V-7/24-07-12

Date : 19-Sep-2013
: 33689688
: 1G0 00200 508
: SBI Life - eShield Level Cover Product Name
Policy No.
Customer No.
Mr Krishna Mohan Chegu
S/O CH GANGA RAM
RKR AUTOMOBILES OLD MARKET MAIN ROAD DALLI
RAJHARA
DURG - 491228
CHATTISGARH, India
To,
RAIPUR PC /1G-PZ002413
1345638 / 13387 / No / SpeedPost / Indian / 127
SPEEDPOST - EA103042815IN
Father's Name:
Contact Details : 8602346511/ 2312482
Mr CH GANGA RAM
Dear Mr Krishna Mohan Chegu,
We welcome you in the SBI Life family and thank you for your trust in our products.
Joining SBI Life family will give you access to best customer service and large range of products which caters to most of your life
insurance needs.
You will find your Policy Document and First Premium Receipt with this letter. Please check all details and make sure that it is
kept safely. Copy of the proposal form is also enclosed.
Please note this is a Regular premium payment insurance Policy. The premium due dates are : 18/09 every year
Your Contact Point
For any information/ clarification, please contact:
Your local service branch : RAIPUR PC, 1ST FLOOR, AJIT TOWERS,RAMSAGAR PARA RAIPUR (C.G.),RAIPUR -
492001,CHATTISGARH or,
1.
Call us toll free at our customer service helpline 1800 22 2123/1800 22 9090/1800 425 9010 2.
In case you have any complaint/grievance, you may contact the following official for resolution:
REGIONAL DIRECTOR,SBI LIFE INSURANCE CO. LTD., 133,2ND FLOOR, KAY KAY BUISNESS CENTRE,, M P NAGAR,
ZONE 1,, BHOPAL, -462011
3.
E mail us at info@sbilife.co.in or visit us at www.sbilife.co.in 4.
Log on to http://mypolicy.sbilife.co.in to get registered in Customer Self service Portal for
a) Viewing policy Details b) Premium Paid Certificate c) Changing personal Details
5.
All your servicing requests should be submitted to your local service branch as
mentioned above or nearest SBI Life branch only.
6.
Free Look Option
In case you are not satisfied with the Terms & Conditions as mentioned in the Policy Document, you have the option to
return the policy to SBI Life Insurance Co. Ltd and cancel the cover within 30 days of receipt of the Policy Document. In
such an event, the initial premium payments will be refunded as per Terms and Conditions of this policy and in
accordance with the Insurance Act, 1938 and Regulations made there under.
Looking forward to be your preferred Life Insurance Company for all your Life Insurance needs.
Yours truly,
Vivek Sthalekar
Head - New Business Processing
Note : The translated version of this letter in the regional language is printed overleaf for your convenience. However, should there be any
ambiguity, the English version shall prevail.
Page 1 of 36
Date : 19-Sep-2013
: 33689688
: 1G0 00200 508
: SBI Life - eShield Level Cover Product Name
Policy No.
Customer No.
Mr Krishna Mohan Chegu
S/O CH GANGA RAM
RKR AUTOMOBILES OLD MARKET MAIN ROAD DALLI
RAJHARA
DURG - 491228
CHATTISGARH, India
To,
RAIPUR PC /1G-PZ002413
Contact Details : 8602346511/ 2312482
Father's Name: Mr CH GANGA RAM
Dear Mr Krishna Mohan Chegu,
;= =+|=|; =|;= +|+| = =|+=| ;||:= =+|= == ; =| ;=|| =|=|=| = |++|= ==| = |= =|=| =c == ;.
=+|=|; =|;= +|+| = n||== ;| = =|+ +;=| |;= =+| =| =| =|=|=| =| = =|+= = == +;- +| == =| =|+=| ==|:|= =|+ +|=| =+=|
=|+===|=| =| +| =.
;= += = =| =|+=| t r t =| r r r == ;. =+=| ==| |++=| =| =|- = = =| ;= ==|= = .=|+= ==|+ += =| |=
=| ;== =| == ;.
=+=| |c = |= =; Regular ||=== ==| +||==| ;. ||=== =| ==| = =| |=|=| 18/09 every year ;.
t t
|==| =|=||,=+c|== = |= =+=| =;| =-+= = .
=|+=| =||= =+|:|=| n|| . RAIPUR PC, 1ST FLOOR, AJIT TOWERS,RAMSAGAR PARA RAIPUR (C.G.),RAIPUR -
492001,CHATTISGARH =|,
1.
;=|| c|= =| ==c= ;-+=|; 1800 22 2123/1800 22 9090/1800 425 9010 =| =|= = 2.
=|; |n=|== ;| + =|+ ==|=| ;= |-|=|= =|==|| = =-+= = === ; .
REGIONAL DIRECTOR,SBI LIFE INSURANCE CO. LTD., 133,2ND FLOOR, KAY KAY BUISNESS CENTRE,, M P
NAGAR, ZONE 1,, BHOPAL, -462011
3.
;= =;| == = . info@sbilife.co.in =| =;| |+|=c = www.sbilife.co.in 4.
|-|=|= ;= ==c= =-= =|+= +|c= = |==c = = |= www.mypolicy.sbilife.co.in + =| =| =
=) +||==| |++= :| +) ||=== ==| =|c|==c =) =|== |++= =| +:=|.
5.
=+ |: = =||= =+| n|| =| |=c= =+|=|; =|; +|- ;| =|+= =| =+| =+=| |+: =| =| =| -||;. 6.
r -
t t r t - t t - t t t t t r t r t - 30 t t r t r t t
t . . t t t r t t t t . r t r t t t r t t t r t
1938 t t t t t t t t t.
=|+=| ==== =|+ +|=| =+=| ===| = |= =|+=| +=:|:| =|;= ;=|-= =+| + =| =|n| =.
=|+=| n=|--==,
|++= ===
t - t
Page 2 of 36
First Premium Receipt
Proposal No
Policy No
Channel Name
Sequence No
Received Date
Channel Code
:1G0 00200 508
:1G-PZ002413
: 8485830
:
:
: September 13, 2013
Policy Holder
Mr Krishna Mohan Chegu
Mode
Date of commencement of policy :September 18, 2013
:Annually Product/Plan :
Sum Assured: Rs.25,00,000/-
SBI Life - eShield Level Cover
Installment Premium Rs. 4,258
Service Tax & Education Cess Rs.527
Total Premium Amount Rs.4,785/-
No. of Premiums Paid 1
Total Amount Received Rs. 4,785/-
Next premium due on September 18, 2014
Due date of Premium payment :September 18, 2013
Payment Method :Online Selling
Amount of initial/first premium paid : Rs. 4,785/-
Rupees Four Thousand Seven Hundred Eighty Five Only
Received the amount as above.
Date : September 18, 2013
Note : In case of any discrepancies, you are kindly requested to advise us immediately. Call us toll free at our customer service helpline
1800 22 2123 or 1800 22 9090 or 1800 425 9010
No interest is payable on excess payments, if any, made by the policyholder. Any shortage/excess, will be adjusted against future premiums payable.
Premium paid under this policy is eligible for tax rebates under section 80C of the Income Tax Act, 1961, as applicable.
S/O CH GANGA RAM
RKR AUTOMOBILES OLD MARKET MAIN ROAD DALLI
RAJHARA
DURG - 491228
CHATTISGARH, India
Service Tax is applicable on premium as mandated by the government , effective 10 Sep 2004.
GST is applicable for the Jammu & Kashmir policies as mandated by government of Jammu & Kashmir .
'This Premium receipt is issued subject to realization of cheque'
Service Tax Registration Number : AAFCS2530PST001
Authorized Signatory
Page 3 of 36






















Page 4 of 36
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Page 5 of 36






















Page 6 of 36
v 101 - 03_2013
SBI Life Insurance Company Limited
Registration Number: 111 Regulated by IRDA
Policy Document
SBI Life - eSHIELD
UIN: 111N089V01
( A NON-PARTICIPATING TERM ASSURANCE PLAN )
Page 7 of 36
v 101 - 03_2013
Welcome to your SBI Life eShield policy and thank you for preferring SBI Life Insurance Company Limited to provide you with
insurance solutions. The UIN allotted by IRDA for this product is 111N089V01.SBI Life eShield is also referred to as eShield in the
policy document.
The information you have given electronically in the web based proposal form, personal statement together with any medical reports and
other documents and declarations form part of this contract of insurance with us. Your policy document, comprising this policy schedule
along with the policy booklet and any endorsements, is evidence of the contract. You should read these carefully to make sure you are
satisfied. Please keep these in a safe place.
If you find any errors, please return your policy document for effecting corrections.
SBI Life eShield provides an excellent package of insurance solution. In return for your premiums we will provide benefits as described
in the following pages of the policy document. The benefits available under this policy are subject to the payment of future premiums as
and when due.
Your Policy is a Non-participating traditional pure term assurance product,
The benefits will be paid to the person(s) entitled as set out in the policy document, on proof to our satisfaction, of such benefits having
become payable and of the title of the persons claiming the payments.
Please communicate any change in your mailing address or any other communication details as soon as possible.
Policy Schedule
Policy Number 1G0 00200 508 1.
Proposal No. 1GPZ002413 2.
Proposal Date 12/09/2013 3.
Customer ID 33689688 4.
Identification
Name of the Life assured Mr Krishna Mohan Chegu 5.
Date of Birth 6.
Age at entry 7.
Personal Information
11/03/1981
32
Male Gender 8.
9. Mailing Address
Telephone Number with STD Code 2312482 10.
Mobile Number 8602346511 11.
E-Mail ID of the policyholder cheks1238@yahoo.co.in 12.
S/O CH GANGA RAM
RKR AUTOMOBILES OLD MARKET MAIN ROAD DALLI RAJHARA
DURG,491228
CHATTISGARH, India
Your Policy
SBI Life - eShield Policy Document
If you require further information, please contact us.
Page 8 of 36
v 101 - 03_2013
Name of the Nominee(s) Relationship with the life assured 13.
Mrs Madhuri Chegu Chegu Wife 28
Age
Nomination
SBI Life - eShield Policy Document
Name of Appointee(s) Relationship with Nominee 14.
N.A. N.A.
Age
N.A.
27 Premium Payment Term (Years)
Premium frequency Annual
Basic policy information
25,00,000 20.
21.
22.
23.
Policy Term (Years) 27
Date of commencement of policy / risk
Date of expiry of term
Policy anniversary date
18/09/2013
18/09/2040
18/09
Important dates
Premium due dates 18/09 every year
15.
16.
17.
18.
19. Plan Option Level Cover
Sum Assured (Rs.)
Basic Policy Benefit
Benefit
Sum Assured
(Rs.)
Policy Term
(Years)
Premium
Paying Term
(Years)
Installment
Premium (Rs.)
Service Tax and
Cess (Rs.)
Base Policy
2500000.0
27 27 4,258 527 18/09/2039
Total Installment
Premium
including Service
tax and Cess
4,785
Accidental Death
Benefit
N.A.
Due Date of Last
Premium
Date of expiry
of term
18/09/2040
Service tax, cess and any other taxes payable may vary as per the taxation laws then applicable. Service tax is currently payable @ 12.00%
of premium, Education Cess @ 2.00% of service tax and Secondary and Higher Education cess @ 1.00% of service tax. The effective rate
works out to 12.36% of the installment premium.
Page 9 of 36
v 101 - 03_2013
N.A.
Applicable Clauses
SBI Life - eShield Policy Document
N.A means ' Not applicable '
Signed for and on behalf of SBI Life Insurance Company Limited,
Date 18 September 2013 Mumbai
Designation Head - New Business Processing
Name Vivek Sthalekar
Place
The stamp duty of Rs 500.00/- (Rupees Five Hundred Only) paid by pay order, vide GRASS DEFACE No.0000024332201314 dated 10th
Jun 2013.Government Notification Revenue and Forest Department No. Mudrank 2004/4125/CR690/M-1, dated 31/12/2004.
(Signature)
Proper Officer
We request you to read this policy schedule along with the policy booklet. If you find any errors,please return the policy for effecting
corrections.
*************************************************** End of Policy Schedule *****************************************
Authorised Signatory
Page 10 of 36


Policy Booklet

Table of Contents

1 Definitions ................................................................................................................................................................................... 13
2 Abbreviations .............................................................................................................................................................................. 14
3 Effective Sum Assured ................................................................................................................................................................ 14
3.1 Level Cover ................................................................................................................................................................................. 14
3.2 Level Cover with Accidental Death Benefit ................................................................................................................................ 14
3.3 Increasing Cover .......................................................................................................................................................................... 14
3.4 Increasing Cover with Accidental Death Benefit ........................................................................................................................ 14
4 Policy Benefits ............................................................................................................................................................................. 15
4.1 Death Benefit ............................................................................................................................................................................... 15
4.2 Paid-up Benefit ............................................................................................................................................................................ 15
4.3 Survival Benefit ........................................................................................................................................................................... 15
4.4 Maturity Benefit .......................................................................................................................................................................... 15
4.5 Surrender ..................................................................................................................................................................................... 15
5 Accidental Death Benefit ............................................................................................................................................................. 15
5.2 Definition of Accident .............................................................................................................................................................. 15
5.3 Exclusions .................................................................................................................................................................................... 16
6 Premiums ..................................................................................................................................................................................... 16
7 Lapse and Revival ....................................................................................................................................................................... 16
8 Claims .......................................................................................................................................................................................... 16
8.1 Death claim .................................................................................................................................................................................. 16
8.2 Survival Claim ............................................................................................................................................................................. 17
8.3 Maturity Claim ............................................................................................................................................................................ 17
8.4 Surrender claim ........................................................................................................................................................................... 17
9 Termination ................................................................................................................................................................................. 17
9.1 Termination of death cover .......................................................................................................................................................... 17
9.2 Termination of your policy .......................................................................................................................................................... 17
10 General Terms ............................................................................................................................................................................. 18
10.1 Free-look period .......................................................................................................................................................................... 18
10.2 Suicide exclusion ......................................................................................................................................................................... 18
10.3 Policy loan ................................................................................................................................................................................... 18
10.4 Nomination .................................................................................................................................................................................. 18
10.5 Assignment .................................................................................................................................................................................. 18
10.6 Nondisclosure ............................................................................................................................................................................ 19
10.7 Grace period ................................................................................................................................................................................ 19
10.8 Misstatement of age ..................................................................................................................................................................... 19
10.9 Participation in profits ................................................................................................................................................................. 19
Page 11 of 36

10.10 Taxation ..................................................................................................................................................................................... 19
10.11 Date formats ............................................................................................................................................................................... 19
10.12 Electronic transactions ............................................................................................................................................................... 19
10.13 Notices ....................................................................................................................................................................................... 20
11 Complaints ................................................................................................................................................................................... 20
12 Relevant Statutes ......................................................................................................................................................................... 21
12.1 Governing laws and jurisdiction .................................................................................................................................................. 21
12.2 Section 41 of the Insurance Act 1938 .......................................................................................................................................... 21
12.3 Section 45 of the Insurance Act 1938 .......................................................................................................................................... 21
12.4 Provision 12 (1) of Redressal of Public Grievances Rules, 1998 ................................................................................................ 21
13 Index ............................................................................................................................................................................................ 22


Page 12 of 36

This is your policy booklet containing the various terms and conditions governing your policy. This policy booklet should be read in
conjunction with the policy schedule and other related documents of your policy.

If you find any errors, please return the policy immediately for effecting corrections.

1 Definitions

These definitions apply throughout your policy document.
The definitions are listed alphabetically. Items marked with alongside are provided in your policy schedule.

Expressions Meanings
1. Accidental Death Benefit is the benefit which is payable on death of the policyholder due to accident.
2. Age is the age last birthday; i.e., the age in completed years.
3. Age at entry is the age last birthday on the date of commencement of your policy.
4. Appointee
is the person who is so named in the proposal form or subsequently changed by
endorsement, who has the right to give a valid discharge to the policy monies in case of the
death of the policy holder before the end of policy term while the nominee is a minor.
5. Assignee
is the person to whom the rights and benefits under this policy are transferred by virtue of
assignment under section 38 of the Insurance Act, 1938.
6. Beneficiary
the person nominated by the policy owner to receive all or part of the insurance benefits
under the provisions of your policy. The Beneficiary is specified in the Application Form,
the policy schedule and other written agreements of your policy, if any.
7. Date of commencement of policy /
risk
is the date from which the insurance benefits under this policy are available.
8. Date of expiry of term is the date on which the benefits under this policy terminate on expiry of the benefit term.
9. Death Benefit is the amount payable on death of the policyholder.
10. Endorsement
a change in any of the terms and conditions of your policy, agreed to and issued by us, in
writing.
11. Effective Sum Assured is as defined in the policy booklet.
12. Free-look period
is the period during which the policyholder has the option to return the policy and cancel
the contract.
13. Grace period is the period beyond the premium due date when the policy is treated as in-force.
14. In-force is the status of the policy when all the due premiums have been paid.
15. Initial Sum Assured
is the Death Benefit offered by us at the time of the inception of policy for plan options:
Increasing Cover and Increasing Cover with Accidental Death Benefit.
16. Installment premium
is the amount of money payable by you on each Premium Due Date in order to keep the
insurance cover in force under the provisions of your policy. This does not include the
service tax and other statutory levies which are payable by you in addition to the premium.
17. Lapse is the status of the policy when a premium is not paid before the end of grace period.
18. Life assured is the person whose life is insured under this policy.
19. Minor is a person who has not completed 18 years of age.
20. Nominee
is the person who is named as the nominee in the proposal form or subsequently changed
by endorsement, as per section 39 of the Insurance Act, 1938, who has the right to give a
valid discharge to the policy monies in case of the death of the life assured during the term
of the policy.
21. Non-participating means that your policy does not have a share in our profits.
22. Policy anniversary
is the same date each year during the policy term as the date of commencement of policy.
If the date of commencement of policy is on 29th of February, the policy anniversary will
be the last date of February.
23. Policy document
means the policy schedule, policy booklet, endorsements (if any), other written agreements
(if any) mutually agreed by you and us during the time your policy takes effect.
24. Policy Schedule is the document that sets out the details of your policy.
25. Policy Holder is the owner of the policy
Page 13 of 36

Expressions Meanings
26. Policy year
is the period between two consecutive policy anniversaries; by convention, this period
includes the beginning policy anniversary as the first day and excludes the next policy
anniversary day at the end.
27. Policy Term is the period, in years, during which the insurance benefits are available
28. Premium
is the contractual amount payable by the life assured to secure the benefits under the
contract. This does not include service tax, cess and other statutory levies which are
payable in addition to the premium.
29. Premium frequency
is the period between two consecutive premium due dates for the policy; only yearly
premium frequency is allowed under this policy.
30. Premium payment term is the period, in years, over which premiums are payable.
31. Revival is the process by which the benefits lost under a lapsed policy, are restored.
32. Revival period is a 2-year period from the due date of the First unpaid premium.
33. Sum assured
is the Death Benefit offered by us at the time of the inception of policy for plan options:
Level Cover and Level Cover with Accidental Death Benefit.
34. Surrender is the voluntary cessation of a benefit by the policyholder.
35. Underwriting
Process of assessment of risk at the time of inception or at the time of revival of the policy.
Based on underwriting, a decision on acceptance or rejection of cover as well as
applicability of suitable revised premium and / or any other terms of the policy is taken.
36. We, Us, Our
SBI Life Insurance Company Limited or its successors.
We are regulated by the Insurance Regulatory and Development Authority (IRDA). The
registration number allotted by the IRDA is 111.
37. You, Your is the person named as the policyholder.


2 Abbreviations

Abbreviation Stands for
IRDA Insurance Regulatory and Development Authority
Rs. Indian Rupees
UIN Unique Identification Number (allotted by IRDA for this product)

These abbreviations bear the meanings assigned to them elsewhere in the policy booklet.


3 Effective Sum Assured

We define Effective Sum Assured under various plan options as follows:

3.1 Level Cover
3.1.1 Effective Sum Assured on any day is equal to the Sum Assured.

3.2 Level Cover with Accidental Death Benefit
3.2.1 Effective Sum Assured on any day is equal to the Sum Assured.

3.3 Increasing Cover
3.3.1 We will add 10% of the initial sum assured at the end of every 5 policy years if your policy is then in force. The effective sum
assured would be the increased sum assured as applicable.

3.4 Increasing Cover with Accidental Death Benefit
3.4.1 We will add 10% of the initial sum assured at the end of every 5 policy years if your policy is then in force. The effective sum
assured would be the increased sum assured as applicable.
3.4.2 Your Accidental Death Benefit would not be increased.


Page 14 of 36

4 Policy Benefits

4.1 Death Benefit
If the policy is in-force on the date of death of the life assured, we will pay the benefit for the various plan options as follows:

4.1.1 Level Cover
4.1.1.1 If death of life assured occurs during the policy term, we will pay the sum assured.

4.1.2 Level Cover with Accidental Death Benefit
4.1.2.1 If death of life assured occurs during the policy term, we will pay the sum assured.
4.1.2.2 If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit in
addition to the sum assured.

4.1.3 Increasing Cover
4.1.3.1 If death of life assured occurs during the policy term, we will pay the Effective Sum Assured on the date of death.

4.1.4 Increasing Cover with Accidental Death Benefit
4.1.4.1 If death of life assured occurs during the policy term, we will pay the Effective Sum Assured as on the date of death.
4.1.4.2 If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit in
addition to the Effective Sum Assured as on the date of death.


4.2 Paid-up Benefit
4.2.1 Your policy does not have any paid-up benefit.

4.3 Survival Benefit
4.3.1 Your policy does not have any survival benefit.

4.4 Maturity Benefit
4.4.1 Your policy does not have any maturity benefit.

4.5 Surrender
4.5.1 Your policy will not acquire any surrender value.
4.5.2 Even if you surrender the policy, we will not pay any benefit.
4.5.3 On receipt of your surrender request, your policy will terminate and we shall not have any liability under the policy.


5 Accidental Death Benefit

5.1.1 This benefit applies only for plan options: Level Cover with Accidental Death Benefit and Increasing Cover with Accidental
Death Benefit.
5.1.2 The benefit is in-built in the above mentioned plan options.
5.1.3 If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit in addition to
the Effective Sum Assured.
5.1.4 We will pay the Accidental Death Benefit subject to all of the following:
5.1.4.1 Your policy is in-force.
5.1.4.2 The life assured has died as a result of an accident as defined in this document.
5.1.4.3 Such accidental death should be proved to our satisfaction.
5.1.4.4 The death of the life assured should occur within 120 days from the date of accident.
5.1.4.5 The death must be solely and directly due to Accident and independent of all other causes.
5.1.4.6 The total Accidental Death Benefit sum assured under eShield policies put together will not exceed Rs. 50,00,000.
5.1.4.7 If you have availed Accidental Death Benefit in addition to Rs. 50,00,000 by not disclosing previous insurance
details under this product, we shall not pay the Accidental Death Benefit cover in excess of Rs. 50,00,000. If we come to
know of this on death of the life assured, we shall pay only the first Rs. 50,00,000.
5.1.4.8 We would not refund the premium paid for the excess Accidental Death Benefit.

5.2 Definition of Accident

5.2.1.1 An accident is a sudden, unforeseen and involuntary event, caused by outward, violent and visible means.
Page 15 of 36


5.3 Exclusions

We will not pay the Accidental Death Benefit sum assured for deaths arising as a consequence of or occurring during the following
events:
5.3.1 Infection: Death caused or contributed to, by any infection, except infection caused by an external visible wound
accidentally sustained.
5.3.2 Drug abuse: Life assured under the influence of alcohol or solvent abuse or use of drugs except under the direction
of a registered medical practitioner.
5.3.3 Self-inflicted injury: Intentional self-inflicted injury including the injuries arising out of attempted suicide.
5.3.4 Criminal acts: Life Assureds involvement in criminal and / or unlawful acts with unlawful or criminal intent.
5.3.5 War and civil commotion: War, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolution
or taking part in a riot or civil commotion.
5.3.6 Nuclear contamination: The radioactive, explosive or hazardous nature of nuclear fuel materials or property
contaminated by nuclear fuel materials or accident arising from such nature.
5.3.7 Aviation: Life assureds participation in any flying activity, other than as a passenger in a commercially licensed
aircraft.
5.3.8 Hazardous sports and pastimes: Taking part or practicing for any hazardous hobby, pursuit or any race not
previously declared and accepted by us


6 Premiums

6.1 You may pay the premiums on the premium due date or within the grace period.
6.2 You have a choice to pay the premium 30 days before the premium due date
6.3 You have to pay the premiums even if you do not receive renewal premium notice. There is no obligation on our part to send
you renewal premium notices or reminders.
6.4 You will be liable to pay all applicable taxes as levied or revised by the Government and other statutory authorities from time
to time.
6.5 If we receive any amount in excess of the required premium, we will refund the excess. We will not pay any interest on this
excess amount.
6.6 If we receive any amount lesser than the required premium and levies, we will not consider the same as premium till you pay
the deficit.
6.7 Insufficient premiums or excess premiums remitted shall be kept in deposit and the amounts kept in deposit shall not earn
any interest.


7 Lapse and Revival

7.1 If premiums are not paid within the grace period, your policy lapses. No benefits are then payable under your policy.
7.2 You can revive your policy within the policy term during its revival period of 2 years from the date of First Unpaid Premium.
7.3 You should write to us during the revival period requesting for revival.
7.4 You have to submit Good Health Declaration and satisfy other underwriting requirements, if any.
7.5 We may accept or reject your revival request. We will inform you about the same.
7.6 We may charge extra premium based on underwriting.
7.7 You have to pay all due premiums, not paid during the revival period, along with interest. The due premiums would include
installment premium including any extra premiums intimated to you at the inception of your policy. If at the time of revival,
an extra premium is charged, you shall pay that extra premium also.
7.8 Interest will be charged at a rate declared by us from time to time.
7.9 You cannot revive your policy after the revival period.


8 Claims

8.1 Death claim

8.1.1 The nomineeor the legal heir should inform the death of the life assured in writing, stating at least the policy number, cause of
death and date of death.
Page 16 of 36



8.1.2 We will require the following documents to process the claim:
- Original policy document
- Original death certificate from municipal / local authorities
- Claimants statement and claim forms in prescribed formats
- Hospital records including discharge summary, etc
- Any other documents including post-mortem report, first information report where applicable

8.1.3 Claim under the policy may be filed with us within 90 days of date of claim event.

8.1.4 However, without prejudice, in case of delay in intimation or submission of claim documents beyond the stipulated period in
the policy document, we, at our sole discretion, may condone such delay and examine the admissibility or otherwise of the claim, if
such delay is proved to be for reasons beyond the control of the nominee / claimant.

8.1.5 We will pay the claim to the assignee, if the policy is assigned.

8.1.6 If the policy is not assigned , we will pay the claim to
8.1.6.1 the nominee, if the nominee is not a minor
8.1.6.2 the appointee, if the nominee is a minor provided an appointee is appointed by you or to the legal guardians if there
is no appointee under the policy and the death claim arises during the minority of the nominee
8.1.6.3 your legal heir, if nomination is not valid.

8.2 Survival Claim

8.2.1 You cannot apply for survival claim as there is no survival benefit in your policy.

8.3 Maturity Claim

8.3.1 You cannot apply for maturity claim as there is no maturity benefit in your policy.

8.4 Surrender claim

8.4.1 You cannot apply for surrender claim as there is no surrender benefit in your policy.


9 Termination

9.1 Termination of death cover

The death cover will terminate on the earliest of the following:

9.1.1 End of the grace period following discontinuation of premium.
9.1.2 The date on which your policy terminates.
9.1.3 Date on which we receive your free-look cancellation request.

9.2 Termination of your policy

Your policy will terminate at the earliest of the following:

9.2.1 on settlement of death benefit.
9.2.2 on the date of expiry of policy term.
9.2.3 on payment of free-look cancellation amount.
9.2.4 at the end of revival period, if not revived.
9.2.5 on receipt of surrender request.




Page 17 of 36

10 General Terms

10.1 Free-look period

10.1.1 You have 30 days from the date of receipt of this policy document to review its terms and conditions. If you are not satisfied,
you can return the policy stating the reasons for your objection.

10.1.2 We will then refund the premium paid after deducting the stamp duty paid, cost of medical expenses, if any, proportionate risk
premium for the period of cover and the proportionate taxes.

10.1.3 You cannot revive, reinstate or restore your policy once you have returned your policy.

10.1.4 We will not pay any benefit under your policy after we receive your free-look cancellation request.

10.2 Suicide exclusion

10.2.1 If the life assured, whether sane or insane, commits suicide, within one year from the date of commencement of policy or date
of revival, we will not pay the death benefit.

10.2.2 We will only pay 80% of the premium paid. We will not consider taxes and extra premiums for the refund. In case of death
due to suicide within one year of date of revival, we will not pay any benefits.

10.3 Policy loan

10.3.1 Your policy will not be eligible for any loan.

10.4 Nomination

10.4.1 You have to make a nomination as per provisions of section 39 of the Insurance Act, 1938.

10.4.2 You have to write to us if you want to change the existing nominees.

10.4.3 You have to make a fresh nomination when you get your policy re-assigned to yourself.

10.4.4 Nomination is for the entire policy and not for a part of the policy.

10.4.5 We do not express any opinion on the validity or accept any responsibility in respect of any nomination you make.

10.5 Assignment

10.5.1 You have to write to us for effecting an assignment of your policy.

10.5.2 On assignment, the assignee will be the sole owner of the policy.

10.5.3 You have to make an assignment as per provisions of section 38 of the Insurance Act, 1938.

10.5.4 Assignment is for the entire policy and not for a part of the policy.

10.5.5 You have to submit your policy document along with a valid and duly attested deed of assignment.

10.5.6 We will effect the assignment by endorsing your policy.

10.5.7 The assignment shall be binding on the Company only from the date on which your assignment is duly registered with us and
not before, irrespective of the actual date of execution of the deed of assignment. If the deed of assignment is not properly executed,
we may, at our sole discretion, refuse to register the assignment.

10.5.8 Assignment will automatically cancel any existing nomination.

10.5.9 Assignment will not be permitted where the policy is under the Married Womens Property Act, 1874.

Page 18 of 36

10.5.10 We do not express any opinion on the validity or accept any responsibility in respect of any assignment you make.

10.6 Nondisclosure

10.6.1 We have issued your policy based on the statements in your proposal form, personal statement, medical reports and any other
documents.

10.6.2 If we find that any of this information is inaccurate or false or you have withheld any material information, we shall declare
your policy null and void but subject to section 45 of the Insurance Act, 1938.

10.6.3 We will not pay any benefits and we will also not return the amounts you have paid.

10.7 Grace period

10.7.1 You can pay your premiums within a grace period of 30 days from the due dates.

10.7.2 Your policy will be treated as in-force during the grace period.

10.7.3 If you do not pay your due premiums before the end of grace period, your policy lapses.

10.7.4 You may revive your policy during the revival period.

10.7.5 If death occurs during the grace period, we shall deduct the unpaid premium from the claim amount.

10.7.6 If death occurs during the grace period, the effective sum assured will be paid assuming that the last due premium was paid.


10.8 Misstatement of age

10.8.1 If we find that the correct age of the life assured is different from that mentioned in the proposal form, we will check your
eligibility for the life cover as on the date of commencement.

10.8.1.1 If eligible,

10.8.1.1.1 If the correct age is found to be higher, you have to pay the difference in premiums along with interest.

10.8.1.1.2 We will terminate your policy, if you do not pay the difference in premiums and applicable interest.

10.8.1.1.3 If the correct age is found to be lower, we will refund the difference in premiums without any interest.
10.8.1.2 If not eligible,

10.8.1.2.1 We will terminate your policy.


10.9 Participation in profits

Your policy does not participate in our profits.

10.10 Taxation

10.10.1 You are liable to pay service tax, cess and statutory levies as per the applicable rates, along with the premium.

10.10.2 We shall collect the taxes and statutory levies along with the premium.

10.10.3 Taxes may change subject to future changes in taxation laws.

10.11 Date formats

10.11.1 Unless otherwise stated, all dates described and used in the policy schedule are in dd/mm/yyyy formats.

10.12 Electronic transactions
Page 19 of 36


10.12.1 We shall accept premiums and pay benefits through any approved modes including electronic transfers.

10.13 Notices

10.13.1 We will communicate to you in writing and deliver the correspondence by hand, post, facsimile, e-mail or any other approved
mode.

10.13.2 We will send correspondence to the mailing address you have provided in the proposal form or to the changed address that is
intimated to us and recorded by us.

10.13.3 You should also communicate in writing and deliver the correspondence by hand, post, facsimile, e-mail or any other
approved mode.

10.13.4 All your correspondence should be addressed to:
SBI Life Insurance Company Limited,
Central Processing Centre,
Kapas Bhawan, Sector 10,
CBD Belapur,
Navi Mumbai 400 614.
Phone : 022 - 6645 6241
E-mail: info@sbilife.co.in

10.13.5 It is important that you keep us informed of your changed address.


11 Complaints

11.1 Grievance Redressal procedure

11.1.1 If you have any query, complaint or grievance, you may approach any of our offices.

11.1.2 You can also call us on our toll-free number.

11.1.3 If you are not satisfied with our decision or have not received any response within 10 working days, you may write to us at:
Head Client Relationship,
SBI Life Insurance Company Limited
Central Processing Centre,
Kapas Bhawan, Sector 10,
CBD Belapur,
Navi Mumbai 400 614.
Telephone No: 022 6645 6241
Fax: 022 6645 6655
Email Id: info@sbilife.co.in

11.1.4 In case you are not satisfied with our decision, and the issue pertains to provision 12 (1) of the Redressal of Public Grievances
Rules, 1998, you may approach the Insurance Ombudsman. You can lodge the complaint with the Ombudsman as per
provision 13 of the said rules. The relevant provisions have been mentioned in the section Relevant Statutes.

11.1.5 The address of the Insurance Ombudsman and the Redressal of Public Grievances Rules, 1998, are, available in the website of
IRDA, http://www.irdaindia.org and in our website http://www.sbilife.co.in. The address of the ombudsman at Mumbai is:
Office of the Insurance Ombudsman (Maharashtra and Goa)
3
rd
Floor, J eevan Seva Annexe,
S.V. Road, Santa Cruz (W),
Mumbai 400 054.
Phone: +91 22 2610 6928
Fax: +91 22 2610 6052
Email: ombudsmanmumbai@gmail.com

11.1.6 We have also enclosed the addresses of the insurance ombudsman.
Page 20 of 36


12 Relevant Statutes

12.1 Governing laws and jurisdiction
12.1.1 This is subject to prevailing Indian Laws. Any dispute that may arise in connection with this shall be subject to the jurisdiction
of the competent Courts of Mumbai.

12.2 Section 41 of the Insurance Act 1938
12.2.1 (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or
continue an insurance in respect of any kind of risk relating to lives 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 rebate as may be allowed in accordance with the published prospectuses or tables of the insurer:
Provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on
his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such
acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the
insurer.
(2) Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five
hundred rupees.

12.3 Section 45 of the Insurance Act 1938
12.3.1 No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of
commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two
years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal
for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of
the policy, was inaccurate or false, unless the insurer shows that such a statement was on a material matter or suppressed facts which it
was material to disclose and that it was fraudulently made by the policy-holder and that the policy holder knew at the time of making
it that the statement was false or that it suppressed facts which it was material t o disclose; Provided that 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.

12.4 Provision 12 (1) of Redressal of Public Grievances Rules, 1998
The Ombudsman may receive and consider
(a) Complaints under Rule 13
(b) Any partial or total repudiation of claims by an insurer
(c) Any dispute in regard to premium paid or payable in terms of the policy
(d) Any dispute on the legal construction of the policy, insofar as such disputes relate to claims
(e) Delay in settlement of claims
(f) Non-issue of any insurance document to customers after receipt of premium

12.5 Provision 13 of Redressal of Public Grievances Rules, 1998
(1) any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint in writing to the
Ombudsman within whose jurisdiction the branch or office of the insurer complained against is located.
(2) the complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly the name and
address of the complainant, the name of the branch or office of the insurer against which the complaint is made, the fact giving
rise to complaint supported by documents, if any, relied on by the complainant, the nature and extent of the loss caused to the
complainant and the relief sought from the Ombudsman.
(3) no complaint to the Ombudsman shall lie unless
(a) the complainants had before making a complaint to the Ombudsman made a written representation to the insurer named in
the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period of
one month after the insurer concerned received his representation or the complainant is not satisfied with the reply given to
him by the insurer.
(b) the complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the
representation of the complainant, and
(c) the complaint is not on the same subject matter, for which any proceedings before any Court, or Consumer Forum or
Arbitrator is pending or were so earlier

***********************************************End of Policy Booklet*******************************************



Page 21 of 36


13 Index
A
AccidentalDeathBenefit 11,13,14,15,16
Age 11,13,19,21
Appointee 13,17
B
Beneficiary 13
D
DeathBenefit 11,13,14,15,16,17,18
E
EffectiveSumAssured 11,13,14,15,19
Endorsement 13
F
Freelook 11,13,17,18
G
Graceperiod 11,13,16,17,19
I
Inforce 13,15,19
InitialSumAssured 13,14
Installmentpremium 13,16
InsuranceRegulatoryandDevelopmentAuthority(IRDA) 14,20
L
Lapse 11,13,16
LifeAssured 13,14,15,16,18,19
M
Minor 13,17
N
Nominee 13,16,17
O
Our 13,14,15,16,17,18,19,20
P
Paidup 11,15
Participating 13
Policy 11,13,14,15,16,17,18,19,21
Policyanniversary 13,14
Policydocument 13,17,18
PolicySchedule 13,19
PolicyTerm 14
Policyyear 14
Policyholder 13,14
Premium 13,14,15,16,17,18,19,21
Premiumfrequency 14
Premiumpaymentterm 14
R
Revival 11,14,16,17,18,19
Revivalperiod 14,16,17,19
S
Surrender 11,14,15,17
SurrenderValue 15
U
UIN 14
Underwriting 14,16
Us13,14,16,17,18,20
W
We 14,15,16,17,18,19,20
Y
You 13,14,15,16,17,18,19,20

Page 22 of 36
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,2ndFloor,
AmbicaHouse,Nr.C.U.ShahCollege,AshramRoad,
AHMEDABAD380014.
Tel.:07927546840Fax:07927546142
Email:ins.omb@rediffmail.com
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
JanakViharComplex,2ndFloor,6,MalviyaNagar,
Opp.Airtel,NearNewMarket,
BHOPAL(M.P.)462023.
Tel.:07552569201Fax:07552769203
Email:bimalokpalbhopal@airtelmail.in
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
62,ForestPark,
BHUBANESHWAR751009.
Tel.:06742596455Fax:06742596429
Email:ioobbsr@dataone.in
Insurance Ombudsman
OfficeoftheOmbudsman NameoftheOmbudsman ContactDetails AreasofJurisdiction
ListofOmbudsmen*:
AHMEDABAD ShriP.Ramamoorthy Gujarat,UTofDadra&NagarHaveli,
DamanandDiu
BHOPAL MadhyaPradesh&Chhattisgarh
BHUBANESHWAR ShriB.P.Parija Orissa
CHANDIGARH Shri Manik Sonawane Punjab Haryana Himachal Pradesh
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
S.C.O.No.101103,2ndFloor,BatraBuilding.Sector17D,
CHANDIGARH160017.
Tel.:01722706468Fax:01722708274
Email:ombchd@yahoo.co.in
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
FathimaAkhtarCourt,4thFloor,453(old312),
AnnaSalai,Teynampet,
CHENNAI600018.
Tel.:04424333668/5284Fax:04424333664
Email:chennaiinsuranceombudsman@gmail.com
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,2/2A,
UniversalInsuranceBldg.,AsafAliRoad,
NEWDELHI110002.
Tel.:01123239633Fax:01123230858
Email:iobdelraj@rediffmail.com
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
JeevanNivesh,5
th
Floor,
NearPanbazarOverbridge,S.S.Road,
GUWAHATI781001(ASSAM).
Tel.:03612132204/5Fax:03612732937
Email:ombudsmanghy@rediffmail.com
Delhi&Rajasthan
CHANDIGARH Shri Manik Sonawane Punjab,Haryana,HimachalPradesh,
Jammu&Kashmir,UTofChandigarh
CHENNAI TamilNadu,UTPondicherryTownand
Karaikal(whicharepartofUTof
Pondicherry)
NEWDELHI ShriSurendraPalSingh
GUWAHATI ShriD.C.Choudhury Assam,Meghalaya,Manipur,
Mizoram,ArunachalPradesh,Nagaland
andTripura
Page 23 of 36
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,6246,
1stFloor,MoinCourt,A.C.Guards,LakdiKaPool,
HYDERABAD500004.
Tel:04065504123Fax:04023376599
Email:insombudhyd@gmail.com
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
2ndFloor,CC27/2603,PulinatBldg.,
Opp.CochinShipyard,M.G.Road,
ERNAKULAM682015.
Tel:04842358759Fax:04842359336
Email:iokochi@asianetindia.com
Ms.ManikaDatta
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
4thFloor,HindusthanBldg.Annexe,4,C.R.Avenue,
Kolkatta700072.
Tel:03322124346/(40)Fax:03322124341
Email : :iombsbpa@bsnl in
AndhraPradesh,KarnatakaandUTof
YanamapartoftheUTof
Pondicherry
OfficeoftheOmbudsman NameoftheOmbudsman ContactDetails AreasofJurisdiction
ShriR.Jyothindranathan Kerala,UTof(a)Lakshadweep,(b)
MaheapartofUTofPondicherry
KOLKATA Ms.ManikaDatta WestBengal,Bihar,JharkhandandUT
ofAndeman&NicobarIslands,Sikkim
HYDERABAD
KOCHI
Email::iombsbpa@bsnl.in
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
JeevanBhawan,Phase2,6thFloor,
NawalKishoreRoad,Hazaratganj,
LUCKNOW226001.
Tel:05222231331Fax:05222231310
Email:insombudsman@rediffmail.com
InsuranceOmbudsman,
OfficeoftheInsuranceOmbudsman,
S.V.Road,Santacruz(W),
MUMBAI400054.
Tel:02226106928Fax:02226106052
Email:ombudsmanmumbai@gmail.com
UttarPradeshandUttaranchal
MUMBAI Maharashtra,Goa
Web:www.gbic.co.in
3rdFloor,JeevanSevaAnnexe,3
rd
Floor,JeevanSevaAnnexe,
S.V.Road,Santacruz(W),S.V.Road,Santacruz(W),
LUCKNOW
MUMBAI400021MUMBAI400021.
Tel:02226106245Tel:02226106980
Fax:02226106949Fax:02226106949
Emailinscoun@gmail.com
*Updatedason07thNovember2012
OFFICEOFTHEGOVERNINGBODYOFINSURANCECOUNCIL
Shri M.V.V. Chalam,SecretaryGeneralTheSecretary
ShriG.B.Pande
Page 24 of 36
PROPOSAL FORM SBI LIFE eShield
(UIN: 111N089V01)
SBI LIFE INSURANCE COMPANY LTD.
Natraj, M.V. Road & Western Express Highway Junction,
Andheri (East),Mumbai - 400 069.
1. ARE YOU AN EXISTING SBI LIFE CUSTOMER?
3.DETAILS OF LIFE TO BE ASSURED
11/MAR/1981 Gender
CountryofResidence
ProposerName
Father's Name
DateofBirth
AgeProof
IdentityProof
Qualifications
Mr.KrishnaMohanChegu
ChGangaRam
Male
India
BirthCertificate
DrivingLicense
PostGraduate
:-
:-
:-
:-
:-
:-
:-
:-
Nationality Indian
:-
AadharNo:-
(UniqueIdentificationNo.)
MaritalStatus
AreyouaPoliticallyExposedPerson(PEP)oracloserelativeofPEP
PEPsareindividualswhoareorhavebeenentrustedwithprominentpublicfunctions,i.e.heads/ministersofcentral/stategovt.,seniorpoliticians,
seniorgovt,judicialormilitaryofficials,seniorexecutivesofgovt.companies,importantpoliticalpartyofficials,immediatefamilymemberofabove
persons(wouldincludespouse,parents,siblings,children,spousesparentsorsiblingsandcloseassociatesofpeps.)
Doyouhaveanyhistoryofconvictionunderanycriminalproceedingsin
Indiaorabroad.
AnnualIncome(inRs.) PAN
IncomeProof SalarySlip
Domicile
Urban
Areyouexposedtoanyspecialhazardassociatedwithyouroccupation
(e.g.chemicalfactory,mines,explosives,corrosives,
combativeduties,oilexploration,highseavoyageetc.)
whichmayrenderyoususceptibletoinjuriesorillnesses?

No
No
2.IS LIFE ASSURED AN INSURANCE ADVISER OF SBI LIFE?
No
Married Occupation Service
No

500000 AZOPM2915R
577318478620
No
:- :-
:-
:-
:- :-
NameOfemployer
:- VANDANAGLOBALLTD
Designation SAPCONSULTANT :-
Lengthofservice 2
:-
AddressOf
employer
:-
VANDANABHAWAN,VANDANAGLOBALLTD,MGROAD,RAIPUR
Years
Proposal No. : 1GPZ002413 Date & Time: 12-Sep-2013 16:48:50
Page 25 of 36
PinCode
Tel.No.(Home)
Tel.No.(Office)
AddressLine1
AddressLine2
AddressLine3
State
MobileNo
EmailID
S/oCHGANGARAM
R.K.RAUTOMOBILES
OLDMARKET,MAINROAD,DALLIRAJHARA
491228 DURG
City
CHATTISGARH
cheks1238@yahoo.co.in
0861-2312482
- 8602346511
:-
:-
:-
:-
:-
:-
:-
:-
:-
:-
4. Communication Address
AddressProof RationCard
:-
AddressLine1
AddressLine2
AddressLine3
City
PinCode
S/oCHGANGARAM
R.K.RAUTOMOBILES
OLDMARKET,MAINROAD,DALLIRAJHARA
DURG 491228
State CHATTISGARH
:-
:-
:-
:-
:-
:-
:-
:-
:-
:-
:-
City :- DURG
Gender
Female :-
5. Permanent Address :
6. NOMINEE DETAILS
Relationshipwiththe
Proposer
FullName
Nominee/Appointee
Address
DateofBirth
Mrs.MADHURICHEGUCHEGU
S/oCHGANGARAMR.K.R
AUTOMOBILESOLDMARKET,MAIN
ROAD,DALLIRAJHARA
04-Apr-1985
State CHATTISGARH
PinCode 491228
Wife
:-
RelationshipwiththeLifetobeAssured:
RelationshiptotheNominee:
FullName
DateofBirth Gender NA
NA
NA
NA
NA
:-
:-
:-
:-
:-
6.1. APPOINTEE DETAILS:
Proposal No. : 1GPZ002413 Date & Time: 12-Sep-2013 16:48:50
Page 26 of 36
7. DETAILS OF THE INSURANCE COVER PROPOSED:
7.1 BASIC PLAN DETAILS:
DoyouconsumeorhaveeverconsumedTobaccoinanyform(Cigarettes/Beedis/
Gutka/Cigar,etc)?
No
Plan(ReferProductSalesBrochurefor
benefitsapplicable)
PolicyTerm(Yrs.) SumAssured PremiumPayable
AnnualPremium(A) 4257.50
ServiceTaxAmount(B) 527
TotalInstallmentPremium(A+B) 4785
27 2500000 4785 SBILife-eShield-LevelCover
"ServiceTaxpayablemayvaryasperthetaxationlawsthenapplicable."
"ThemaximumAccidentalDeathBenefitSumAssuredisrestrictedtoRs.50LakhsforallpoliciesownedbytheLife
AssuredundereShieldProduct".
10. FAMILY HISTORY OF THE LIFE TO BE ASSURED :
Relation Alive/NotAlive PresentAge/
AgeatDeath
Haveanyofyourparents,brothersorsistersdiedorsuffered
fromanyofthediseases/disordersspecifiedbelow?*
NatureofDisorder* Particulars,includingdateof
diagnosis.Ifnotalive,specify
causeofdeath.
Father Alive 61
Mother Alive 56
Spouse Alive 27
11. MEDICAL AND OTHER DETAILS OF THE LIFE TO BE ASSURED:
Height Weight 5'9" 72kgs
VisibleIdentificationMarks,Ifany
Yes
BlackmoleonrightsideofHead
8. DETAILS OF PREMIUM REMITTANCE :
NameasitappearsinBankAccount/Debit/creditcard
BankAccountnumber/LastfourDigitofCreditCardNumber
chKrishnaMohan
NameofBank/Creditcardissuer StateBankofIndia
9658
PaymentOptionselected NetBanking
Previous Insurance Details
Nameof
InsuranceCo.
Policy/
Proposal
No.
Yearof
Issue
Product/Pl
an/Rider/
Option
Medical
(Y/N)
Yearly
Premium(`)
Sum
Assured
(`)
Self/Spouse/
Parent(Pls.
specify)
Policy
Status

9.1 DO YOU HAVE ANY OTHER INDIVIDUAL LIFE INSURANCE POLICY OR HAVE YOU APPLIED FOR ONE? No
9.2 Is any of your proposals rejected, declined, postponed or accepted with additional premium by any
insurance company?
No
Proposal No. : 1GPZ002413 Date & Time: 12-Sep-2013 16:48:50
Page 27 of 36
Duringthelastoneyear,hastherebeenanyincrease/decreaseinyourweightover5kgs?
No
Duringthelast10years,haveyouundergoneoradvisedtoundergohospitalizationoranoperationorany
investigationortestsorMedicalTreatment?
No
Duringthelast5years,whetheryouwereunderanymedicaltreatment,undergonesurgeryorregular
monitoringformorethan14consecutivedays?
No
Duringthelast5years,haveyouremainedabsentfromyourplaceofwork(professionalornon-professional)
ongroundsofhealthfor30consecutivedaysormore?
No
DoyouplanorhavebeenadvisedtoundergoanySurgery,orhospitalizationorvisittoadoctororpractioner
foranyphysical,mentaloremotionalcondition,injuryorsicknessinnearfuture?
No
DoyouhaveanyPhysicaldeformityorcongenital/acquireddefect?
No
HaveyouundergoneanytestforHIV?
No
IfYeswasHIVpresent?
No
Heartdisease(Chestpain,Vasculardiseaseetc)?
No
HaveyouundergoneanytestforHepatitis-A/B/C?
No
Ifyes,wasHepatitisA/B/CPresent?
No
Haveyoumetwithanyaccidentorsufferedfromanyphysicalimpairments/headinjuries/lossof
ConsciousnessDuetoaccident?
No
Haveyoueverbeentestedortreatedorhaveyoubeenadvisedtoundergoinvestigationforasexually
transmitteddisease?
No
DoyouhavehighBloodpressureorhaveyoueversufferedortreatedorhaveyoubeenadvisedtoundergo
investigationforHighBloodpressure?
No
DoyouhaveDiabetesorhaveyoueversufferedortreatedorhaveyoubeenadvisedtoundergo
investigationforDiabetes?
No
Areyousufferingfrom,ordidyousufferorundergoinvestigationinthepastfromorhaveyoubeenadvised
toundergoinvestigationortreatmentfor:Cancer/Leukemia/Lymphoma?
No
Kidneydisease(stones,bloodinurineetc)?
No
Liverdisease(Jaundice/Hepatitisetc)?
No
DigestiveDisorder(Ulcer,Gastricbleedingetc)?
No
Lung/Respiratorydisease(TB,Asthma,Pneumoniaetc)?
No
Goitre/Thyroid/OtherEndocrinediseases?
No
Bone/Joint/Backdisease/Arthritisetc?
No
Mentaldisorders(depression,anxietyetc)?
No
Chronicinfections/Circulatory/Blooddisorder?
No
Brain/Nervoussystemdisease/Stroke?
No
Tumor/Cysts/Anyotherunusualgrowth/Lumps?
No
Eyedisease/Eardisorders?
No
Skindisorders(psoriasisetc)?
No
Proposal No. : 1GPZ002413 Date & Time: 12-Sep-2013 16:48:50
Page 28 of 36
13. DETAILS OF HOBBIES AND PASTIMES:
14. DECLARATION BY THE LIFE TO BE ASSURED:
DoyouconsumeorhaveeverconsumedNarcoticsubstancesoraddictivedrugsinanyform?
DoyouconsumeorhaveeverconsumedTobaccoinanyform(Cigarettes/Beedis/Gutka/Cigaretc)
DoyouconsumeorhaveeverconsumedAlcoholinanyformorhaveyousufferedfromcomplicationsduetoalcohol
consumption?
No
No
No
Do you take part in any adventurous hobbies/activities that could be dangerous in any way, such as aviation (other than
fare paying passenger), mountaineering,any form of racing, etc?
No
Iherebydeclarethattheforegoingstatementsandanswershavebeengivenbymeafterfullyunderstandingthe
questionsandthesamearetrue,accurateandcompleteineverymannerandthatIhavenotwithheldoromittedto
giveanyinformation.Further,Ihavenotprovidedanyfalseinformationinreplytoanyquestion.Iunderstandand
agreethatthestatementsinthisproposalconstitutewarranties.Idoherebyagreeanddeclarethatthesestatements
andthisdeclarationshallbethebasisofthecontractofassurancebetweenmeandSBILifeInsuranceCo.Ltd.
(Company)andthatifthereisanymis-statementorsuppressionofmaterialinformationorifanyuntruestatementsbe
containedthereinthesaidcontractshallbeabsolutelynullandvoidandallmoneyswhichshallhavebeenpaidin
respectthereofshallstandforfeitedsubjecttosection45oftheInsuranceAct1938.
IalsounderstandandagreethatthecompanyshalladditionallylevyorrecoveralltheapplicabletaxeslikeService
Tax,Surcharges,Cess,etc.fromthepremiumwhicharenecessitatedbyvariousenactmentsofCentraland/orState
Legislaturesfromtimetotime.
IundertaketoundergoallmedicaltestsasmayberequiredbytheCompanyforthegrantofinsurance.
Notwithstandingtheprovisionofanylaw,usage,customorconventionforthetimebeinginforceprohibitingany
doctor,hospitaland/oremployerfromdivulginganyknowledgeorinformationaboutmeconcerningmyhealth,
employmentonthegroundsofsecrecy,I,myheirs,executors,administratorsandassigneesoranyotherpersonor
personshavinginterestofanykindwhatsoeverinthepolicycontractissuedtome,herebyagreethatsuchauthority,
havingsuchknowledgeorinformation,shallatanytimebeatlibertytodivulgeanysuchknowledgeorinformationto
theCompany.
Ifurtheragreethatifafterthedateofsubmissionofthisproposalbutbeforetheissueofthepremiumreceiptbythe
Company(i)ifthereareanyadversecircumstancesconnectedwiththegeneralhealthofmyself,or(ii)ifaproposal
forassuranceonmylifemadetoanyotherinsurancecompanyhasbeenwithdrawnordroppedoracceptedatan
increasedpremiumorontermsotherthanasproposedbyme,or,(iii)ifthereisanychangeinmyoccupation,Ishall
forthwithintimatethesametoSBILifeInsuranceCo.Ltd.inwritingtoreconsiderthetermsofacceptanceofthis
proposal.Anyomissiononmyparttodososhallrenderthecontractofassuranceinvalid.Intheeventthatthis
proposalisnotconvertedintoapolicy,IagreethattheCompanyhastherighttorecoverfromme,anymedical
expensesincurredbytheCompany.IunderstandandagreethatSBILifewillnotberesponsibleforanydelayin
premiumpaymentirrespectiveofanymodeforremittanceopted.
IunderstandthesignificanceofthecontractandthatthecontractwillbegovernedbytheprovisionsoftheInsurance
Act,1938,ITAct,2000andtheIndianContractAct,1872,andthatthesamewillnotcommenceuntilwritten
communicationaboutacceptanceofthisproposalbythecompanyisreceivedbyme.Ialsoagreethattheamount
heldinproposal/policydepositshallnotearnanyinterest.
IfurtherstatethatIhavethoroughlyreadtheproductfeaturesandhavecompletelyunderstoodthetermsand
conditionsofthepolicyandagreethatbysubmittingthisapplicationthroughthecompanyswebsite,Iwillbeboundby
suchstatements/disclosuresofmaterialfactsinthesamemannerandtothesameextent,asifIhavesignedand
submittedthewrittenproposalforinsurancetothecompany.
"IfurtherrequestSBILIFEtosendmeanyinformationrelatingtomyproposals/policiesandIherebygivemyconsent
toreceivesuchinformationthroughSMS/Email/Phone/Letter,notwithstandinganyRegulations/Statutoryprovisions
tothecontrary.ThisconsentshallholdgoodevenifIregistermynumberwiththeNationalCustomerPreference
Register(NCPR)"
Iherebydeclarethatthedepositforthisproposalhasbeenpaidfrommyownsource/income.Ifurtherdeclarethat
thepremiumispaidfrommycredit/debitcard/internetbankaccount.
Section41oftheInsuranceAct,1938:
(1)Nopersonshallalloworoffertoallow,eitherdirectlyorindirectly,asaninducementtoanypersontotakeorrenew
orcontinueaninsuranceinrespectofanykindofriskrelatingtolivesorpropertyinIndia,anyrebateofthewholeor
partofthecommissionpayableoranyrebateofthepremiumshownonthepolicy,norshallanypersontakingoutor
renewingorcontinuingapolicyacceptanyrebate,exceptsuchrebateasmaybeallowedinaccordancewiththe
publishedprospectusesortablesoftheinsurer:
Proposal No. : 1GPZ002413 Date & Time: 12-Sep-2013 16:48:50
Page 29 of 36
Providedthatacceptancebyaninsuranceagentofcommissioninconnectionwithapolicyoflifeinsurancetakenout
byhimselfonhisownlifeshallnotbedeemedtobeacceptanceofarebateofpremiumwithinthemeaningofthis
sub-sectionifatthetimeofsuchacceptancetheinsuranceagentsatisfiestheprescribedconditionsestablishingthat
heisabonafideinsuranceagentemployedbytheinsurer.
(2)Anypersonmakingdefaultincomplyingwiththeprovisionsofthissectionshallbepunishablewithfinewhichmay
extendtofivehundredrupees
Section45oftheInsuranceAct,1938:
NopolicyoflifeinsuranceeffectedbeforethecommencementofthisActshallaftertheexpiryoftwoyearsfromthe
dateofcommencementofthisActandnopolicyoflifeinsuranceeffectedafterthecomingintoforceofthisActshall,
aftertheexpiryoftwoyearsfromthedateonwhichitwaseffected,becalledinquestionbyaninsurerontheground
thatastatementmadeintheproposalforinsuranceorinanyreportofamedicalofficer,orreferee,orfriendofthe
insured,orinanyotherdocumentleadingtotheissueofthepolicy,wasinaccurateorfalse,unlesstheinsurershows
thatsuchstatementswasonamaterialmatterorsuppressedfactswhichitwasmaterialtodiscloseandthatitwas
fraudulentlymadebythepolicyholderandthatthepolicyholderknewatthetimeofmakingitthatthestatementwas
falseorthatitsuppressedfactswhichitwasmaterialtodisclose;
Providedthatnothinginthissectionshallpreventtheinsurerfromcallingforproofofageatanytimeifheisentitledto
doso,andnopolicyshallbedeemedtobecalledinquestionmerelybecausethetermsofthepolicyareadjustedon
subsequentproofthattheageofthelifeinsuredwasincorrectlystatedintheproposal.
I,Mr.KrishnaMohanCheguunderstandandagreethatbysubmittingthisproposalthroughtheCompany'swebsite,I
willbeboundbysuchstatements/disclosuresofmaterialfactsinthesamemannerandtothesameextent,asifI
havesignedandsubmittedawrittenproposalforinsurancetotheCompany.
Place:-Raipur
Date:-12-Sep-2013
Proposal No. : 1GPZ002413 Date & Time: 12-Sep-2013 16:48:50
Page 30 of 36

SBI Life Insurance Co. Ltd, Corporate Office: "Natraj", M.V Road & Western Express Highway Junction, Andheri (East), Mumbai400069
Central Processing Center: Kapas Bhavan, Plot No.3A, Sector No.10, CBD Belapur, Navi Mumbai400614
PS41/Ver1.0/ 1 Feb 2013
Page 1 of 1
REQUESTFORCHANGEINPOLICYDETAILS
Please use separate form for each policy::Kindly fill all details in capitals::Any Corrections in the form need to be counter signed.
To,
SBI Life Insurance Co Ltd, Branch_________________

Date Policy No

Name of the Policy Owner


Contact No
Email ID
Kindly amend my policy as below
All fields are mandatory (At least one contact no is mandatory for processing your request. Contact nos mentioned above will be updated for future communication)
Change / Correction in Name Policy Holder Life Assured Nominee Appointee Life Beneficiary


Reason for Change (In case of Surname / Complete name Change)_________________________________________________
Change will be effected in all the policies where the client exists * For minor spelling corrections, supporting proof needs to be submitted
For married women with a change in surname, Marriage certificate or Declaration signed by two witnesses along with a copy of marriage invitation is needed.
For all other requests involving significant change a Gazette copy is required.
Change in Date of Birth Policy Holder Life Assured Nominee Appointee Life Beneficiary

Reason for Change: _____________________________________________________________________________________

Supporting proof attached: Birth Certificate School Certificate Passport PAN Driving Licence Others___________
Change in Premium Payment Frequency: Kindly change my payment frequency to: (Please tick the desired option)
Yearly Half Yearly Quarterly Monthly


One of the following Auto debit modes is mandatory for monthly frequency. Select one and fill up the corresponding mandate.
ECS Direct Debit Standing Instructions EFT (for State Bank Group Account holders only)

For other frequencies, we strongly advise that you take the advantage of one of our various alternate premium pay methods. Please enquire with our staff for full details.

Change in Premium

Change in Sum Assured

.
Change in Term / Vesting Age
Deletion of Rider: I would like to cancel the following riders: 1.______________________ 2.______________________
Update PAN Number (Self attested copy of the PAN Card is mandatory)
I have understood the meaning and scope of the change request form and take complete responsibility of the changes submitted by me. Any changes
in the Policy / Personal details are subject to the policy terms and conditions and relevant underwriting guidelines.







Note: Changes are subject to product terms & conditions. Some changes are subject to underwriting approval and evidence of insurability including medical
examinations as per the extant underwriting guidelines might be called for by SBI Life Insurance Company.

d d m m y y y y

Residence Office Mobile
s t d s t d m o b i l e


From d d m m y y y y TO d d m m y y y y
From Rs. TO Rs.
From Rs. TO Rs.
From Years TO Years


Signature of Policy Holder
Page 31 of 36






















Page 32 of 36

SBI Life Insurance Co. Ltd, Corporate Office: "Natraj", M.V Road & Western Express Highway Junction, Andheri (East), Mumbai400069
Central Processing Center: Kapas Bhavan, Plot No.3A, Sector No.10, CBD Belapur, Navi Mumbai400614
PS40/Ver1.0/ 1 Feb 2013
Page 1 of 1
REQUESTFORCHANGEINCONTACTDETAILS
To,
SBI Life Insurance Co Ltd, Branch __________________


Date Policy No


Name of the Policy Owner

Kindly amend my policy as below
Change in Address (Tick One) Correspondence Permanent Both
Request for Address change has to be submitted in person at any of the branches of SBI Life Insurance Co Ltd
Permanent Address must be of India and cannot be given as that of employer.
House # & Bldg / Society

Road / Sector & Landmark

City/Village & Taluka

District

State
Pin
Country


Any one of the following documents will be accepted as Residence proof and should be produced in original for verification by SBI
Life official along with one photo identity proof and the form (Tick )
Driving License Passport Election ID Card Aadhar Card Ration Card Utility Bills not older than 6 months*
Rent/Lease agreement with last 3 months rent receipts Letter from recognized Public Authority
Bank passbook/ Account Statement with transactions till previous month Others (specify)_________________________
*Gas Bill not older than 3 months
Any one of the following documents will be accepted as photo identity proof and should be produced in original for verification by
SBI Life official along with the form (Tick )
Driving License Passport Pan Card PIO Card with photograph Election ID Card Aadhar Card
Armed forces ID Card with Photograph Bank Passbook with photo Employer ID Card Ration Card with photo
Change in Contact Number / Email ID

(For office use only. To be filled in by Branch)
I confirm that the customer has visited the branch. I also confirm that I have verified the originals of the above documents.

Name & Designation: _________________________________,
Date_____________ Employee Code : ____________
Branch : ____________

Changes done in Portal on __________________. Changes done by:
Sign & Name: ____________________________________________________
Designation & Employee Code: ______________________________________
d d m m y y y y


Residence Office Mobile
Contact No



Email ID

Signature of SBIL Employee

Signature of Policy Holder
Page 33 of 36






















Page 34 of 36






















Page 35 of 36






















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