sBIGeneral INSURANCE GROUP PERSONAL ACCIDENT INSURANCE POLICY 1800221111 | 1800 102 THT vw sbigenerlin Proposal Form ‘BI Sovings Bonk | Invidual Curent Ale No| SB! Bronch Nome Code Nome ofthe proposed L_| | JL ttt titi ttitit ity titi tiririity Insured Person ‘Addross fortis Policy willbe the some as provided by me tothe State Bank of Inia for my Savings Bank / Individual Current Account cited above. Gonder Mote [7] Femote Date of Binh Email O* Mobile No These els repent however they are mothe esi that we a eo er yo bt Summ tsured Option [[] Sum insured: Rs.2.00000- | [[] sum insures: Rs400000- | [] sum nsured: As.10.00,000- | [sum ise 2000000 for Premium: Rs. 100 for Premium: Rs-200/- ‘or Premium: Rs.500/- ‘or Premium: Rs. 1000/- (aol of Serve Tx (in of Serie Ta. el of See Tax {in of Serie Tax Kindly Note: * Coverageis for Accidental Death (AD) only + Periodof insurance willbe one year from the date of account debi transaction * Occupations like serving in any branch of police, poramiltry, miltary & armed forces of ony Country, whether peace or war are not covered under thispolicy PEN * thereby declare thatthe stotorents made by me inthis Proposal Form are rueto the bes of my knowledge ond belie and completelnlleespects * agree thar this proposal and the declarations shal bethe bass ofthe contact between me ond $8 Generel Isuronce Co, Lid * also decarethat any changes nthe information given above ate thesubmisian of his would be conveyed to SS Generel immediately * understand tha this contract wansactionis between SBI General Insurance Co. Led. and mysel. tote Bank of Inds merely faciiteting the purchase of his insurance paieyand hes n oligtion towards settlement of lls. + hove read the bi terms & conditions ofthe Policy printed overeat ond confirm that lam eligible fr coverage under this Poly do hereby nominate MeiMesiM os the person & MriMrsiMs, 1 Guardion ofthe Nominee (In case nominees a minor to receive the omount poyable by SBI General Insurance Co, Ltd, in the evert of my Accidental Decth and helshe (Nominee) is related to me os (Relation to the Insured) and | futher declare thet hisher receipt shall be sufficient discharge to the Company. Deted this Dayef 20__at Address ofthe Nominee /Guardion Doe: lca Signature ofthe proposed Insured Sa No person shal or offerte allow ether directly orindrecty as an inducement to ary person o takeout or renew or continue an insurance in respect of any Kind of ik ‘eleting to Ines or property in inca, ary rebate of whale or part f the commission poyabve or any rebete ofthe premium shown onthe policy, nr shall any person taking out or renewing or contiuing policy accept ary rebate except such rebate as maybe cllowed in accordance withthe published prospectuses ortobles ofthe Insure ‘ANY PERSON MAKING DEFAULT IN COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE WITH FINE, WHICH MAY EXTEND TO FIVE HUNDRED RUPEES, Forintemal purpose only (Tobe filed by SB Branch Offi): AccountNo. Journal No Date. Inswronce the sbjact matter of the sallehaon, Sl Genera sian Company Lied, [ROA Reg, No. 144 dated 15/1272008 Corporate & Registered Office: ‘Nato’, 101, 201 & 301, Junction of Western Express Highway & Andher- Kurla Road, Andherl (Fost), Mumbai - 400 069, Version 2.0, Bee 2013‘MOST IMPORTANT TERMS & CONDITIONS OF THE MASTER POLICY “This Insurances subject tothe terms ond conditions ofthe Moster Policy Number mentioned on the Certificate of Insuroncelssued to Stote Bank of Indio ond is based on this Proposal end payment ofthe Premium. This recerds the agreement batwean Insured and SBl General insurance Compeny and sets out he brit {ers insurance andthe obligations of ech party as below: “TERMS & CONDITIONS «This Policy can be Bought by ary permanent Indian resident having c Sevings Bank/Invidual Curent Account with SBl and agedbetween 18 yeorsto 65 yrs. + leespective ofthe number af accounts the Insured has with State Bank of IndiaStote Bank of Hyderabed/State Bank of Mysore/State Bank of Bkener ond JoipurStae Bonk of TravancoreState Bank of Paola, insured i eligible to take ony one pay rom SBI Genera! insurance. Our ably wil be rertictee to ox s:200,000 Rs 400,000 Rs, 10,00,000 Rs 20,00,000 asthe case moy be, perife, fr setlement of Caim * Coverage under this Plicy willbe over and above any ther Personal Accident Polis Insured hos with SBI General or with any ether Indian General Insurence Componies. Insured may terminate this Policy ot ary tie by ging us 15 days witen notice, Ino claim hos been made under the Palcy, then we will refund premium in accordance withthe able below: See Pee 25%, upto I month 75% uptoémonths upto3 months 50%, exceeding months o%, + We may terminate this Policy upon 1S days natice by sending @ writen notice of cancllaton to your address ond we shall refund a rteable proportion ofthe premium actualy pid in respec of any insured Person. Terminoton of ths Policy shal ot affect ony claim fied prior tothe date on which termination becomes ‘lective as spectieg inthe notice of termination ‘Such Termination maybe on grounds of mi-representotion, fraud, noniclosure of materiel facts ornon- cooperation ofthe insured, ‘The prorium atthe ime ofthe ranewal ofthe policy would be the applicable premium a the dete of renewel and as approved by IRDA However, renowel willbe subject othe Account he Insured wth State Bark of India being sillweand operational ‘The policy shall become voidabe atthe option of Insurer, inthe event of any untrue orncorrectstotement, misrepresentaton, non description orn disclosure in ‘any materal particular inthe propos formipersanalstlement, decloroian and connected decuments 0” cny motel information heving been withheld by the Insured or anyone acting on nsured'sbehalt Ary person who, knowingly and withintent a defraud the Company orary other person, files a proposal for insurance Containing any fle information, or conceals or the purpose of misleading, information concerning any fect mctarial hereto, commis araudulent insurance at, ‘which wil render the palcy voideble atthe sale cscretion ofthe Company, ‘The Company shall not be liable for any cloim or claims under this Policy arising from + Suleie, attempted sulide whether sone o nsene) or intentionally self-inflicted injury or iness, or sexually trarsmited conditions, mental or nervous disorder, ‘nsiey stress oF depression, Acqulted Immune Deficiency Syndrome (AIDS), Human Immune deficiency Vitus (HIV) infection or + Occupations ike serving in any bronch of alice, paromilitary, milter 8 ormed forces of ny county, whetherin peace or wa oF + Being under theinfluence or cbuse of deus, eleoho,orather intoxicants orhollucinogens unless propel prescribed bya physician and token as prescribed; oF + Portlpotionin an ctuol or attempted felony at, crime, misdemecnour ar cilicommetion; oF + Operating or learning to operate any aircroft, oF performing dates es ¢ member ofthe crew on any crcraftopor from a Scheduled Aldine or whist engaged in aviation or ballooning, oF whist mounting int, dsmounting rom or weveling ln any bellaon or ateraft other than es @ passenger (fore paying o otherwse) in any duylicensed standard ypeot areraf anywhere inthe word oF + Anyloss arising out of war cil wa, invasion, insurrection, revolution, ect of foreign enemy, hostities (whether warbe declared or nat}, rebelion, mutiny, use of milftary power or usurpation of government ormiltary ower or * Payment of compensation in case af death ofthe insured person from nuclear damage cousee by, contrbuted to, by oF arising from ionising eadiation or conteminatan by radioactivity from: - anynuclearfuelorfrom any nuclecrwaste; or - fromthe combustion of nuclear ful including any sot-sustaining process cfruclecrfission); - muclearwecpons material + ruclecr equipment orany partofthat equipment; or + The ispersal or application of pathogenicor poisonous biological ar chemical materials the rlecseof pathogenic arpoisoncus biological or chemical material, orcangentalanomealesorany complications or condtionsarising therefrom oF * Participation in winter spars, skydiving/parachuting, hand gliding, Bungee jumping, scuba diving, ballooning, mountcin climbing (where ropes or guides are customarily used), ing or drving in races or rales using @ motorized vehicle or bicycle, caving orpo-holng, hunting or equestrian ectvtes, skin ving orothor Lnderwoler activi, ring or canacing involving white woter rapids, yachting or boating outside const woters (2 nowteal miles), poreipation in ony professional sports, ony body contact spar orand any other hazordous or potentially dangerous sport for which Insuredis untrained, or + Deothresuting directly orindirecty, contributed ar oggravated or prolonged by hildbith or rom pregnancy; ot + For any loss to which o contrbuting cause wes insured persons actual or attempted commission, or wil prtlpaton in, on illegal actor ony violation oF attempted violation afthelaw or esstance to ares or insured person commiting any breach of aw with emia intent + Loss caused directly or indirectly, wholly orpartybylnfections (excep pyogenic infections which shalloccur through an cccidental cut or wound) or ony other kind ofdiseace For complete detolis of Coverage & Paley Wording, kindly vst our website - wan sbigenera in ‘Grievance Redressal Procedure We value your relationship and ore commited to offer you best in cles service. However you are disatsied wit the sences rendered by us during any of your Interections with uso on resolution provided by us on your service request or complain, we request yout register your concern wth our Customer Care by felling the steps mentioned below We wil acinowledge receipt of your concerns within nest 72 working hous and wil respond a you as soon as possible, upon completion ofthe vestigation, ‘Step 1 Callus ct 1800-102-1111 /1800-22-1111(Telléee 8:00 em to 8:00 pm - Monday to Saturday or wie to us at customer care@sbigenerl in. Kyou dont Ihe fom us within 48 hs please falow Step ‘Step 2: f you are nat happy with the resolution provided, please wite to Head ~ Customer Core ot our Registered Office adéress printed ovedeat. If ter having followed Step 1 ond Step 2 your issue remains unresolved for more than 30 doys fom the date of fling your fist complaint, you may approach the Insurance ‘Ombudsman forrcresta|ofyour grievance.