Proposal Number 1KNA002454

COMMON ULIP PROPOSAL FORM

SBI LIFE INSURANCE COMPANY LTD.
Registered & Corporate Office: SBI Life Insurance Co. Ltd, Natraj, M.V. Road & Western Express Highway Junction, Andheri (East), Mumbai
- 400 069.IRDAI Registration no. 111.
website: www.sbilife.co.in | Email: info@sbilife.co.in | CIN: U99999MH2000PLC129113 | Toll Free: 1800 22 9090 (Between 9:00 AM & 9:00 PM)
"IN CASE OF UNIT LINKED INSURANCE POLICIES THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER"

Channel Name

Corporate Agency(SBG)

Product Code

1K

Proposal Number

Product Name

SBI Life - Smart Wealth Builder

1KNA002454

Plan Option

Limited

Channel Details(This section is filled by Sales Representative)

IA/CIF/SP Code

990515913

IA/CIF Name

SRIKANTH GUDIPATI

Bank/Broker/CA Code

04

Bank/Broker/CA Bank Name

State Bank Of Mysore

Sourcing Branch Code

345

Sourcing Branch Name

12/517-A, OPP TTD

KALYANAMANDAPAM

Selling Branch Code

40345

For Alternate Channel / Corporate Agency(SBG) only

Code 1

Code 2

Code 3

1. Are You an Existing SBI Life Customer

No

2. Whether Proposal is Under : (please submit relevant Questionnaire/annexure/supporting

documents along with the Proposal form as applicable)

State Bank Group Staff

3. Simultaneous Proposals (If any)

4. Preferred Language For Communication

English
5. PROPOSER DETAILS

Proposer Name

Mr. srikanth gudipati

Father's Name

g suryanarayana

Gender

Male

Date of Birth

19-09-1985

Nationality

Indian

Country of Residence

Age Proof

Pancard

Identity Proof

Pancard

Marital Status

Married

Qualification

Post Graduate

Occupation
Name and Address of Employer/Business Organisation/Work Place
Exact Nature of your Duties

India

Service
state bank of mysore
banking

Employee Number/Force Number

Are you exposed to any special hazard associated with your occupation(e.g chemical factory,
mines, explosives, corrosives, combative duties, oil exploration, high sea voyage etc.) which may
render you susceptible to injuries or illnesses?

No

Are you a Politically Exposed Person (PEP) or a close relative of PEP? (PEPs are individuals

No
1

Proposal Number 1KNA002454

who are or have been entrusted with prominent public functions, i.e. heads / ministers of central /
state govt., senior politicians, senior govt, judicial or military officials, senior executives of govt.
companies, important political party officials, immediate family member of above persons (would
include spouse, parents, siblings, children, spouses parents or siblings and close associates of
PEPs.)
Do you have any history of conviction under any criminal proceedings in India or abroad
Please indicate whether you or
your spouse is working / retired
from State Bank Group

Yes

Annual Income

No

Self :PF/Pension Index/ Employee

No

Rs. 500000

Self-Employee No28493,OrganizationName - State

Bank of Mysore (SBM)

Source of Income

Please submit self attested copy of PAN Card or PAN Exemption form if annualised premium under this proposal is Rs. 50,000 or above
If total premium paid by you is Rs. 1 lakh and above please submit documents to show the fund source.
Pan Card No

AQAPG0793Q

Income Proof

Not Applicable

Document Submitted for annualised premium Rs. 50,000 or above

Domicile

Urban

Copy of PAN
Aadhar Number

Communication Address

S/o, gudi pati suryanarayana, 12/517-A maruthi nagar, opp TTD

kalyanamandapamu maruthi nagar guntakal anantapurGUNTAKAL, 515801, ANDHRA PRADESH

Mobile Number

9916565874

Email Id

Tel.No(Home)

gsrikanth14@gmail.com

Alternate Contact No.

Communication Address Proof

Aadhar Card

Indian Permanent Address

S/o, gudi pati suryanarayana, 12/517-A maruthi nagar, opp TTD

kalyanamandapamu maruthi nagar guntakal anantapurGUNTAKAL, 515801, ANDHRA PRADESH

Indian Permanent Address Proof

Aadhar Card
6. MINOR / LIFE ASSURED DETAILS(Same as Proposer)

Name

Mr. srikanth gudipati

Address

S/o, gudi pati suryanarayana, 12/517-A maruthi nagar, opp TTD

kalyanamandapamu maruthi nagar guntakal anantapurGUNTAKAL, 515801, ANDHRA PRADESH

Gender

Male

Date of Birth

Relationship with the Proposer

Life Assured is same as Proposer

Age Proof

19-09-1985
Pancard

7. NOMINEE DETAILS

Nominee Name

Mrs. sandhya B

Gender

Female

Date of Birth

Relationship with the Proposer

Address

04-04-1989
Wife

S/o, gudi pati suryanarayana, 12/517-A maruthi nagar, opp TTD

kalyanamandapamu maruthi nagar guntakal anantapurGUNTAKAL, 515801, ANDHRA PRADESH
7.1. APPOINTEE DETAILS (Where nominee is a minor, details of an Appointee to be provided)

Appointee Name
Address
Gender

Date of Birth

Relationship with Life to be

Assured

Relationship to the Nominee

Signature of Appointee

Proposal Number 1KNA002454

8. DETAILS OF INSURANCE COVER PROPOSED

Plan Type

Limited

Plan Option

NA

Premium Frequency

Yearly

Objective of taking this Policy

Both

Basic Plan Details

Plan/Rider/option Benefit

Policy Term(Yrs)

Premium Paying Term(Yrs)

SAMF

Sum Assured(Rs)

Premium Payable(Rs)

Basic plan

10

10.0

500000

50000

Modal Premium Payable(Rs)

NA

50000

Fund Details
Min Allocation To any Plan/Funds is Nil,Max.100%.Allocation to Diffrent Plans/Funds Should be in Multiple of 1%.If the Allocation Percantage is not Equal to 100%,the Proposal Form will be
Returned to Define new Allocation.
Fund Option

Amount Invested(%)

Equity Fund

50 %

Equity Optimiser Fund

0%

Growth Fund

0%

Balanced Fund

30 %

Bond Fund

20 %

Money Market Fund

0%

Top 300 Fund

0%

9. Details Of Premium Remittance

Is deposit for premium under this proposal paid by you

Yes

10. Mode of Payment of Renewal Premium

EFT (Available only through SBG Branches)

11. Do you have any other individual life insurance policy or have you applied for one

No

12. FAMILY HISTORY OF THE LIFE TO BE ASSURED

Relation

Alive/Not Alive

Present Age/Age at Death

Present Health State

Father

Alive

63

Good

Mother

Alive

51

Good

Spouse

Alive

26

Good

Brother

Alive

32

Good

Sister

Alive

26

Good

Daughter

Alive

Good

Nature of Disorder

Particulars,including date of diagnosis.if

not alive,specify cause of death.

13. MEDICAL AND OTHER DETAILS OF THE LIFE TO BE ASSURED

1A) Height

170.18 Cms

1B) Weight

59 Kgs

Proposal Number 1KNA002454

2) Visible Identifications marks, if any

No

3) During the last one year, has there been any increase/decrease in your weight over 5 Kgs ?

No

4) During the last 10 yrs, have you undergone or advised to undergo hospitalization or an operation or any investigation
or tests or Medical treatment ?

No

5) During the last 5 yrs, whether you were under any medical treatment or regular monitoring for more than 14
consecutive days ?

No

6) During the last 5 yrs, have you remained absent from your place of work (Professional or Non Professional) on
grounds of health, injury, mental condition or sickness for 30 consecutive days or more ?

No

7) Do you plan or have been advised to undergo any surgery or hospitilization or visit to a doctor or practitioner for any
physical, mental or emotional condition, injury, or sickness in near future ?

No

8) Do you have any Physical Deformity or congenital/acquired defect ?

No

9) Have you undergone any test for HIV ?

No

10) Have you undergone any test for Hepatitis A/B/C ?

No

11) Have you met with any accident or suffered from any physical impairment/ head injuries/ loss of consciousness due
to any accident ?

No

12) Have you ever been tested or treated or have been advised to undergo investigation for a sexually transmitted
disease ?

No

13) Do you have High Blood Pressure or have you ever suffered or treated or have you been advised to undergo
investigation for High Blood Pressure ?

No

14) Do you have Diabetes or have ever suffered or treated or have you been advised to undergo investigation for
Diabetes?

No

15) Are you suffering from, or did you suffer or undergo investigation in the past from or have you been advised/ referred to undergo investigation or
treatment for any of the following conditions :
a) Cancer/ Leukemia/ Lymphoma

No

h) Bone/ Joint / Back Disease/

Arthritis

No

b) Kidney Disease(Stones, blood

in Urine, etc)

No

i) Mental Disorders(Depression,
Anxiety, etc)

No

c) Liver Disease(Jaundice/
Hepatitis, etc)

No

j) Chronic Infections/ Circulatory/

Blood Disorder

No

d) Heart Disease(Chest
Pain,Vascular Disease)

No

k) Brain/ Nervous System Disease/

Stroke

No

e) Digestive Disorder(Ulcer,
Gastric Bleeding, etc)

No

l)Tumor/ Cysts/ Any other unusual

growth/ Lumps

No

f) Lung/ Respiratory disease(T.B,

Asthma, Pneumonia, etc)

No

m) Eye Disease/ Ear Disorders

No

g) Goitre/ Thyroid/ Other

Endocrine Diseases

No

n) Skin Disorders(Psoriasis, etc)

No

16) Do you consume or have ever consumed Narcotic substances or addictive drugs in any form (Heroin, Ganja,
Cocaine)?

No

17) Do you consume or have ever consumed Tobacco in any form(Cigarettes/ Beedis/ Guthka/ Cigar, etc) ?

No

18) Do you consume or have ever consumed Alcohol in any form or have you suffered from complications due to
Alcohol consumptions ?

No

14. DETAILS OF HOBBIES AND PASTIMES

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, diving or any form of racing, etc?

No

15. PROPOSER BANK ACCOUNT DETAILS

Please Provide accurate details to avoid wrong payments as all future payouts from SBI Life shall be based on the information furnished here.

Proposal Number 1KNA002454

Bank Type

A/C No

SBG & Other Banks

64099575739

Name of the A/C Holder

Bank Name

Copy of Bank Statement

A/C Type

Savings

Mr srikanth gudipati
STATE BANK OF MYSORE

For State Bank Group

Branches,please provide Bank
Code
MICR Code

Documents submitted for direct

credit of any refunds/payouts if
any to this account

Bank Branch Name

INDIRANAGAR (HAL II
STAGE)

Branch Code

560006021

IFSC Code

Do you wish to avail direct credit of any refunds/ payouts if any to this account?

40345

SBMY0040345
Yes

I declare that the information given above is true and correct. I hereby authorise SBI Life to directly credit payout/refund, if any, to the above
mentioned account. I shall not hold SBI Life responsible for non-credit/nonpayment of payout or refund due to any reason including but not limited to
incorrect/incomplete information.I hereby authorise SBI Life to directly credit payout//refund,if any ,to the above mentioned account
Signature of Proposer

#Valid Resident Indian Account *Please submit original cancelled cheque/Authorisation Letter from Bank (In case cheque does not contain account holder name) along with Proposal Form. (Giving bank
account details will help speedy payment of payouts, if any, from SBI Life.)
Disclaimer: Please Note that account details provided above will be considered for direct credit of payout, if any, from SBI Life. SBI Life shall not credit payout/refund to any third party account under any
circumstances. SBI Life reserves right to use any alternative payout option such as cheque/demand draft in spite of providing above information. Decision of SBI Life in this regard shall be final and
binding upon Proposer/Life Assured

16. e-Insurance A/C details

Do you want to receive the Insurance Policy and all the information related to the proposed insurance policy through insurance repository ? No
Do you already have an e-Insurance A/C ? No

e-Insurance A/c No

Repository Name
17. DECLARATION BY THE PROPOSER

I state that the product features, the terms and conditions of the policy and the benefit illustration have been fully and thoroughly explained to me. I have
fully understood the said details and that I consent to the same.
I hereby declare that the foregoing statements and answers have been given by me after fully understanding the questions and the same are true, accurate
and complete in every manner and that I have not withheld any information.
Further, I have not provided any false information in reply to any question. I understand and agree that the statements in this proposal constitute
warranties.
I further state that the contents of the proposal form have been also fully explained to me and I have fully understood the significance of the proposed
contract.
I do hereby agree and declare that these statements and this declaration shall be the basis of contract of assurance between me and SBI Life Insurance
Co. Ltd. (Company) and that if there is any mis-statement or suppression of material information or if any untrue statements are contained therein or in
case of fraud, the said contract shall be treated as per the provisions of Section 45 of the Insurance Act 1938, as amended from time to time.
I understand and agree that by submitting this application through the tablet device, I shall be bound by such statements/disclosures of material facts in
the same manner and to the same extent, as if I have signed and submitted the written proposal for insurance to the company.
I also understand and agree to the various charges like Mortality Charges, Policy Administration Charges, Premium Allocation Charges, etc. which will
be recovered by the Company by way of cancellation of units/by deductions from the Premium at the rates approved by IRDAI.
I also understand and agree that the company shall additionally levy or recover all the applicable taxes like Service Tax, Surcharges, Cess, etc. from the
premium which are necessitated by various enactments of Central and/or State Legislatures from time to time.

Proposal Number 1KNA002454

I understand and agree that the Net Asset Value per Unit of the Investment Fund may increase or decrease as per the performance of the financial
market and other risks.
Notwithstanding the provision of any law, usage, custom or convention for the time being in force prohibiting any doctor, hospital and/or employer
from divulging any knowledge or information about me concerning my health, employment on the grounds of secrecy, I, my heirs, executors,
administrators and assignees or any other person or persons having interest of any kind whatsoever in the policy contract issued to me, hereby agree that
such authority, having such knowledge or information, shall at any time be at liberty to divulge any such knowledge or information to the Company.
I further agree that if after the date of submission of this proposal but before the issue of the premium receipt by the Company (i) if there are any
adverse circumstances connected with the general health of myself, or (ii) if a proposal for assurance on my life made to any other insurance company has
been withdrawn or dropped or accepted at an increased premium or on terms other than as proposed by me, or, (iii) if there is any change in my
occupation, I shall forthwith intimate the same to SBI Life Insurance Co. Ltd. in writing to reconsider the terms of acceptance of this proposal. Any
omission on my part to do so shall render the contract of assurance invalid.
In the event that this proposal is not converted into a policy, I agree that the Company has the right to recover from me, medical expenses (if any)
incurred by the Company. I understand and agree that SBI Life will not be responsible for any delay in premium payment, irrespective of any mode for
remittance opted.
I understand that the contract will be governed by the provisions of the Indian Insurance Act 1938, and other applicable Statutes and prevailing laws in
India and that the risk cover will not commence until a written acceptance of this proposal is issued by the Company and that the risk cover and other
benefits under the policy shall be subject to the terms and conditions contained in the contract of assurance.
I also agree that the amount held in proposal/policy deposit shall not earn any interest.
I further request SBI LIFE to send me any information relating to this proposal/resulting policy and I hereby give my consent to receive such
information through SMS/ Email/ Phone/ Letter, notwithstanding any Regulations/ Statutory provisions to the contrary. This consent shall hold good even
if I register my number with the National Customer Preference Register (NCPR).
I understand that the Company may have tie-ups with banks, financial institutions and third party service providers for verification of proposal details
and servicing of policies. I hereby authorize the Company to provide by details to such banks, financial institutions and third party service providers for
processing the insurance proposal and for servicing of my/our policies.
I hereby understand and agree that no physical policy document will be issued to me if I have requested for issuing this insurance policy in electronic
format to my eInsurance Account. I also agree to receive all policy related communications through electronic means i.e. email, sms, calls etc.
For Regular Premium Policyholders Only Please Note Smart Wealth Builder is a regular premium/limited premium policy and I am aware that I
would need to pay premium for 5 years (Premium Payment Term).
Signature of the Proposer

Signature of the Witness

Place :bangalore

Name And Address of Witness -hal 2nd stage

Date :22-07-2015

Section 41 of the Insurance Act, 1938, as amended from time to time.

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out 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 prospectus 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.

Proposal Number 1KNA002454

Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
Section 45 of the Insurance Act 1938, as amended from time to time
No policy of life insurance shall be called into question on any ground whatsoever after the expiry of three years from the date of policy. A policy of life
insurance may be called into question at anytime within three years from the date of policy, on the ground of fraud or on the ground that any statement of
or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which
the policy was issued or revived or rider issued. The insurer shall have to communicate in writing to the insured or legal representatives or nominees or
assignees of the insured, the grounds and materials on which such decision is based.
No insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the mis-statement or suppression of material fact was
true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis-statement or suppression are
within the knowledge of the insurer. In case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive.
In case of repudiation of the policy on the ground of misstatement or suppression of a material fact and not on the grounds of fraud, the premiums
collected on the policy till the date of repudiation shall be paid.
Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be
called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the
proposal.
For complete details of the section and the definition of 'date of policy', please refer Section 45 of the Insurance Act 1938, as amended from time to time.

Trade logo displayed above belongs to State Bank of India and is used by SBI Life under license.

SBI Life Insurance Co. Ltd Corporate Office: 'Natraj', M.V. Road and Western Express, Highway Junction, Andheri (East),Mumbai 400069.
Regn No. 111

Benefit Illustration for SBI LIFE - Smart Wealth Builder (UIN No -- 111L095V01)

Quotation Number

OL1K0009905159132207201505
3102

Proposer Name

Mr. srikanth gudipati

Insurance Regulatory & Development Authority (IRDAI) requires all life insurance companies operating in India to provide official illustrations to
their customers. The illustrations are based on the investment rates of return set by the Life Insurance Council (constituted under Section 64C(a) of the
Insurance Act 1938) and is not intended to reflect the actual investment returns achieved or which may be achieved in future by SBI life Insurance
Company Limited. The two rates of investment return currently declared by the Life Insurance Council are 4% and 8% per annum.
The main objective of the illustration is that the client is able to appreciate the features of the product and the flow of benefits in different
circumstances with some level of quantification. For further information on the product, its benefits and applicable charges please refer to the sales
brochure and/or policy document. Further information will also be available on request.
Some benefits are guaranteed and some benefits are variable with returns based on the future fund performance of SBI Life Insurance Company
Limited. If your policy offers guaranteed returns then the same will be clearly marked as guaranteed in the illustration table on this page. If your
policy offers variable returns then the illustration on this page will show two different rates of assumed future investment returns. These assumed rates
of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependent on a
number of factors including future fund investment performance.

Staff Discount

yes

Plan Details
Life Assured Age at Entry
Life Assured Gender
Annualised Premium
Mode

29 Years
Male
Rs. 50000
Yearly

Maturity Age
Term of the policy
Sum assured
Premium Payment Term

39 Years
10 Years
Rs. 500000
5 Years

Allocation and FMC to the Funds chosen

Fund Option

Amount Invested(%)

FMC

Equity Fund

50 %

1.35%

Equity Optimiser Fund

0%

1.00%

Growth Fund

0%

1.35%

Balanced Fund

30 %

1.25%

Bond Fund

20 %

1.00%

Money Market Fund

0%

0.25%

Top 300 Fund

0%

1.35%

No. of years elapsed since

10 Years

Reduction in Yield @ 8%

1.84 %

inception
Maturity At

10 Years

Reduction in Yield @ 8%

Assuming gross interest rate of 4% pa

1.84 %

Assuming gross interest rate of 8% pa

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

Policy
Year

Annualis
ed
Premium
*

Premium
Allocatio
n Charge

Amount
available
for
investme
nt(out of
premium
)

Policy
Administ
ration
Charge

Mortality
Charges

Total
Charges

Total
Service
Tax on
Charges

Fund
before
FMC

Fund
Manage
ment
Charge

Guarante
ed
Addition

Fund
value at
end

Surrende
r Value

Death
Benefit

Mortality
Charges

Total
Charges

Total
Service
Tax on
Charges

Fund
before
FMC

Fund
Manage
ment
Charge

Guarante
ed
Addition

Fund
value at
end

Surrende
r Value

Death
Benefit

Commiss
ion/
Brokerag
e if
payable

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

50000

50000

564

564

174

51236

630

50606

47606

500000

563

563

176

53208

643

52565

49565

500000

50000

2250

47435

515

515

575

101150

1240

99910

97910

500000

510

510

582

107145

1291

105854

103854

500000

50000

2250

47435

464

464

662

152377

1865

150512

149012

500000

453

453

678

164633

1981

162652

161152

500000

50000

2000

47720

410

410

717

205251

2511

202740

201740

500000

389

389

746

226217

2721

223496

222496

500000

50000

2000

47720

353

353

809

259521

3174

256347

256347

500000

316

316

855

291862

3509

288353

288353

500000

720

362

1082

642

264783

3243

261540

261540

500000

306

1026

707

309485

3726

305759

305759

500000

720

374

1094

653

270158

3309

266849

266849

500000

294

1014

739

328254

3951

324303

324303

500000

720

388

1108

666

275651

3376

272275

272275

500000

281

1001

774

348251

4191

344060

344060

500000

720

405

1125

678

281263

3445

277818

277818

500000

263

983

810

369560

4447

365113

365113

500000

10

720

424

1144

692

289494

3515

2500

285979

285979

500000

241

961

848

394771

4720

2500

390051

390051

500000

Net Yield - 6.17 %

*It is a base premium

Notes
1)Kindly note that above is only an illustration and does not in any way create any rights and/or obligations. The actual experience on the contract may
be different from what is illustrated. The non-guaranteed low and high rate mentioned above relate to assumed investment returns at different rates and
may vary depending upon market conditions. For more details on risk factors, terms and conditions please read sales brochure carefully.
2)The unit values may go up as well as down and past performance is no indication of future performance on the part of SBI Life Insurance Co. Ltd.
We would request you to appreciate the associated risk under this plan vis--vis the likely future returns before taking your investment decision.
3)The interest rates of 4 % and 8 % are gross rates i.e. taken before the deduction of Fund Management Charges (FMC).
4)Please read this benefit illustration in conjunction with Sales Brochure and the Policy Document to understand all Terms, Conditions & Exclusions
carefully.
5) It is assumed that the policy is in force throughout the term.
6) Surrender Value equals the Fund Value at the end of the year minus Discontinuance Charges. Surrender value is available on or after 5th policy
anniversary.
7) Acceptance of proposal is subject to Underwriting decision. Mortality charges are for a healthy person.
8)Currently the service tax applicable is 14% and is subject to any change in tax rates. The Service tax column in this illustration includes service tax
on FMC, Premium allocation charge, Policy administration charges, Mortality charges. (Service Tax on FMC is based on the existing tax laws
considering FMC rate as 1.35% p.a., the maximum prescribed by IRDAI). The surrender values will be subject to a further deduction of service tax,
wherever surrender penalty is applicable.
9)This policy provides guaranteed death benefit of Rs. 500000
10) Net Yields have been calculated after applying all the charges (except service tax, education cess, mortality charges).
11) This illustration has been prepared in compliance with the IRDAI (Linked Products) Regulations, 2013.
12) Col (24) gives the commission payable to the agent/ broker in respect of the policy .

Definition of Various Charges

Premium allocation charge is the percentage of premium that would not be utilised to purchase units.
Policy administration charges a charge of a fixed sum which is applied at the beginning of each policy month by canceling units for equivalent
amount.
Fund management charge is the deduction made from the fund at a stated percentage before the computation of the NAV of the fund.
Mortality charges are the charges recovered for providing life insurance cover.

I, Mr. srikanth gudipati

into the contract.

having received the information with respect to the above, have understood the above statement before entering

PolicyHolder's Signature
Place :bangalore

Date :22-7-2015

Marketing official's Signature

Place :bangalore

Date :22-7-2015