Welcome To The World of Aditya Birla Capital!: Mobile No

Please check your contact details and
Mrs. Gagandeep Kaur ensure it is up- to-date.

C-582 Majlis Park
Gali No. 7 Adarsh Nagar
Mobile No. : 8448063609
Delhi
New Delhi
Delhi
India DHILLONGAGANDEEP905@GMAIL.C
E-mail ID :
110033 OM
Mobile No :8448063609
Tel No :8448063609
Tel. : 8448063609
Welcome to the world of Aditya Birla Capital!

Dear Mrs. Gagandeep Kaur,
We thank you for the trust you have shown by making us your preferred choice for your PROTECTING needs. It’s our pleasure to have you as a
valued customer.
Aditya Birla Capital's PROTECTING solutions enable you to protect what you value the most.
Your decision to choose Aditya Birla Sun Life Insurance Nishchit Aayush Plan will safeguard not only your future but also that of your loved
ones.
Your policy details :
Plan Name : ABSLI Nishchit Aayush Plan Policy Number : 009186750
Premium Payment Term : 10 Years Premium Payment Frequency : Annual(1)
Instalment premium : ` 203,132.00 Policy Term : 40 Years
Meeting your life’s money needs
Aditya Birla Capital offers a wide range of solutions that enable you to fulfill all your life’s needs regarding money, throughout your life.
While you have availed our PROTECTING solution from Aditya Birla Sun Life Insurance, Aditya Birla Capital also offers to help you with
INVESTING in your aspirations and FINANCING your life’s dreams, needs and desires.
The ease of ONE WINDOW
We enable you to manage your money with confidence and ease by offering the convenience of one window and one point of contact for all
your money needs.
You now have one number, 1-800-270-7000 you can call, or one website, www.adityabirlacapital.com, you can visit, for any of your money
needs.
You can also create your ONE Login ID by registering on the above website.
This ID will enable you to login to your account across all businesses of Aditya Birla Capital including Aditya Birla Sun Life Insurance.
It will enable you to securely and conveniently transact and service all your PROTECTING, INVESTING and FINANCING needs.
Looking forward to a long and successful journey ahead!
Yours sincerely,
Chief Operations Officer

Aditya Birla Sun Life Insurance Company Limited
Please note that this is an electronically generated document and does not require a signature.
Page 1
Our service philosophy
ABSLI Nishchit Aayush Plan Part A
Our service philosophy is to be transparent and responsive that will enable us to empower you to make the right financial decisions.
Transparency - Review Your Policy
We request You to go through the enclosed Policy document in detail and check the accuracy of information provided herein. You will have the
right to return Your Policy to Us within 30 days from the date of receipt of the Policy in case You disagree with the terms & conditions of Your
Policy. We will refund the premium paid post receipt of written notice of cancellation ( along with reasons thereof) together with the original
Policy document from Your end. We may reduce the amount of the refund by proportionate risk premium for the period of cover and expenses
incurred by us on medical examination, if any and stamp duty charges while issuing Your Policy in accordance to IRDAI (Protection of
Policyholders Interest) Regulations, 2017.
Where the date of receipt of Policy shall be determined basis the below:
- 30 days in case of receipt of Policy document for policies purchased through mode of Distance Marketing or in case of electronic policies; the
delive date of the email confirming the credit of the Insurance policy by the IR to the eIA.
For clarity, Distance Marketing includes eve activity of solicitation (including lead generation) and sale of insurance products through voice
mode, SMS, electronic mode, physical mode ( like postal mail) or any other means of communication other than in person. While handing over
the original Policy document, it is critical that You collect a valid written acknowledgement on submission of the same, as the said
acknowledgment would be required for all future references.
Health Evaluation
Further, for Your reference, we are sharing the results of Your medical examination, if applicable, conducted for assessment of Your proposal
for insurance. The medical examination report was obtained for assessment of Your health conditions, which is relevant to take a decision on
the proposal to obtain insurance cover from Us. The results of the tests are only indicative in nature. Aditya Birla Sun Life Insurance Company
Limited expresses no opinion on the matters contained in the medical reports and we will not be held responsible for the same whatsoever.
Responsiveness
We are committed towards addressing all customer queries within a maximum of 10 days of receipt of the same.
Claims Connect
We understand that settlement of Claims is of utmost importance. Hence, in order to make claims a hassle-free experience, we have streamlined the
process and assure our customers that we are there in the hour of need.
Empower
A single Log-in ID and Password that will enable you to securely and conveniently transact and service all your PROTECTING needs.
Here you can :
 Track and manage your policy with ease for lifetime
 Set alerts - Obtain timely and important information regarding your policy through the Set Alerts feature
 Download feature - Instant download of policy document, statements and receipts pertaining to your policy
 Convenience to pay premium - Easy and varied premium payment options to suit your convenience
 Manage your policy - Submit your policy servicing requests online
 Stay updated - Track your policy details and service request status online
⦁ SMS alerts : Access a host of policy and fund related information on your phone by sending a simple text message.
⦁ Call center / IVRS : Call our toll free number 1800-270-7000 and follow the IVR (Interactive Voice Response) flow to ensure that you have
easy and quick resolution of your queries. For NRI, call +91 22 66917777 (Call charges apply) between 9 am and 9 pm, Monday to
Saturday.
"You can submit Policy related request or documents at any of our branch near to you. To know your nearest branch,visit our website OR send
Hi to 8828800040 on whatsapp OR contact our call center OR connect with your agent".
For any queries or clarifications, please contact Your existing ABSLI policy/ies as policyholder Under
your advisor at the touch points mentioned
below – Client ID 6646630066 is/are:
1 ABSLI Guaranteed Milestone 2019 008427025

Advisor Name : HDFC BANK LTD
2 ABSLI Guaranteed Milestone 2019 008422172
Advisor Code : 002651
Your recent policies have been displayed above.
Advisor Mob. No. : 8700910087
Advisor Email :
Advisor Res. No. :
Advisor Off. No. :
Branch Name : HEAD OFFICE -
BIRLA SUN LIFE
Branch Contact : 1800-270-7000
Page 2
First premium receipt
Name of Life Insured : Mrs. Gagandeep Kaur
Name of Policyholder : Mrs. Gagandeep Kaur
Address of Policyholder : C-582 Majlis Park

Delhi
New Delhi 110033
Delhi India
Client ID : 6646630066
Policy No. : 009186750 GSTIN : 07AABCB4623J1ZU
Policy Identification Type : General State Code : 07
Date of Policy Issue : 30/09/2023 Receipt No. : 147217504
Coverage Details
Coverage No. Coverage Name Date of Issue Modal Premium (`)
01 ABSLI Nishchit Aayush Plan 30/09/2023 203,132.00
Premium Details
Description Amount (`)
First Premium 200,000.00
Goods and Services Tax (GST) 3,132.00
Instalment Premium (Total) 203,132.00
⦁ Any sum paid on an insurance policy with Aditya Birla Sun Life Insurance Company would be eligible for applicable tax benefits, under the Income
Tax Act, 1961, as amended from time to time.
⦁ For specific suitability, you are requested to consult your tax advisor.
⦁ The charges are/shall be subject to applicable taxes and levies, prevailing from time to time, during the validity of the policy contract.
This is not a Tax invoice, a separate tax invoice will be sent to you on your registered email id.
Branch Name : HEAD OFFICE - BIRLA SUN LIFE SAC Desc : Life Insurance
Branch Address : G. Corp Tech Park, SAC Code : 00440186
5th & 6th Floor, Kasar Wadavali, Ghodbunder
Road, Thane MAHARASHTRA 400601
Insurance Advisor Code : 002651 State Code : 07
This is a digitally signed document and does not require a signature. GSTIN : 07AABCB4623J1ZU
Page 3
Your policy details
Must read
A Non-Linked Non-Participating Individual Savings Life Insurance Plan Policy Preamble | Policy Schedule
This Policy is the evidence of a contract between Aditya Birla Sun Life Insurance Company Limited (‘ABSLI’, ‘We’, ‘Our’, ‘Us’ or ‘the Company’)
and the Policyholder (‘You’, ‘Your’ or ‘Policyholder’) as described in the Policy Schedule. This Policy is based on the Proposal made by the
within named Policyholder and submitted to the Company along with the required documents, declarations, statements, benefit illustration and
other information received by the Company from the Policyholder, Life Insured or on behalf of the Policyholder. This Policy is written under and
will be governed by the applicable laws in force in India and all premium and benefits expressed are payable in Indian Rupees.
Policy Information
Product Unique Identification Number : 109N137V04 Policy Issue Date : 30/09/2023
Policy Number : 009186750 Risk Commencement Date : 30/09/2023
Policyholder : Mrs. Gagandeep Kaur Relationship with Life Insured : SAME PERSON
Address : C-582 Majlis Park
Delhi
New Delhi 110033
Delhi India
DOB : 09/09/1990 Gender : Female
Age Admitted : 33 Years, Yes
Life Insured : Mrs. Gagandeep Kaur
Address : Same as Policyholder Address
DOB : 09/09/1990 Gender : Female
Age Admitted : 33 Years, Yes
Nominee Details Nominee Gender Date of Birth Relationship with Life Insured Allocation Percentage
DINESH DANG Male 10/07/1975 Spouse 100%
Appointee Relationship
Appointee in case Nominee is a Minor : with Nominee :
Page 4
Your policy details
Must read
A Non-Linked Non-Participating Individual Savings Life Insurance Plan Policy Preamble | Policy Schedule
Policy Premium
Premium Payment Term : 10 Years Policy Term : 40 Years
Deferment Period : 0 Year Premium Payment Mode : Annual(1)
Modal Loading Factor : 0.00% Annualized Premium* : ` 200,000.00
Installment premium : ` 203,132.00 Instalment Premium due on the 30th of eve September
Rider Premium : ` 0.00 Total Installment Premium : ` 203,132.00
including rider premium & taxes
for year 1
Last Premium due on : 30/09/2032 Total Installment Premium : ` 203,132.00
including rider premium & taxes
for year 2 & onwards
Benefit Information
Benefit Option : Long Term Income Income Variant : Level Income with
Enhanced Lumpsum
Benefit
Income Benefit : ` 73,100.00 Income Frequency : Annual
First Income Benefit Payment Date : 30/09/2024 Sum Assured : ` 2,000,000.00
Enhanced Guaranteed Lumpsum : ` 4,000,000.00 Income Benefit Factor : 36.55%
Benefit^
^Payable only when all due premiums have been paid during the premium paying term
Signed for and on behalf of Aditya Birla Sun Life Insurance Company Limited.
Chief Operations Officer

Aditya Birla Sun life Insurance Compnay Limited.
Please note that this is an electronically generated document and does not require a signature.
Please read Your Policy Schedule carefully to verify that it correctly reflects the policy you applied for. If you notice any discrepancies, do return this
policy document to us for correction immediately.
To claim a benefit or request a change in Your Policy Schedule, contact your advisor or write to our nearest Branch Office or Customer Service Team.
Please notify us promptly of change in any of your contact details.
Stamp Duty Details

Stamp Duty of Rs 400.00 is paid as provided under Article 47(D) of Indian Stamp Act, 1899 and included in Consolidated Stamp Duty Paid to the
Government of Maharashtra Treasury vide Order of Addl. Controller Of Stamps, Mumbai at General Stamp Office, Fort, Mumbai - 400001., vide his Order
No. (LOA/CSD/104/2023 Validity Period Dt. 17/08/2023 To 16/05/2024 / (O/w No 0) Date : 18/08/2023)
Page 5
Aditya Birla Sun Life Insurance
Nishchit Aayush Plan
A non-linked non-participating individual savings life insurance plan POLICY CONTRACT
PART B – DEFINITIONS
GENERAL
In this contract, “You” or “Your” will refer to the owner of this Policy and “We”, “Us”, “Our”, “insurer”, “ABSLI” or “the
Company” will refer to Aditya Birla Sun Life Insurance Company Limited, or any of its successors.
Please read this Policy document carefully.
 “Act” refers to the Insurance Act 1938 as amended from time to time and shall include the Insurance Laws
(Amendment) Act 2015.
 “Accidental Death” means that the Life Assured sustains any bodily injury resulting solely from an Accident and
where such injury solely and directly and independently of all other causes results in the death of the Life Assured.
 “Age” refers to age of the Life Insured in completed years as on the last birthday.
 “Appointee” is the person who is appointed by You and as named in the Policy Schedule, in case where Nominee
is minor.
 “Annualized Premium” as shown in the Policy Schedule is the amount of premium payable in a year chosen by the
Policyholder, excluding taxes, rider premiums, underwriting extra premiums and loadings for modal premiums, if
any. Further, any discount on the first year premium, if applicable, shall be excluded.
 “Assignee” means the person to whom the rights and benefits are transferred by virtue of an assignment.
 “Assignment” means a provision wherein the Policyholder can assign or transfer a Policy in accordance with Section
38 of the Insurance Act, 1938 as amended from time to time.
 “Basis Point” means one-hundredth of a percentage point. E.g. One hundred basis points equals to 1%.
 “Benefit Option” means the option chosen by the Policyholder at Policy inception, as specified in the Policy
Schedule. The benefits offered under the Policy will be based on the option chosen at inception and cannot be
changed later on during the Policy Term.
 “Benefit Payout Frequency” refers to the frequency of receiving the Income Benefit chosen by the Policyholder.
The policyholder can choose to receive the Income Benefit annually, semi-annually, quarterly, or monthly.
 “Claimant” means You, Nominee(s) (if valid nomination is effected), assignee(s) or their heirs, legal
representatives, or holders of a succession certificate in case Nominee(s) or assignee(s) is/are not alive at the time
of claim.
 “Date of Commencement of Risk” is the date as shown in the Policy Schedule when risk cover on the life of the Life
Insured begins under this Policy.
 “Death Benefit” means the benefit payable on death of the Life Insured as specified in the Policy Contract.
 “Deferment Period” means the period in years from policy commencement date post which the first Income
Benefit becomes payable to the Policyholder.

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110
Policy Contract_V04_14/08/2023
Page 6
 “Free-Look Period” means the period as specified in the Policy Contract, during which You can return the Policy in
case You are not satisfied with the terms and conditions of the Policy.
 “Grace Period” means the time granted by Us from the due date for the payment of Premium, without any penalty
or late fee, during which time the Policy is considered to be in-force with the risk cover without any interruption,
as per the terms and conditions of the Policy. The grace period is a period of 15 (Fifteen) days from the due date
of the first unpaid Premium for monthly Premium payment mode and 30 (Thirty) days from the due date of the
first unpaid Premium for annually, semi-annually or quarterly premium payment modes.
 “Guaranteed Lumpsum Benefit (GLB)” refers to the Total Premiums Paid by You multiplied by the applicable
Lumpsum Factor. Where, ‘Lumpsum Factor’ refers to a pre-defined percentage of Total Premiums Paid as per the
chosen benefit option, income variant, premium payment term and policy term.
 “Guaranteed Surrender Value” means the Surrender Value computed in Section 4 of Part D, which is guaranteed
by Us.
 “Instalment Premium” is the premium as payable by You as per the Policy Schedule to effect and continue this
Policy Contract.
 “Income Benefit” is defined as a percentage of Annualized Premium and varies by Benefit Option, Deferment
Period, Income Variant, Premium Payment Term, Policy Term, Life Insured’s Age at inception of the policy and the
Annualized Premium.
 “IRDAI” or “Authority” means the Insurance Regulatory and Development Authority of India.
 “Lapsed Policy” means a Policy which has not acquired the Surrender Value and where the due Premium has not
been received for any of the first two Policy Years.
 “Life Insured” is the person on whose life the insured contingent events have to occur for the benefits to be payable
and as named in the Policy Schedule.
 “Loan” means an amount granted by the Company, at a specified interest rate, to the Policyholder against the
Surrender Value available under the Policy in accordance with Section 5 of Part D.
 "Maturity Benefit" means the benefit, which is payable on maturity as stated in Section 3 of Part C.
 “Major” is a person who is aged 18 years and above.
 “Minor” is a person who has not completed 18 years of age.
 “Nomination” is the process of nominating a person who is named as “Nominee” in the proposal/application form
or subsequently included/ changed by an endorsement. Nomination should be in accordance with provisions of
Section 39 of the Insurance Act, 1938 as amended from time to time.

Mumbai – 400013
Page 7
 “Nominee” is the person who is nominated by You and as named in the Policy Schedule, to receive the Death
Benefit as specified in the Policy Contract. Nomination can only be effected if the Policyholder and Life Insured are
the same.
 “Policy Anniversary” means the date corresponds numerically with the Policy Issue Date in every calendar year
until Policy Maturity Date.
 “Policyholder” or “You” or “Your” means the owner of the Policy at any point of time.
 “Policy Issue Date” is the date this Policy is issued, and Your rights, benefits and risk cover begin, as shown in Policy
Schedule.
 “Policy Year” is the period of twelve calendar months starting from the Policy Anniversary.
 “Proposer” is a person, who proposes for insurance on and has an insurable interest in the life of the Life Insured.
 “Reduced Paid-up” means the continuance of this Policy with reduced paid up benefits, as specified under Section
3 of Part D.
 “Revival” means restoration of the Policy, which was discontinued due to the non-payment of premium, by the
insurer with all the benefits mentioned in the Policy document, with or without rider benefits if any, upon the
receipt of all the premiums due and other charges or late fee if any, as per the terms and conditions of the Policy,
upon being satisfied as to the continued insurability of the Insured or Policyholder on the basis of the information,
documents and reports furnished by the Policyholder, in accordance with Board approved Underwriting Policy.
 "Revival Period" means the period of five consecutive years from the date of first unpaid premium, during which
period You are entitled to revive the Policy.
 “Risk Commencement Date” is the date as shown in the Policy Schedule when risk cover on the life of the Life
Insured begins under this Policy.
 “Special Surrender Value” means the value as specified in Section 4 of Part D.
 “Sum Assured on Death” means an absolute amount of benefit which is guaranteed to become payable on death
of the Life Insured in accordance with the terms and conditions of the Policy.
 "Surrender" means complete withdrawal or termination of the entire Policy.
 "Surrender Value" means an amount that becomes payable in case of surrender of this Policy, in accordance with
Section 4 of Part D.
 “Sum Assured” is the amount as specified in the Policy Schedule.
 “Survival Benefit” refers to an amount, payable on survival of Life Insured during the Policy Term as per the benefit
option, income variant and deferment period chosen.

Mumbai – 400013
Page 8
 “Total Premiums Paid” means total of all the premiums received, excluding underwriting extra premium, rider
premiums, loadings for modal premiums and applicable taxes. Further, any discount on the first year premium, if
applicable, shall be excluded.
 “Vesting” means the transfer of Policy benefits to the Life Insured on attainment of majority in case the Policy is
issued to a Minor.
ABSLI Nishchit Aayush Plan Ver 04/ August/ 2023 POL/ 8/23-24/1444 UIN: 109N137V04

Mumbai – 400013
Page 9
PART C – POLICY FEATURES, BENEFITS AND PREMIUM PAYMENT
1. Death Benefit
On death of the Life Insured anytime during the Policy Term, provided the Policy is in force, we will pay the Death
benefit in lumpsum to the Nominee(s) / legal heir(s), where Death Benefit will be highest of the following:
a) Sum Assured on Death
b) Surrender Benefit
The Sum Assured on Death is the highest of,

- Sum Assured
- 105% of the Total Premiums Paid till the date of death
Where Sum Assured is as specified in the Policy Schedule.
Staggered Death Benefit Option

The Nominee(s)/legal heir(s) will have an option to take Death Benefit in Monthly/Annual instalments payable at
the end of the month/year, as specified in the table below, over a period of 5 years instead of the lump sum
payment as specified above.
Instalments Frequency Annual Monthly

Instalment
21.80% 1.855%
(as % of Death Benefit)
Total payments
109.00% 111.30%
(as % of Death Benefit)
The above percentages are determined at a compound interest rate of 4.50% per annum. ABSLI may revise the
instalment based on the then prevailing market conditions subject to prior approval from IRDAI. Any change in
the methodology/formula for calculating the instalment shall also be subject to prior approval from IRDAI.
Once the Instalment mode has been opted by the Nominee, it cannot be changed thereafter. However, the
Nominee shall, at any point, have an option to receive the future instalments as a lumpsum, wherein the lump
sum will be at least equal to the Sum Assured on Death less instalments, if any, already paid.
2. Survival Benefit
On survival of Life Insured during the Policy Term, provided all due premiums are paid, Survival Benefit in the form
of Guaranteed Income is payable by the Company as per the benefit option, income variant and deferment period
chosen (as specified in Your Policy Schedule) by You.
The Benefit Option, Income Variant and Deferment Period as chosen at the Policy Issue Date, cannot be changed
thereafter. However, for added flexibility, the Benefit Payout Frequency chosen can be changed anytime during
the Policy Term.
3. Maturity Benefit
On Survival of life insured till the end of Policy Term, Guaranteed Lumpsum Benefit (GLB) shall be payable as
Maturity Benefit. Guaranteed Lumpsum Benefit is equal to the Total Premiums Paid multiplied with the applicable
Lumpsum factor. Where, ‘Lumpsum Factor’ refers to a pre-defined percentage of Total Premiums Paid as per the
chosen benefit option, income variant, premium payment term and policy term.
Guaranteed Lumpsum Benefit is further enhanced by 100%, provided all due premiums are paid. If Income Only
Benefit is chosen as Income Variant as per Policy Schedule, no Guaranteed Lumpsum Benefit shall be payable.

Mumbai – 400013
Page 10
4. Premiums
You can pay the Premiums annually, semi-annually, quarterly or on monthly basis, as per the premium payment
mode chosen by You. You can pay Premium at any of Our offices or through Our website
https://lifeinsurance.adityabirlacapital.com/ or by any other means, as informed by Us. Any Premium paid will be
deemed to have been received by Us only after the same has been realized and credited to Our bank account. The
Premium payment receipt will be issued in Your name, which will be subject to realization of cheque or any other
instrument/medium. The responsibility of Instalment Premium payment shall be upon the Policyholder.
5. Grace Period
The Premium is due and payable by the due date specified in the Schedule. If the Premium is not paid by the due
date, You will be given a Grace Period of 30 days (15 days in case of monthly mode) to make the payment of due
premium, during which time all benefits under the Policy will continue.
If the premium is not paid within the Grace Period then one of the following will happen:
 If less than two full years premiums have been paid then policy will lapse and all benefits will cease
immediately.
 Otherwise, the policy will continue on a Reduced Paid-Up basis.
In case of death during the Grace Period, we will recover the unpaid premium due from the death benefit payable.
6. Risk coverage for minor and vesting on attaining majority

For policies issued on minor life, the date of commencement of risk shall be the Date of commencement of the
policy. In case the Life Insured is a minor, the Policy will automatically vest in him/her on his/her attaining the Age
of majority. Where the Life Insured (whether major or minor) and Proposer/Policyholder is different, on the death
of the Proposer/Policyholder, his legal heirs, in accordance with the existing succession laws, will be considered
as new Proposer/Policyholder. As there is no Death Benefit payable on the death of the Proposer/Policyholder,
the Policy status does not change, and the Policy continues. However, if the premiums are not paid before the
expiry of the grace period the Policy would be subject to the provisions mentioned in Part D below.

Mumbai – 400013
Page 11
PART D – POLICY TERMS AND CONDITIONS
1. Free-look Period
You have a free look period of 15 days from the date of receipt of the policy document and period of 30 days in
case of electronic policies and policies obtained through distance mode, to review the terms and conditions of
the policy and where you disagree to any of those terms or conditions, you have the option to return the original
policy document to us for cancellation, stating in writing the reasons for your objection, you shall be entitled to
a refund of the premium paid subject to a deduction of a proportionate risk premium for the period of cover and
the expenses incurred by us on medical examination and stamp duty charges in accordance to IRDAI (Protection
of Policyholders Interest) Regulations, 2017.
2. Lapsation of Policy
If the Instalment Premium is not paid within the Grace Period during the first two Policy Years, the Policy will
become a Lapsed Policy from the due date of first unpaid Instalment Premium and thereafter no benefits will
be payable under the Policy.
3. Reduced Paid-Up (RPU) Benefits

If this Policy has acquired a Surrender Value, i.e. on payment of all Instalment Premiums during the first two
Policy Years, then, in the event of non-payment of the due Instalment Premiums by You to Us, on the expiry of
the Grace Period this Policy will not become a Lapsed Policy but will continue with reduced paid-up benefits as
specified below unless revived. In such a case, the benefits payable shall be as follows:
The RPU Sum Assured shall be equal to the Sum Assured multiplied by the RPU Factor,
where the RPU Factor is the ratio of:

 The number of Instalment Premiums paid to date; over
 The total number of Instalment Premiums originally payable for the Policy Term .
All future income benefits will cease and will be paid in the form of Terminal Value 1 or
Terminal Value 2 mentioned below.
Death Benefit for RPU Policies

If the Life Insured dies during the Policy Term, the Death Benefit shall be:
Long Term Income:
Higher of:
 RPU Sum Assured on Death
 Surrender Benefit
Whole Life Income:

Higher of:
 RPU Sum Assured on Death + Terminal Value 1*
 Surrender Benefit
where, RPU Sum Assured on Death is the highest of:

 RPU Sum Assured
 105% of the Total Premiums Paid up to the date of death
* Terminal Value 1 = RPU Factor * Sum of Income Benefits payable from the date of RPU to the date of Death

Mumbai – 400013
Page 12
Survival/ Maturity Benefit for RPU Policies

On survival of Life Insured till the end of the Policy Term, RPU Maturity Benefit shall be:
 Guaranteed Lumpsum Benefit; plus
 Terminal Value 2**
**Terminal Value 2 = RPU Factor * Sum of Income Benefits payable from the date of RPU to the date of
Maturity
Please Note: No Enhanced Guaranteed Lumpsum Benefit will be payable for RPU policies.
4. Surrender Benefits
This Policy shall acquire a Surrender Value provided all the due Instalment Premiums for the first two Policy
Years have been received by Us. The Policyholder can Surrender the Policy any time before the end of Policy
Term. The Policy will terminate after payment of the Surrender Value and thereafter no other benefits under
this Policy shall be payable.
The Surrender Value payable will be equal to the higher of Guaranteed Surrender Value and Special Surrender
Value.
The Guaranteed Surrender Value (GSV) is defined as:

 GSV Factor * Total Premiums Paid; less
 Any Survival Benefit already paid
GSV Factors are provided in Annexure 1.
Your Policy also acquires a Special Surrender Value (SSV). Special Surrender Value is not guaranteed and may
be revised by the Company from time to time. Any change in method/ formula for calculating the SSV is subject
to prior approval from the Authority.
5. Policy Loan
You may take a loan against Your Policy once it has acquired a Surrender Value. The minimum loan amount is
Rs.5,000 and the maximum is 80% of the then applicable Surrender Value less any outstanding Policy loan
balance as on that date. On exercising this option, the Policy shall automatically get assigned to the Company to
the extent of the outstanding Policy loan balance. The outstanding Policy loan balance is an amount of loan still
unpaid plus all accrued but unpaid loan interest up to the given date.
Where the Policy is in-force (premium paying) or all due Instalment Premiums under the Policy have been paid,
and if the outstanding loan plus interest becomes equal to or exceeds the Surrender Value, the Company will
inform the Policyholder of the same with a 90-days advance notice to repay such outstanding Loan balance along
with applicable interest.
If a Policy is a Reduced Paid-up Policy, and if the outstanding Loan plus Loan interest exceeds the Surrender
Value available under the Policy as on that date, then We shall send a notice 90 days in advance informing to
the Policyholder to repay such outstanding Loan balance along with applicable interest. If the Policyholder
doesn’t repay the Loan or fails to respond to the notice, the policy will be terminated.
Any payment of a proceed against Death, Survival Benefit or Maturity Benefit provisions or as a Surrender Value
shall be reduced by any outstanding Policy loan balance at that time and the residual value shall be payable. We
shall be issuing the loan re-payment schedule at the time Policyholder opts for the loan against Policy.

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At the beginning of a Policy Year, the Policy shall be assigned the latest Loan Interest Rate declared by company.
We shall declare the Loan Interest Rate applicable to all policies under this product on June 1 st of every calendar
year which shall be assigned to policies on their next Policy Anniversary and is equal to the base rate of the State
bank of India plus 100 basis points (i.e. absolute 1%). The compound interest rate applicable as on June 1st, 2022
is 8.55% p.a. Any change in basis of determination of interest rate for Policy loan can be done only after prior
approval of IRDAI.
6. Revival
A Lapsed Policy or a Policy in the Reduced Paid up mode can only be revived within a Revival Period of five years
from the due date of first unpaid premium, subject to following conditions:
• Paying all outstanding premiums together with interest and/or late fees as declared by Us from time to
time;
• Providing evidence of Life Insured’s insurability satisfactory to Us
• Revival of the Policy shall take effect only when these requirements are met and after Revival of the Policy
is approved by Us basis the Board Approved Underwriting Policy and communicated to You in writing.
Once the Policy has been revived, all benefits under the Policy will be restored to their full value.
The provisions of Section 45 of the Insurance Laws (Amendment) Act, 2015, as amended from time to time will
also be applicable in case of Revival of the Policy. Refer Annexure C.
The monthly interest rate charged on unpaid premiums will be declared by ABSLI on June 1 st of each calendar
year and is determined as (x+1%)/12 rounded to the next 0.5%, where x is the base rate of the State Bank of
India. The current applicable interest rate, as declared on June 1st, 2022, is 1% per month.
Any change in basis of determination of interest rate for Revival can be done only after prior approval of the
Authority.
If a Lapsed Policy without having acquired any paid-up value is not revived within five years, the Policy shall be
terminated, and no value is payable to You.
7. Payments of Benefits:
The benefits under this Policy will be payable only on submission of satisfactory proof to Us. The benefits under
this Policy will be payable to You/the Claimant (Nominee) as the case may be.
Once the benefits under this Policy are paid to You/the Claimant (Nominee) as the case may be, the same will
constitute a valid discharge of Our liability under this Policy.
8. Termination of Policy
Your Policy will terminate upon the occurrence of any of the following events:
 the date of payment of the Surrender Value; or
 the date of settlement of Death Benefit; or
 the date of payment of Maturity Benefit; or
 the date on expiry of the Revival Period after the Policy has lapsed as per Premium Discontinuance
provision; or
 the date of payment of free-look cancellation amount

Mumbai – 400013
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PART E – POLICY CHARGES
This Policy is a non-linked non-participating individual savings life insurance plan and therefore, Part E is not applicable
to this Policy.

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PART F – GENERAL TERMS AND CONDITIONS
1. Contract
Your contract includes this Policy Document, the proposal for the Policy and any endorsements agreed upon in
writing after the Policy is issued. The contract also includes declarations given by the Policyholder and written
statements and answers furnished as evidence of insurability. We are bound only by statements that are part of
the contract. Only our authorized officers can agree to any change in the contract and then only in writing.
This contract can be issued in cases where the Life Insured is different from the Policyholder. In all situations, it
is ensured that the Policyholder has an insurable interest in the Life Insured. This contract does not provide for
participation in the distribution of profits or surplus declared by us.
All the communication/ documents including the Contract document will be sent to Your registered address. It
shall be Your responsibility to confirm Your address, email ID, mobile no, bank account details (contact
information) or update any change in such contact information. In the event of non- receipt of the Contract You
should contact Our Customer Care Unit before expiry of the Free-Look Period.
We encourage You to open E- Insurance Account. For more details on E-Insurance Policy, please visit our website
or contact our Relationship Manager.
In case of purchase of Policy by electronic mode through online or E-app, the Application form and Sales
Illustration shall be validated through One-time password (OTP) sent on Your mobile number/e-mail ID and
undertaking obtained in the Client Declaration form if any or through any other means as may be notified by the
Company from time to time.
2. Taxes
All Premiums are subject to Goods and Services tax (GST), other applicable taxes, cesses, and levies, if any which
will entirely be borne by You and will always be paid by You along with the payment of Premium. If any
imposition (tax or otherwise) is levied by any statutory or administrative body under the Policy, ABSLI reserves
the right to claim the same from You. Alternatively, ABSLI has the right to deduct the amount from the benefits
payable by Us under the Policy.
Tax benefits and liabilities under the Policy may be available as per prevailing tax laws. Tax laws and the benefits
arising thereunder are subject to change. You are advised to seek an opinion of Your tax advisor in relation to
the tax benefits and liabilities applicable to You.
3. Claim Procedures
The Policyholder/Nominee should notify the claim with proof of claim at the nearest Aditya Birla Sun Life
Insurance Co. Ltd. branch office or through our Customer Portal
https://lifeinsurance.adityabirlacapital.com/customer-service/claim-procedure/online-claim or to the 'Claims
Department' at claimsnotification.lifeinsurance@adityabirlacapital.com and the claim documents to be
simultaneously sent at Aditya Birla Sun Life Insurance Company Limited, G- Corp Tech Park, 5th & 6th Floor,
Kasar Vadavali, Near Hypercity Mall, Ghodbunder Road, Thane (West) – 400601.
The claim is required to be intimated to us within a period of 90 days from the date of death. However, we may
condone the delay in claim intimation, if any, and the delay is proved to be for reasons beyond the control of
the claimant. We will be able to proceed with the claim intimation request only on receipt of the following
mandatory claim documents:
For processing a Death claim under this Policy, We will require the following documents:
Mandatory Claim Requirements:
1) Claimant Statement Form
2) Death Certificate issued by Municipal Corporation/Gram Panchayat (Self attested copy)

Mumbai – 400013
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3) Original Policy Document

4) KYC Document of beneficiary ( Self attested copy)
5) Relationship of beneficiary with Life Insured
6) Bank details of the beneficiary
Additional Requirements: (Claims within 3 years from date of issue/Revival)
1) Medical Attendant's Certificate, if any
2) Hospital or treatment records, if any (Self attested copy)
3) Employer's Certificate (if applicable)
Additional Requirements for Accidental/Unnatural Death:
1) FIR & Final Police Closure Report
2) Post Mortem Report
3) Policy Inquest Report/Inquest Panchnama
4) News Paper Cutting (if any)
For processing Maturity claim under this Policy, Maturity proceeds shall be credited in Policyholder’s bank
account as per the bank details available in our records. In case of any change in the bank details You are
requested to update the bank details by submitting a request at the nearest Aditya Birla Sun Life Insurance Co.
Ltd. branch office or through our website https://lifeinsurance.adityabirlacapital.com/ or Customer Portal or
any other mode as allowed by the company.
Any other relevant information/ document as may be required by ABSLI depending on the circumstances of the
death or illness needs to be provided.
Beneficiary can download the claim documents from our website https://lifeinsurance.adityabirlacapital.com/
or can obtain the same from any of ABSLI branches. In case You are unable to provide any or all the above
documents, in exceptional circumstances such as a natural calamity, we may at our own discretion conduct an
investigation/ verification and accord a claim decision. For any further queries, You can call us at our toll free no.
1800 270 7000 or email us at Aditya Birla Capital - Life Insurance “claims.lifeinsurance@adityabirlacapital.com”
Claimant/Beneficiary may intimate Us about Death claim via the following ways:
 Online intimation through ABSLI Website (https://lifeinsurance.adityabirlacapital.com/)
 Through e-mail on claims.lifeinsurance@adityabirlacapital.com
 Visit nearest ABSLI Branch Office
4. Fraud, Misstatement
Fraud, misstatement would be dealt with in accordance with provisions of Section 45 of the Insurance Act,
1938, as amended from time to time. For more details on Section 45 of the Insurance Act, 1938, as amended
from time to time, please refer to Annexure C.
5. Suicide Exclusion
In case the Life Insured, either minor or major, dies due to suicide within 12 months from the Risk
Commencement Date or date of Revival of the Policy, the Policy shall immediately terminate, and Company shall
pay the following to the Nominee:
 Where the Policy has acquired the Surrender Value, higher of Surrender Value or (Total Premiums Paid plus
underwriting extra premiums paid plus loadings for modal premiums paid excluding applicable taxes) till
date of death.
 Where the Policy hasn’t acquired the Surrender Value, Total Premiums Paid plus underwriting extra
premiums paid plus loadings for modal premiums paid excluding applicable taxes) till date of death.

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6. Travel and Occupation

There are no restrictions on travel or occupation under this Policy.
7. Assignment
Assignment is allowed as per the provisions of Section 38 of the Insurance Act, 1938 as amended from time to
time. For more details on the nomination, please refer to Annexure A.
8. Nomination
Nomination is allowed as per the provisions of Section 39 of the Insurance Act, 1938 as amended from time to
time. For more details on the nomination, please refer to Annexure B.
9. Policy Currency
This Policy is denominated in Indian Rupees. (INR) Any benefit/claim payments under the Policy will be made in
Indian Rupees by Us or in any other currency in accordance with the applicable guidelines issued by the Reserve
Bank of India from time to time.
10. Electronic Transactions

You will comply with all the terms and conditions with respect to all transactions effected by or through facilities
for conducting remote transactions including the internet, world wide web, electronic data interchange, call
centre, tele-service operations or by other means of telecommunication established by Us or on Our behalf, for
and in respect of the Policy or services, which will constitute legally binding and valid transactions when executed
in adherence to and in compliance with the terms and conditions for such facilities.
11. Communication and Notices

All notices meant for Us should be in writing and delivered to Our address as mentioned in Part G or such other
address as We may notify from time to time. You should mention the correct Policy number in all
communications including communications with respect to Premium remittances made by You. All notices
meant for You will be in writing and will be sent by Us to Your address as shown in the Schedule or as
communicated by You and registered with Us. We may send You notices by post, courier, hand delivery, fax or
e-mail/electronic mode or by any other means as determined by Us. If You change Your address, or if the address
of the Nominee changes, You must notify Us immediately. Failure in timely notification of change of address
could result in a delay in processing of benefits payable under the Policy. For any updates, please visit Our
website https://lifeinsurance.adityabirlacapital.com/
12. Governing Law and Jurisdiction

The Policy will be governed by and enforced in accordance with the laws of India. The competent courts in India
will have exclusive jurisdiction in all matters and causes arising out of the Policy.
13. Loss of Policy Document

The Policyholder can make an application for duplicate Policy on payment of ₹ 250/- upon loss of Policy
document along with other requirements as may be prescribed by the Company.

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PART G – GRIEVANCE REDRESSAL MECHANISM AND OMBUDSMAN DETAILS
Grievance or Complaint
You may register Your grievance or complaint with any of our nearest branches or with our Head Customer Response
& Resolution at Customer Care Unit, Aditya Birla Sun Life Insurance Company Ltd., at G- Corp Tech Park, 5th & 6th
Floor, Kasar Vadavali, Near Hypercity Mall, Ghodbunder Road, Thane (West) – 400601 or at Company’s registered
address at One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone
Road, Mumbai – 400013. You may also call our toll-free no. 1-800-270-7000 or on Whatsapp no. 8828800040 or email:
care.lifeinsurance@adityabirlacapital.com and for NRI Customers - absli.nrihelpdesk@adityabirlacapital.com.
In case You are dissatisfied with the decision of the above office or have not received any response with 10 days, You
may contact Head Service Assurance at Customer Care Unit, Aditya Birla Sun Life Insurance Company Ltd. , at G- Corp
Tech Park, 5th & 6th Floor, Kasar Vadavali, Near Hypercity Mall, Ghodbunder Road, Thane (West) – 400601 or at
Company’s registered address at One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat
Marg, Elphinstone Road, Mumbai – 400013.
You may also call our toll free no. 1-800-270-7000 or on Whatsapp no. 8828800040 or email:
grievance.lifeinsurance@adityabirlacapital.com.
The complaint should be made in writing duly signed or through email by the complainant or by his/her legal heirs
with full details of the complaint and the contact information of complainant.
For senior citizens, we provide priority redressal of grievances and complaints. Please email us at:
ABSLI.SeniorcitizenLifeinsurance@adityabirlacapital.com
If You are not satisfied with the response or do not receive a response from us within 15 days, You may approach the
Grievance Cell of the Insurance Regulatory and Development Authority of India (IRDAI) on the following contact
details:
IRDAI Grievance Call Centre – Bima Bharosa Shikayat Nivaran Kendra TOLL FREE NO: 155255 or 18004254732
Email ID: complaints@irdai.gov.in
You can also register Your complaint online at
https://bimabharosa.irdai.gov.in
Address for communication for complaints by fax/paper:
Insurance Regulatory and Development Authority of India,
Policyholder's protection & Grievance Redressal Department – Grievance Redressal Cell
4th floor, Sy No. 115/1, Financial District,
Nanakramguda, Gachibowli, Hyderabad – 500 032
Ph: (040) 20204000
Insurance Ombudsman
For redressal of Claims related grievances, claimants can also approach Insurance Ombudsman who provides for low
cost, speedy arbitration to customers.
The Ombudsman, as per Insurance Ombudsman Rules, 2017, can receive and consider complaints or disputes relating
to the matters such as:
(a) Delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance
Regulatory and Development Authority of India Act,1999
(b) Any partial or total repudiation of claims by the life insurer, General insurer or the health insurer;
(c) Disputes over premium paid or payable in terms of insurance policy;
(d) Misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
(e) Legal construction of insurance policies insofar as the dispute relates to claim;
(f) Policy servicing related grievances against insurers and their agents and intermediaries;
(g) Issuance of life insurance policy, general insurance policy including health insurance policy which is not in
conformity with the proposal form submitted by the proposer;

Mumbai – 400013
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(h) Non-issuance of insurance policy after receipt of premium in life insurance and general insurance including
health insurance; and
(i) Any other matter resulting from the violation of provisions of the Insurance Act, 1938, as amended from time to
time, or the regulations, circulars , guidelines or instructions issued by IRDAI from time to time or the terms and
conditions of the policy contract, in so far as they relate to issues mentioned at clauses (a) to (f).
As per provision 14(3) of the Insurance Ombudsman Rules 2017, the complaint to the Ombudsman can be made:
i. only if the grievance has been rejected by the grievance redressal machinery of the insurer;
ii. within a period of one year from the date of rejection by the insurer; and
iii. if it is not simultaneously under any litigation
Risk Factors / Disclaimers

This Policy is underwritten by Aditya Birla Sun Life Insurance Company Limited (ABSLI) and is a non-linked non-
participating individual life insurance savings plan. All terms & conditions are guaranteed throughout the Policy term.
ABSLI reserves the right to recover levies such as the GST levied by the authorities on insurance transactions. If there
be any additional levies, they too will be recovered from You.
NOTWITHSTANDING ANYTHING CONTAINED IN THIS POLICY DOCUMENT, THE PROVISIONS HEREIN SHALL STAND ALTERED, AMENDED,
MODIFIED OR SUPERCEDED TO SUCH EXTENT AND IN SUCH MANNER AS MAY BE REQUIRED BY ANY CHANGE IN THE APPLICABLE LAW
(INCLUDING BUT NOT LIMITED TO ANY REGULATIONS MADE OR DIRECTIONS / INSTRUCTIONS OR GUIDELINES ISSUED BY THE IRDAI) OR ANY
OTHER COMPETENT AUTHORITY OR AS MAY BE NECESSARY UNDER A JUDGEMENT OR ORDER /DIRECTION/ INSTRUCTION OF A COURT OF LAW .

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PART G – LIST OF OMBUDSMAN
Office Details Jurisdiction of Office (Union Territory, District)

AHMEDABAD - Shri Collu Vikas Rao Gujarat,
Office of the Insurance Ombudsman, Dadra & Nagar Haveli,
Jeevan Prakash Building, 6th floor, Daman and Diu.
Tilak Marg, Relief Road,
Ahmedabad – 380 001.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU – Shri Vipin Anand Karnataka.
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL – Shri R M Singh Madhya Pradesh
Office of the Insurance Ombudsman, Chattisgarh.
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR - Shri Manoj Kumar Parida Orissa
62, Forest park,
Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in
CHANDIGARH - Shri Atul Jerath Punjab,
Office of the Insurance Ombudsman, Haryana(excluding Gurugram, Faridabad, Sonepat and
S.C.O. No. 101, 102 & 103, 2nd Floor, Bahadurgarh)
Batra Building, Sector 17 – D,
Himachal Pradesh, Union Territories of Jammu &
Chandigarh – 160 017.
Kashmir,
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274 Ladakh & Chandigarh.
Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI - Shri Segar Sampathkumar Tamil Nadu,
Fatima Akhtar Court, 4th Floor, 453, Puducherry Town and
Anna Salai, Teynampet,
Karaikal (which are part of Puducherry).
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in

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DELHI - Ms Sunita Sharma Delhi &
Office of the Insurance Ombudsman, Following Districts of Haryana - Gurugram, Faridabad,
2/2 A, Universal Insurance Building, Sonepat & Bahadurgarh.
Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in
GUWAHATI - Shri Somnath Ghosh Assam,
Office of the Insurance Ombudsman, Meghalaya,
Jeevan Nivesh, 5th Floor, Manipur,
Nr. Panbazar over bridge, S.S. Road, Mizoram,
Guwahati – 781001(ASSAM). Arunachal Pradesh,
Tel.: 0361 - 2632204 / 2602205 Nagaland and Tripura.
Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD - Shri N Sankaran Andhra Pradesh,
Office of the Insurance Ombudsman, Telangana,
6-2-46, 1st floor, "Moin Court", Yanam and
Lane Opp. Saleem Function Palace, part of Union Territory of Puducherry.
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR – Shri Rajiv Dutt Sharma Rajasthan.
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM - Shri G Radhakrishnan Kerala,
Lakshadweep,
Office of the Insurance Ombudsman, Mahe-a part of Union Territory of Puducherry.
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in
KOLKATA - Ms Kiran Sahdev West Bengal,
Office of the Insurance Ombudsman, Sikkim,
Hindustan Bldg. Annexe, 4th Floor, Andaman & Nicobar Islands.
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in
LUCKNOW- Shri. Atul Sahai Districts of Uttar Pradesh :
Office of the Insurance Ombudsman, Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
6th Floor, Jeevan Bhawan, Phase-II, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
Nawal Kishore Road, Hazratganj, Jaunpur, Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao,
Lucknow - 226 001. Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,

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Tel.: 0522 - 2231330 / 2231331 Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti,
Fax: 0522 - 2231310 Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar,
Email: bimalokpal.lucknow@cioins.co.in Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur,
Chandauli, Ballia, Sidharathnagar.
MUMBAI – Shri Bharatkumar S Pandya Goa,
Office of the Insurance Ombudsman, Mumbai Metropolitan Region
3rd Floor, Jeevan Seva Annexe, excluding Navi Mumbai & Thane.
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in
NOIDA - Shri Bimbadhar Pradhani State of Uttaranchal and the following Districts of Uttar
Office of the Insurance Ombudsman, Pradesh:
Bhagwan Sahai Palace Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar,
4th Floor, Main Road, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad,
Naya Bans, Sector 15, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad,
Distt: Gautam Buddh Nagar, Firozbad, Gautambodhanagar, Ghaziabad, Hardoi,
U.P-201301. Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal,
Tel.: 0120-2514252 / 2514253 Amroha, Hathras, Kanshiramnagar, Saharanpur.
Email: bimalokpal.noida@cioins.co.in
PATNA - Ms Susmita Mukherjee Bihar,
Office of the Insurance Ombudsman, Jharkhand.
1st Floor, Kalpana Arcade Building,,
Bazar Samiti Road,
Bahadurpur,
Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@cioins.co.in
PUNE - Shri Sunil Jain Maharashtra,
Office of the Insurance Ombudsman, Area of Navi Mumbai and Thane
Jeevan Darshan Bldg., 3rd Floor, excluding Mumbai Metropolitan Region.
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in

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Annexure A:
Section 38 - Assignment and Transfer of Insurance Policies
Assignment or transfer of a Policy should be in accordance with Section 38 of the Insurance Act, 1938 as amended by the Insurance
Laws (Amendment) Act, 2015. The extant provisions in this regard are as follows:
a. This Policy may be transferred/assigned, wholly or in part, with or without consideration.

b. An Assignment may be effected in a Policy by an endorsement upon the Policy itself or by a separate instrument under notice
to the Insurer.
c. The instrument of assignment should indicate the fact of transfer or assignment and the reasons for the assignment or transfer,
antecedents of the assignee and terms on which assignment is made.
d. The assignment must be signed by the transferor or assignor or duly authorized agent and attested by at least one witness.
e. The transfer of assignment shall not be operative as against an insurer until a notice in writing of the transfer or assignment
and either the said endorsement or instrument itself or copy there of certified to be correct by both transferor and transferee
or their duly authorised agents have been delivered to the insurer.
f. Fee to be paid for assignment or transfer can be specified by the Authority through Regulations.
g. On receipt of notice with fee, the insurer should Grant a written acknowledgement of receipt of notice. Such notice shall be
conclusive evidence against the insurer of duly receiving the notice.
h. If the insurer maintains one or more places of business, such notices shall be delivered only at the place where the Policy is
being serviced.
i. The insurer may accept or decline to act upon any transfer or assignment or endorsement, if it has sufficient reasons to believe
that it is
i. not bonafide or
ii. not in the interest of the Policyholder or
iii. not in public interest or
iv. is for the purpose of trading of the insurance Policy.
j. Before refusing to act upon endorsement, the Insurer should record the reasons in writing and communicate the same in
writing to Policyholder within 30 days from the date of Policyholder giving a notice of transfer or assignment.
k. In case of refusal to act upon the endorsement by the Insurer, any person aggrieved by the refusal may prefer a claim to IRDAI
within 30 days of receipt of the refusal letter from the Insurer.
l. The priority of claims of persons interested in an insurance Policy would depend on the date on which the notices of assignment
or transfer is delivered to the insurer; where there are more than one instruments of transfer or assignment, the priority will
depend on dates of delivery of such notices. Any dispute in this regard as to priority should be referred to Authority.
m. Every assignment or transfer shall be deemed to be absolute assignment or transfer and the assignee or transferee shall be
deemed to be absolute assignee or transferee, except
1. where assignment or transfer is subject to terms and conditions of transfer or assignment OR
2. where the transfer or assignment is made upon condition that
i. the proceeds under the Policy shall become payable to Policyholder or Nominee(s) in the event of assignee or
transferee dying before the insured OR
ii. the insured surviving the term of the Policy. Such conditional assignee will not be entitled to obtain a loan on Policy
or Surrender the Policy. This provision will prevail notwithstanding any law or custom having force of law which is
contrary to the above position.
n. In other cases, the insurer shall, subject to terms and conditions of assignment, recognize the transferee or assignee named in
the notice as the absolute transferee or assignee and such person
i. shall be subject to all liabilities and equities to which the transferor or assignor was subject to at the date of transfer
or assignment and
ii. may institute any proceedings in relation to the Policy
iii. obtain loan under the Policy or Surrender the Policy without obtaining the consent of the transferor or assignor or
making him a party to the proceedings
o. Any rights and remedies of an assignee or transferee of a life insurance Policy under an assignment or transfer effected before
commencement of the Insurance Laws (Amendment) Act, 2015 shall not be affected by this section.

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[Disclaimer: This is not a comprehensive list of amendments of the Insurance Laws (Amendment) Act, 2015 and only a simplified
version prepared for general information. Policy Holders are advised to refer to Original Act Gazette Notification dated March 23,
2015 for complete and accurate details. ]Annexure 2: Section 39 – Nomination by Policyholder

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Annexure B:
Section 39 – Nomination by Policyholder
Nomination of a life insurance Policy is as below in accordance with Section 39 of the Insurance Act, 1938 as amended by the Insurance
Laws (Amendment) Act, 2015. The extant provisions in this regard are as follows:
1. The Policyholder of a life insurance on his own life may nominate a person or persons to whom money secured by the Policy shall
be paid in the event of his death.
2. Where the Nominee is a minor, the Policyholder may appoint any person to receive the money secured by the Policy in the event
of Policyholder’s death during the minority of the Nominee. The manner of appointment to be laid down by the insurer.
3. Nomination can be made at any time before the maturity of the Policy.
4. Nomination may be incorporated in the text of the Policy itself or may be endorsed on the Policy communicated to the insurer and
can be registered by the insurer in the records relating to the Policy.
5. Nomination can be cancelled or changed at any time before Policy matures, by an endorsement or a further endorsement or a will
as the case may be.
6. A notice in writing of Change or Cancellation of nomination must be delivered to the insurer for the insurer to be liable to such
Nominee. Otherwise, insurer will not be liable if a bonafide payment is made to the person named in the text of the Policy or in
the registered records of the insurer.
7. Fee to be paid to the insurer for registering change or cancellation of a nomination can be specified by the Authority through
Regulations.
8. On receipt of notice with fee, the insurer should grant a written acknowledgement to the Policyholder of having registered a
nomination or cancellation or change thereof.
9. A transfer or assignment made in accordance with Section 38 shall automatically cancel the nomination except in case of
assignment to the insurer or other transferee or assignee for purpose of loan or against security or its reassignment after
repayment. In such case, the nomination will not get cancelled to the extent of insurer’s or transferee’s or assignee’s interest in
the Policy. The nomination will get revived on repayment of the loan.
10. The right of any creditor to be paid out of the proceeds of any Policy of life insurance shall not be affected by the nomination.
11. In case of nomination by Policyholder whose life is insured, if the Nominees die before the Policyholder, the proceeds are payable
to Policyholder or his heirs or legal representatives or holder of succession certificate.
12. In case Nominee(s) survive the person whose life is insured, the amount secured by the Policy shall be paid to such survivor(s).
13. Where the Policyholder whose life is insured nominates his
(a) parents or
(b) spouse or
(c) children or
(d) spouse and children
(e) or any of them
14. If Nominee(s) die after the Policyholder but before his share of the amount secured under the Policy is paid, the share of the
expired Nominee(s) shall be payable to the heirs or legal representative of the Nominee or holder of succession certificate of such
Nominee(s).
15. The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance policies maturing for payment after the
commencement of the Insurance Laws (Amendment) Act, 2015.
16. If Policyholder dies after maturity but the proceeds and benefit of the Policy has not been paid to him because of his death, his
Nominee(s) shall be entitled to the proceeds and benefit of the Policy.
17. The provisions of Section 39 are not applicable to any life insurance Policy to which Section 6 of Married Women’s Property Act,
1874 applies or has at any time applied except where before or after the Insurance Laws (Amendment) Act, 2015, a nomination is
made in favour of spouse or children or spouse and children whether or not on the face of the Policy it is mentioned that it is made
under Section 39. Where nomination is intended to be made to spouse or children or spouse and children under Section 6 of MWP
Act, it should be specifically mentioned on the Policy. In such a case only, the provisions of Section 39 will not apply.
2015 for complete and accurate details.

Mumbai – 400013
Page 26
Annexure C:
Section 45 – Policy shall not be called in question on the ground of mis-statement after three years
Provisions regarding Policy not being called into question in terms of Section 45 of the Insurance Act, 1938, as amended by the
Insurance Laws (Amendment) Act, 2015 are as follows:
1. No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3 years from
b. the date of issuance of Policy or
c. the date of commencement of risk or
d. the date of Revival of Policy or
e. the date of rider to the Policy
whichever is later.
2. On the ground of fraud, a Policy of Life Insurance may be called in question within 3 years from
a. the date of issuance of Policy or
b. the date of commencement of risk or
c. the date of Revival of Policy or
d. the date of rider to the Policy
whichever is later.
For this, the insurer should communicate in writing to the insured or legal representative or Nominee or assignees of insured,
as applicable, mentioning the ground and materials on which such decision is based.
3. Fraud means any of the following acts committed by insured or by his agent, with the intent to deceive the insurer or to
induce the insurer to issue a life insurance Policy:
a. The suggestion, as a fact of that which is not true and which the insured does not believe to be true;
b. The active concealment of a fact by the insured having knowledge or belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be fraudulent.
4. Mere silence is not fraud unless, depending on circumstances of the case, it is the duty of the insured or his agent keeping
silence to speak or silence is in itself equivalent to speak.
5. No Insurer shall repudiate a life insurance Policy on the ground of Fraud, if the Insured / beneficiary can prove that the
misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such
mis-statement of or suppression of material fact are within the knowledge of the insurer. Onus of disproving is upon the
Policyholder, if alive, or beneficiaries.
6. Life insurance Policy can be called in question within 3 years on the ground that any statement of or suppression of a fact
material to expectancy of life of the insured was incorrectly made in the proposal or other document basis which Policy was
issued or revived or rider issued. For this, the insurer should communicate in writing to the insured or legal representative or
Nominee or assignees of insured, as applicable, mentioning the ground and materials on which decision to repudiate the
Policy of life insurance is based.
7. In case repudiation is on ground of mis-statement and not on fraud, the premium collected on Policy till the date of
repudiation shall be paid to the insured or legal representative or Nominee or assignees of insured, within a period of 90 days
from the date of repudiation.
8. Fact shall not be considered material unless it has a direct bearing on the risk undertaken by the insurer. The onus is on insurer
to show that if the insurer had been aware of the said fact, no life insurance Policy would have been issued to the insured.
9. The insurer can call for proof of Age at any time if he is entitled to do so and no Policy shall be deemed to be called in question
merely because the terms of the Policy are adjusted on subsequent proof of Age of Life Insured. So, this Section will not be
applicable for questioning Age or adjustment based on proof of Age submitted subsequently.
2015 for complete and accurate details.]

Mumbai – 400013
Page 27
ANNEXURE 1:
Guaranteed Surrender Value Factor (% of Total Premiums Paid)
Year of Policy Term-->

Surrender 25 30 35 40 45 46 47 48 49 50
1 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
2 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%
3 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%
4 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
5 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
6 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
7 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
8 52% 52% 51% 51% 51% 51% 51% 51% 51% 51%
9 54% 53% 53% 52% 52% 52% 52% 52% 52% 52%
10 57% 55% 54% 54% 53% 53% 53% 53% 53% 53%
11 59% 57% 56% 55% 54% 54% 54% 54% 54% 54%
12 61% 59% 57% 56% 55% 55% 55% 55% 55% 55%
13 63% 60% 59% 57% 56% 56% 56% 56% 56% 56%
14 66% 62% 60% 58% 57% 57% 57% 57% 57% 57%
15 68% 64% 61% 60% 58% 58% 58% 58% 58% 57%
16 70% 66% 63% 61% 59% 59% 59% 59% 59% 58%
17 72% 67% 64% 62% 61% 60% 60% 60% 60% 59%
18 74% 69% 66% 63% 62% 61% 61% 61% 60% 60%
19 77% 71% 67% 65% 63% 62% 62% 62% 61% 61%
20 79% 73% 69% 66% 64% 63% 63% 63% 62% 62%
21 81% 74% 70% 67% 65% 64% 64% 64% 63% 63%
22 83% 76% 71% 68% 66% 65% 65% 65% 64% 64%
23 86% 78% 73% 69% 67% 66% 66% 66% 65% 65%
24 90% 80% 74% 71% 68% 67% 67% 67% 66% 66%
25 90% 81% 76% 72% 69% 68% 68% 68% 67% 67%
26 83% 77% 73% 70% 69% 69% 69% 68% 68%
27 85% 79% 74% 71% 71% 70% 70% 69% 69%
28 87% 80% 75% 72% 72% 71% 70% 70% 70%
29 90% 81% 77% 73% 73% 72% 71% 71% 70%
30 90% 83% 78% 74% 74% 73% 72% 72% 71%
31 84% 79% 75% 75% 74% 73% 73% 72%
32 86% 80% 76% 76% 75% 74% 74% 73%
33 87% 82% 77% 77% 76% 75% 75% 74%
34 90% 83% 78% 78% 77% 76% 76% 75%
35 90% 84% 79% 79% 78% 77% 77% 76%
36 85% 81% 80% 79% 78% 78% 77%
37 86% 82% 81% 80% 79% 79% 78%
38 88% 83% 82% 81% 80% 80% 79%
39 90% 84% 83% 82% 81% 80% 80%
40 90% 85% 84% 83% 82% 81% 81%
41 86% 85% 84% 83% 82% 82%

Mumbai – 400013
Page 28
42 87% 86% 85% 84% 83% 83%

43 88% 87% 86% 85% 84% 83%
44 90% 88% 87% 86% 85% 84%
45 90% 90% 88% 87% 86% 85%
46 90% 90% 88% 87% 86%
47 90% 90% 88% 87%
48 90% 90% 88%
49 90% 90%
50 90%
Policy Term-->
Year of
Surrender 51 52 53 54 55 56 57 58 59 60
1 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
2 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%
3 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%
4 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
5 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
6 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
7 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
8 51% 51% 51% 51% 51% 51% 51% 51% 51% 51%
9 52% 52% 52% 52% 52% 52% 52% 52% 52% 52%
10 53% 53% 53% 53% 53% 52% 52% 52% 52% 52%
11 54% 54% 53% 53% 53% 53% 53% 53% 53% 53%
12 55% 54% 54% 54% 54% 54% 54% 54% 54% 54%
13 55% 55% 55% 55% 55% 55% 55% 55% 55% 55%
14 56% 56% 56% 56% 56% 56% 56% 55% 55% 55%
15 57% 57% 57% 57% 57% 57% 56% 56% 56% 56%
16 58% 58% 58% 58% 58% 57% 57% 57% 57% 57%
17 59% 59% 59% 59% 58% 58% 58% 58% 58% 58%
18 60% 60% 60% 59% 59% 59% 59% 59% 58% 58%
19 61% 61% 60% 60% 60% 60% 60% 59% 59% 59%
20 62% 62% 61% 61% 61% 61% 60% 60% 60% 60%
21 63% 62% 62% 62% 62% 61% 61% 61% 61% 61%
22 64% 63% 63% 63% 63% 62% 62% 62% 62% 61%
23 65% 64% 64% 64% 63% 63% 63% 63% 62% 62%
24 65% 65% 65% 64% 64% 64% 64% 63% 63% 63%
25 66% 66% 66% 65% 65% 65% 64% 64% 64% 64%
26 67% 67% 67% 66% 66% 66% 65% 65% 65% 64%
27 68% 68% 67% 67% 67% 66% 66% 66% 65% 65%
28 69% 69% 68% 68% 68% 67% 67% 66% 66% 66%
29 70% 70% 69% 69% 68% 68% 68% 67% 67% 67%
30 71% 70% 70% 70% 69% 69% 68% 68% 68% 67%
31 72% 71% 71% 70% 70% 70% 69% 69% 68% 68%
32 73% 72% 72% 71% 71% 70% 70% 70% 69% 69%
33 74% 73% 73% 72% 72% 71% 71% 70% 70% 70%
34 75% 74% 73% 73% 73% 72% 72% 71% 71% 70%
35 75% 75% 74% 74% 73% 73% 72% 72% 72% 71%
36 76% 76% 75% 75% 74% 74% 73% 73% 72% 72%
37 77% 77% 76% 76% 75% 74% 74% 74% 73% 73%

Mumbai – 400013
Page 29
38 78% 78% 77% 76% 76% 75% 75% 74% 74% 73%
39 79% 78% 78% 77% 77% 76% 76% 75% 75% 74%
40 80% 79% 79% 78% 78% 77% 76% 76% 75% 75%
41 81% 80% 80% 79% 78% 78% 77% 77% 76% 76%
42 82% 81% 80% 80% 79% 79% 78% 77% 77% 76%
43 83% 82% 81% 81% 80% 79% 79% 78% 78% 77%
44 84% 83% 82% 81% 81% 80% 80% 79% 78% 78%
45 85% 84% 83% 82% 82% 81% 80% 80% 79% 79%
46 85% 85% 84% 83% 83% 82% 81% 81% 80% 79%
47 86% 86% 85% 84% 83% 83% 82% 81% 81% 80%
48 87% 86% 86% 85% 84% 83% 83% 82% 82% 81%
49 88% 87% 87% 86% 85% 84% 84% 83% 82% 82%
50 90% 88% 87% 87% 86% 85% 84% 84% 83% 82%
51 90% 90% 88% 87% 87% 86% 85% 85% 84% 83%
52 90% 90% 88% 88% 87% 86% 85% 85% 84%
53 90% 90% 88% 88% 87% 86% 85% 85%
54 90% 90% 88% 88% 87% 86% 85%
55 90% 90% 88% 88% 87% 86%
56 90% 90% 88% 88% 87%
57 90% 90% 88% 88%
58 90% 90% 88%
59 90% 90%
60 90%
Policy Term-->
Year of
Surrender 61 62 63 64 65 66 67 68 69 70
1 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
2 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%
3 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%
4 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
5 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
6 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
7 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
8 51% 51% 51% 51% 51% 51% 51% 51% 51% 51%
9 51% 51% 51% 51% 51% 51% 51% 51% 51% 51%
10 52% 52% 52% 52% 52% 52% 52% 52% 52% 52%
11 53% 53% 53% 53% 53% 53% 53% 53% 53% 53%
12 54% 54% 54% 54% 53% 53% 53% 53% 53% 53%
13 54% 54% 54% 54% 54% 54% 54% 54% 54% 54%
14 55% 55% 55% 55% 55% 55% 55% 55% 55% 54%
15 56% 56% 56% 56% 56% 55% 55% 55% 55% 55%
16 57% 57% 56% 56% 56% 56% 56% 56% 56% 56%
17 57% 57% 57% 57% 57% 57% 57% 57% 56% 56%
18 58% 58% 58% 58% 58% 57% 57% 57% 57% 57%
19 59% 59% 59% 58% 58% 58% 58% 58% 58% 58%
20 60% 59% 59% 59% 59% 59% 59% 59% 58% 58%
21 60% 60% 60% 60% 60% 59% 59% 59% 59% 59%
22 61% 61% 61% 61% 60% 60% 60% 60% 60% 60%

Mumbai – 400013
Page 30
23 62% 62% 61% 61% 61% 61% 61% 60% 60% 60%
24 63% 62% 62% 62% 62% 62% 61% 61% 61% 61%
25 63% 63% 63% 63% 62% 62% 62% 62% 62% 61%
26 64% 64% 64% 63% 63% 63% 63% 62% 62% 62%
27 65% 65% 64% 64% 64% 64% 63% 63% 63% 63%
28 66% 65% 65% 65% 64% 64% 64% 64% 64% 63%
29 66% 66% 66% 65% 65% 65% 65% 64% 64% 64%
30 67% 67% 66% 66% 66% 66% 65% 65% 65% 65%
31 68% 67% 67% 67% 67% 66% 66% 66% 65% 65%
32 69% 68% 68% 68% 67% 67% 67% 66% 66% 66%
33 69% 69% 69% 68% 68% 68% 67% 67% 67% 67%
34 70% 70% 69% 69% 69% 68% 68% 68% 67% 67%
35 71% 70% 70% 70% 69% 69% 69% 68% 68% 68%
36 71% 71% 71% 70% 70% 70% 69% 69% 69% 68%
37 72% 72% 71% 71% 71% 70% 70% 70% 69% 69%
38 73% 73% 72% 72% 71% 71% 71% 70% 70% 70%
39 74% 73% 73% 72% 72% 72% 71% 71% 71% 70%
40 74% 74% 74% 73% 73% 72% 72% 72% 71% 71%
41 75% 75% 74% 74% 73% 73% 73% 72% 72% 72%
42 76% 75% 75% 75% 74% 74% 73% 73% 73% 72%
43 77% 76% 76% 75% 75% 74% 74% 74% 73% 73%
44 77% 77% 76% 76% 76% 75% 75% 74% 74% 73%
45 78% 78% 77% 77% 76% 76% 75% 75% 75% 74%
46 79% 78% 78% 77% 77% 76% 76% 76% 75% 75%
47 80% 79% 79% 78% 78% 77% 77% 76% 76% 75%
48 80% 80% 79% 79% 78% 78% 77% 77% 76% 76%
49 81% 81% 80% 79% 79% 78% 78% 78% 77% 77%
50 82% 81% 81% 80% 80% 79% 79% 78% 78% 77%
51 83% 82% 81% 81% 80% 80% 79% 79% 78% 78%
52 83% 83% 82% 82% 81% 81% 80% 80% 79% 79%
53 84% 83% 83% 82% 82% 81% 81% 80% 80% 79%
54 85% 84% 84% 83% 82% 82% 81% 81% 80% 80%
55 86% 85% 84% 84% 83% 83% 82% 81% 81% 80%
56 86% 86% 85% 84% 84% 83% 83% 82% 82% 81%
57 87% 86% 86% 85% 84% 84% 83% 83% 82% 82%
58 88% 87% 86% 86% 85% 85% 84% 83% 83% 82%
59 89% 88% 87% 86% 86% 85% 85% 84% 84% 83%
60 90% 89% 88% 87% 87% 86% 85% 85% 84% 84%
61 90% 90% 89% 88% 87% 87% 86% 85% 85% 84%
62 90% 90% 89% 88% 87% 87% 86% 85% 85%
63 90% 90% 89% 88% 87% 87% 86% 86%
64 90% 90% 89% 88% 87% 87% 86%
65 90% 90% 89% 88% 87% 87%
66 90% 90% 89% 88% 87%
67 90% 90% 89% 88%
68 90% 90% 89%
69 90% 90%
70 90%

Mumbai – 400013
Page 31
PROPOSAL NO: EA04976548 Form ID: 111001
Nature of Business/Duties Services Designation Are you a registered person under GST Law Yes No
LIFE INSURANCE *Annual Income Rs 1000000 If yes provide your GST registration number
*Proof is mandatory only where annualized 1 year premium acrossed all policies held by Single individual is > Rs.
(please share a copy of GST registration Certificate)
Aditya Birla Sun Life Insurance Company Ltd. 1,00,000
If not earning, state Parent's / Spouse's Annual Income Rs.

For Student/Non earning (Single), state Parents Insurance cover
COMMON PROPOSAL FORM PROPOSAL NO. EA04976548 Rs.
IN UNIT LINKED POLICIES, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER For House wife, state Spouse Insurance cover Rs.
CA Ref A: 7292235 CA Ref B:
Are you a registered person under GST Law Yes No
Insurance Advisor No. Agency Mgr. No. If yes provide your GST registration number
For internal use only
Broker/Corp. Agent No. 002651 Specified Person - Please paste recent (please share a copy of GST registration Certificate)
Officer of CA/Initiator Code
photograph(3cmx3cm) of the
proposer
Broker Verifier Code X30391 CA Branch Code H00144 self-attested 3 AGE PROOF of Life to be Insured (Please self-attest)
by him/her
ZT8082 Passport Pan Card Driving License Municipal Birth Certificate School / College Certificate
USM Code Verifier Code
Others
PROPOSAL FOR INSURANCE ON OWN LIFE / ANOTHER LIFE AGE 18 years & ABOVE
VER20/JUN/2018
a) This form to be filled in BLOCK LETTERS WITH A BLACK PEN. b) Any cancellation/alteration in this form to be authenticated by the proposer and all documents submitted 4 MANDATORY DETAILS IN ACCORDANCE WITH ANTI MONEY LAUNDERING GUIDELINES AS PRESCRIBED BY IRDAI
with this Proposal Form must be self attested by the Proposer. c) Insurance contract is based upon utmost good faith between Insurer and the Insured which requires the
Proposer and Life to be Insured to disclose all material facts. d) Please attach an extra sheet, where any additional information needs to be given.
A Identification Proof of the Proposer (any one) PAN Card Passport Driving License Others
1 LIFE to be INSURED 2 PROPOSER (if not the LIFE to be INSURED)
B Address proof of the Proposer (any one) Voter Card Passport Driving License Others
Do you have an existing policy with ABSLI or Yes No Do you have an existing policy with ABSLI or Yes No
have currently applied simultaneously Address Type Residential/Business Residential Business Registered Office Unspecified
have currently applied simultaneously
FOR/6/18-19/2940
If yes, please quote If yes, please quote

C Income Proof of the Proposer (any one) (mandatory only if total annual policy premiums to ABSLI is Rs. 1 Lac or above) ITR Others
Policy/Proposal Number/Client ID Policy/Proposal Number/Client ID
Permanent Account Number (PAN) CNJPK4913L D PEP - State whether the Proposer or the Life to be Insured or Nominee are Politically Exposed Person @ Yes No
.
Permanent Account Number (PAN)

Mobile Number ~
Mobile Number E PAN Card copy is mandatory along with the proposal form if the customer pays Rs. 50,000 or more in a financial year
8448063609
@
CKYC Number CKYC Number PEP: "Individuals who are or have been entrusted with prominent public functions domestically or by a foreign country or by an international organization, for
Title Mr. Mrs. Ms. Dr. Mx. Title Mr. Mrs. Ms. Dr. Mx. M/S example Heads of State or government, senior politicians, senior government, judicial or military officials, senior executives of state-owned corporationsand
Full Name important political party officials OR Family members /close associates who are related or have business relationships with PEP's.".
Full Name Gagandeep
~
Form 60 is to be filled and signed by the person who is exempted from the requirement of PAN.
Kaur FOR CORPORATE AND OTHER ENTITIES Please fill up and attach "Annexure - I" available separately, as required.
Personal Details
Father/Spouse's Name Dinesh Father/Spouse's Name

Date of Birth 09-09-1990 Date of Birth
5 ELECTRONIC INSURANCE ACCOUNT DETAILS of PROPOSER
Country of Birth India Country of Birth India
Male Female Transgender Relationship with Life to be Insured e-INSURANCE A/C details (email address is mandatory) dhillongagandeep905@gmail.com
Gender
Marital Status Single Married Widowed Divorced Relationship If Other Yes No I would like to receive my insurance policy and all the information related to the proposed insurance policy through insurance repository.
Mother's Name Maiden's Name Gender Male Female Transgender If opted for the above, please submit requisite annexure with the proposer form
Nationality Indian NRI PIO Marital Status Single Married Widowed Divorced
If you already have e-insurance A/C number, please provide the same
FNIO Others Mother's Name Maiden's Name
e-insurance A/C No Repository Name Central Insurance Repository Limited
Are you holding citizenship of any other country?* Yes No Nationality Indian NRI PIO
Would you like to apply. If yes, please mention your preferred Insurance Repository (IR) KARVY NSDL CDSL CAMS
If yes please provide country name FNIO Others
Are you a tax resident of any other country?* Yes No Are you holding citizenship of any other country?* Yes No
If yes please provide unique tax identification number If yes please provide country name 6 ADDRESS for COMMUNICATION with PROPOSER# (all fields are mandatory)
Are you a tax resident of any other country?* Yes No
Address1 c-582 majlis park
If yes please provide unique tax identification number gali no. 7 Adarsh Nagar
Address2
*If the response to any of the above questions is yes a detailed NRI questionnaire *If the response to any of the above questions is yes a detailed NRI questionnaire delhi
will have to be provided will have to be provided Address3
SSC HSC Graduate SSC HSC Graduate Area

Qualification Qualification
City/Town/Village new delhi
Postgraduate Professional Postgraduate Professional
State DELHI Pin 110033
Others Others
Proof is mandatory only where annualized 1 year premium acrossed all policies held by Single individual is > Rs. 10,000
Occupation Service Professional Business Occupation Service Professional Business
Tel. No. Res./Office 8448063609 Alternate Mobile
Army/ Navy Skilled worker Retired Army/ Navy Skilled worker Retired dhillongagandeep905@gmail.com
E-mail Address
/ Police / Police
Your preferred language for communication (select only one) English Hindi Marathi Tamil Telegu
Professional Details
Housewife Student Agriculture Housewife Student Agriculture

Others Others Kannada Bengali Gujarati Malayalam Punjabi
Name of Employer/Business Dang enterprise Name of Employer/Business Details where we can send you updates regarding your policy, renewal reminders and ongoing services
Pleases tick on the below box if you wish to receive the renewal reminders, policy statements, ongoing services, various notifications etc. in electronic
form
Type of Organization Govt. Public Ltd. Private Ltd. Type of Organization Govt. Public Ltd. Private Ltd. Do you wish to receive policy doucment in physical mode? Yes No
Partnership Proprietorship HUF Partnership Proprietorship HUF
I request you to send my policy documents in electronic form at above email id.
Trust Society NGO Trust Society NGO
I request you to send information on my policy regarding renewal reminders, policy statements, ongoing services in electronic form at above email id and
Charity Charity Whatsapp as a medium of communication.
Type of Proposal General HUF Keyman Nature of Business/Duties Designation Do you wish to receive the renewal reminders, policy statements, ongoing services, various Yes No
notifications etc in physical mode ?
Employer- MWP Partnership *Annual Income Rs.
Employee # If the address of life insured is different than the proposer, please fill in the details in "Annexure for Life Insured Address" which forms part of proposal.
*Proof is mandatory only where annualized 1 year premium acrossed all policies held
by Single individual is > Rs. 1,00,000
01 02
Page 32
PROPOSAL NO: EA04976548 Form ID: 111001 PROPOSAL NO: EA04976548 Form ID: 111001
Riders ABSLI Waiver of Premium (applicable only if Life to be Insured and Proposer are same)
7 PERMANENT ADDRESS for COMMUNICATION with PROPOSER (If different from communication address)
Name ABSLI ABSLI ABSLI ABSLI
Address 1
Sum Assured Rs. Rs. Rs. Rs.
Address 2 Policy Premium Rs. 200000.00 Instalment Premium Rs. 203132 Mode# A S Q M
# Payout mode for Annuity Plan
Address 3
Area
11 INSURANCE PLAN DETAILS
City/Town/Village
For the below mentioned products, Simplfied Proposal Form is mandatory
State Pin
Sr. Product Policy Term Premium Paying Basic Premium / Instalment Premium / Sum Assured
No. Name (in years) Term (in years) Purchase Price* (in Rs.) Payout* (in Rs.) (in Rs.)
Plan 2
8 NOMINEE (under Section 39 of Insurance Act, 1938)
* applicable only in case of ABSLI Immediate Annuity Plan
Nominee(if Life to be Insured and Proposer are the same person) Note: For every product mentioned in the above table, please provide a duly filled Simplified Proposal Form. All relevant details of the above mentioned products are captured in the Simplified Proposal
Form. In case of any discrepancy in the above mentioned details and the ones provided in the Simplified Proposal Form, values from the signed benefit illustration will be considered final.
Sr. Nominee Name Gender Date of Birth Relationship with Nomination
No. (dd/mm/yyyy) Life to be Insured Share*(in %)
First Name Last Name 11(a) PREMIUM PAYMENT DETAILS
1 Dinesh Dang M 10-07-1975 Spouse 100 Payment Method Direct Bill NACH / Direct Debit Credit Card Salary Deduction Single Premium Others
* Sum total of all nomination share should be equal to 100%
Payment Mode Annually Semi-Annually Quarterly* Monthly* *not eligible for Direct Bill
Appointee (if Nominee is a minor --- Appointee cannot be Life to be Insured)
Initial Premium Rs. 203132.00 In case of NACH / Direct Debit, Preferred Draw Date 1st 8th 15th 22nd
First Name 9 PURPOSE OF INSURANCE
Top-up Premium Rs. 0 (Incase date is not chosen, policy issuance date will be considered as draw date)
Last Name Protection Savings Childs Education Childs Marriage
Total Amount paid Rs. 203132.00
Gender Male Female Transgender Retirement Planning Legacy Planning
Date of Birth (Cheque / DD should be drawn on a local branch of a bank made payable to "ADITYA BIRLA SUN LIFE INSURANCE COMPANY LTD APP NO EA04976548")
Others
Relationship with Nominee Cash (up to Rs. 50,000) Cheque / DD No. Issuing Bank
Date Payable at (Branch)
10 INSURANCE PLAN DETAILS You are requested to pay cash premium only at ABSLI branches or at authorised collection points and not to the advisor or employee. The company will not be responsible for any loss
in this regard.
Plan 1 ABSLI Nishchit Aayush Plan Option Policy Term 40 years or Whole life Source of Funds Salary Business Income Others
Basic Premium Rs. 200000 Pay Term 10 years or Regular Pay 11(b) POLICY PAYOUT DETAILS
Basic Sum Assured Rs. 2000000 Income Benefit Term/Education Milestone Benefit Payout Mode NEFT ABSLI will make payout(s) to the Proposer, in accordance and subject to the terms and conditions of the policy.
Period
Bank Name HDFC BANK Bank Address MODEL TOWN
Deferment Period 0 year 1 year 5 years 10 years
Account Holder's Name Gagandeep kaur
Income Variant Level Income with Lumpsum Level Income with Enhanced Increasing Income with Lumpsum
Lumpsum Account Type Savings Current Account No 50100350756520
Marriage Milestone 100% 150% 200% Assured Benefit Payment Term IFSC Code HDFC0004411 (Mandatory)
benefit Multiple
Please provide a cancelled blank cheque leaf. In case the cheque does not bear the pre printed name of the account holder /bank account number,we will need photocopy of the bank statement showing
*only applicable in case 'Education and Marriage Milestone Benefit' is chosen in ABSLI Child's Future Assured Plan account holder name, address and account number. The bank statement has to be self attested by customer & attested by ABSLI authorized personnel. In case of any changes in the above bank details in
Benefit Option ~ Short Term Income Long Term Income Whole Life Income - Whole Life Income - future , please fill up the payout option form available separately along with copy of cancelled cheque and submit the same at your nearest branch.
To Age 85 To Age 100
Bonus Utilization Option~ Paid Up Additions Cash Value of Paid Up Additions
12 INSURANCE HISTORY OF THE LIFE to be INSURED (Mandatory)
~Applicable for ABSLI Vision LifeIncome Plus Plan & ABSLI Nishchit Aayush Plan (Only Long Term Income & Whole Life Income - To Age 100 Options applicable)
Benefit Payout 10 years 20 years 25 years 30 years Others, A Is there any concurrent proposal and any existing insurance on your life for Life / Health / Accident / Critical Illness and other riders in Yes No
Period# (please effect with ABSLI and any other insurer in India or abroad? If Yes, give details.
specify)
Benefit Option# Income only Income Benefit with Return of Premium (RoP) *Mention year of Lapse/ Revival applied for
Benefit Policy / Name of the Insurer Year of Sum Assured (in Annual Premium (in Base Plan Medical In Force /
Benefit Payout Frequency# Annual Semi-Annual Quarterly Monthly Proposal No. Issue/ Rs.) Rs.) /Rider Policy (Y/N) Lapsed*
# only Applicable only for ABSLI Assured Income Plus and ABSLI Vision LifeIncome Plus Plan (Benefit Payout Frequency of only Annual and Monthly Mode applicable for ABSLI Vision LifeIncome Plus Plan) proposal Decision
Retirement Age^ 60 years 65 years 70 years 75 years
Sum Assured Escalation Rate^ 5% 10% Sum Assured Reduction Factor^ 50% 25%
B Has any of your new proposal for revival/reinstatement for life, accident, medical, health related insurance or riders or critical illness Yes No
Enhanced Lifestage Protection^ Yes No ACI Benefit^ Yes No ACI Sum Assured Rs. been refused, withdrawn, declined, postponed or offered with restricted benefits or with an increased premium or made any claim
Monthly Income^ Level Increasing @ 5% p.a. under any such policy of insurance with ABSLI or any other insurer in India or abroad? If Yes, give details.
ônly applicable in case of ABSLI DigiShield Plan and ABSLI Poorna Suraksha Kawach (Enhanced Lifestage Protection Not Applicable for ABSLI Poorna Suraksha Kawach)
Plan Option $ Legacy Variant Milestone Variant

Name of the Insurer Sum Assured (in Rs.) Reasons
$only applicable in case of ABSLI Wealth Infinia
Purchase Price* Rs. 0 Annuity Option*

Increasing Sum Assured 5% 10% (for applicable plans only) ABG EMployee/Partner Discount Yes No
Enhanced Insurance 50% 100% 200% ABG Partner Name 13 LIFESTYLE, PERSONAL AND MEDICAL DETAILS OF THE LIFE to be INSURED
Cover
A PERSONAL DETAILS
Investment Option LifeCycle Option Smart Option Risk Profile Conservative Moderate Aggressive
(choose any 1 option) Return Optimser Option Frequency Monthly Weekly Transfer Date 1st 8th 15th 22nd i (a) Height 160 cms Weight 68 kgs
Systematic Transfer Option (Applicable only for monthly mode) (b) Is there any weight change during the past one year over 5 kg? Yes No
Transfer Fund % % % % (c) Increase / Decrease Reason :
(In increments of 5% with minimum of 5% and maximum of 100% in any fund option. Total must be 100%)
B LIFE STYLE INFORMATION & FAMILY MEDICAL HISTORY
Self-Managed Option (In increments of 5% with minimum of 5% and maximum of 100% in any fund option. Total must be 100%)
i Do you intend to live or travel outside India for a period of more than 180days ? If Yes, submit appropriate questionnaire. Yes No
Liquid Plus % Income Advantage % Assure % Protector % Builder %
Enhancer % Creator % Magnifier % Capped Nifty Index % Asset Allocation % ii Are you involved or do you intend to involve in any hazardous occupation or avocation? (for e.g. flying other than a fare-paying Yes No
Maximiser % Multiplier % Super 20 % Pure Equity % Value & Momentum % passenger, diving, mountaineering, working at heights, underground or offshore, using explosives or any other dangerous activity) If
MNC % Yes, submit appropriate questionnaire.
(Note: For the Segregated Fund Identification Number (SFIN) please refer the product brochure / leaflet or Benefit Illustration. You may also logon to our website www.adityabirlasunlifeinsurance.com iii Do you consume or have you ever consumed any narcotic substance? If Yes, give details. Yes No
If the above mentioned values are not legible, missed or mismatch found with proposal form, then values from Signed Benefit Illustration will be considered)
03 04
Page 33
PROPOSAL NO: EA04976548 Form ID: 111001 PROPOSAL NO: EA04976548 Form ID: 111001
iv Do you consume alcohol ? If Yes, give details. Yes No I (we) confirm that the premiums have not been and will not be generated from proceeds of crime related to any of the offences listed in the Prevention of
Substance In the form of Quantity per Have you ever been advised to stop consumption of the Money Laundering Act 2002 and any other applicable statutory provisions as may be in force from time to time.
day | week | month substance by a Physician? If Yes, specify the reason. I (we) have not made any statement to the agent, medical examiner or any other person associated with ABSLI, which in any way modifies the statements and
Alcohol ml answers in this proposal or the simplified proposals for insurance and addendum, if any. I (we) are not involved in any criminal proceedings nor have any history
Alcohol ml of conviction in India or abroad.
Alcohol ml I (we) understand and agree that in case of any fraud or misrepresentation, the policy shall be treated in accordance with Section 45 of the Insurance Act, 1938
v Do you consume cigarettes/bidis/cigars or use any other tobacco/nicotine products in any form? If Yes, when was it last consumed Yes No as amended from time to time.
Last 12 months During 13 to 60 months Before 60 months I (we) understand and agree that ABSLI must be notified of any changes in my / our health and circumstances and any proposal of insurance with any other
insurer in India or abroad logged between the date of this proposal including the simplified proposals for insurance submitted along with this common proposal
Substance In the form of Quantity per day No. of years Have you ever been advised to stop consumption of the
and prior to the acceptance of the risk.
substance by a Physician? If Yes, specify the reason.
I (we) understand and agree that completion of this proposal, simplified proposal (s) submitted for insurance along with this proposal for insurance and further
addendums, if any, in no way implies that a policy / policies for insurance on the Life to be Insured will be issued by ABSLI. Further, the proposal for insurance
vi Has any of your parents, brothers or sisters been diagnosed with / suffering from / have died due to any hereditary or chronic Yes No submitted through this form and along with this proposal of insurance as simplified proposal for insurance will be underwritten and processed as separate
disorder, heart ailment, stroke, high blood pressure/Hypertension, Diabetes, mellitus/High blood sugar, cancer, kidney disease, proposals for insurance and issuance of any one of the proposal for insurance should not imply the issuance of the other proposals of insurance. Each proposal
paralysis, other disease not stated above prior to age 60? If Yes, specify details as mentioned herein shall be underwritten and reviewed for processing and issuance / rejection separately and independently.
Age (if living) State of Health If deceased, age at death Cause of Death I (we) hereby declare that the contents of this proposal and the contents of the simplified proposals for insurance submitted as a part of this common proposal
Father 60 Ok/Good form have been fully explained to me.
Mother 59 Ok/Good
I (we) hereby declare that the particulars of the bank account details are true and correct and shall be made applicable for payout(s) if any under this proposals
Brother(s)
including the simplified proposal for insurance duly signed and submitted along with this proposal for insurance. I (we) hereby understand that the payout ( if any)
Sister(s)
shall be received via NEFT mode against the details provided from my end in the proposal form.
I (we) understand and agree that this proposal form containing my personal information will be shared by ABSLI with its service providers for processing
C MEDICAL HISTORY purpose including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory
authority for the present policy only.
I) Have you remained absent from place of work on grounds of health for a continuous period of more than 10 days for reasons other Yes No
than pregnancy, minor fracture, cold or flu? I (we) hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are
true and complete in all respects to the best of my knowledge and that I/We am/are authorized to propose on behalf of these other persons.
II) In the past five years, have you ever undergone any surgical operation at a hospital or clinic or undergone any investigations with other Yes No
than normal or negative results (including X-rays, ECG, blood tests, biopsies etc.)? I (we) understand that the information provided by me/us will form the basis of the insurance policy, and is subject to the Board approved underwriting policy of
the insurance company and that the policy will come into force only after full receipt of the premium chargeable.
III) Have you ever sought advice or suffered from any of the following?
(a) Chest pain, low or high blood pressure, high cholesterol, heart attack, heart murmur or other heart disorders? Yes No
(b) Asthma, chronic cough, pneumonia, shortness of breath, tuberculosis (TB) or other respiratory or lung disorders ? Yes No
(c) Diabetes / elevated blood sugar or sugar in the urine? Yes No
(d) Ulcer, colitis, chronic diarrhoea, hepatitis or jaundice or other liver or any gastrointestinal disorders? Yes No
(e) Cancer, tumour, abnormal growth, cyst, enlarged glands or enlarged lymph nodes? Yes No
(f) Dizziness / fainting spells, epilepsy, paralysis, stroke, mental/ psychiatric disorder or any other neurological disorder? Yes No
(g) Kidney, urinary, bladder, reproductive organ, prostate or any genitourinary disorders? Yes No
(h) Arthritis, gout or joint pain, muscle disorder, bone fracture or any other musculoskeletal disorders? Yes No
(i) Disorder of eyes (such as cataract, glaucoma etc.) or throat or ears? Yes No
(j) Any other illness, surgery, ailment or injury which is specifically not mentioned above? Yes No
If any of question is answered as Yes, please submit the appropriate questionnaire.

IV) Do you have any congenital anomaly/disorder, physical defects, impairment, deformities and / or any condition affecting mobility, sight Yes No
and / or hearing?
V) Have you or your spouse received any medical advice, testing or treatment for any sexually transmitted disease or Hepatitis B or C? Yes No
VI) Do you have any health symptoms or complaints for which a physician has not been consulted or treatment received? (persistent fever, Yes No
unexplained weight loss, loss of appetite, pain, swelling etc.)
VII) For female lives only:
1) Are you pregnant? If Yes, number of weeks Yes No

2) Have you suffered from or do you have any gynaecological problems or illness related to uterus / ovaries or breasts? Yes No
Question Exact Diagnosis and Details of treating Doctor / Surgeon Date of Diagnosis Date of last Consultation
No. details of current symptoms (Name, Qualification, Contact No.) and Details and date of hospitalization and surgery done
List of medication being consumed currently
14 DECLARATION BY THE LIFE to be INSURED (and PROPOSER if not the Life to be Insured)
These declarations would apply to the proposal for insurance and the details as contained in the proposal for insurance duly filled and signed
by the Life to be insured and proposer if not the life to be insured, through this common proposal form and aforementioned supplemetary
proposal form (s).
I (we) authorize any medical practitioner, hospital, employer, institution or any other person, to disclose to Aditya Birla Sun Life Insurance Company Limited
("ABSLI") any information relating to my health or employment now or at any time in the future.
I (we) understand and agree that no agent or medical examiner has the authority to waive or vary any stipulations or requirements set by ABSLI. I (we)
understand and agree that the statements and answers given by me (us) during the medical examination (if any) to the medical examiner acting on behalf of
ABSLI and any other documents, medical reports and financial reports required in this proposal and simplified proposal (s) for insurance and addendum, if any,
shall be deemed to be incorporated in this proposal.
I (we) agree and consent to ABSLI for seeking medical information from any doctor or from a hospital who at anytime has attended on the life to be
insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to be assured/proposer and
seeking information from any insurance company to which an proposal for insurance on the life to be assured/proposer has been made and any other authorities
as may be required for the purpose of underwriting the proposal and/or claim settlement.
05 06
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Aditya Birla Sun Life Insurance Version 1
PROPOSAL NO: EA04976548 Form ID: 111001 ABSLI Nishchit Aayush Plan UID : 932022123G2G02
A non-linked non-participating individual savings life insurance plan Aug 22, 2023 17:30:29
15 SECTION 41 AND 45 OF THE INSURANCE ACT, 1938
Section 41 of Insurance Act, 1938, as amended from time to time:No person shall allow or offer to allow either directly or indirectly, as an inducement to Your Benefit Illustration
any person to take out or renew or continue an insurance in respect of any kind of risk relating to Iives or property in India, any rebate of the whole or part of
the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any
rebate, except such rebates as may be allowed in accordance with the published prospectus or tables of the Insurer. Any person making default in complying
LIFE INSURANCE
with the provisions of this section shall be punishable with a fine which may extend to ten lakh rupees.
Extract of Section 45 of the Insurance Act, 1938, as amended from time to time: No policy of Life Insurance shall be called into question on any ground
This shall form a part of the policy contract
whatsoever after the expiry of three years from the date of policy. A policy of life insurance may be called into question at any time within three years from the
date of policy, on the ground of fraud or on the ground that any statement of or suppression of a fact material to the expectancy of the life of the insured was
Proposal No: EA04976548
incorrectly made in the proposal or other document on the basis of which the policy was issued or revived or rider issued. The insurer shall have to
communicate in writing to the Insured or legal representative or nominees or assignee of the insured, the grounds and materials on which such decision is Proposer Mrs. GAGANDEEP KAUR Age : 32 years Gender : Female
based. no insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the misstatement or suppression of material fact
Life Insured Mrs. GAGANDEEP KAUR Age : 32 years Gender : Female
was true to the best of his knowledge and belief or that there was no deliberate Intention to suppress the fact or that such misstatement or suppression are
within the knowledge of the insurer. In case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive. In case of
repudiation of the policy on the ground of misstatement or suppression of a material fact and not on the grounds of fraud, the premiums colected on the policy This benefit illustration is intended to show year wise premiums payable and benefits under the policy:
till the date of repudiation shall be paid. Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no
policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life Insured was
incorrectly stated in the proposal. For complete details of the section and the definition of date of policy, please refer Section 45 of the Insurance Act, 1938, as Policy Details
amended from time to time.
UIN : 109N137V04
Annualized Premium : Rs. 200,000 Premium Paying Term : 10 years
Dated 22-08-2023 Place new delhi IA / Broker / SP of CA Code: X30391 Policy Term : 40 years
Deferment Period : 1 year
Premium Payment Frequency : Annual
Amount Allocated for Savings : Rs. 182600
Mr. GAURAV SHARMA
Signature or Thumb Impression of the LIFE to be INSURED Name of IA / Broker / SP of CA Code Policy Details
Benefit Option : Long Term Income Sum Assured : Rs. 2,000,000
Income Variant : Level Income with Enhanced Sum Assured on Death (at inception : Rs. 2,000,000
Lumpsum Benefit of policy)
Signature or Thumb Impression of the PROPOSER (if not Life to be Signature of IA / Broker / SP of CA Code
Benefit Payout Frequency : Annual Income Benefit Factor : 40.6%
Insured)
VERNACULAR DECLARATION
Rider Details
I, (full name of declarant) hereby declare that I have explained the contents of the proposal form to the Life to be
Rider Name Sum Assured Rider Term Annualized Premium
Insured / Proposer in language and that I have read out to the answers to the questions ABSLI Accidental Death Benefit Rider Plus -- -- --
dictated by me to the Life Insured/Proposer and that the Life to be Insured/Proposer has/have put his/her thumb impresssion after fully understanding the ABSLI Critical Illness Rider -- -- --
contents thereof.
ABSLI Surgical Care Rider -- -- --
ABSLI Hospital Care Rider -- -- --
Name & Signature of Declarant ABSLI Waiver of Premium Rider -- -- --
I, Gagandeep Kaur (Proposer) confirm that I have been explained the contents of the proposal form in my language and the information
recorded are as provided by me.

Premium Summary (in Rs.) Base Plan Riders Total
Annualized Premium 200,000 0 200,000
Installment Premium before Modal Loading (A) 200,000 0 200,000
Signature/Thumb Impression of the PROPOSER/LIFE to be INSURED signing in vernacular language Modal Loading Factor (B) 0% 0% 0%
Installment Premium without GST after Modal Loading 200,000 0 200,000
{(A*B) + A}
First year's GST 3,132 0 3,132
Installment Premium with First Year GST 203,132 0 203,132
Installment Premium with GST 2nd Year onwards 203,132 0 203,132
07
Prepared for: Mrs. GAGANDEEP KAUR ABSLI Nishchit Aayush Plan Page 1
Page 35
Aditya Birla Sun Life Insurance Version 1 Aditya Birla Sun Life Insurance Version 1
ABSLI Nishchit Aayush Plan UID : 932022123G2G02 ABSLI Nishchit Aayush Plan UID : 932022123G2G02
A non-linked non-participating individual savings life insurance plan Aug 22, 2023 17:30:29 A non-linked non-participating individual savings life insurance plan Aug 22, 2023 17:30:29
Your Benefit Illustration Your Benefit Illustration
LIFE INSURANCE LIFE INSURANCE

Aditya Birla Sun Life Insurance Company Limited Aditya Birla Sun Life Insurance Company Limited
- Surrender Benefit
(Amount in rupees)
The Sum Assured on Death is the highest of:
Guaranteed Non
Guaranteed • Sum Assured
Policy • 105% of the Total Premiums Paid up to the date of death
Year Annualized Cumulative Survival Maturity Total Benefits Death Minimum Guaranteed Special
Premium(1) Annualized
Premium Benefit (A) Benefit (B) (A) + (B) Benefit(2) Surrender Value* Surrender
Value
Where,
• "Total Premiums Paid" means total of all the premiums received, excluding underwriting extra premium, loadings for modal premium, any rider premium, first
BOY EOY* EOY EOY* EOY EOY EOY year discounts and applicable taxes, cesses and levies, if any.
1 200,000 200,000 0 0 0 2,000,000 0 0 • Sum Assured is the absolute amount equal to 10 times the Annualized Premium.
2 200,000 400,000 81,200 0 81,200 2,000,000 120,000 120,000 *Income Benefit/s paid till date are deducted from the Surrender Values indicated above.
3 200,000 600,000 81,200 0 81,200 2,000,000 128,800 128,800
-
4 200,000 800,000 81,200 0 81,200 2,000,000 237,600 237,600
Please refer the Product Brochure for more details on the terms used in this illustration.
5 200,000 1,000,000 81,200 0 81,200 2,000,000 256,400 98,464
The rider benefit(s), if any, shall not be payable if the policy is in reduced paid-up mode.
6 200,000 1,200,000 81,200 0 81,200 2,000,000 275,200 116,208
7 200,000 1,400,000 81,200 0 81,200 2,000,000 294,000 166,628
8 200,000 1,600,000 81,200 0 81,200 2,000,000 328,800 187,184
9 200,000 1,800,000 81,200 0 81,200 2,000,000 367,600 248,314 I,................................................................, have explained the premiums, I,................................................................, having received the information
10 200,000 2,000,000 81,200 0 81,200 2,100,000 430,400 391,032 and benefits under the policy fully to the prospect/policyholder.. with respect to the above, have understood the above statement before
entering into the contract.
11 0 0 81,200 0 81,200 2,100,000 369,200 450,520
12 0 0 81,200 0 81,200 2,100,000 308,000 508,384 Place :
13 0 0 81,200 0 81,200 2,100,000 246,800 501,888
14 0 0 81,200 0 81,200 2,100,000 185,600 557,316 Date :22/8/2023 Date :22/8/2023
15 0 0 81,200 0 81,200 2,100,000 144,400 611,120
16 0 0 81,200 0 81,200 2,100,000 83,200 663,300
17 0 0 81,200 0 81,200 2,100,000 22,000 713,856
____________________________________ ____________________________________
18 0 0 81,200 0 81,200 2,100,000 0 762,788
19 0 0 81,200 0 81,200 2,100,000 0 867,960 Signature of Agent/Intermediary/ Official Signature of Prospect/Policyholder
20 0 0 81,200 0 81,200 2,100,000 0 912,832
21 0 0 81,200 0 81,200 2,100,000 0 956,080 V04 - 22/8/2023
22 0 0 81,200 0 81,200 2,100,000 0 1,053,132
23 0 0 81,200 0 81,200 2,100,000 0 1,146,936 For further details please refer to the product brochure.
24 0 0 81,200 0 81,200 2,100,000 0 1,237,492
25 0 0 81,200 0 81,200 2,100,000 0 1,324,800 Aditya Birla Sun Life Insurance Company Limited Reg. No. 109
26 0 0 81,200 0 81,200 2,100,000 0 1,461,040
27 0 0 81,200 0 81,200 2,100,000 0 1,541,040
28 0 0 81,200 0 81,200 2,100,000 0 1,668,348
29 0 0 81,200 0 81,200 2,100,000 0 1,790,784
30 0 0 81,200 0 81,200 2,100,000 0 1,957,280
31 0 0 81,200 0 81,200 2,117,280 0 2,117,280
32 0 0 81,200 0 81,200 2,270,784 0 2,270,784
33 0 0 81,200 0 81,200 2,417,792 0 2,417,792
34 0 0 81,200 0 81,200 2,603,988 0 2,603,988
35 0 0 81,200 0 81,200 2,826,936 0 2,826,936
36 0 0 81,200 0 81,200 3,040,140 0 3,040,140
37 0 0 81,200 0 81,200 3,243,600 0 3,243,600
38 0 0 81,200 0 81,200 3,522,188 0 3,522,188
39 0 0 81,200 0 81,200 3,787,784 0 3,787,784
40 0 0 81,200 4,000,000 4,081,200 4,040,388 0 0
"BOY" = refers to cash flows payable at the "Beginning of the Year", "EOY" = refers to cash flows payable at the "End of the Year", "EOY*" = refers to
cashflows payable in arrears as per the Benefit Payout Frequency chosen
Notes:
(1) Annualized Premium means Premium amount payable during a Policy Year, excluding underwriting extra premiums, loadings for modal premiums, rider
premiums, first year discounts and applicable taxes, cesses and levies, if any.
(2) In the event of death of the Life Insured during the Policy Term, the benefit shall be, Higher of :
- Sum Assured on Death
Prepared for: Mrs. GAGANDEEP KAUR ABSLI Nishchit Aayush Plan Page 2 Prepared for: Mrs. GAGANDEEP KAUR ABSLI Nishchit Aayush Plan Page 3
Page 36
Application No.: E A 0 4 9 7 6 5 4 8
• Initial Insurance premium should only be accepted for blood relations after ascertaining the Insurable Interest. The allowable relationships
should be as under:
Self Proposer Third Party: Spouse Parent Children Sibling Grandparent Company/Partnership HUF-Karta Sole Proprietorship
• Mode of Payment: HDFC Bank Cheque HDFC Bank DD Net Banking Debit Card Online/Offline Credit Card Direct Debt
• In case of Third Party Payor, enclosing Third Party Declaration & KYC
I / We confirm that the product has been clearly explained to me/us by Bank employee with following details:
Bank Employee Name: Amit Sehgal Employee Code: A2273

Application No.: E A 0 4 9 7 6 5 4 8 (Electronic proposal form ID number)
Specified Person Code of Bank Employee: D8482
Cusomer Signature
Type of Insurance Plan (tick correct option): Protection Investment Pension Savings Health Cover
Name of Insurance Plan: ABSLI Nishchit Aayush Plan
The premium payable is 2 0 3 1 3 2 on a Annual frequency for a premium paying term of 1 0 years & the Sum
Assured is 2 0 0 0 0 0 0 (1 S-Single Premium, M-Monthly, Q-Quarterly, HY-Half Yearly, Y-Yearly)
• Have you filled the electronic proposal form / has a third party or sales official assisted you in the proposal form vide above application number? (tick if yes)
• Do you agree to the Illustration / suitability questionnaire signed by you / received by you on your email ID with above application number? (tick if yes)
• Do you agree to all the Terms and Conditions mentioned in the electronic proposal form vide above application number? (tick if yes)
• Have you understood these Policy details: (tick if yes)
Death Benefit Maturity Benefit Loan Details

Not applicable for Term Policies ^Not applicable for ULIP Policies *Not applicable for limited & regular Term Policies
• Have you understood the Policy provisions with regard to Pre-Closure/Surrender?* (tick if yes)
• This application is for a fresh insurance Policy and is neither linked with an existing Policy nor with any other financial products like credit card, loan, etc. (tick if yes)
For Unit Linked Policy (ULIP), have you understood: Deductible Charges (tick if yes) Partial Withdrawal Facility (tick if yes)
I / We have been explained the features of this plan and understand that this is not a Fixed Deposit or Recurring Deposit but an Insurance Plan. I / We understand that the
returns in Unit Linked Products may not be guaranteed and are subject to investment risks associated with capital markets, associated risk are borne by the Policy Holder
Are you a tax resident of India only as per the Indian Income-tax law? Yes No (If No, please submit relevant documents)
I / We would like to receive a Dematerialized Policy Yes No (If Yes, please submit relevant documents)
Pg. 1/3
FOR/1/17-18/1440
Name: Gagandeep Kaur Name: Gagandeep Kaur
Date: 22-Aug-2023 Place: Delhi Date: 22-Aug-2023 Place: Delhi
*If the nominee / Beneficiary is a minor, a person should be appointed to receive the amount secured by the Policy in the event of death of the Life to be Assured during the period when the nominee
is a minor. (Please attach appointee declaration for Employer-Employee case)
Page 37
Renewal Insurance premium should only be accepted for blood relations after ascertaining the Insurable Interest. The allowable relationships should be as under:
Self Proposer Third Party: Spouse Parent Children Sibling Grandparent
1. I/ We hereby declare that the particulars given in the proposal form and above are correct and complete. 2. I/We hereby declare that in case of a third party account holder
a KYC form of the third party account holder shall be submitted. 3. I/ We undertake to keep suficient funds in the account mentioned in the mandate as on the date of
execution of debit. 4. I/ We hereby authorise the Bank / Tech Process Solutions Ltd / Bill desk / any other intermediaries to communicate my / our funding account number
and any other account details (as may be necessary) to Aditya Birla Sun Life Insurance Company Limited (ABSLI) for the specific purpose of recovering my/ our Aditya Birla
Sun Life Insurance Company Limited (ABSLI) premium payments through a debit instruction to my/ our account. 5. I/ We hereby authorise Aditya Birla Sun Life Insurance
Company Limited (ABSLI), in the instance of the ECS/SI/DD/NACH failing for any reason, to authorise the Bank/ Tech Process Solutions Ltd /Bill desk to recover the
premium payable through a direct debit to my/our account with the mentioned bank. 6. If the transaction is delayed or not effected at all for reasons of incomplete or
incorrect information, I will not hold Aditya Birla Sun Life Insurance Company Limited (ABSLI), the Bank or the other Intermediaries responsible. 7. I/ We agree that for
changing the premium amount as per my requirement, I/ We will furnish a fresh mandate for such change in the premium amount, which will supersede all other mandates
previously given. 8. I/ We agree that in the event of any violation by me/ us of any undertaking confirmed in the agreement herein, shall amount to an event of default in
the terms of the Insurance Policy and Aditya Birla Sun Life Insurance Company Limited (ABSLI) shall be entitled to invoke the remedies available to it in terms of the Policy
agreement. 9. I/ We agree that in the event of the Bank being unable to debit my account for want of suficient funds or for any other reason, Aditya Birla Sun Life Insurance
Company Limited (ABSLI) shall be entitled to deal with my Policy in the manner as described in the Policy provisions, unless the payment is received by any alternate mode
on or before the specified date. 10. I/ We hereby authorise my/ our Bank to debit my/ our account with the amount of GST and other levies as maybe stipulated by the
Government, from time to time, on the premium stated above and for this purpose, no further or revised authority is required by my/ our Bank. 11. I/We hereby authorise
that in the instance of a transaction failure towards an NACH request, Aditya Birla Sun Life Insurance Company Limited (ABSLI) can represent twice the transaction to my
/our account for realising this premium. 12. I/ We wish to avail the ECS/SI/DD/NACH facility and hereby express my unconditional consent to debit premium of my Policy
to above through participation in National Automated Clearing House (NACH)/ Direct Debit. I/ We understand and agree that premium amount to be debited from my account
may vary due to taxes and other statutory leaves as may be applicable from time to time. 13. I/ We understand and accept that the transaction will be effected on the Policy
on the due date (provided the day is a working day). I/ We agree to discharge the responsibility expected of me/ us as participants under the scheme. I take full responsibility
Pg. 3/3
of correctness of the details filled herein. 14. I/ We authorise the above mentioned bank to debit my bank account if my/our NACH mandate is active and until I give a written
request for cancellation of ECS/SI/DD/NACH. 15. In the future, if I/We opted out of NACH/Direct Debit mode there may be an increase in premium amount. 16. I/ We
understand and agree that the submission of this form does not mean that the request will be processed. I/ We understand that any payout under the Policy shall be strictly
in accordance with the Policy terms and conditions. Also, any payment shall be subject to realisation of the last renewal premium payment. 17. I/ We also understand and
FOR/1/17-18/1440
agree that the Company reserves the right to use any payout option. 18. For SI with Aditya Birla Sun Life Insurance Company Limited (ABSLI) premium will be debited from
your account on the debit date. However, if the 1st attempt is unsuccessful, 3 more attempts will be made within grace period. 19. I/ We authorise the above mentioned
bank to debit the amount from my bank account if my ECS/SI/DD/NACH is active, until I give a written request for cancellation of the Mandate. I hereby provide my consent
to receive call from Aditya Birla Sun Life Insurance Company Limited (ABSLI) or its authorized Service Providers in connection with any matter related to my above.For SI with HDFC Bank,premium will
be debited from your account on debit date. However, in case of failure, we will debit your account anytime again upto 180 days from date of debit.I authorise the Company to deduct all
the outstanding premium along with interest (in case of non Unit Linked Products) for the purpose of revival.I am aware that in case of Conventional products,company may deduct the Mortality
and the other charges for the period while the policy was in lapsed stage.I understand that the Company reserves the right to refuse revival of the policy subject to terms and conditions.
1. Any cancellation, correction, alteration etc. should be countersigned by the Account Holder. 2. For SI cases (Aditya Birla Sun Life Insurance Company Limited (ABSLI)), the
NAV allotted will be the date on which the bank gives a confirmation of the debit. 3. For NACH, NAV would be allocated on the basis of the debit date. 4. For Direct Debit
NAV will be provided for the day when the payment is received in the Aditya Birla Sun Life Insurance Company Limited (ABSLI) account. 5. Request for de-activation of Auto
debit facility has to be submitted at least 15 days prior to the next premium due date. 6. The premium will be debited starting from the premium due date which occurs
after the date of this mandate. Till the last premium due date unless the mandate is revoked. 7. In case of any increase or decrease in premium amount due to changes in
payment frequency or any Policy related changes including reduction in premium*, the existing debit instruction will be de-activated. Hence, a fresh Auto Debit Mandate is
required to be submitted at any Aditya Birla Sun Life Insurance Company Limited (ABSLI) branch at least 30 days prior to the next premium due date. 8. If the money is
received on the draw date which is prior to the due date, NAV will be applied on the due date. If money is received post due date, NAV will be applied on the date of receipt
of money.In case of Non Payment, Grace period will start from following day from premium due date only and not from Preferred billing date.
*Reduction in premium is a product-specific alteration.
Page 38
GRIEVANCE REDRESSAL PROCEDURE
At Aditya Birla Sun Life Insurance, it is our constant endeavour to ensure that your queries and concerns are resolved on priority.
In case you have any concern or complaint, please feel free to get in touch with us on the
contact points mentioned below:
 Call our toll free customer care number 1-800-270-7000 between 9 am to 9 pm, Monday
to Saturday
Step 1
or
 Please write to us at the address mentioned below
or
 Please email us at care.lifeinsurance@adityabirlacapital.com
or
 Visit our website www.adityabirlasunlifeinsurance.com and register your complaint
We will respond to you within 15 days from the date of receipt of your communication.
If our response is not as per your expectations please feel free to write to our Grievance
Redressal Officer (GRO) by visiting our website www.adityabirlasunlifeinsurance.com and
Step 2
the tab ‘register your complaint’
If our response is not as per your expectations please feel free to write to our Chief
Grievance Redressal Officer(CGRO) by visiting our website
Step 3 www.adityabirlasunlifeinsurance.com and the tab ‘register your complaint’
GRO contact number 022-39961116 GRO email id - gro.lifeinsurance@adityabirlacapital.com
For any correspondence addressed to Aditya Birla Sun Life Insurance, please write to us at:
Insurance Ombudsman
In case you are dissatisfied with the decision/resolution of the company, you may approach the Insurance Ombudsman located nearest to you
(please refer to the contact details mentioned at the end of this Policy Document or visit our website www.adityabirlasunlifeinsurance.com) if your
grievance pertains to;
 Insurance claim that has been rejected or dispute of a claim on legal construction of the policy;
 Delay in claim settlement;
 Dispute with regard to premium; or
 Non-receipt of your policy document.
As per provision 14(3) of the Redressal of Public Grievances Rules 2017, the complaint to the Ombudsman can be made:
 Only if the grievance has been rejected by the grievance redressal machinery of the insurer;
 Within a period of one year from the date of rejection by the insurer; and
 If it is not simultaneously under any litigation.
Page 39

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Welcome to the world of Aditya Birla Capital!

Premium Payment Term : 10 Years Premium Payment Frequency : Annual(1)

Instalment premium : ` 203,132.00 Policy Term : 40 Years

Meeting your life’s money needs

The ease of ONE WINDOW

Looking forward to a long and successful journey ahead!

Chief Operations Oﬃcer

1 ABSLI Guaranteed Milestone 2019 008427025

Name of Policyholder : Mrs. Gagandeep Kaur

Address of Policyholder : C-582 Majlis Park

Policy No. : 009186750 GSTIN : 07AABCB4623J1ZU

Policy Identiﬁcation Type : General State Code : 07

Date of Policy Issue : 30/09/2023 Receipt No. : 147217504

01 ABSLI Nishchit Aayush Plan 30/09/2023 203,132.00

Description Amount (`)

First Premium 200,000.00

Goods and Services Tax (GST) 3,132.00

Instalment Premium (Total) 203,132.00

Chief Operations Officer

Stamp Duty Details

Aditya Birla Sun Life Insurance Company Limited

 “Major” is a person who is aged 18 years and above.

 “Minor” is a person who has not completed 18 years of age.

Aditya Birla Sun Life Insurance Company Limited

 “Special Surrender Value” means the value as specified in Section 4 of Part D.

 "Surrender" means complete withdrawal or termination of the entire Policy.

 “Sum Assured” is the amount as specified in the Policy Schedule.

Aditya Birla Sun Life Insurance Company Limited

Aditya Birla Sun Life Insurance Company Limited

PART C – POLICY FEATURES, BENEFITS AND PREMIUM PAYMENT

The Sum Assured on Death is the highest of,

Where Sum Assured is as specified in the Policy Schedule.

Staggered Death Benefit Option

Instalments Frequency Annual Monthly

Aditya Birla Sun Life Insurance Company Limited

6. Risk coverage for minor and vesting on attaining majority

Aditya Birla Sun Life Insurance Company Limited

PART D – POLICY TERMS AND CONDITIONS

3. Reduced Paid-Up (RPU) Benefits

where the RPU Factor is the ratio of:

Death Benefit for RPU Policies

Whole Life Income:

where, RPU Sum Assured on Death is the highest of:

Aditya Birla Sun Life Insurance Company Limited

Survival/ Maturity Benefit for RPU Policies

The Guaranteed Surrender Value (GSV) is defined as:

GSV Factors are provided in Annexure 1.

Aditya Birla Sun Life Insurance Company Limited

Aditya Birla Sun Life Insurance Company Limited

PART E – POLICY CHARGES

Aditya Birla Sun Life Insurance Company Limited

PART F – GENERAL TERMS AND CONDITIONS

Aditya Birla Sun Life Insurance Company Limited

3) Original Policy Document

Aditya Birla Sun Life Insurance Company Limited

6. Travel and Occupation

10. Electronic Transactions

11. Communication and Notices

12. Governing Law and Jurisdiction

13. Loss of Policy Document

Aditya Birla Sun Life Insurance Company Limited