VOLUNTARY GROUP TERM INSURANCE

Option for Group Term Insurance Scheme with LIC

SCHEME-I
1. Tentative Date of commencement of Policy : 01.03.2024
2. Maximum Cover : Rs.50 Lakhs
3. Membership of Duration : Till Retirement
4. Premium Payment : Annually
5. Annual Premium rate (Born on or after : Rs. 9440/- (including GST)
15.09.1973) : Rs. 45430/- (including GST)
6. Annual Premium rate (Born before 15.09.1973
)

SCHEME-II : 01.03.2024
1. Tentative Date of commencement of Policy : Rs.20 Lakhs
2. Sum Assured : Till Retirement
3. Membership of Duration : Annually
4. Premium Payment : Rs. 18172/- (including GST)
5. Annual Premium rate (Born before 15.09.1973
):

Group Term Insurance Option of:

1. Name of Executive :NAVEEN KUMAR GUPTA
2. HR No :200301800
3. Designation :Sub Divisional Engineer (Regular)
4. Date of Birth :30.11.1978
5. Age as on(01.03.2024) :Year- 45 Month- 3 Day- 2
6. Present Circle :3200 - UP (E) Telecom Circle
7. Present SSA :3201 - CO ,Lucknow
8. Applicable Premium :Rs.9,440.00 /-

Certified that I have read above information to the best of my knowledge and
therefore I hereby opt for the GTI as decided by BSNL and authorize the employer
to deduct the premium of term insurance scheme from my salary on annual basis.

I Agree(Scheme I)

Submission Date: 12.02.2024