy shall be void and all claims to any benefit in virtue of this
A
Y rZ hm
|J
o,
O°gmg_ -̀g _`na
g ße m
o{
YVhm
o. policy shall be subject to the provisions of Section 45 of the Insurance
Act, 1938, as amended from time to time.

7
.A m À
_ h
À m̀
:h̀
n m
∞{b g
rAd°Y
hm
oO
m E
Jr 7. Suicide: This policy shall be void
`
i){ X ~r
{
_ VÏ`
{∫$( _mZ{
gH$Í
$ng
oÒdÒ
W m̀
AÒd
ÒW)O m o{I_e

$
hmoZoH
$
s {
V{
W
i) If the Life Assured (whether sane or insane) commits suicide at any
g o1 2 _mh
Ho$
^r
V a {
H $
gr^rg
_`A m
À_
hÀ m̀
H
$ab
oVm
h°Vm o{
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am
B gn
m∞{
bgr time within 12 months from the date of commencement of risk the
H
o$ AßV
J©V
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gr ^ rXm
don
a {
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ma Z
ht
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H $m̀
OmE
Jm
,‡X Œm ‡
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% H
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o Corporation will not entertain any claim under this policy except to the
N>moãS
>H$
a
, {Og_|H $
moB
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a
, A{
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a ∫
$‡r{
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dßX
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>Z m
de{h
Vb m
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B>a extent of 80% of the premiums paid excluding any taxes, extra
S
premium and Accident Benefit Rider premium, if any, provided the
‡r { _`_,`{
XH$
moB©h
°,em
{_
b Zh
th°,
~
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H$
nm
∞{
bgrMm
b yA dÒ
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policy is inforce.
ii) `
{X
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_mZ
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g H$ Í $
ngoÒ
dÒW m̀AÒd
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n wZ : ‡dV
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2 ii) If the Life Assured (whether sane or insane) commits suicide within 12
_
mhH
o$
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$gr^r g_` Am
À_hÀ m̀
H
$a b
oV
mh°V
mo_ •À`wH
$s
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{WVH
$ ‡XŒm months from date of revival, an amount which is higher of 80% of the

r{
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% (H
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∫ $‡
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^amBS>a premiums paid till the date of death (excluding any taxes, extra
premium and Accident Benefit Rider premium, if any,) or the

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a) m̀
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o` surrender value, shall be payable. The Corporation will not entertain
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g r any other claim under this policy.
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.
8. Surrender Value: The policy can be surrendered at any time during
8
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g
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©n
depend on the policy term and policy year in which the policy is
AmYm[
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{bE surrendered and is enclosed as Annexure - I to this document.
n[a{
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However, under this policy, Special Surrender Value will be payable, if
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Condition 4). These discounting factors applicable to this policy may
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No surrender value will be available on Accident Benefit Rider, if any.
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9. Policy Loan: Loan can be availed under this policy provided atleast
9
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1. The Policy shall be assigned absolutely to and held by the


1
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2
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am 2. Interest on Loan shall be paid on compounding half-yearly basis to
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including policies with in-built Accident Benefit taken with Life
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H $s A {Y H $ V _ H w$ b g r _ m { H $g r ^ r pÒ W {V _ |È . 1 0 0 b m I g oA { Y H $ Z h t h m
oJr. ` { X group policies on the same life to which following benefits apply shall
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X H w$ b X ˛K ©Q >Z m b m ^ È . 1 0 0 b mI g o not in any event exceed Rs.100 lakhs. If there be more policies than
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s { V {W H o$ A Z wg m a ‡ W _ È . 1 0 0 b mI one and if the total Accident Benefit exceeds Rs.100 lakhs, the
benefits shall apply to the first Rs. 100 lakhs Sum Assured in order of
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proved to the satisfaction of the Corporation, the Corporation in
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Benefit Sum Assured, if the death of the Life Assured shall:
(i) O m Z ~ yP H $ a A n Z oH $ m oM m oQ >n h ˛ßM m Z o, A mÀ _ h À m̀ H $ m ‡ m̀g H $ a Z o, n mJb n Z
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immorality or whilst the Life Assured is under the influence or
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(ii) { H $g r X ˛K ©Q >Z m H o$ H $ m a U h m oJ r , O ~ { H $O rd Z ~ r{ _ V { H $ g r ^ r d m ` w m̀ Z _ |, O m o
(ii) take place as a result of accident while the Life Assured is
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H o$ ~ r M C ãS >mZ ^ a Z oH o$ { b E A { Y H •$
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A mß{ e H $ ^ wJ V m Z H $ a Z od m b o m̀ ^ wJ V m Z Z H $ a Z od m b o m̀ {Ã̀ m |H o$ A b m d m{ H $ g r craft which is authorised by the relevant regulations to carry such
passengers and flying between established aerodromes. The Life
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Assured flying as a passenger in such capacity should have at
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(iii) X ßJ m |, A g °{ Z H $ C n – d m |, g e Û { d – moh , ` w‹ X ( ^ b oh r ` w‹ X H $s K m of U m H $ s J B © (iii) be caused by injuries resulting from taking any part in riots, civil
h m o m̀ Z H $ s J B ©h m o) , A m H ´$ _ U , { e H $ m
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g r ^ r commotion, rebellion, war (whether war be declared or not),
‡ H $ m
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Q >J , a m o_ m ßM H $ I ob m |_ |^ m J b oZ m H o$ invasion, hunting, mountaineering, steeple chasing, racing of any
kind, paragliding or parachuting, taking part in adventure sports;
\ $ b Ò d Í $ n M moQ >b J Z oH o$ H $ m a U h m oJ r A W d m , or
(iv) ~ r {_ V Ï ` { ∫ $ ¤ m a m A n a m { Y H $ B a m X og oH $ m oB ©A n a m{ Y H $ H •$À ` H $ a Z oH o$ n [a U m _ (iv) result from the Life Assured committing any breach of law with
Ò d Í $ n h m o; m̀ criminal intent; or
(v) ( E ) ` w’ ( M m h oK m o{ f V h m o m̀ A K m o{ f V ` w’ ) _ |{ H $g r ^ r X oe H o$ g e Û ~ b m̀ (v) (a) arise from employment of the Life Assured in the armed forces
g °› ` g od m _ |a moµO J ma g oC À n fi h m oV r h °.h̀ A n d O ©Z b mJ yZ h t h m oV m h°, ` { X or military service of any country at war (whether war be declared
O rd Z ~ r { _ V V ~ { H $ g r X ˛K ©Q>Z m H $ m { e H $ m a h moV m h °O ~ d h S >Á yQ >r n a Z h t h ° m̀ or not). This exclusion is not applicable if the Life Assured was
{
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a V oh ˛E { H $g r ^ r ~ M m d H $ m ` ©_ |e m { _ b involved in an accident when he is not on duty or was involved in
any rescue operations while combating natural calamities in our
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>r _ |e m{ _ b h moZ o (b) arise from being engaged in police duty in any military, naval
g oh moV r h °.h̀ A n d O ©Z b m J yZ h t h °, O h m±n w{ b g S >Á yQ >r _ |a h Z oH o$ X m °a m
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X ˛K ©Q >Z m g oh ˛E X ˛K ©Q >Z m b m ^ H $
m oA m d [ a V H $ a Z oH $m { d H $Î n M wZ mJ̀ m h m o; m̀ option to cover Accident Benefit arising on accident while
engaged in police duty, has been chosen; or
(vi) ~ r {_ V Ï p̀ ä V H o$ X ˛K ©Q >Z m J ´Ò V h m oZ oH $ s{ V {W g o1 8 0 { X Z m|H o$ ~ m X h m oJ r .
(vi) occur after 180 days from the date of accident of the Life Assured.

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Policy Year 10 11 12 13 14 15 16 17 18 19 20
1 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
2 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
3 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00%
4 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%
5 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%
6 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%
7 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%
8 65.00% 60.00% 57.50% 56.00% 55.00% 54.29% 53.75% 53.33% 53.00% 52.73% 52.50%
9 80.00% 70.00% 65.00% 62.00% 60.00% 58.57% 57.50% 56.67% 56.00% 55.45% 55.00%
10 80.00% 80.00% 72.50% 68.00% 65.00% 62.86% 61.25% 60.00% 59.00% 58.18% 57.50%
11 80.00% 80.00% 74.00% 70.00% 67.14% 65.00% 63.33% 62.00% 60.91% 60.00%
12 80.00% 80.00% 75.00% 71.43% 68.75% 66.67% 65.00% 63.64% 62.50%
13 80.00% 80.00% 75.71% 72.50% 70.00% 68.00% 66.36% 65.00%
14 80.00% 80.00% 76.25% 73.33% 71.00% 69.09% 67.50%
15 80.00% 80.00% 76.67% 74.00% 71.82% 70.00%
16 80.00% 80.00% 77.00% 74.55% 72.50%
17 80.00% 80.00% 77.27% 75.00%
18 80.00% 80.00% 77.50%
19 80.00% 80.00%
20 80.00%

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NOTE: In case you have any Complaint/Grievance, you may approach Grievance Redressal Officer/Insurance Ombudsman whose address is as under:

Address of Insurance Ombudsman

YOU ARE REQUESTED TO EXAMINE THIS POLICY, AND IF ANY MISTAKE BE FOUND THEREIN, RETURN IT IMMEDIATELY FOR CORRECTION.