Policy Certificate

MUTHURAMAN M
103 M
S.K.ILLAM, THILLAI NAGAR
P VELUR PO PARAMATHY VELUR TK

Intermediary 92789 Intermediary Name: STATE BANK OF INDIA Certificate No. 043098379

Date: 20/08/2020 This is to certify that

MUTHURAMAN M

is insured for an amount of INR 400000 /- , under Personal Accident Policy subject to exclusions, provisions and
other terms as specified in Master Policy No.043098379 for a period of 1 year from 20/08/2020

Nominee : VALLIMALAR RM Relationship Spouse

:
Name with

Proposal Ref.
SBI Account No.:

Premium received: 200

INR 200/- inclusive of tax as applicable
Authorised Signatory