COI No: 80180583 Ageas Federal Life Insurance Group Credit Shield Plan II - v1.0 - 02022023 Page 1 of 22

COI No: 80180583 Ageas Federal Life Insurance Group Credit Shield Plan II_v1.
0_02022023 Page 1 of 22
Ageas Federal Life Insurance Group Credit Shield Plan II
A Single premium, Non-linked, Non-participating, Group Pure Risk Premium, Life Insurance Plan
UIN: 135N087V01
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COI No: 80180583 Ageas Federal Life Insurance Group Credit Shield Plan II_v1.0_02022023
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UIN: 135N087V01
PART A
WELCOME LETTER
09-11-2023
Mrs. SUGITHA Y
NO 4 581 PRAKASH NAGAR
TRY-620013
TAMIL NADU
Tel No: 918903329219
COI No: 80180583
Dear Mrs. SUGITHA Y,
Thank you for choosing Ageas Federal as your life insurance partner. On behalf of Ageas Federal, please allow us to extend a
warm welcome to you.
All the relevant details of your insurance cover are mentioned in certificate of insurance (COI) attached with this letter.
Please read the contents of this COI carefully to ensure that the benefits, terms and conditions and premium details for the
insurance cover provided to you are accurate. We would also recommend that you ensure the safe storage of your COI. You have opted
for a cover term of 48 months. The insurance cover is available for the entire cover term.
This cover has been issued on the basis of the medical statement and other details confirmed by you in the member enrolment
form/Declaration of good health and the reports of your medical tests undertaken for the cover, as applicable.
You are entitled to a free look period of 15 days from the date of receipt of the certificate of insurance to review the terms and
conditions of the certificate of insurance. In case you do not agree with any of the terms and conditions in the certificate of insurance,
you have the option to return the same to us for cancellation by communicating the same in writing stating the reasons for objections.
We will refund the premium amount after deducting the proportionate risk premium for the cover provided during that time plus any
medical examination cost and stamp duty charges incurred by us in respect of the same. All the benefits under the policy will stand
extinguished immediately on the cancellation of the Policy under the free look.
We have the following as your contact details.

Mobile no. 918903329219, Email ID: sugitha315@gmail.com
If you need any assistance for policy servicing and claim related queries, please feel free to contact us on below mentioned contact
details.
Call us on our toll free number 1800 209 0502 (From Monday to Saturday, 8 am to 8 pm) / Write to us at support@ageasfederal.com
/ - Visit your nearest Ageas Federal branch (For a list of branches, please visit our website www.ageasfederal.com) / - Visit your bank
branch or contact your advisor.
Thank you again for joining the Ageas Federal family. We look forward to a long and fruitful association with you.
Yours Sincerely,
Authorised signatory
AGEAS FEDERAL LIFE INSURANCE COMPANY LIMITED

IRDAI Regn. No. 135, Corporate Identity Number (CIN) – U66010MH2007PLC167164
Registered Office: 22nd Floor, A Wing, Marathon Futurex, N M Joshi Marg, Lower Parel - East, Mumbai 400013, MaharashtraContact
No: Toll free No - 1800 209 0502
Email ID: support@ageasfederal.com
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COI No: 80180583 Ageas Federal Life Insurance Group Credit Shield Plan II_v1.0_02022023
Page 3 of 22
UIN: 135N087V01
PREMIUM RECEIPT
Name of the insured member Client ID
SUGITHA Y 1272297433
Certificate number
80180583
Premium Payment Details

Plan name (A Single Premium, Non-Linked, Non-participating, Group
Pure Risk Premium, Life Insurance Plan)
Name of Master policy holder THE FEDERAL BANK LTD
Insured member Mrs. SUGITHA Y
Date of birth of the insured person 30-05-1979
Joint insured member( if applicable) Not applicable
Death Sum assured Rs. 426000.00
Cover term 48 months
Premium payment term Single
Premium paid (excluding goods and services tax and applicable Rs. 3101.32
cess) (a)
Goods and Services Tax and applicable cess (b) Rs. 558.24
Total Premium paid (a+b) Rs. 3659.56
1. The insurance cover under the policy is subject to realisation of premium payment cheque.
2. If the cheque bounces due to any reason:
a) Premium payment receipt shall be void; b) this policy will be cancelled without any intimation.
You may be eligible for tax benefits for the premiums paid under the Income Tax Act, 1961. The death benefit amount received
by you/ your beneficiary in event of death within the policy term, may be exempted from Income Tax Act (as per the prevailing
tax laws). Please note that the tax benefits are subject to change in the tax laws from time to time. We urge you to consult your
tax advisor for more details.
This is a computer-generated receipt and does not require a signature.

The Goods and Services Tax is subject to change as per applicable laws.
Stamp Duty of Rs. 1.00/- is paid as provided under Article 53 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 this Order No. (LOA NO/CSD/484/Validity Period Dt. 15/10/2022 To Dt. 31/12/2025
(O/w.No.4367) Date: 10/10/2022.
Call our Toll Free Number
1800-209-0502 (From Monday to Saturday, 8 am to 8 pm)
Visit us at www.ageasfederal.com
AGEAS FEDERAL LIFE INSURANCE COMPANY LIMITED

IRDAI Regn. No. 135, Corporate Identity Number (CIN) – U66010MH2007PLC167164
Registered Office:22nd Floor, A Wing, Marathon Futurex, N. M. Joshi Marg, Lower Parel – East, Mumbai – Maharashtra 400013
Contact No: Toll free No - 1800 209 0502 (From Monday to Saturday, 8 am to 8 pm)
COI No: 80180583 Ageas Federal Life Insurance Group Credit Shield Plan II_v1.0_02022023 Page 4 of 22
Page 4 of 21
UIN: 135N087V01
CERTIFICATE OF INSURANCE (COI)

A Single premium, Non-Linked, Non-Participating, Group Pure Risk Premium, Life Insurance Plan
IRDAI product unique identification number 135N087V01
Personal details of SUGITHA Y

Client ID 1272297433 Channel BANCASSURANCE
Name Mrs. SUGITHA Y Date of birth 30-05-1979
Gender Female
Age at cover start date: 44 Age verified Yes
In case of Joint Life cover
Client ID Not applicable
Name: Not applicable Date of birth Not applicable
Gender Not applicable
Age at cover start date: Not applicable Age verified Not applicable
Address of insured member
NO 4 581 PRAKASH NAGAR, TRY, TAMIL NADU - 620013
Cover details
THE FEDERAL BANK LTD Cover option: Reducing death benefit
Master policyholder: option
Cover benefit : Single life cover
Master policy number: 2000000276
Share of cover (in case of Details of Other Co-borrowers Not applicable
Not applicable
proportionate cover) (in case o proportionate cover)
Certificate no.: Cover commencement date: 09-11-2023
80180583
Cover term: 48 months Cover expiry date: 08-11-2027
Moratorium period(if 0 Total Cover Term 48 months

applicable) (including moratorium period)
Interest accrual during Moratorium Period No
Premium details
Premium mode Single
Premium Rs. 3101.32
Goods and Services Tax and cess as applicable Rs. 558.24
Premium Paid ( including Goods and Services tax and cess as applicable Rs. 3659.56
Benefit details
Death sum assured: Rs. 426000.00
Benefit schedule interest rate: 14.14% p.a.
Nominee details (including under Section 39 of the Insurance Act, 1938)

Name Gender Date of birth Age Relationship to Percentage
insured person Share
JEPARAJ S JEPARAJ S Male 06-03-1975 48 Spouse 100%
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UIN: 135N087V01
Appointee Details (Applicable when Nominee is Minor)

Name Gender Date of birth Relationship to Nominee
Not applicable Not applicable Not applicable Not applicable
Associated loan details

Loan ref. no.: LN515437859574309 Loan term: 48 months
Loan Interest rate 14.14% p.a.
Special provisions
Premium loading: Not applicable
Additional exclusions: Not applicable
Endorsement: Not applicable
Date of issue: 09-11-2023 Place: Mumbai
1. The insurance cover under the policy is subject to realisation of premium payment cheque.
2. If the cheque bounces due to any reason:
a) Premium payment receipt shall be void; b) this policy will be cancelled without any intimation.
Important information
This certificate of insurance describes the premiums, benefits and conditions which apply to your cover under the Ageas Federal Life
Insurance Group Credit Shield Plan II master policy issued to THE FEDERAL BANK LTD
Your plan is governed only by the full legal terms, conditions and exclusions contained in the master policy and in case of any
discrepancy between this certificate of insurance and the master policy; the provisions of the master policy shall apply.
You can obtain a copy of the master policy from the master policyholder.
How to contact us
Please contact the master policyholder or Ageas Federal Life Insurance Company Limited:
• To pay your premium
• To make a claim
• To ask any questions or for any other matter
The master policyholder The insurer – Ageas Federal

THE FEDERAL BANK LTD. Ageas Federal Life Insurance Company Limited
Retail Liabilities, 22 Floor, A Wing, Marathon Futurex
Federal Tower,7th floor, N. M. Joshi Marg, Lower Parel – East, Mumbai – 400013
Marine Drive, Ernakulam- 682031
Kerala.
Authorised signatory
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UIN: 135N087V01
Benefit Schedule
This benefit schedule has been generated with a rate of interest of 14.14 % per annum, calculated on a monthly reducing death
benefit.
Benefit Schedule
Cover month Death Benefit
1 Rs. 426000.00
2 Rs. 419229.00
3 Rs. 412384.00
4 Rs. 405462.00
5 Rs. 398464.00
6 Rs. 391388.00
7 Rs. 384233.00
8 Rs. 377000.00
9 Rs. 369686.00
10 Rs. 362291.00
11 Rs. 354814.00
12 Rs. 347255.00
13 Rs. 339611.00
14 Rs. 331883.00
15 Rs. 324069.00
16 Rs. 316169.00
17 Rs. 308181.00
18 Rs. 300105.00
19 Rs. 291939.00
20 Rs. 283682.00
21 Rs. 275334.00
22 Rs. 266894.00
23 Rs. 258360.00
24 Rs. 249732.00
25 Rs. 241007.00
26 Rs. 232186.00
27 Rs. 223268.00
28 Rs. 214250.00
29 Rs. 205133.00
30 Rs. 195915.00
31 Rs. 186594.00
32 Rs. 177170.00
33 Rs. 167642.00
34 Rs. 158008.00
35 Rs. 148267.00
36 Rs. 138418.00
37 Rs. 128461.00
38 Rs. 118393.00
39 Rs. 108213.00
40 Rs. 97920.00
41 Rs. 87514.00
42 Rs. 76992.00
43 Rs. 66353.00
44 Rs. 55597.00
45 Rs. 44721.00
46 Rs. 33725.00
47 Rs. 22607.00
48 Rs. 11366.00
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UIN: 135N087V01
TERMS AND CONDITIONS
1. Definitions:
1. Assignee is the person to whom the rights and benefits are transferred by virtue of an Assignment under Section 38 of
the Insurance Act, 1938, as amended from time to time.
2. Assignment under the policy will be governed by Section 38 of the Insurance Act, 1938 as amended from time to time.
Please refer Annexure A of the Policy Document for further details.
3. Beneficiary means the person who is entitled to receive benefits under this Policy. The Beneficiary may be Insured
member or Policyholder or Nominees or proved Executors or Administrators or other Legal Representatives as the case
may be.
4. Benefit schedule means the table showing the death benefit during each cover month as shown in the certificate of
insurance.
5. Borrower means a loan customer of the master policyholder who has availed loan from the master policyholder.
6. Certificate of insurance means the document certifying the coverage of the insured member under the terms,
conditions and parameters as mentioned therein.
7. Co-insured member(s) means member(s) who have taken a loan collectively and hence fall under the same loan account
number and who are provided a proportionate cover as per their individual share of the loan covered.
8. Cover means the insurance cover provided to the insured members under a master policy.
9. Cover commencement date means the date of commencement of cover/date of inception of cover/ date of acceptance
of risk for the insured member as shown in the certificate of insurance.
10. Cover expiry date means the date on which the insurance cover expires for each insured member as shown in the
certificate of insurance.
11. Cover month is the period of one month following the date of commencement of cover and every subsequent month.
12. Cover term means the duration of cover for each insured member as shown in the certificate of insurance.
13. Death Sum Assured means the face amount chosen as cover on the cover commencement date by the insured member.
14. Insured member means the eligible member of the group who is enrolled under the master policy, is liable for loan
repayment either directly or as partner in the borrower partnership firm and upon whose life the cover is effected as
set out in the certificate of insurance.
15. Joint insured member(s) means insured member(s) under the same loan account number who is/are provided a joint
life cover on a first to die basis under the master policy.
16. Master policy means the document containing the terms, conditions and parameters issued to the master policyholder.
17. Master policyholder means the holder of the master policy, as shown in the Policy schedule.
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UIN: 135N087V01
18. Moratorium period is chosen by the member is fixed at the outset and shown in the member certificate of insurance.
A moratorium period of 1 to 7 years is available under this plan.
19. Nominee is the person who has been nominated by the Insured member in accordance with Section 39 of the Insurance
Act, 1938 as amended from time to time.
20. Nomination under the Policy will be governed by Section 39 of the Insurance Act, 1938 as amended from time to time.
Please refer to Annexure B of the policy document for further details
21. Policy commencement date means the commencement date of the master policy.
22. Proportionate cover means the share of cover as shown in the certificate of insurance applicable for co-borrowers of a
loan, insured for their respective share of loan.
23. Proposer in case of education loans, means either of the parents, grandparents or legal guardian of a minor life (age at
entry below 18 years), who wants to insure the minor by proposing a life cover on him/her.
24. Regulated Entities means entities which are master policyholders and are authorized by IRDAI to receive the claim
proceeds payable on occurrence of an insured event, to the extent of outstanding credit balance, subject to due
authorization by the insured member.
25. Single Premium means premium received, excluding any extra premium, any rider premium and taxes.
26. Surrender means complete withdrawal or termination of the Master Policy / Certificate of Insurance.
27. Surrender Value means an amount, if any, that becomes payable in case of surrender in accordance with the terms and
conditions of this policy.
28. We/ Our/ Us/The Company means Ageas Federal Life Insurance Company Limited.
29. You/Your means the master policyholder named in the schedule or his/her legal personal representative.
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UIN: 135N087V01
2. Death benefit:
In case of death of an insured member while the cover is still in force, a Death Benefit will be paid immediately. The benefit
payable will depend on the Death Benefit Option and Cover Option chosen by the insured member. Death Sum Assured is
the amount chosen at inception by you and shall be less than or equal to sanctioned loan amount (except for interest accrual
cases) at policy inception.
At inception of the policy, the Death Benefit shall be equal to Death Sum Assured. Death benefit will reduce monthly starting
from the beginning of the second policy month. In case of death during the policy term, Death Benefit as per the Benefit
Schedule issued at the outset for each member in Certificate of Insurance shall be paid.
The death benefit is paid in case of death of the insured member. On payment of Death Benefit, the cover will terminate
and all rights, benefits and interests under the cover will stand extinguished.
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UIN: 135N087V01
In case Master Policy Holder is regulated by RBI, NBFCs, NMDFC and NHBs
At the time of claim settlement we will call for a credit account statement from the master policy holder. If the master policy
holder is either of the following:
1. Reserve Bank of India (RBI) regulated Scheduled Commercial Banks( including co operative banks)
2. NBFCs having Certificate of Registration from RBI
3. National Housing Bank(NHB) Regulated Housing Finance Companies
4. National Minority Development Finance Corporation (NMDFC) and its State Channelizing Agencies
5. Small Finance Banks regulated by RBI
6. Mutually Aided Cooperative Societies formed and registered under the applicable State Act concerning such Societies
7. Microfinance companies registered under section 8 of the Companies Act, 2013
8. Any other category as approved by the Authority
And in case there is any outstanding loan balance, the death benefit will be paid to the master policy holder to the extent
of outstanding loan balance subject to due authorization by the insured member at the time of enrolment, balance claim
amount (if any) will be payable to the beneficiary of the insured member. Balance claim amount is equal to death benefit
less outstanding loan balance.
In case of Master Policy Holder is other than stated above

All the claims will be settled in the name of the beneficiary
Suicide claim provision

Provided the cover is in force, the company will pay suicide claim as defined below:
The death sum assured will not be payable in case of death due to suicide within 12 months from the date of commencement of
risk under the policy /joining the scheme, as applicable. In such cases the nominee or beneficiary of the insured member shall
only be entitled to 80% of the Single Premium, provided the policy is in force.
The risk cover ceases on occurrence of the death of the insured member.
3. Premium payment option:

Only single premium payment option is available.
4. Maturity benefit:
There is no maturity benefit payable under the Plan.
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UIN: 135N087V01
5. Claim requirements:
All claims must be notified to us in writing. We have requirements to establish the validity of any claim that is made under
this COI before we can make any benefit payment. We will ask for the below in case of a claim:
• Original Certificate of Insurance for non-employer employee cases

• Death Claim Form to be signed and attested by the party to whom benefits are payable
• Death Certificate issued by Municipal Corporation / Gram Panchayat
• O/s Loan Schedule as on date of Death
• KYC of the claimant & Relationship Proof between Life Assured and Claimant
• Bank Account details with IFSC code of Beneficiary
• Credit account statement from Master policy holder
In case of an unnatural death, we will ask for the below:

• First Information Report
• Post Mortem report
• Panchnama
• Police Final Investigation Report
Claim discharge form is sent along with our claim settlement letter to MPH/Claimant with a request to furnish complete
discharge form.
Any further documentation or information that we may need in support of the claim before we can process the claim
In exceptional circumstances company may waive the requirement of any or all of the above documents
We may conduct investigation which we consider necessary before we initiate processing of the claim .
A claim should be notified to us within 90 days from the date of insured event and submit the claim documents to:
Ageas Federal Life Insurance Company Limited
22nd Floor, A Wing, Marathon Futurex,
N. M. Joshi Marg, Lower Parel – East,
Mumbai 400 013. Maharashtra
If the delay occurs due to events beyond the control of the claimant we may overlook the delay.
We urge you to ensure the safe storage of this certificate of insurance for a smooth claim
6. Surrender value:
The member cover acquires a Surrender Value immediately on commencement. The insured member can surrender the
policy anytime during the entire cover term.
Surrender Value is as below:

60% x Single Premium x (Unexpired Policy Term in months / Total Policy Term in months) x (Death Benefit as on date of
surrender according to Benefit Schedule / Death Sum Assured); Rounded down to multiple of hundred.
On payment of Surrender Value, the policy will terminate and all rights, benefits and interests under the policy will stand
extinguished.
• Surrender by Master Policy holder:

Master policy holder may surrender the policy at any time by giving written notice at least three months or of such period
as mutually agreed between the master policyholder and us. In this event the insurer shall not accept any new members.
If the Master Policyholder surrenders the Policy, an option to continue the cover will be given to you. If you opt to surrender
the policy, then surrender value will be paid and the life cover ceases immediately.
If you opt to continue, your cover continues as per schedule till the end of the cover term. We/intermediary if any, shall
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UIN: 135N087V01
continue to be responsible to serve you till the coverage is terminated.
On payment of Surrender Value, the policy will terminate and all rights, benefits and interests under the policy will stand
extinguished.
7. Pre- closure or transfer of the loan to another institution:

In case you repay entire outstanding loan amount before the end of the cover term or in case of transfer of the loan to
another bank or a financial institution or any lending institution before the end of the cover term, you can choose either of
the following
• Continue with the cover till the end of the cover term and death benefit shall be payable as per benefit schedule in case
of death within the cover term.
• Surrender the member COI and avail surrender benefit.
8. Termination of cover:
The cover will terminate and our obligations will cease on the earliest of any of the following:
• The cover expiry date as shown in the certificate of insurance irrespective of whether the loan in conjunction with which
the certificate of insurance was issued continues or has been extended
• Free Look Cancellation
• In case of fraud or misrepresentation, the provisions of section 45 of the Insurance Act, 1938 as amended from time to
time will apply. Please refer Annexure C of the policy document for further details,
• Surrender of cover by member and payment of surrender value
• On Death of the Insured member:
• Single life cover: Death of the insured member
• Joint life cover: On first death of either of the joint insured members or simultaneous death of both members.
• Proportionate cover: On death of all the co-insured members
9. Nomination:
Nomination will be allowed as per provisions of Section 39 of the Insurance Act, 1938 as amended from time to time.
10. Assignment:
The benefits in respect of each insured member are strictly personal and cannot be assigned, charged or alienated in any
way whatsoever by the insured member.
11. Loans:
No loan is available under this COI.
12. Endorsements:
The terms and conditions of this certificate of insurance cannot be waived or changed except by an endorsement approved and
signed by our authorised officials.
13. Travel, residence and occupation:

The insured members are free from all restrictions as to travel, residence and occupation unless specifically restricted in the
master policy or certificate of insurance.
14. Changes in applicable law:

Notwithstanding anything contained in this master policy, the provisions herein shall stand altered, amended, modified or
superseded 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 or instructions or guidelines issued by the IRDAI or any other statutory bodies) or as may
be necessary under a judgement or order of a court of law.
15. Fraud, Misstatement and Suppression:

Fraud, Misstatement and Suppression would be dealt with in accordance with provisions of Section 45 of the Insurance Act 1938
as amended from time to time. Please refer Annexure C for further details.
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UIN: 135N087V01
16. Governing law & jurisdiction:

Indian law shall govern this master policy / insurance cover and the relationship between the master policyholder, insured
member and us. The parties shall be subject to the exclusive jurisdiction of the courts in India for all matters and disputes arising
from, relating to or concerning the master policy / insurance cover.
17. Currency and place of payment:

All payment to or by us will be in accordance with the prevailing Exchange Control regulations and other relevant laws and
regulations of India.
Indian Rupee is the currency of this master policy/insurance cover. We will make or accept payments at any of our offices in India
or such other locations as determined by us from time to time.
18. Free look period

For the Master Policyholder
The master policyholder is entitled to a free look period of 15 days from the date of receipt of the Master policy to review the
terms and conditions of the policy. In case he/she do not agree with any of the terms and conditions, they have the option to
return the policy to us for cancellation by communicating the same in writing stating the reasons for objections. We will refund
you the premium amount after deducting the proportionate risk premium for the cover provided during that time plus any
medical examination cost and stamp duty charges incurred by us in respect of the policy. All the benefits under the policy will
stand extinguished immediately on the cancellation of the Master Policy under the free look. A Master Policy once returned
cannot be revived, reinstated or restored at any point in time and a new proposal will have to be made for a new Master Policy.
For the Insured Member

You are entitled to a free look period of 15 days from the date of receipt of the certificate of insurance to review the terms and
conditions of the certificate of insurance. In case you do not agree with any of the terms and conditions in the certificate of
insurance, you have the option to return the same to us for cancellation by communicating the same in writing stating the reasons
for objections. We will refund the premium amount after deducting the proportionate risk premium for the cover provided during
that time plus any medical examination cost and stamp duty charges incurred by us in respect of the same. All the benefits under
the certificate of insurance will stand extinguished immediately on the cancellation of the Policy under the free look.
In case of return of a certificate of insurance, the master policyholder shall thereafter also remove the names of the dissatisfied
member from the membership register.
19. Loss of Certificate of Insurance:

If the certificate of insurance is lost then we will, pursuant to a written request duly signed by you addressed to our registered
office and upon being satisfied as to the fact and cause of the loss, provide a duplicate copy of the document. If a duplicate copy
is issued, the original certificate of insurance will cease to be of any legal effect. You agree to keep us indemnified and hold us
harmless from any costs, expenses, claims, awards or judgments arising out of or howsoever connected with the original
certificate of insurance. We do not levy any charges for providing a duplicate copy of the policy document.
20. Minor Lives

Policies can be issued on minor life only for Educational Loans. For such policies, the risk shall commence on the policy
commencement date. In case of minor lives being Life Assured, only Parent, Grandparent or Legal guardian can be the
Policyholder. The ownership of the policy shall vest in insured member on attainment of majority. For such policies, the Death
Benefit shall be paid to the policyholder or his/her legal heir.
In the event of the death of the insured member, the legal guardian of the minor will be the policyholder until the minor becomes
a major.
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UIN: 135N087V01
GRIEVANCES
1. Notices
All notices meant for us whether under this policy or otherwise must be in writing and delivered to us at the address
mentioned below, or such other address as we may notify to you from time to time.
All notices meant for you will be in writing and we will send the same to the most recent address registered with us. If you
change address, you must notify us immediately.
Please notify us immediately in case of any change in postal/permanent address/contact details along with relevant KYC
documents. This will enable the Company to send you regular updates on your policy.
2. Grievances
In case you have any query, request or complaint/grievance, you may approach any of our branches.
For the list of branches and their address, please visit www.ageasfederal.com
Alternatively, you may contact our head office at the following address:
Head Office Address:

Manager-Customer & Sales Support
22nd Floor, A Wing, Marathon Futurex
Mumbai - 400 013.
Toll free No.: 1800 209 0502(From Monday to Saturday, 8 am to 8 pm)
2. 1 In case you are not satisfied with the decision of the above office, or have not received any response within 10
days, you may contact the following official for resolution:
Chief Operations Officer

22nd Floor, A Wing, Marathon Futurex,
Mumbai 400 013.
Contact No.: 022 23029200
Email ID: grievance@ageasfederal.com
2. 2 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 IRDAI on the following contact details:
IRDAI Grievance Call Centre (IGCC) TOLL FREE NO:155255
Email ID: complaints@irdai.gov.in
You can also register your complaint online at http://www.igms.irda.gov.in/

Address for communication for complaints
Consumer Affairs Department - Grievance Redress Cell
Insurance Regulatory and Development Authority (IRDAI)
Sy No. 115/1, Financial District,
Nanakramguda, Gachibowli,
Hyderabad - 500 032, Telangana.
2.3 The Ombudsman shall receive and consider complaints or disputes relating to—
(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;
(c) disputes over premium paid or payable in terms of insurance policy;
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UIN: 135N087V01
(d) misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
(e) legal construction of insurance policies in so far as the dispute relates to claim;
(f) policy servicing related grievances against insurers and their agents and intermediaries;
(g) issuance of life insurance policy, which is not in conformity with the proposal form submitted by the proposer;
(h) non-issuance of insurance policy after receipt of premium in life 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 the 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).
2.4 Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or
assignee, make a complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the
branch or office of the insurer complained against or the residential address or place of residence of the
complainant is located.
2.5 The complaint shall be in writing, duly signed by the complainant or through his legal heirs, nominee or
assignee and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer
against whom the complaint is made, the facts giving rise to the complaint, supported by
documents, the nature and extent of the loss caused to the complainant and the relief sought from the
Insurance Ombudsman.
2.6 No complaint to the Insurance Ombudsman shall lie unless—

(a) the complainant makes a written representation to the insurer named in the complaint and—
(i) either the insurer had rejected the complaint; or

(ii) the complainant had not received any reply within a period of one month after the insurer received his
representation; or
(iii) the complainant is not satisfied with the reply given to him by the insurer;
(b) The complaint is made within one year—
(i) after the order of the insurer rejecting the representation is received; or
(ii) after receipt of decision of the insurer which is not to the satisfaction of the complainant;
(iii) after expiry of a period of one month from the date of sending the written representation to the insurer
if the insurer named fails to furnish reply to the complainant .
2.7 No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings
are pending before or disposed of by any court or consumer forum or arbitrator.
2.8 In case you are not satisfied with the decision/resolution of IRDAI, you may approach the Insurance Ombudsman at the
address given below.
Page 16 of 21
UIN: 135N087V01
Address of Insurance Ombudsman
Jurisdiction of Office Union

Office Details
Territory, District)
AHMEDABAD - Shri Kuldip Singh Office of

the Insurance Ombudsman,Jeevan
Prakash Building, 6th floor, Tilak Marg, Gujarat,
Relief Road, Dadra & Nagar
Ahmedabad – 380 001. Haveli,Daman
Tel.: 079 - 25501201/02/05/06 and Diu.
Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU
Office of the Insurance Ombudsman, Jeevan
Soudha Building,PID No. 57-27-N-19Ground
Floor, 19/19, 24th Main Road,
Karnataka.
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL
Office of the Insurance Ombudsman,Janak
Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,Near
Madhya Pradesh
New Market,
Chattisgarh.
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR
Office of the Insurance Ombudsman,62,
Forest park,
Bhubneshwar – 751 009. Orissa.
Tel.: 0674 - 2596461 /2596455
Email: bimalokpal.bhubaneswar@cioins.co.in
CHANDIGARH
Office of the Insurance Ombudsman,
Punjab,
S.C.O. No. 101, 102 & 103, 2nd Floor,Batra
Haryana(excluding Gurugram, Faridabad,
Building, Sector 17 – D, Chandigarh – 160
Sonepat andBahadurgarh)
017.
Himachal Pradesh, Union Territories of Jammu &
Tel.: 0172 - 2706196 / 2706468
Kashmir,Ladakh & Chandigarh.
Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI
Office of the Insurance Ombudsman, Tamil Nadu,
Fatima Akhtar Court, 4th Floor, 453, Anna PuducherryTown and
Salai, Teynampet, Karaikal (which are part of Puducherry).
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Page 17 of 21
UIN: 135N087V01
Jurisdiction of Office Union Territory, District)

Office Details
Email: bimalokpal.chennai@cioins.co.in
DELHI
2/2 A, Universal Insurance Building, Delhi &
Asaf Ali Road, Following Districts of Haryana - Gurugram, Faridabad,
New Delhi – 110 002. Sonepat &Bahadurgarh.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in
GUWAHATI
Assam,
Meghalay,
Jeevan Nivesh, 5th Floor,
Manipur,
Nr. Panbazar over bridge, S.S. Road,
Mizoram,
Guwahati – 781001(ASSAM).
Arunachal Pradesh,
Tel.: 0361 - 2632204 / 2602205
Nagaland and
Email: bimalokpal.guwahati@cioins.co.in
Tripura.
HYDERABAD
Office of the Insurance
Ombudsman,6-2-46, 1st floor,
Andhra Pradesh,
"Moin Court",
Telangana,
Lane Opp. Saleem Function Palace,
Yanam and
A. C. Guards, Lakdi-Ka-Pool,
part of Union Territory of Puducherry.
Hyderabad - 500 004.
Tel.: 040 - 23312122
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR -
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg, Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM
2nd Floor, Pulinat Bldg., Kerala,
Opp. Cochin Shipyard, M. G. Road, Lakshadwee,
Ernakulam - 682 015. Mahe-a part of Union Territory of Puducherry.
Tel.: 0484 - 2358759 / 2359338
Email: bimalokpal.ernakulam@cioins.co.in
KOLKATA
Office of the Insurance
West
Ombudsman,Hindustan Bldg.
Bengal,
Annexe, 4th Floor, 4, C.R. Avenue,
Sikkim,
KOLKATA - 700 072.
Andaman & Nicobar Islands.
Tel.: 033 - 22124339 / 22124340
Page 18 of 21
UIN: 135N087V01
Jurisdiction of Office
Office Details
Union Territory,
District)
Email: bimalokpal.kolkata@cioins.co.in
LUCKNOW Districts of Uttar

Office of the Insurance Ombudsman,6th Pradesh :
Floor, Jeevan Bhawan, Phase-II, Nawal Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
Kishore Road, Hazratganj, Lucknow - 226 Allahabad,Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
001. Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao,
Tel.: 0522 - 2231330 / 2231331 Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,
Email: bimalokpal.lucknow@cioins.co.in Gonda, Faizabad, Amethi,Kaushambi, Balrampur, Basti,
Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar,
Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur,
Chandauli, Ballia, Sidharathnagar.
MUMBAI
Office of the Insurance Ombudsman,3rd
Floor, Jeevan Seva Annexe,
Goa,
S. V. Road, Santacruz (W),
Mumbai Metropolitan
Mumbai - 400 054.
Region excluding Navi
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31
Mumbai & Thane.
Email: bimalokpal.mumbai@cioins.co.in
NOIDA
State of Uttaranchal and the following Districts of Uttar
Pradesh:Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun,
Bhagwan Sahai Palace
Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut,
4th Floor, Main Road,Naya
Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Bans, Sector 15,
Farrukhabad, Firozbad,Gautambodhanagar, Ghaziabad,
Distt: Gautam Buddh Nagar,U.P-
Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
201301.
Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
Tel.: 0120-2514252 / 2514253
Email: bimalokpal.noida@cioins.co.in
PATNA
Office of the Insurance Ombudsman,2nd
Floor, Lalit Bhawan,
Bihar,
Bailey Road, Patna
Jharkhand.
800 001.
Tel.: 0612-2547068
Email: bimalokpal.patna@cioins.co.in
PUNE
Jeevan Darshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,Pune Maharashtra,
– 411 030. Area of Navi Mumbai and Thane
Tel.: 020-41312555 excluding Mumbai Metropolitan
Email: bimalokpal.pune@cioins.co.in Region.
Page 19 of 21
UIN: 135N087V01
Annexure A
A. Section 38 - Assignment and Transfer of Insurance Policies

Assignment or transfer of a policy will be in accordance with Section 38 of the Insurance Act, 1938 as amended from time to
time. The extant provisions in this regard are as follows:
1. This policy may be transferred/assigned, wholly or in part, with or without consideration.

2. An Assignment may be effected in a policy by an endorsement upon the policy itself or by a separate instrument under
notice to the Company
3. 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.
4. The assignment must be signed by the transferor or assignor or duly authorized agent and attested by at least one
witness.
5. The transfer of assignment shall not be operative as against the company 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 Company
6. Fee to be paid for assignment or transfer can be specified by the Authority through Regulations.
7. On receipt of notice with fee, we will grant a written acknowledgement of receipt of notice. Such notice shall be
conclusive evidence against the Company of duly receiving the notice.
8. The policyholder may send such notice to our office address as mentioned in the policy document where the policy is
being serviced.
9. We may accept or decline to act upon any transfer or assignment or endorsement, if it has sufficient reasons to believe
that it is
a) not bonafide or
b) not in the interest of the policyholder or
c) not in public interest or
d) is for the purpose of trading of the insurance policy.
10. Before refusing to act upon endorsement, we will 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.
11. In case of refusal to act upon the endorsement by the Company, any person aggrieved by the refusal may prefer a claim
to IRDAI within 30 days of receipt of the refusal letter from the Company
12. 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 Company; 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 shall
be referred to Authority.
13. 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
a) where assignment or transfer is subject to terms and conditions of transfer or assignment OR
b) 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.
14. In other cases, we will, 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
a) 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
b) may institute any proceedings in relation to the policy
c) 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
15. 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.
Please note: This is not a comprehensive list of amendments of Insurance Laws (Amendment) Act, 2015 and only a simplified
version prepared for general information. Policyholders are advised to refer to Insurance Laws (Amendment) Act, 2015 Gazette
Notification dated March 23, 2015 for complete and accurate details.
Page 20 of 21
UIN: 135N087V01
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 from time
to time. 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.
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
company and can be registered by the company 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 Company for the Company to be
liable to such nominee. Otherwise, we will not be liable if a bonafide payment is made to the person named in the
policy or in the registered records of the company.
7. Fee to be paid to the Company for registering change or cancellation of a nomination can be specified by the Authority
through Regulations.
8. On receipt of notice with fee, we will 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 Company 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 the Company’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
the nominees are beneficially entitled to the amount payable by the Company to the policyholder unless it is proved that
policyholder could not have conferred such beneficial title on the nominee having regard to the nature of his title.
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 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 (MWP Act) applies or has at any time applied except where before or after 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
Notification dated March 23, 2015 for complete and accurate details
Page 21 of 21
UIN: 135N087V01
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 from
time to time are as follows:
1. No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3 yrs 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.
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, we will 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 Company
or to induce the Company 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. We will not 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 Company. 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 Company will 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 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 Company. The onus is
on the Company to show that if the Company 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 it 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.
Notification dated March 23, 2015 for complete and accurate details.
Page 22 of 21
Loan ref. no.
LN515437859574309
Ageas Federal Life Insurance Co. Ltd. E-mail: support@ageasfederal.com, www.ageasfederal.com
80180583
Ageas Federal Life Insurance Group Credit Shield Plan II (UIN:135N087V01)

(For Personal Loans of RBI regulated Scheduled Commercial Bank)
Proposal number 80180583

Servicing branch code 1834 Application receipt date 09-11-2023
Tiruverumbur Acknowledgement (ACK) number Not applicable
;
Servicing branch name

Bank/Distributer name THE FEDERAL BANK LTD Cheque deposit date/Fund transfer date Not applicable
URN Number Not applicable Ageas Federal employee code Not applicable
Bank customer ID Not applicable Branch credit manager code Not applicable
ST1 Code Not applicable Branch sales manager code Not applicable
ST2 Code Not applicable Branch operation manager code Not applicable
Loan Type : Personal Loan
General instructions & warnings: 1. While answering questions in this form and providing any other information in respect of the insurance, the borrower must make a full and frank disclosure of all
material facts. If a full and frank disclosure is not made of all material facts, or if any material fact is misrepresented, the policy issued is liable to be cancelled with immediate effect in accordance with
section 45 of insurance act. 1938 as amended from time to time. Further details on this section are provided on page 2. 2.Please read the sales literature to understand the products. 3.All corrections made
in this form have to be duly countersigned. 4.Wherever space provided is insufficient, please use additional sheets to provide details. 5.All questions have to be answered. 6.Please fill this form in block
capitals and tick option chosen wherever applicable. 7.The requirement of disclosure of material information in this form or policy apply both to the insured and the insurer. 8.Underwriting questions/details
for the person to be insured shall be obtained separately as per the applicable Underwriting Policy of the Company from time to time.
PART-I: DETAILS OF MEMBER TO BE INSURED

1. Title Mrs. 2. Gender: Female
3. Name SUGITHA Y
4. Date of birth 30-05-1979
5. Nationality Indian
6. Mailing Address
NO 4 581 PRAKASH NAGAR
(Member Address)
PIN 620013
City TRY State TAMIL NADU

Mobile 918903329219 Not applicable
Email sugitha315@gmail.com
7. PAN No Not available
PART-II : NOMINEE DETAILS

Name Gender Relationship Date of birth % Share Address with contact number
JEPARAJ S JEPARAJ S Male Spouse 06-03-1975 100%
PART-III: LOAN AND PLAN DETAILS

A. Plan details
1. Cover option Single Life Cover
2. Cover benefit Reducing death benefit option
3. Death sum Assured (Rs)* 4.Cover term 5. Premium payment term
Rs. 426000.00 48 months Single

B. Premium details
1. Premium mode 2. Total Payment (Rs)
Single Rs. 3659.56
AFLI/NB/MEF/PL/GCSP II/V1.0/022023 Page 1

80180583
PART-IV: DECLARATION AND AUTHORIZATION
I understand that this form has been filled for becoming an insured member of Ageas I further agree that if after the date of submission of the application but before the issue
Federal Life Insurance Group Credit Shield Plan II UIN: 135N087V01. I authorize of Certificate of Insurance there is (i) any change in my occupation or any adverse
Ageas Federal Life Insurance Co Ltd. (hereinafter referred as AFLIC or Company) to circumstances connected with my financial position or my health or (ii) if a proposal for
settle claims under the member cover in the following manner: - At the time of claim assurance or an application for revival of a policy on my life made to any other insurer
settlement AFLIC will call for a credit account statement from the master policyholder is withdrawn, deferred, declined or accepted at an increased premium or subject to a
and if there is any outstanding loan balance, the claim proceeds will be paid to the lien or on terms other than as proposed, I shall forthwith intimate the same to the
master policyholder to the extent of outstanding loan balance. Balance claim amount Company in writing. I consent, authorise and direct any doctor, hospital, or employer to
(if any) will be payable to the beneficiary. disclose to the Company any information relating to my present state of health and my
past health history. I agree and declare that in event of me being medically examined,
I authorise Ageas Federal to use my mobile number and email ID as provide by me for
the answers given by me to the medical examiner acting on behalf of Company shall be
sending alerts relating to this enrolment and COI/policy document electronically. I
deemed to be part of the statements and answers given in relation to this application
authorise the master policyholder to pay the premium payable on my behalf/collected
and they shall form basis of this application. I agree that the risk cover proposed under
from me and disclose to the insurer electronically or otherwise such particulars as they
the master policy may not commence till the Company accepts this application and
may require including the details given above and changes to the same such as loan
communicates to me the commencement of risk by way of certificate of insurance except
details, personal details such as name, date of birth, gender, address, occupation,
to the extent as specifically mentioned in the master policy document. I declare that the
financial details and other material information, documents as required for issuance of
premiums paid have not been generated from the proceeds of any criminal activities/
the cover.
offences and I shall abide by and conform to the Prevention of Money Laundering Act,
I hereby declare and warrant on my behalf that all the answers given in response to 2002 and amendments made therein or any other applicable laws. I understand that in
the questions hereinabove and the statements made in this form or otherwise in case of fraud or misstatement by me, action will be initiated as per provisions of section
support of this application are true, correct and complete in all respects, and there is 45 of the insurance act 1938 as amended from time to time.
no other information material to this application that has not been disclosed.
SECTION 45 OF THE INSURANCE ACT, 1938 as amended from time to time: statement of or suppression of a fact material to the expectancy of the life of the insured
was incorrectly made in the proposal or other document on the basis of which the policy
1) No policy of life insurance shall be called in question on any ground whatsoever was issued or revived or rider issued: Provided that the insurer shall have to
after the expiry of three years from the date of the policy, i.e., from the date of issuance communicate in writing to the insured or the legal representatives or nominees or
of the policy or the date of commencement of risk or the date of revival of the policy or assignees of the insured the grounds and materials on which such decision to repudiate
the date of rider to the policy, whichever is later. 2) A policy of life insurance may be the policy of life insurance is based: Provided further that in case of repudiation of the
called in question at any time within three years from the date of the issuance of policy policy on the ground of misstatement or suppression of a material fact, and not on
or the date of commencement of risk or the date of revival of the policy or the date of grounds of fraud, the premiums collected on the policy till the date of repudiation shall be
rider to the policy, whichever is later, on the ground of fraud. Provided that the insurer paid to the insured or the legal representative or nominee or assignees of the insured
shall have to communicate in writing to the insured or the legal representatives or within a period of ninety days from the date of such repudiation. Provided further that
nominees or assignees of the insured the grounds and materials on which such nothing in this section shall prevent the insurer from calling for proof of age at any time if
decision is based. 3) Notwithstanding anything contained in the sub-section (2), no s/he is entitled to do so, and no policy shall be deemed to be called in question merely
insurer shall repudiate a life insurance policy on the ground of fraud of the insured can because the terms of the policy are adjusted on subsequent proof that the age of the Life
prove that the misstatement of or suppression of a material fact was true to the best of Insured was incorrectly stated in the proposal.
his knowledge and belief or that there was no deliberate intention to suppress the fact
or that such misstatement of or suppression of material fact are within the knowledge Corporate Agent disclaimer
of the insurer: Provided that in case of fraud, the onus of disproving lies upon the
beneficiaries, in case the policyholder is not alive. 4) A policy of life insurance may be In this product, Federal Bank is doing purely an agency service and strictly on a non-
called in question at any time within three years from the date of issuance of the policy risk participation basis.
or the date of commencement of risk or the date of revival of policy or the date of the
rider to the policy, whichever is later, on the ground that any
AFLI/NB/MEF/PL/GCSP II/V1.0/022023
Page 2
80180583
ADDENDUM TO MEMBER ENROLLMENT FORM

Ageas Federal Life Insurance Group Credit Shield Plan II (UIN:135N087V01)
(For Personal Loans of RBI regulated Scheduled Commercial Bank)
Proposal number 80180583

Servicing branch Code 1834 Application receipt date 09-11-2023
Servicing branch name Tiruverumbur Acknowledgement (ACK) number Not applicable
Bank Distributor Name THE FEDERAL BANK LTD Cheque deposit date/Fund transfer date Not applicable
URN Number Not applicable Ageas Federal employee code Not applicable
LOAN DETAILS
Bank Customer ID Not applicable Branch credit manager code Not applicable
ST1 Code Not applicable Branch sales manager code Not applicable
ST2 Code Not applicable Branch operation manager code Not applicable
Loan Type Personal Loan
General instructions & warnings: 1. While answering questions in this form and providing any other information in respect of the insurance, the borrower must make a full and frank disclosure of all material
facts. If a full and frank disclosure is not made of all material facts, or if any material fact is misrepresented, the policy issued is liable to be cancelled with immediate effect in accordance with section 45 of
insurance act. 1938 as amended from time to time. Further details on this section are provided on page 2. 2.Please read the sales literature to understand the products. 3.All corrections made in this form have
to be duly countersigned. 4.Wherever space provided is insufficient, please use additional sheets to provide details. 5.All questions have to be answered. 6.Please fill this form in block capitals and tick option
chosen wherever applicable. 7.The requirement of disclosure of material information in this form or policy apply both to the insured and the insurer. 8.Underwriting questions/details for the person to be insured
shall be obtained separately as per the applicable Underwriting Policy of the Company from time to time.
PART-I: DETAILS OF MEMBER TO BE INSURED

1. Title Mrs. 2. Gender (Male | Female | Transgender) Female
SUGITHA Y
3. Name
4. Date of birth 30-05-1979
5. Educational Qualification (Post Graduate and above / Graduate / 12th
Passed / 10th
Passed / Below Not Applicable
10th / Uneducated / Diploma / Professional qualification)
6. Occupation (Professional / Business Owner / Housewife / Retired/Pensioner / Self- Not Applicable
employed / Private sector / Public sector / Government sector)
Name of Organization:
Designation:
7. Annual Income Others
Not applicable 8. Age Proof
9. Nature of work (Purely administrative | Mostly administrative | Skilled-manual | Unskilled- Not applicable
manual)
10 Relationship with primary member to be insured self
(Applicable in case of proportionate cover)
PART-II: LOAN AND PLAN DETAILS

A. Loan details
1. Loan Type Personal Loan
2. Loan ref. no. LN515437859574309
3a. Moratorium period without interest accrued in moratorium (up to 7 years) Not applicable
3b. Moratorium period with interest accrued in moratorium (up to 7 years) Not applicable
4. EMI Amount 5. Loan Term (Including moratorium period, if any) 48 months
6. Loan Amount Rs. 426000.00 (Please mention sanctioned loan amount. Premium funded by bank/lending institution to be excluded)
7. No of co-borrowers Not applicable (For Proportionate cover only) Every co-borrowers need to fill a separate member enrolment form
8. Share of loan Not applicable (For Proportionate cover only) The total proportionate share of loan across all co-borrowers should be 100%
9. Loan interest rate 14.14% p.a.
10. Date of first disbursement 09-11-2023 11. LIP a/c no. Not applicable
B. Premium funding (Bank/lending institution funded | Self-funded) Self-funded
C. Payment Method - (Cheque | Demand draft | Direct Debit) Direct Debit
Cheque/DD number & date Not applicable
Bank Name Not applicable
Branch Not applicable
Amount Not applicable
D. Do you have any existing life cover and/or you simultaneously applying for life cover with Ageas Federal Life Insurance Co. Ltd and other companies
Yes/No Not applicable
If yes, please provide the following details
Policy / Application number Total Sum Assured Name of Insurance Company Acceptance Terms*
Not applicable Not applicable Not applicable Not applicable
*Please indicate if risk is accepted at Ordinary or with Extra Mortality Rates or Declined
Page 1
AFLI/NB/AMEF/PL/GCSP II/V1.0/022023
Application no.:
80180583
PART-III: HEALTH DECLARATION OF MEMBER TO BE INSURED

(To be filled for death sum assured upto Rs 35 Lacs)
Q 1. Do you have any of the medical conditions in the past and / or if you are on treatment for any heart disease, liver disease, respiratory or lung disease, brain related
conditions, kidney disease, endocrine abnormality, blood disorders, any type of Cancer, HIV or mental disorder?
Ans: No
Q 2. Have you been home quarantined for COVID in the last 2 months or hospitalized due to COVID in the last 6 months?
Ans: No
In case of "Yes" please fill the details in PART IV
AFLI/NB/AMEF/PL/GCSP II/V1.0/022023 Page 2

COI No: 80180583 Ageas Federal Life Insurance Group Credit Shield Plan II - v1.0 - 02022023 Page 1 of 22

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COI No: 80180583 Ageas Federal Life Insurance Group Credit Shield Plan II_v1.

COI No: 80180583

Dear Mrs. SUGITHA Y,

We have the following as your contact details.

AGEAS FEDERAL LIFE INSURANCE COMPANY LIMITED

Premium Payment Details

This is a computer-generated receipt and does not require a signature.

Call our Toll Free Number

1800-209-0502 (From Monday to Saturday, 8 am to 8 pm)

AGEAS FEDERAL LIFE INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE (COI)

Personal details of SUGITHA Y

Cover term: 48 months Cover expiry date: 08-11-2027

Moratorium period(if 0 Total Cover Term 48 months

Nominee details (including under Section 39 of the Insurance Act, 1938)

Appointee Details (Applicable when Nominee is Minor)

Associated loan details

Date of issue: 09-11-2023 Place: Mumbai

The master policyholder The insurer – Ageas Federal

TERMS AND CONDITIONS

In case of Master Policy Holder is other than stated above

Suicide claim provision

3. Premium payment option:

• Original Certificate of Insurance for non-employer employee cases

In case of an unnatural death, we will ask for the below:

Surrender Value is as below:

• Surrender by Master Policy holder:

continue to be responsible to serve you till the coverage is terminated.

7. Pre- closure or transfer of the loan to another institution:

13. Travel, residence and occupation:

14. Changes in applicable law:

15. Fraud, Misstatement and Suppression:

16. Governing law & jurisdiction:

17. Currency and place of payment:

18. Free look period

For the Insured Member

19. Loss of Certificate of Insurance:

20. Minor Lives

Head Office Address:

Chief Operations Officer

You can also register your complaint online at http://www.igms.irda.gov.in/

2.6 No complaint to the Insurance Ombudsman shall lie unless—

(i) either the insurer had rejected the complaint; or

Address of Insurance Ombudsman

Jurisdiction of Office Union

AHMEDABAD - Shri Kuldip Singh Office of

Jurisdiction of Office Union Territory, District)

LUCKNOW Districts of Uttar

A. Section 38 - Assignment and Transfer of Insurance Policies

1. This policy may be transferred/assigned, wholly or in part, with or without consideration.

Ageas Federal Life Insurance Co. Ltd. E-mail: support@ageasfederal.com, www.ageasfederal.com

Ageas Federal Life Insurance Group Credit Shield Plan II (UIN:135N087V01)

Proposal number 80180583

Servicing branch name

PART-I: DETAILS OF MEMBER TO BE INSURED

City TRY State TAMIL NADU

7. PAN No Not available

PART-II : NOMINEE DETAILS

PART-III: LOAN AND PLAN DETAILS

3. Death sum Assured (Rs)* 4.Cover term 5. Premium payment term

Rs. 426000.00 48 months Single

AFLI/NB/MEF/PL/GCSP II/V1.0/022023 Page 1