general GROUP PERSONAL ACCIDENT INSURANCE POLICY ARN ONS Savings ark naval coe ‘seas forthe Poy llbe ne sme provided by eto the ak or my Sevnge dank InwaulCuret Account ete sboW8 Travels ore optnaTrowever they atemosthlpulinensiving tet weareabletoaerve your Aadae CaedNo- PANN: Sum insures Option ‘Sum insured: €2,00,000/- |/—] Sum insured: 4,00,000/- | —] Sum insured: €10,00,000/-][— | Sum Insured: €20,00,000/- {for Premium: ?100/- {for Premium: 200/- or Premium: ®500/+ or Premium: 1000/- no ofAppesble Taxes) {ic of Appeal Taxes) nc of Apleste Taxes) thc of Aepleabe Toxes) + CoveragetsforAecdentalDeath AD] ony «= Penadflnsurance wile one yar rom the dts of account dene ansacin + Oezypations fe servintanybraneh pace, pramitary, itary &armed eres ey County. whether inpeacecr war erenetcoveredunde his Pay + oley stallorcrany be renewable except on grounds ofa, moral hazard or misreresantation or on-ccopertion bythe nrc, Frtar, Sl shallot be ho tbl for ronreneal ofthe Pali fer not debi the acount af the lnsured or whtsoeveresson \Wehoreby confem that l premiums have been willbe pc framborafde sources andr promiumshave besn/llbe pai out of proceeds of cre rebtedtoany ofthe offence FstedinPrevetion of Money Laundering Act 2002 l understand tha the Compares the ight to cal fr documents to estaba source of ids, The surance Company hes the ‘ign to cael the InsurancoGantract neat any have been found guy by any competent cour ofl under any status, dec or nrecty governing te Prevention of Money Laundering in, Nasonlty:fean/Nan- nan IrNomnan, please spect the County a "yp of Organisation: Corporation Goverment/Non-Covermantl Organisation Socey/T ust Parner! teational Oransation/Cooperstve/Secton& Campanas EU Wie herby echre that the statements madeby mein his ProposalFormare we to thebestof my onldge and bal nd cometeteinalespets | Vwiesgre tat his ropoelandthe decartiona sabe ne asiafthecontrict battean me snd 8 Gearllaurane Co. Wits dec tat any changesintheinfrmation given boveatter te submission ofthis woddbe conveyed ta S8IGeneral immediate. | VWicundersang that mi contract wanracton between Sl Ganealrsurance Co Lt. ndmyzalé. The Banke marly felts te purchase ofthis eurance Paley an has no obgatin towards settlement ofelams Wie have rade brit terms &condons ofthe Poy printed oveeafaecontrm tat am eg for coverage undo thisPlly. CE 0 herby nominate MMe the person & Meas the Gama ofthe Nomina at the Nines 9 ia orca the wut payabeby S81 General insane Co, Ltn the ever of my Acczetal Death and he/she Nominees reateto me IRatatorsvo wth ‘he neue ane ther decorethathishr recital sient to charge fr he Company. One, Dayot na § Astras oftneNominee Ge i bate; ontreottnropesediewes XE ES | eutherae for tomate Gatto renewal premium ofthe cover fom my account a long a the terms and conden and te premium paysble remain Unchanged, ‘understandthat this authorisation canbe revoked bymeat my wil by submitting a writen ntie tothe Bank: x ate “Sgnatre/ Tha pression ofthe Propose] Prarie Fornterrlprpose only (Tbe filed by the Bark ranch Oil islam: Sl General surance Company Limited Corporate & Rgiteea Ofc Nara. $1, Junction of Western Express Highay & Ananer~ Kurla Rd, Arona (Ese -Mamoa- 400089. |For more deta on na skorts anccondton, pase refer tothe Sales Brochure and Paley Worangs carey before conducting sl. | Fors ‘Generar nsurance Company Lined DAI Re No, 144 dated 15/12/2005 | CN: UsEOODMH20099.C190546 Sl Lope splayed belongs to State BankoF na ang used by SAL ‘Geveansrence Comper Limstesundereence,/ Ue S8PAGPII005V011015, ° \ Catl(Tot Free | 280022 1121 | 18001021112 | © ww-sbigeneralin-Applabiewherethe Proposer silteate ris suferng rome dsabity dus to whieh wing srestcteder where the Proposerhas signed nverncu langue (tot: The blow must be wirssey smeane other than the AdviserEmploee the Company le cena the post pp for by refs an tha conan ofthe Proposal Form havebeen clr excsned eal anal/Me hive fly understood tram. Wether ety hat repli the Proposal Forfa ben recorded part Infomation rovidesby mas. Ulam often Relationship wh the Proposer sdutanainabtane of! and residng at. ‘to erey corey thet nave red out and explained the contents of ha Proposal Form andat other documents Inedertal to avang the nsurance Poy ttm S81 General surance Compeny Ltd tothe Proposet/rimary Insured and he/she/they have understood the sme. ecore that ‘whatever nave tuted aren abovelstrutand correct tothe bet of my knowledge and bali ‘Spat Thanb moessen ofthe Feposer PES ‘choote your surance Rpostor For those selecting e-Fermat) NsoLDstaManagemare.ts. [__] costineuance RepoetoryLt Kary heuranceRepostarytte| | CAMS Reposkary Service ts MycxYCN. (Ca PEN 1 Nopersonstllor fet etbw ether srectirindect a aninducement to any person to tke out. anew ocotihuesn hsurancein respect of ery indo Felting > vee property nin, any bate of whoo par ofthe commission pyle or any east ofthe promian showninthepaey, nor sallany preon aking au renewing oF continuing aelcyaecapany rebate except suchrabate as may be allowedinecordence withthe publshedpospecusesar lables ofthe sue. Kom Your Customer Registry Numba ovate, Ca ae “This lswranco sujet tothe terms and candtons fhe Master Paley Number meting onthe Crate of surance sued oS &Rogana Rural Gan" and ised on {tes Proposal and payment of the Pramien. TS records the agreement between the sured ad 8 General Insurance Corgan Ld ana es out tei as of surance andthe oblgptoneafescnpary sbalow “Sauresnre Grain Bald Mizoram Rua Band Meghelye Rural Sank/ Lange Dehang Rul Sark! Andie Pradesh Grameen Vikas Bank! Puvencal Band The Rajsthan aruchara Gramean Bank Telangana Grmasn dan! Arunachal Pradesh Rural Bink! Machyarchal Garsen Bank/ Malan Grameen Bork sain: Dens Sank Varanchal Green an Kaver Grameen Bani Uk Green Bani Utara Gran Bank Chala Raja Grameen Bank, re + Ths Potcy canbe bought by ary parmanent an resident having a Savings Bonk / néiual Current Accourt with RRBs" of SB and aged between 18 years to 5 years. RenewalethePaley ane don beyond 8 yeseaf age + respective ofthe amber of acountsthelnsured ns with Bio ts Regional Rural Banks" he shes allowed t ake only one Policy. Mul Poke forthe some sured are allowed Even fultpe Polis ra ‘aken through an or morethan ona sccount with SB Reson Rural Usk" for any ror oy willbe reseed oan one Pofey wth the highest Sum Insure, Acta Plies Salle deemed as rll an void. eas fon account. we Separte Pos maybe issued in cafe bth the account holder opt forrespectiveinsviunPlees + Coverage unde ths Poey wilbeoverand ove any oer Personal Accident Pole the hauredhas wth Sl Genero wih anyother Indian Geneainauance Companies, + aurecmsy termite Pole at ny ome by ging 1 aye wrttennotie Ina cams bean msde under the Ply, then wena refine premuminaccorsncevth Se “Greve Rares Procedure: Wevalue your elaiorsh ond are committed offer youbestr-dass evs However youre dati wit the sence rendered ‘during any of your teractions wth us oronrerlton provdeby ur on yoursericsrequertar compa, we equertyoutoregteryourconcermwith or Customer Cre ty folowing the steps mentioned teow. We wl cknowledge receipt of your concema within next 72 waking hows end wil rapond to you as soon a8 posse, pen Completon of ti ivestgiton, Step ss Call ur at 300-302-1811 / 1800-22-1113 (Toltfee 600 am t> #90 pm ~ Monday t© Satrdsy or wre to ot 3 eustomercaresbigneralin. If you dont heat rom us wihin 48 rs, lene fotlow Step 2: Fyau ae ao hapoy with the resollon provided please wite to Heed Customer are at ou Repstere Of adres prints vera. fer having flowed Stp 1 nd Step 2 you lsu8 remains unescved for more than 30 dys rom the cat ong our feat complil,yourny approsch the rarance Onbudsnn for redress of your reve islam: Sl General surance Company Limited Corporate & Rgiteea Ofc Nara. $1, Junction of Western Express Highay & Ananer~ Kurla Rd, Arona (Ese -Mamoa- 400089. |For more deta on na skorts anccondton, pase refer tothe Sales Brochure and Paley Worangs carey before conducting sl. | Fors ‘Generar nsurance Company Lined DAI Re No, 144 dated 15/12/2005 | CN: UsEOODMH20099.C190546 Sl Lope splayed belongs to State BankoF na ang used by SAL ‘Geveansrence Comper Limstesundereence,/ Ue S8PAGPII005V011015, ° \ Catl(Tot Free | 280022 1121 | 18001021112 | © ww-sbigeneralin+ Wemay terminate this Pokey upon 15 days notice by sending a witen nis of ancliton to your adres and we hall efunda rateable proprton ofthe premium actly sida rerpec ofan neuro Perzon. Termination fs Pali shallot foc ary cl fled prior othe date an whch the termination becomes fective a sped inthe rote often. «Such tarmntion yb on riot representation Fd, nn dior of mate acts ono cooprston thelnsired + Thepremiumat the time othe renewal the Poly woukébe the apaleabe pramiumat the date of renewal and as aprovedty RDAL However. renewal be sibect tothe + The Ply shal become vidal atthe option of he Insure. the event of any untrue or ncoect statement. msepesetaion,nen-despion or ors ny mater partelr inthe proposal form/persanal statement decraton and cornered dacurerts ar any materi nformation having bean thald by the sured anyone ‘cng onthe Insured’ Baa, Any person who, knowingly and wih intent to dau te Company anyother parton, les a proposal fr heurancecenating any fae Infomation or concn for he purpose of miseacing,nforntion concaring ny fact materal thereto, commis 3 ruler surance act, hich wil be held aeponseto ‘ender te Poy vite at hese discretion of he Cooery. Ex + Suid, altmtd aude (whether sane or insane orintetionaly ef-ntedijury ries, or seul anamtedcondvons, mental or nervous sore, aaiaty, sass or dpresion, Aequred nmune Oefany Syrrome (ADSI Hunanimmune dficuncy Vitus HV infection Cccupaton ka zerving nny branch ofa, pramitry,mitary& smeercs ofan county Whetheinpascecr Wr ot Beng under the irtuenceorabus of. alcoho aher intoxicants or allcinogen nls propel prescrbedby apyscianand taken asprescbed oF ‘Operating or ering to operat any ara or performing ites a a member ofthe crew on any ara apart fm a Schaded Alnor whist engaged in vation or ballooning or whit mounting nt, dismcuntng fom or avling inary balloon or zr other than ae 3 passenger fre paying a other] in anya Henao standard ype ofaerattanywnerenthe wer or -Anyloze sing out of war, il war, nasionncurecton, volition, ac of foregn enemy, hole (hatha war be ecard or net. rebellon mutiny ute of mtr power or usurpation f goverment or mit power oe Payment of cmpansation In caso of death ofthe sured person fam nuclsr damage auto by, contibutd to, by or asin rom ening ration or contamination by raonctvty from Ssryrclerfuslorfomanyntcksrwaste: fromthe comburtencfracler ful ncuding ay selt-sustaning process ofl fasion racer wesoons tei nucle equsmenter any prt oftetequent ‘The depen or sppetonofpatnogencor porous bislopcalorchemlealmaterak the release of pathogenic or pogorous bloga or chemical mater, congenial svemaes or any compteatons or condor ing there of accion n winter spars, seavnafparachtng hand-saing, bungee jumping, cuts ding alboring, mountain lnbing where ropes o gues are customary wsdl Figo ing races or ales using ameotase hie or bcyele, avng or potalng, hung or questa aes sin ving othe underwater ates, tng ot ‘aronng nvoking white waterapde,ycing opoting outa contal waters 2 rates mils) patelpaton nary profesional sports, any nol conte sport andor my cotternaardous or sotental dangerous spor forwhch elnsired sunbed ot Death resting det or nach, contributed or aarovated or protoges by chisithr fom pregnancy. oF For any loss to which a conibuting cause was the Insured person's stu o tempted comission or wilful prtkpstion in an Hegel stor any volaton or stamped elation ef thetow or resistance to arrestor the nsued person commiting anybeackoow wthcrininalitent:or + Lseeausaddrecy arnt whol rary fection laceptpjogenicefectonsbichshal ccc throughan acide wound orany other kindof dese islam: Sl General surance Company Limited Corporate & Rgiteea Ofc Nara. $1, Junction of Western Express Highay & Ananer~ Kurla Rd, Arona (Ese -Mamoa- 400089. |For more deta on na skorts anccondton, pase refer tothe Sales Brochure and Paley Worangs carey before conducting sl. | Fors ‘Generar nsurance Company Lined DAI Re No, 144 dated 15/12/2005 | CN: UsEOODMH20099.C190546 Sl Lope splayed belongs to State BankoF na ang used by SAL ‘Geveansrence Comper Limstesundereence,/ Ue S8PAGPII005V011015, ° \ Catl(Tot Free | 280022 1121 | 18001021112 | © ww-sbigeneralin