PA01010104456424

20-09-2021

Mr Uttam Shankar Shelke

Near laxmi mandir s no 106
Gosavi wasti vaiduwadi hadpsar
Pune - 411028

EXIDE LIFE INSURANCE COVER NOTE

Dear Uttam Shankar Shelke,

Thank you for choosing Exide Life Insurance Company Limited as your preferred insurance solution provider.

We confirm the receipt of your proposal form and would like to inform you that the risk coverage on the Life
Assured shall commence after acceptance of the risk by the company.

Summary of Proposed Policy:

Proposal No. 04456424

Name of the Proposed Life Assured Uttam Shankar Shelke
E-mail Address shelkeuttam76@gmail.com
Telephone Number(s) 9767816055
Date of Birth of Life Assured 05-06-1975
Name of the Nominee(s) Vaishali Uttam Shelke

Premium
Policy payment Modal
Sum Premium Payment
Plan Name term Term Premium
Assured (`) (`) Frequency
(Years) Frequency- (Yearly) (`)
(Years)
T35-Exide Life Smart Term
1000000 20 20 18934.36 Yearly 18119
Edge - Classic RP
Agent Code:60318296 Agent Telephone: Agent Name: Vidya Sahakari BankLtd

Call : 1800 419 8228 (TOLL FREE); +91 80 4134 5444 Email : care@exidelife.in Visit : exidelife.in

Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001.
IRDAI Registration No. 114 CIN: U66010KA2000PLC028273
 PA01010104456424

Payment Summary:
Receipt No(s): 38680361
Mode of payment Cheque
Amount `18935
Cheque No. 117700
Cheque Date 18-09-2021
Bank Name Vidya Sahakari Bank Ltd
Total amount in words `18935 Eighteen Thousand Nine
Indian Rupees Hundred and Thirty Five

To enable us to consider your proposal for life insurance, we request you to complete the following Medical
tests at the earliest:

Medical Examiner Report

Please note that our service team will be in touch with you, to coordinate for the medicals and other
requirements arising basis our processing.

We hope to hear from you soon.

Yours sincerely,

Customer Services Team

Exide Life Insurance Company Limited

This is a system generated letter and requires no signature.

Points to remember:

1. This cover note is an acknowledgment of your proposal for Exide Life Insurance Company Limited Policy and shall be
valid till the acceptance / rejection of the risk by the company.
2. Acceptance of your proposal is subject to the verification of the documents submitted and on confirmation of the
details as stated by you in the proposal form. The company reserves the right to call for additional documents /
information from you if deemed necessary.
3. Please note that the original policy bond shall be dispatched to you after the acceptance of the risk by the company.
If you do not receive the Policy bond within 30 days from the date of this cover note, contact your advisor or visit the
nearest branch of Exide Life Insurance Company Limited to know the status of your proposal.
4. If you have opted for/hold an e-insurance account/policy, your new policy details will be automatically linked to your
existing e-insurance account. Physical copy of Policy Bond will not be issued. To view policy details login to your
e-insurance account.
5. In case the Policy gets cancelled, the premium amount paid by you towards the proposed policy shall be refunded
without any interest.
6. In case of dishonor of the premium cheque or non- production of information or production of incorrect information
or requirement for any additional documents, this document automatically stands cancelled from inception.
7. Premium amount provided to you may vary after underwriting evaluation of all the information provided to us.
8. Goods & Services Tax (GST) or any other form of taxes including applicable cess or charges will be additionally
charged as per prevailing tax laws and regulations notified by the Government of India from time to time.

Call : 1800 419 8228 (TOLL FREE); +91 80 4134 5444 Email : care@exidelife.in Visit : exidelife.in

Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001.
IRDAI Registration No. 114 CIN: U66010KA2000PLC028273