Date : 25 Jan, 2022

EA610352309IN
BNPL.MR/DA-NM/6 Customer No : 752754760
03/11-12
i&"d $ e*/_k
BHOPAL/2QCR114185- SP
Policy No : 2Q303356802
552/560

Product Name : SBI Life - Saral Jeevan Bima

i2$3d *Vak
To,
UIN : 111N128V01
Mr. Brij Bhushan Pal
H.NO 20
PIYUSH NAGAR
AWADHPURI
BHOPAL
MADHYA PRADESH-462022,India
Contact Details : 091 8319845220

Dear Mr. Brij Bhushan Pal,

We welcome you to the SBI Life family and thank you for your trust in our products.
Joining SBI Life family will give you access to the best customer service and to a wide range of products which cater to most of your life
insurance needs.
Please note that you have opted for a REGULAR premium payment insurance Policy. The premium due dates are: 22nd of every
month during Premium Payment Term
1. For any information/clarification, please contact : Your local SBI Life service branch:
BHOPAL, SBI LIFE INSURANCE CO LTD 2ND FLOOR, STAR SQUARE, PLOT NO. 3 ZONE - 12, KASTURBA NAGAR, ISBT, WARD NO. 58,
BHOPAL MADHYA PRADESH India 462023, +91-7554020759

2. In case you have any complaint/grievance you may contact the following official for resolution:
REGIONAL DIRECTOR,SBI LIFE INSURANCE CO. LTD.,SBI LIFE INSURANCE CO LTD 2ND FLOOR RANJEET TOWER PLOT NO 8
M.P.NAGAR ZONE 2 BHOPAL MADHYA PRADESH India 462011

3. We enclose the following as a part of the Policy booklet:

3.1 Policy Document.
3.2 First Premium Receipt.
3.3 Copy of proposal form signed by you.
3.4 Copy of KYC and other documents as follows:

Particulars Documents Received

Age Proof Pan card
Identity Proof AADHAAR Card No.
Address Proof AADHAAR Card No.
Consent & Revised Benefit Illustration No
Medical Reports No

4. In case of any clarification / discrepancy, call us toll free on our customer service helpline 18002679090 or email us at info@sbilife.co.in, also you
may visit us at www.sbilife.co.in.

5. Register on our Customer Self Service website http://mypolicy.sbilife.co.in to avail various online services available.

6. All your servicing requests should be submitted to your local SBI Life service branch as mentioned above or nearest SBI Life branch only.

7. Please note that the digitally signed copy of your policy document is available on our website www.sbilife.co.in. This can be viewed in a
secure manner through one time password. Please visit our website for details.
Please check all details. Please make sure that the policy document is kept safely.
"There is a waiting period of 45 days from the date of commencement during which there will be no insurance cover. However, this
Policy will only cover death due to accident during the waiting period of 45 days from the date of commencement of risk.
In case of Death of the Life assured other than due to accident during the waiting period of 45 days, an amount equal to 100% of all
premiums received excluding taxes, if any, shall be paid and the sum assured shall not be paid and the contract will terminate.”
Free Look Option
You can review the terms and conditions of the policy, within 15 days, from the date of receipt of the policy document, for policies other than
electronic policies and policies sourced through any channel other than Distance Marketing and within 30 days , from the date of receipt of the policy
document, for electronic policies and policies sourced through Distance Marketing, from the date of the receipt of the policy document and if you
disagree with any of the terms and conditions, you have the option to return the policy seeking cancellation of the policy, stating the reasons for your
objection. Premiums paid by you will be refunded after deducting stamp duty and cost of medical expenses incurred, if any, and applicable tax and/or
any other statutory levies/duty/surcharges. The proportionate risk premium along with the applicable tax and/or any other statutory
levies/duty/surcharges for the period of cover will also be deducted.
The Free look period applicable under this policy is 30 days. Your request for cancellation of this policy under the free look option must
reach your nearest SBI Life Office within a period of 30 days.

This Policy
We always look forward to be your preferred Life Insurance Company for all your Life Insurance needs.Document is digitally signed for SBI Life Insurance

Signer: Bipin Vishnu Dabholkar

Yours truly, Date: Friday,Jan 28 2022 01:11 PM
Location: Navi Mumbai
Reason:
Policy Encryption

Authorised Signatory
New Business Processing 613/625
Page 1 of 48 Policy No. 2Q303356802
 Date : 25 Jan, 2022

Customer No : 752754760
BHOPAL/2QCR114185-SP
Policy No : 2Q303356802
i2$3d *Vak
Product Name : SBI Life - Saral Jeevan Bima
To,
Mr. Brij Bhushan Pal UIN : 111N128V01
H.NO 20
PIYUSH NAGAR
AWADHPURI
BHOPAL
MADHYA PRADESH-462022, India
Contact Details : 091 8319845220

Dear Mr. Brij Bhushan Pal,

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BHOPAL,SBI LIFE INSURANCE CO LTD 2ND FLOOR, STAR SQUARE, PLOT NO. 3 ZONE - 12, KASTURBA NAGAR, ISBT, WARD
NO. 58, BHOPAL MADHYA PRADESH India 462023,+91-7554020759
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REGIONAL DIRECTOR,SBI LIFE INSURANCE CO. LTD.,SBI LIFE INSURANCE CO LTD 2ND FLOOR RANJEET TOWER PLOT NO 8
M.P.NAGAR ZONE 2 BHOPAL MADHYA PRADESH India 462011

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 SBI Life Insurance Company Ltd CIN:L99999MH2000PLC129113
Central Processing Centre
7th Level (D Wing) & 8th Level,
Seawoods Grand Central Tower 2, Plot No R-1,
Sector-40, Seawoods, Nerul Node, Dist. Thane,
i2d$E4k
Navi Mumbai-400 706
Phone Number: 022 6645 6000

FIRST PREMIUM RECEIPT/ TAX INVOICE

Invoice No : MPI012200071229
Proposal No : 2QCR114185 Invoice date : January 23, 2022
Sequence No : 69249
Policy No : 2Q303356802 Channel Code :
Channel Name :

Policy Holder Servicing Branch Address:

Mr. Brij Bhushan Pal SBI LIFE INSURANCE CO LTD 2ND FLOOR, STAR SQUARE,
H.NO 20 PLOT NO. 3 ZONE - 12, KASTURBA NAGAR, ISBT, WARD NO.
PIYUSH NAGAR 58, BHOPAL MADHYA PRADESH India 462023
AWADHPURI
BHOPAL - 462022
MADHYA PRADESH , India
Place of Supply:MADHYA PRADESH/23
GSTIN:N.A. GSTIN:23AAFCS2530P1Z9

Premium Payer Name : Mr. Brij B Pal

Premium Payer Relationship : Self
Mode : Monthly
Product/Plan :SBI Life - Saral Jeevan Bima
Date Of Commencement Of Policy : January 22, 2022
HSN code : 997132
Sum Assured :Rs.5,00,000.00/-
HSN Description : Life Insurance Services
Installment Premium : Rs.140.68/
Due date of Premium Payment : January 22, 2022 Taxable Value :Rs.140.68
Integrated GST 18% : Rs.0.00/-
State / UT GST 9% : Rs.12.66 /-
Payment Method : Online Selling
Central GST 9% : Rs.12.66/-
Total Premium Amount : Rs.166.00/-
No. of Premiums Paid : 01
Total Amount Received : Rs.167.00/-
Excess : Rs.0.00/-

Whether the tax is payable under Reverse charge : No

Next premium due on Feb 22, 2022

Amount of initial/first premium paid : Rs. 166.00/-
Rupees One Hundred Sixty Six Only
Received the amount as above.
Date of Commencement of Risk : January 22, 2022

Note : In case of any discrepancies, you are kindly requested to advise us immediately. Call us toll free at our customer service helpline
1800 267 9090 info@sbilife.co.in / www.sbilife.co.in
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.
TDS shall be deducted from the benefit proceeds (i.e. maturity, surrender etc) , as applicable, which are considered as taxable under the Income Tax Laws.
Tax laws are subject to change from time to time. Please consult your tax advisor for further details.
Goods & Service Tax (GST)/ Cess and/or any other statutory levy/ duty/surcharge, at the rate notified by the Central Government/ State Government
/ Union Territories of India from time to time, shall be levied on premium /charges (as applicable) as per the provisions of the prevalent tax laws.
As per GOI notification, GST has been levied on your insurance policy @18% on premium or charges. (or as applicable) w.e.f 01.07.2017. In the case
of endowment policy, the taxable value is 25% of the premium for first year and 12.5% for second & subsequent year. For single premium annuity policy, the
taxable value is 10% of the premium. Please refer SBI Life website for details.
'This Premium receipt is issued subject to realization of cheque'
GST Registration No.23AAFCS2530P1Z9. SAC code of Life Insurance Services: 997132

Authorized Signatory

Page 3 of 48 Policy No. 2Q303356802 613/625

Page 4 of 48 Policy No. 2Q303356802 613/625
 PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

KEY FEATURES DOCUMENT

Congratulations on your purchase. SBI Life – Saral Jeevan Bima (UIN: 111N128V01), an Individual Non-linked, Non-
Participating Life Insurance Pure Risk Premium Product, offers you

1 Aim of policy SBI Life – Saral Jeevan Bima is an Individual Non-linked, Non-Participating Life Insurance Pure
Risk Premium Product. It is a standard, individual term life insurance product, with simple
features and standard terms and conditions and is targeted towards the customer who finds it
difficult to select the right product among the complex products available in the market and who
would like to choose a simple life insurance product while making an informed choice.
2 Benefits of the policy Death Benefit:

There is a waiting period of 45 days from the date of commencement of the policy during
which there will be no insurance cover.
However, On death of the Life Assured due to Accident during the Waiting Period and
provided the Policy is in force and if the claim is found admissible, the Death Benefit amount
is payable as a lump sum and the Death Benefit will be as under:
In case of Accidental Death, for regular premium or limited premium payment policy,
death benefit will be equal to “Sum Assured on Death” which is the highest of:
a) 10 times of Annualized Premium, or
b) 105% of all premiums paid as on the date of death, or
c) Absolute amount assured to be paid on death.
In case of Accidental Death, for single premium policy, death benefit will be equal to
“Sum Assured on Death” which is the higher of:
a) 125% of Single premium or
b) Absolute amount assured to be paid on death.

On death of the Life Assured other than due to accident during the Waiting period of 45
days and provided the Policy is in force:

Death Benefit is limited to refund of 100% of all Premiums paid excluding taxes, if any
and the Sum Assured on death shall not be paid.

On death of the Life Assured after the expiry of Waiting Period but before the
Stipulated date of maturity and provided the Policy is in force and if the claim is found
admissible, the Death Benefit amount will be payable as a lump sum and will be computed
as under:
For Regular premium or Limited premium payment policy, “Sum Assured on Death” will
be payable which is the highest of:
a) 10 times of annualized premium; or
b) 105% of all the premiums paid as on the date of death; or
c) Absolute amount assured to be paid on death.
For Single premium policy, “Sum Assured on Death” will be payable, which is the
higher of:
a) 125% of Single Premium or
b) Absolute amount assured to be paid on death.

Annualized premium is the total amount of premium payable in a policy year excluding taxes,
underwriting extra premiums and loadings for modal premiums, if any.

Premiums as referred above shall not include any extra amount chargeable under the policy
due to underwriting decision, if any.

Absolute amount assured to be paid on death shall be an amount equal to Basic Sum Assured

Page 5 of 48 Policy No. 2Q303356802 613/625

 PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Maturity Benefit: No maturity benefit shall be payable under the policy, on the Life assured
surviving the stipulated Date of maturity.
3 Policy Cancellation Value For Regular Premium: No policy cancellation value is payable
For Single Premium Policies: The Policy Cancellation Value acquires immediately after receipt
of Single Premium and is calculated as:
70% *Single Premium^ paid * (Unexpired Policy Term/Original Policy Term)
For Limited Premium Payment Policies: The Policy Cancellation Value acquires if at least two
(2) consecutive full year’s premiums are paid and is calculated as:
70% *Total Premiums^ paid * (Unexpired Policy Term/Original Policy Term)
^ Inclusive of extra premium, if any
4 Paid Up Value Not Available

5 Loans on the Policy Not Available

6 Exclusions Waiting period:
There is a waiting period of 45 days from the date of commencement of the policy during
which there will be no life cover.
However, This Policy will only cover death due to accident during the waiting period of 45 days
from the date of commencement of risk.
In case of Death of the Life assured other than due to accident during the waiting period, an
amount equal to 100% of all premiums received excluding taxes, if any, shall be paid and the sum
assured shall not be paid.

Suicide: Under Regular/Limited Premium Policy: This policy shall be void if the Life Assured
commits suicide at any time within 12 months from the date of commencement of risk, provided
the policy is inforce or within 12 months from the date of revival and the Company will not
entertain any claim except for 80% of the premiums paid (excluding any extra amount if charged
under the policy due to underwriting decisions and taxes, if any) till the date of death.

Under single Premium Policy: This policy shall be void if the Life assured commits suicide
at any time within 12 months from the date of commencement of risk and the Company will
not entertain any claim except that the Company will refund only 90 % of the Single Premium
paid excluding any extra amount if charged under the policy due to underwriting decisions, if
any.

After paying the benefit as applicable, the policy will be terminated.

7 Grace period A grace period of 30 days from the premium due date where the mode of payment of Premium is
yearly or half yearly and 15 days in case of monthly, is allowed for the payment of each renewal
Premium. If the premium is not paid before the expiry of the days of grace, the Policy lapses.

If the death of the Life Assured occurs within the grace period but before the payment of the
premium then due, the policy will still be valid and the benefits if any, shall be paid after
deductions of the said unpaid premium as also the balance premium(s), if any, falling due from
the date of death and before the next policy anniversary, provided the claim is found admissible
and payable.
8 Revival If the Policy has lapsed due to nonpayment of due premium within the days of grace, it may be
revived during the life time of the Life Assured, but within the Revival Period of five consecutive
years from the date of the first unpaid premium and before the Date of Maturity, whichever is
earlier.
In case of revival of policy, the waiting period shall not be applicable

9 Free look provision The Policyholder has a free look period of 15 days (30 days in case of electronic policies and
policies obtained through distance mode) from the date of receipt of the policy document, to
review the terms and conditions of the policy and where the policyholder disagrees to any of those
terms and conditions, the policy holder has the option to return the policy to the Company for

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 PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

cancellation, stating the reasons, in writing, for his objection, then the policyholder shall be
entitled to a refund of the premium paid subject to the deduction of a proportionate risk premium
for the period of cover and expenses incurred by the Company on medical examination of the
proposer and stamp duty charges.

A request received by the Company for free look cancellation of the policy shall be processed and
premium refunded within 15 days of receipt of the request, as stated above.

10 Tax Payable - The amount of applicable taxes as per the prevailing rates, shall be payable by the
policyholder on premiums including extra amount if charged under the policy due to
underwriting decisions, which shall be collected separately over and above in addition to the
premiums payable by the policyholder.

Benefit - The tax benefits, if any, would be as per the prevailing provisions of the tax laws in
India. The Policyholder or the beneficairies shall be liable for compliance with applicable tax
provisions
11 Claim Details are mentioned in the Policy Document or contact the Company or your advisor or bank
branch, for further details

Note: This document contains brief information about the key features of the Product. The same shall not be construed as
terms and conditions of the Policy or part thereof. For detailed terms and conditions governing the Policy, please read all
parts of the Policy document. In case of any conflict between the information given in the Key Features document and the
terms and conditions of the policy, the terms and conditions of the Policy document shall prevail.

Page 7 of 48 Policy No. 2Q303356802 613/625

Page 8 of 48 Policy No. 2Q303356802 613/625
 SBI Life Insurance Company Limited
Registration Number: 111 Regulated by IRDAI

Policy Document

SBI LIFE - Saral Jeevan Bima

UIN: 111N128V01

(AN INDIVIDUAL NON-LINKED NON-PARTICIPATING LIFE

INSURANCE PURE RISK PREMIUM PRODUCT)

Registered & Corporate Office: SBI Life Insurance Co. Ltd, “Natraj”, M.V. Road & Western Express Highway
Junction, Andheri (East), Mumbai - 400 069.

Website: www.sbilife.co.in | Email: info@sbilife.co.in | CIN: L99999MH2000PLC129113

Toll Free: 1800 267 9090 (Between 9.00 am & 9.00 pm)

Page 9 of 48 Policy No. 2Q303356802 613/625

 PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Policy Preamble

Welcome to your SBI Life – Saral Jeevan Bima policy and thank you for preferring SBI Life Insurance Company Limited to provide you with
insurance solutions.The UIN allotted by IRDAI for this product is 111N128V01. SBI Life – Saral Jeevan Bima is also referred to as Saral Jeevan
Bima in the policy document.

The information you have given in your proposal form, your personal statement together with any medical reports and other documents and
declarations submitted by you 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 that you are satisfied with the terms
and conditions of the policy. Please keep these in a safe place.

We request you to read the Policy Document. If you find any errors, please return your Policy Document for effecting corrections.

SBI Life – Saral Jeevan Bima 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 an Individual, non-linked, non-participating, life insurance pure risk premium product.

The benefits will be paid to the person(s) entitled as set out in the policy document, if such benefits have been found to be payable and subject to 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.

If you require further information, please contact us or the Intermediary/ Agent mentioned below.
Intermediary/ Agent Details :
Policy Document
Identification

1. Policy Number 2Q303356802

2. Proposal Number 2QCR114185

3. Proposal Date 16/01/2022

4. Customer ID 752754760

Personal Information

5. Name of the Life Assured Mr. Brij Bhushan Pal

6. Date of Birth 16/05/1992

7. Age at Entry 29
g

8. Gender Male

H.NO 20
PIYUSH NAGAR
9.Mailing Address AWADHPURI
BHOPAL - 462022
MADHYA PRADESH , India

10. Telephone Number with STD Code N.A.

11. Mobile Number 091 8319845220

12. E-Mail ID of the Policyholder BRIJPAL457@GMAIL.COM

Page 10 of 48 Policy No. 2Q303356802 613/625

Form 566
PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Nomination

13. Name of the Nominee(s) Gender Relationship with the life assured Age % of Share

Mr. Ram Lakhan Pal Male Father 77 100%

14. Name of the Appointee(s) Gender Relationship with nominee Age

N.A. N.A. N.A. N.A.

Important Dates

15. Date of Commencement of Policy / risk 22/01/2022

16. End of Waiting period 07/03/2022

17. Policy Anniversary Date 22/01

18. Premium due dates 22nd of every month

19. Due Date of Last Premium 22/12/2026

20. Date of maturity 22/01/2027

Basic Policy Information

21. Basic Sum Assured (Rs) 500000.00

22. Policy Term (years) 5

23. Premium Payment Term (years) 5

24. Premium Frequency Monthly

Page 11 of 48 Policy No. 2Q303356802 613/625

Form 566
PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Basic Policy Benefit

Premium Installment
Sum Assured Policy Term Applicable Due Date of Date of
Benefit paying Term Premium
(Rs.) (Years) Taxes (`) Last Premium Maturity
(Years) (`)

Base Policy 500000.00 5 5 140.68 25.32 22/12/2026 22/01/2027

Total Installment Premium,

excluding Applicable taxes 140.68
(Rs.)

Applicable Taxes (Rs.) 25.32

Applicable rate of Tax* 18.00%

Total Installment Premium,

166.00
including taxes (Rs.)

* Includes Applicable Taxes and/ or any other statutory levy/ duty/ surcharge, at the rate notified by the Central Government/ State
Government / Union Territories of India from time to time, as per the provisions of the prevalent tax laws.

Applicable Clauses

N.A.

Page 12 of 48 Policy No. 2Q303356802 613/625

Form 566
 SBI Life - Shubh
Signed
PART for
A and on behalf of SBI Life Insurance Company Limited,
SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product
Authorised Signatory

Signed for and on behalf of SBI Life Insurance Company Limited,

Name Signatory
Authorised N Parameshwar
Designation Head - New Business Processing
Name Bipin Vishnu Dabholkar
Date
Designation AVP - New14/09/2015
Business (Operations) Place Mumbai
Date 22/01/2022 Place Mumbai
The stamp duty of Rs 20.00/- (Rupees Twenty Only) paid by pay order, vide GRASS DEFACE No.000160971920
2015.Government
The Notification
stamp duty of Rs 100.00/- Revenue
(Rupees One Hundred andvide
Only) paid Forest Department
Letter of Authorisation No.No. Mudrank 2004/4125/CR690/M-1,
LOA/CSD/234/2022/86 dated 06 Jan 2022 issued by dated 31/1
Pradhan Mudrank Karyalay.

(Signature)
Signature
Proper Officer
(Proper Officer)

We request you to read this policy schedule along with the policy booklet. If you find any errors, please return your policy document for effecting
We request you to read this policy schedule along with the policy booklet.If you find any errors, please
corrections. return you
effecting corrections.
************************************************ *End of Policy Schedule***************************************************

***********************************************End of Policy Schedule**************************

Page 13 of 48 Policy No. 2Q303356802 613/625

Form 566
 Page 14 of 48 Policy No. 2Q303356802 613/625
Form 566
PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Policy Booklet

Table of Contents

PART B .................................................................................................................................................................................................................... 17
2 Definitions...................................................................................................................................................................................................... 17
3 Abbreviations ................................................................................................................................................................................................. 19
Part C 20
4 Benefits .......................................................................................................................................................................................................... 20
4.1 Death Benefit ................................................................................................................................................................................................. 20
4.2 Survival Benefit ............................................................................................................................................................................................. 20
4.3 Maturity Benefit ............................................................................................................................................................................................. 20
5 Payment of Premiums .................................................................................................................................................................................... 21
6 Grace Period ................................................................................................................................................................................................... 21
Part D 22
7 Conditions related to Servicing Aspects ......................................................................................................................................................... 22
7.1 Proof of age .................................................................................................................................................................................................... 22
7.2 Free-look period ............................................................................................................................................................................................. 22
7.3 Forfeiture provisions ...................................................................................................................................................................................... 22
7.4 Revival of lapsed Policies (Applicable for Regular and Limited Premium policies) ...................................................................................... 23
7.5 Surrender ........................................................................................................................................................................................................ 23
7.6 Paid-up Benefit............................................................................................................................................................................................... 23
7.7 Policy Cancellation Value .............................................................................................................................................................................. 23
7.8 Policy Loan .................................................................................................................................................................................................... 23
7.9 Termination of your policy............................................................................................................................................................................. 24
7.10 Suicide Exclusion ........................................................................................................................................................................................... 24
7.11 Normal requirements for a claim .................................................................................................................................................................... 24
Part E 25
8 Charges .......................................................................................................................................................................................................... 25
Part F 26
9 Other Terms and Conditions .......................................................................................................................................................................... 26
9.1 Assignment .................................................................................................................................................................................................... 26
9.2 Nomination .................................................................................................................................................................................................... 26
9.3 Section 45 of the Insurance Act 1938 ............................................................................................................................................................. 26
9.4 Tax ................................................................................................................................................................................................................. 26
9.5 Non – disclosure............................................................................................................................................................................................. 26
9.6 Policy Cancellation ........................................................................................................................................................................................ 27
9.7 Issuance of Duplicate Policy .......................................................................................................................................................................... 27
9.8 Jurisdiction ..................................................................................................................................................................................................... 27
9.9 Legislative Changes ....................................................................................................................................................................................... 27
Part G 28
10 Grievance Redressal Mechanism.................................................................................................................................................................... 28

Form 566

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PART A SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

11 Relevant Statutes ............................................................................................................................................................................................ 29

11.1 Governing laws and jurisdiction ..................................................................................................................................................................... 29
11.2 Section 41 of the Insurance Act 1938, as amended from time to time ............................................................................................................ 29
11.3 Section 45 of the Insurance Act 1938, as amended from time to time ............................................................................................................ 29
11.4 Rule 13 of Ombudsman Rules, 2017 .............................................................................................................................................................. 29
11.5 Rule 14 of Ombudsman Rules, 2017 .............................................................................................................................................................. 29
11.6 Protection of Policyholders’ Interest .............................................................................................................................................................. 30
Annexure I ................................................................................................................................................................................................................ 31
Annexure II ............................................................................................................................................................................................................... 33
Annexure III ............................................................................................................................................................................................................. 35
Annexure IV ............................................................................................................................................................................................................. 37

Form 566

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PART B SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

PART B

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.

2 Definitions

These definitions apply throughout your policy document.The definitions are listed alphabetically.

Expressions Meanings
is the age of the Life Assured on the last birthday at the time of commencement of the
1. Age
policy.
is the total amount of premium payable in a policy year excluding taxes, underwriting extra
2. Annualized Premium
premiums and loadings for modal premiums, if any.
is the person to whom the proceeds/benefits secured under the Policy are payable if the
3. Appointee benefit becomes payable to the nominee and nominee is minor as on the date of claim
payment.
is the person to whom the rights and benefits under the policy are transferred by virtue of
4. Assignee
an Assignment.
is the process of transferring the rights and benefits to an “Assignee,” in accordance with
5. Assignment
the provisions of Section 38 of Insurance Act, 1938, as amended from time to time.
6. Assignor means the person who transfers the rights of the life insurance policy to the Assignee.
is that part of the Policy referring to basic benefit (benefits referred to in this Policy
7. Base Policy
Document)
means the amount specified in the Schedule as opted by the Policyholder at the time of
8. Basic Sum assured
taking the policy
means the person who is entitled to receive benefits under this Policy. The Beneficiary may
9. Beneficiary/Claimant be Life Assured or Policyholder or his Assignee or Nominees or proved Executors or
Administrators or other Legal Representatives as the case may be.
means the day on which the offices of the Company remain open for transactions with the
10. Business Day or Working day
public at the place where the concerned transaction is to be carried out.
11. Company or Corporation Means SBI Life Insurance Co. Ltd
12. Date of commencement of policy is the start date of this Policy.
is the date on which the Company accepts the risk for insurance (cover) as evidenced in the
13. Date of commencement of risk
schedule of the policy.
14. Date of issuance of policy means the date as specified in the policy schedule.
15. Date of Maturity means the date specified in the Schedule on which the Policy Term is completed.
means the benefit, agreed at the commencement of the contract, and means the amount as
16. Death Benefit specified in the policy bond and is payable on death of Life Assured as per the terms and
conditions of the policy.
is the form to be filled by policyholder/claimant to claim the death benefit/refund under the
17. Discharge Form
policy.
This is applicable in case of Regular Premium / Limited Premium payment.
18. Due date
It means a fixed date on which the policy premium is due and payable by the policyholder
means conditions attached/ affixed to this Policy incorporating any amendments or
19. Endorsement
modifications agreed to or issued by the Company.
20. Free-look period is the period of 15 days (30 days if the Policy is an electronic policy or is purchased

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PART B SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Expressions Meanings
through Distance Marketing where distance marketing means through any means of
communication other than in person) from the date of receipt of the Policy Document by
the Policyholder to review the terms and conditions of this policy and where the
Policyholder disagrees to any of those terms and conditions, he/ she has the option to return
this policy as detailed in section 6.2 of Part D of this Policy Document.
is the time granted by the insurer from the due date for the payment of premium, without
21. Grace period any penalty/ late fee, during which time the policy is considered to be inforce with the
insurance cover without any interruption as per the terms of the policy.
means a policy in which all the due premiums have been paid and the premiums are not
22. Inforce Policy
outstanding.
23. IRDAI/ Authority means Insurance Regulatory and Development Authority of India.
Lapse is the status of the Policy when due premium is not paid within the grace period and
24. Lapse
the benefits under the Policy will cease from the date of such unpaid premium.
25. Life assured is the person on whose life the insurance cover has been accepted.
is the information already known to the Life Assured at the time of applying for Life
26. Material Information Insurance, which has a bearing on underwriting / risk assessment of the proposal /Policy
submitted.
is the process of nominating a person(s) in accordance with provisions of Section 39 of the
27. Nomination
Insurance Act, 1938 as amended from time to time.
means the person(s) nominated by the Policyholder (who is also the Life Assured) under
28. Nominee (s)
this Policy who is(are) authorised to receive the claim benefit payable under this Policy.
means the Policy is not eligible for share of profit depending upon the Company’s
29. Non-participating
experience and the policy shall not earn any bonus.
means one year from the date of commencement of the Policy and the same date falling
30. Policy anniversary
each year thereafter, till the date of maturity.
means complete withdrawal or termination of the entire policy before the stipulated date of
31. Policy Cancellation
maturity.
means an amount, if any, that becomes payable in case of cancellation in accordance with
32. Policy Cancellation Value
the terms and conditions of this policy.
means this document along with endorsements, if any, issued by the Company which
33. Policy/ Policy document
evidences the contract of Insurance between the policyholder and the Company.
34. Policy Holder is the legal owner of this policy
is the period, in years, as chosen by the policyholder and mentioned in the Schedule,
35. Policy Term
commencing from the Date of commencement of policy to the date of Maturity.
is the period between two consecutive policy anniversaries. This period includes the first
36. Policy year
day and excludes the next policy anniversary day.
is the contractual amount payable by the Policyholder at specified times periodically as
mentioned in the schedule of this Policy Document to secure the benefits under the policy.
37. Premium The premium payable will be “Total Single / Instalment Premium” which includes single /
instalment Premium for Base Policy. The term ‘Premium’ used anywhere in this Policy
Document does not include any taxes which are payable separately.
38. Premium paying term means the period, in years, during which premium is payable.
is the information that may be sought from the policyholder to decide revival of the policy.
This includes Form of declaration of Good Health, Medical Reports, Special Reports and
39. Proof of continued insurability
any such document as may be called for by the Company, in accordance with the Board
Approved Underwriting Policy of the Company.
40. Proposer is a person who proposes the life insurance proposal.
means restoration of a lapsed policy which was discontinued due to the non-payment of
41. Revival of a policy
premium, by the insurer with all the benefits mentioned in the policy document, upon the

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PART B SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Expressions Meanings
receipt of all the premiums due and other charges/late fee, if any, as per the terms and
conditions of the policy, upon being satisfied as to the continued insurability of the insured/
policyholder on the basis of the information, documents and reports furnished by the
policyholder, in accordance with the then existing Board Approved Underwriting Policy of
the Company.
means the period of five consecutive years from the due date of first unpaid premium or as
42. Revival period is allowed under applicable Product Regulations, during which period the policyholder is
entitled to revive the policy which was discontinued due to the non-payment of premium.
43. Schedule is the part of policy document that gives the specific details of your policy.
is the life insurance cover opted by the Proposer and is the absolute amount of benefit
which is guaranteed to become payable on death of the life assured, if the claims is found
44. Sum Assured on Death
admissible and payable, in accordance with the terms and conditions of the policy, as
mentioned in section 3.1 of Part C of this Policy Document.
45. Surrender means complete withdrawal / termination of the entire policy before maturity.
means an amount, if any, that becomes payable in case of surrender in accordance with the
46. Surrender Value
terms and conditions of this policy.
is the term used to describe the process of assessing risk and ensuring that the cost of the
cover is proportionate to the risks faced by the individual concerned. Based on
47. Underwriting
underwriting, a decision on acceptance or rejection of cover as well as applicability of
suitable premium or modified terms, if any, is taken.
48. UIN means the Unique Identification Number allotted to this plan by the IRDAI.
means a period of 45 (forty five) days from the Date of Commencement of Risk during
49. Waiting Period which death due to any reason other than due to accident shall not be covered. In case of
revival of Policy, the Waiting period shall not be applicable.

The above definitions are provided only for the purpose of proper comprehension of the terms & phrases used in the policy document.
The actual benefits under the policy are payable strictly as per the terms and conditions of the policy only.

3 Abbreviations

Abbreviation Stands for

IRDAI Insurance Regulatory and Development Authority of India
Rs. Indian Rupees
UIN Unique Identification Number (allotted by IRDAI for this product)

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

Form 566

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PART C SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Part C

4 Benefits

The following are the benefits under the policy:

4.1 Death Benefit

4.1.1 On death of the Life Assured during the Waiting Periodof 45 days and provided the Policy is in force and if the
claim is found admissible and payable, the Death Benefit amount will be payable as a lump sum and the amount
will be:
4.1.1.1 In case of Accidental Death, for regular premium or limited premium payment policy, the amount payable
shall be equal to “Sum Assured on Death” which is the highest of:
a) 10 times of Annualized Premium, or
b) 105% of all premiums paid as on the date of death, or
c) Absolute amount assured to be paid on death.
4.1.1.2 In case of Accidental Death, for single premium policy, the amount payable shall be equal to “Sum Assured
on Death” which is the higher of:
a) 125% of Single premium or
b) Absolute amount assured to be paid on death.
4.1.1.3 On death of the Life Assuredother than due to accident during the Waiting Period, and provided the
Policy is in force, the Death Benefit amount payable as a lump sum is as follows: Death Benefit is equal to
100% of all Premiums paid excluding taxes, if any and the Sum Assured on death shall not be paid.
4.1.2 On death of the Life Assured after the expiry of Waiting Period but before the Stipulated date of maturity and
provided the Policy is in force and if the claim is found admissible and payable, the Death Benefit amount will be
payable as a lump sum which is:
4.1.2.1 For Regular premium or Limited premium payment policy, the amount payable will be“Sum Assured on
Death” which is the highest of:
a) 10 times of annualized premium; or
b) 105% of all the premiums paid as on the date of death; or
c) Absolute amount assured to be paid on death.
4.1.2.2 For Single premium policy, the amount payable will be “Sum Assured on Death” which is the higher of:
a) 125% of Single Premium or
b) Absolute amount assured to be paid on death.
4.1.3 Premiums referred above shall not include any extra amount chargeable under the policy due to underwriting
decision, if any.
4.1.4 Absolute amount assured to be paid on death shall be an amount equal to Basic Sum Assured which is mentioned in
the policy schedule

4.2 Survival Benefit

4.2.1 Your policy does not have any survival benefit.

4.3 Maturity Benefit

4.3.1 No maturity benefit shall be payable on the Life assured surviving the stipulated Date of maturity.

Form 566

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PART C SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

5 Payment of Premiums

5.1 This is applicable for Regular & Limited premium payment policies only.
5.2 The policyholder has to pay the premiums on or before the due dates, as specified in the schedule of this policy document
along with the applicable taxes if any.
5.3 In case of death of Life Assured under an in-force policy wherein all the premiums due till the date of death have been paid
and where the mode of payment of premium is other than yearly, balance premium(s), if any, falling due from the date of
death and before the next policy anniversary shall be deducted from the claim amount
5.4 The company does not have any obligation to issue a notice that premium is due or for the amount that is due.
5.5 Installment premium and premium due dates are clearly mentioned in the policy schedule.

6 Grace Period

6.1 This is applicable for Regular & Limited premium payment policies only.
6.2 A grace period of 30 days from the premium due date where the mode of payment of Premium is yearly or half yearly and a
grace period of 15 days in case of monthly, is allowed for the payment of each renewal Premium. If the premium is not
paid before the expiry of the days of grace, the Policy lapses.
6.3 If the death of the Life Assured occurs within the grace period but before the payment of the premium then due, the policy
will still be valid and the benefits shall be paid after deductions of the said unpaid premium as also the balance premium(s),
if any, falling due from the date of death and before the next policy anniversary, provided the claim is found admissible and
payable.

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PART D SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Part D

7 Conditions related to Servicing Aspects

7.1 Proof of age

7.1.1 The premiums under the Policy are calculated based on the age of the Life Assured as declared in the Proposal.
7.1.2 If the Age of the life assured has been misstated and if the correct Age of the Life Assured makes the Life
Assured ineligible for this Policy, the Company may offer a suitable plan as per the then existing underwriting
norms. If the life assured does not wish to opt for the alternative plan or if it is not possible for the Company to
grant any other plan, then the Policy shall be cancelled and the premiums paid shall be refunded without interest,
subject to deduction of stamp duty paid and the cost of medicals, if any. The Policy will terminate on the said
payment.
7.1.3 If the correct Age of the Life Assured makes the Life Assured eligible for this Policy, revised Premium
depending upon the Correct Age will be payable. Difference of premium from inception will be collected with
interest, if age declared is higher and excess premium collected will be refunded without interest, if age is found
to be lower. If the Life Assured does not pay the difference of premium, then the Policy shall be cancelled and
the premiums paid shall be refunded without interest, subject to deduction of stamp duty paid and the cost of
medicals, if any. The Policy will terminate on the said payment.
7.1.4 The provisions of Section 45 of the Insurance Act, 1938 as amended from time to time shall be applicable.

7.2 Free-look period

7.2.1 This is an option to review the Policy following receipt of Policy Document. You havea free look period of 15
days (30 days in case of electronic policies and policies obtained through distance mode) from the date of receipt
of the policy document, to review the terms and conditions of the policy and where you disagree to any of those
terms and conditions, you havethe option to return the policy to the Company for cancellation, stating the
reasons for objection, then youshall be entitled to a refund of the premium paid subject only to the deduction of a
proportionate risk premium for the period of cover and expenses incurred by the Company on medical
examination of the proposer and stamp duty charges.
7.2.2 A request received by the Company for free look cancellation of the policy shall be processed and premium will
be refunded within 15 days of receipt of the request, after deduction of applicable charges as stated vide 7.2.1
above.
7.2.3 The Policy shall terminate on payment of this amount and all rights, benefits and interests under this Policy will
stand extinguished.

7.3 Forfeiture provisions

7.3.1 In case of Regular Premium, if the premium has not been paid in respect of this policy and any subsequent
premium be not duly paid, all the benefits shall cease after the expiry of grace period from the date of first
unpaid premium and nothing shall be payable, and the premiums paid till then are also not refundable
7.3.2 Forfeiture in Certain Other Events: In case any condition herein contained or endorsed hereon be contravened or
in case it is found that any untrue or incorrect statement is contained in the proposal, personal statement,
declaration and connected documents or any material information is withheld, then and in every such case this
policy shall be void and all claims to any benefit by virtue hereof shall be subject to the provisions of Section 45
of the Insurance Act , 1938, as amended from time to time.

Form 566

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PART D SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

7.4 Revivalof lapsed Policies (Applicable for Regular and Limited Premium policies)

7.4.1 If the Policy has lapsed due to non-payment of due premium within the days of grace, it may be revived during
the life time of the Life Assured, but within the Revival Period of five consecutive years from the date of first
unpaid premium but before the Date of Maturity, as the case may be, on payment of all the arrears of premium(s)
together with interest at a rate which shall be determined as follows:
7.4.2 Interest will be charged at a rate declared by us from time to time.
7.4.3 Our current policy is based on the nominal interest rate per annum and is 250 basis points greater than the
benchmark yield of repo rate as on 1st April of each of the financial year and it will be compounding on half-
yearly basis. The repo rate as on the 1st April 2020 is 4.40% and hence the applicable interest rate for Financial
Year 2020-2021 is 6.90%.Any change in the basis of determination of interest rate shall be done only after prior
approval of the Authority.
7.4.4 In addition to the arrears of premium with interest, proof of continued insurability may be required for revival of
the discontinued policy. The Company, however, reserves the right to accept at original terms, accept with
modified terms or decline the revival of a discontinued policy. The revival of the discontinued policy shall take
effect only after the same is approved by the Company and is specifically communicated to the Policyholder.
The revival will be effected subject to underwriting based on company’s board approved underwriting policy.
7.4.5 If a lapsed policy is not revived within the revival period but before the Date of Maturity, the policy will
automatically terminate. In case of Regular Premium policies, nothing shall be payable. However, in case of
Limited Premium Payment policies, the amount as payable in case of policy cancellation, if any, shall be
refunded and the policy will terminate.
7.4.6 In case of revival of policy, the waiting period shall not be applicable.

7.5 Surrender

7.5.1 Surrender value is not applicable under this policy.

7.6 Paid-up Benefit

7.6.1 Your policy does not have any paid – up benefit.

7.7 Policy Cancellation Value

Policy Cancellation Value shall be payable:

7.7.1 upon the Policyholder applying for the same before the stipulated date of maturity in case of Single premium Policy; or
7.7.2 upon the Policyholder applying for the same before the stipulated date of maturity or at the end of revival period if the
policy is not revived, in case of Limited Premium Payment Policies
7.7.3 The amount payable shall be as follows:
7.7.3.1 For Single Premium Policies:The Policy Cancellation Value acquires immediately after receipt of Single
Premium and is calculated as follows:
70% *Single Premium paid * (Unexpired Policy Term/Original Policy Term)
7.7.3.2 Single Premium shall be inclusive of extra premium, if any
7.7.3.3 For Limited Premium Payment Policies: The Policy Cancellation Value acquires if at least two(2)
consecutive full year’s premiums are paid and is calculated as follows:
70% *Total Premiums paid * (Unexpired Policy Term/Original Policy Term)
7.7.3.4 Total Premiums Paid shall be inclusive of extra premiums, if any.
7.7.4 No policy cancellation value shall be payable in respect of regular premium policies

7.8 Policy Loan

7.8.1 No loan will be available against this policy

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PART D SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

7.9 Termination of your policy

The policy shall immediately and automatically terminate on the earliest occurrence of any of the following events:
7.9.1 The date on which death benefit becomes payable; or
7.9.2 The date on which refund, if applicable, is settled, in case of cancellation of policy; or
7.9.3 The date of maturity; or
7.9.4 On expiry of revival period, if the policy has not been revived; or
7.9.5 on payment of free-look cancellation amount;

7.10 Suicide Exclusion

7.10.1 Under Regular/Limited Premium Policy:

7.10.1.1 This policy shall be void if the Life Assured commits suicide at any time within 12 months from the date of
commencement of risk, provided the policy is inforce or within 12 months from the date of revival and the
Company will not entertain any claim except for 80% of the premiums paid (excluding any extra amount if
charged under the policy due to underwriting decisions and taxes, if any) till the date of death.
7.10.1.2 This clause shall not be applicable for a lapsed policy as nothing is payable under such policies

7.10.2 Under single Premium Policy:

7.10.2.1 This policy shall be void if the Life assured commits suicide at any time within 12 months from the date of
commencement of risk and the Company will not entertain any claim except refunding 90 % of the Single
Premium paid excluding any extra amount if charged under the policy due to underwriting decisions, if any.
7.10.3 After paying the benefit as applicable, the policy will be terminated.

7.11 Normal requirements for a claim

Death claim
7.11.1 The normal documents which the claimant shall submit while lodging the claim in case of death of the Life
Assured shall be claim forms, as prescribed by the Company, accompanied with original policy document,
NEFT mandate from the claimant for direct credit of the claim amount to the bank account, proof of title, proof
of death, medical treatment prior to the death (if any), school/ college/ employer's certificate, whichever is
applicable, to the satisfaction of the Company. If the age is not admitted under the policy, the proof of age of the
Life assured shall also be submitted.
7.11.2 In case of unnatural death or death on account of or arising from an accident, the Company may call for the
copies of First Information Report (FIR), Panchnama and Post Mortem report. The Company may also call for
additional documents as may be required by them.
7.11.3 Within 90 days from the date of death, intimation of death along with death certificate must be notified in
writing to the office of the Company where the policy is serviced. However, delay in intimation of the genuine
claim by the claimant, may be condoned by the Company, on merit, and where delay is proved to be for the
reasons beyond his/her control
7.11.4 The nominee or 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.
7.11.5 We will pay the claim, if found admissible
7.11.5.1 to the assignee, if the policy is assigned.
7.11.5.2 If the policy is not assigned, we will pay the claim to
a) the nominee, if the nominee is not a minor
b) the appointee, if the nominee is a minor
c) your legal heir, if nomination is not valid.
7.11.6 We may ask for additional information related to the claim.
7.11.7 You can claim death benefit only once under this plan.
7.11.8 If there is any dispute about the title under the policy, the benefits shall be paid only to the legal heir/s as
certified by a court of competent jurisdiction

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PART E SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Part E

8 Charges

Not Applicable

Form 566

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PART F SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Part F

9 Other Terms and Conditions

9.1 Assignment

Assignment is allowed under this plan as per section 38 of the Insurance Act, 1938, as amended from time to time. The
current provisions of Section 38 are contained in Annexure-1 of this Policy Document.The notice for assignment should be
submitted for registration to the office of the company, where the policy is serviced.

9.2 Nomination

Nomination by the holder of a policy of life assurance on his/her own lifeis allowed as per Section 39 of the Insurance Act,
1938, as amended from time totime.The current provisions of Section 39 are contained in Annexure-2 of this
PolicyDocument.The notice for nomination or change of nomination should be submitted for registration to the office of
the company, where the policy is serviced. In registering nomination, the company does not accept any responsibility or
express any opinion as to its validity or legal effect.

9.3 Section 45 of the Insurance Act 1938

9.3.1 The provisions of Section 45 of the Insurance Act 1938, as amended from time to time, shall be applicable. The
current provisions are contained in Annexure-3 of this policy document.

9.4 Tax

9.4.1 Statutory Taxes, if any, imposed on such insurance plans by the Government of India or any other constitutional tax
Authority of India shall be as per the Tax laws and the rate of tax as applicable from time to time.
9.4.2 The amount of applicable taxes as per the prevailing rates, shall be payable by the policyholder on premiums
including extra amount if charged under the policy due to underwriting decisions, which shall be collected separately
over and above in addition to the premiums payable by the policyholder.
9.4.3 The amount of tax paid shall not be considered for the calculation of benefits payable under the plan.
9.4.4 The tax benefits, if any, would be as per the prevailing provisions of the tax laws in India. The Policyholder or the
nominee shall be liable for compliance of applicable tax provisions

9.5 Non – disclosure

9.5.1 We have issued your policy based on your statements in your proposal form, personal statement, medical reports and
any other documents that are submitted to us.
9.5.2 If we find that any of this information is inaccurate or false or you have withheld any material information, or in case
of fraud, we will have a right to repudiate all the claims under your policy and / or cancel your policy and no benefit
under the policy is payable.
9.5.3 If we repudiate the claim under your policy / and or cancel your policy on the grounds of fraud, we would forfeit the
premiums received under your policy and we shall not entertain any claim under your policy subject to the provisions
of Section 45 of the Insurance Act 1938, as amended from time to time.
9.5.4 If we repudiate death claim / and or cancel your policy on any grounds other than fraud, we may pay such amounts as
are payable subject to the provisions of Section 45 of the Insurance Act 1938, as amended from time to time.

Form 566

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PART F SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

9.6 Policy Cancellation

9.6.1 In case of cancellation of the policy, the Policyholder shall submit the discharge form along with the original
policy document, NEFT mandate from the claimant for direct credit of the claim amount to the bank account.

In addition to above, any requirement mandated under any statutory provision or as may be required as per law shall also be
required to be submitted

9.7 Issuance of Duplicate Policy

9.7.1 The Policyholder can make an application for duplicate Policy on payment of Policy Printing Charges of ₹100Plus
Stamp duty Plus GST, upon loss of policy document along with other requirements as may be prescribed by the
Company.

9.8 Jurisdiction

9.8.1 The Policy shall be governed by the laws of India and the Indian Courts shall have jurisdiction to settle any
disputes arising under the Policy

9.9 Legislative Changes

9.9.1 The Terms and Conditions including the premiums and benefits payable under this policy are subject to variation
in accordance with the applicable laws and regulations.

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PART G SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Part G

10 Grievance Redressal Mechanism

10.1 Grievance RedressalMechanism

10.1.1 If you have any query, complaint or grievance, you may approach any of our offices.
10.1.2 You can also call us on our toll-free number: 1800 267 9090 (9a.m. to 9p.m.).
10.1.3 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
7th Level (D Wing) & 8th Level,
Seawoods Grand Central
Tower 2, Plot No R-1,Sector-40,
Seawoods, Nerul Node, Dist. Thane,
Navi Mumbai-400 706.
Telephone No.: +91 - 22 – 6645 6785
Email Id: info@sbilife.co.in

10.1.4 Grievance RedressalMechanismof IRDAI – In case the policyholder is not satisfied with the response or does
not receive a response from the Company within 15 days, then the customer may approach the Grievance Cell of
the IRDAI through any of the following modes:
10.1.4.1 Calling Toll Free Number 155255 / 18004254732 (i.e. IRDAI Grievance Call Centre)
10.1.4.2 Sending an email to complaints@irdai.gov.in
10.1.4.3 Register the complaint online at http://www.igms.irda.gov.in
10.1.4.4 Address for sending the complaint through courier / letter:
Consumer Affairs Department, Insurance Regulatory and Development Authority of India, Survey
No.115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad-500032, Telangana.

10.1.5 Ombudsman:For redressal of Claims related grievances, claimants can also approach Insurance Ombudsman who
provides for low cost, speedy arbitration to customers.
10.1.5.1 The Ombudsman, as per Insurance Ombudsman Rules, 2017, can receive and consider complaints or
disputes relating to the matters such as:
(a) Delay in settlement of claims, beyond the time specified in the regulations, framed under the
Insurance Regulatory and Development Authority of India Act,1999
(b) Any partial or total repudiation of claims by the life insurer, General insurer or the health insurer;
(c) Disputes over premium paid or payable in terms of insurance policy;
(d) Misrepresentation of policy terms and conditions at any time in the policy document or policy
contract;
(e) Legal construction of insurance policies insofar as the dispute relates to claim;
(f) Policy servicing related grievances against insurers and their agents and intermediaries;
(g) Issuance of life insurance policy, general insurance policy including health insurance policy which is
not in conformity with the proposal form submitted by the proposer;
(h) Non-issuance of insurance policy after receipt of premium in life insurance and general insurance
including health insurance; and
(i) Any other matter resulting from the violation of provisions of the Insurance Act, 1938, as amended
from time to time, or the regulations, circulars , guidelines or instructions issued by IRDAI from time to
time or the terms and conditions of the policy contract, in so far as they relate to issues mentioned at
clauses (a) to (f).

10.1.5.2 We have also enclosed the details of existing offices of the Insurance Ombudsman as Annexure IV.

Note: In case of dispute in respect of interpretation of these terms and conditions and special provisions/conditions the
English version shall stand valid.
Form 566

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PART G SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

YOU ARE REQUESTED TO EXAMINE THIS POLICY DOCUMENT, AND IF ANY MISTAKE BE FOUND
THEREIN, RETURN IT IMMEDIATELY FOR CORRECTION

11 Relevant Statutes

11.1 Governing laws and jurisdiction

11.1.1 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 India.

11.2 Section 41 of the Insurance Act 1938, as amended from time to time
(1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or
reneworcontinue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the
whole or partof 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 publishedprospectuses 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
ofthissub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing
that heis a bona fide insurance agent employed by the insurer.

(2) Any person making default in complying with the provisions of this section shall be liable for penalty whichmayextend
to ten lakh rupees.

11.3 Section 45 of the Insurance Act 1938, as amended from time to time
[A leaflet containing the simplified version of the provisions of Section 45 is enclosed in Annexure – III for reference]

11.4 Rule 13 of Ombudsman Rules, 2017

1. The Ombudsman shall receive and consider complaints or disputes relating to:
a) delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance
Regulatory and Development Authority of India Act, 1999;
b) any partial or total repudiation of claims by the life insurer, General insurer or the health insurer;
c) disputes over premium paid or payable in terms of insurance policy;
d) misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
e) legal construction of insurance policies in so far as the dispute relates to claim;
f) policy servicing related grievances against insurers and their agents and intermediaries;
g) issuance of life insurance policy, general insurance policy including health insurance policy which is not
inconformity with the proposal form submitted by the proposer;
h) non-issuance of insurance policy after receipt of premium in life insurance and general insurance including
health insurance; and
i) any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations,circulars,
guidelines or instructions issued by the IRDAI from time to time or the terms and conditions of the policy
contract, in so far as they relate to issues mentioned at clauses (a) to (f) .
2. The Ombudsman shall act as counsellor and mediator relating to matters specified in sub-rule (1) provided there is
written consent of the parties to the dispute.
3. The Ombudsman shall be precluded from handling any matter if he is an interested party or having conflict of
interest.
4. The Central Government or as the case may be, the IRDAI may, at any time refer any complaint or dispute relating
to insurance matters specified in sub-rule (1), to the Insurance Ombudsman and such complaint or dispute shall be
entertained by the Insurance Ombudsman and be dealt with as if it is a complaint made under Rule 14

11.5 Rule 14 of Ombudsman Rules, 2017

(1) Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee,make a
complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the branch or officeof the insurer
complained against or the residential address or place of residence of the complainant is located.
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PART G SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

(2) Thecomplaint shall be in writing, duly signed by the complainant or through his legal heirs, nominee or assignee andshall
state clearly the name and address of the complainant, the name of the branch or office of the insurer againstwhom the
complaint is made, the facts giving rise to complaint, supported by documents, the nature and extent ofthe loss caused to the
complainant and the relief sought from the Insurance Ombudsman.
(3) Nocomplaint to the Ombudsman shall lie unless –
a) The complainant makes a written representation to the insurer named in the complaint and
a. Either the insurer had rejected the complaint; or
b. the complainant had not received any reply within a period of one month after the insurer received
hisrepresentation; or
c. the complainant is not satisfied with the reply given to him by the insurer
b) the complaint is made within one year
a. after the order of the insurer rejecting the representation is received; or
b. after receipt of decision of the insurer which is not to the satisfaction of the complainant;
c. after expiry of a period of one month from the date of sending the written representation to the insurer ifthe
insurer named fails to furnish reply to the complainant
(4) The Ombudsman shall be empowered to condone the delay in such cases as he may consider necessary, after callingfor
objections of the insurer against the proposed condonation and after recording reasons for condoning the delayand in case the
delay is condoned, the date of condonation of delay shall be deemed to bethe date of filing of thecomplaint, for further
proceedings under these rules.
(5) No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on whichproceedings are
pending before or disposed of by any court or consumer forum or arbitrator.

11.6 Protection of Policyholders’ Interest

The IRDAI (Protection of Policyholders’ Interests) Regulations, 2017, provide for protection of the interests of the
policyholders. The provisions of this regulation will be applicable and subject to the prevailing law, as amended from time to
time.

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

Form 566

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 SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Annexure I

Section 38 - Assignment and Transfer of Insurance Policies

Assignment or transfer of a policy should be in accordance with Section 38 of the Insurance Act, 1938 as amended by Insurance
Laws (Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this regard are as follows:

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

02. An Assignment may be effected in a policy by an endorsement upon the policy itself or by a separate instrument under notice
to the Insurer.

03. The instrument of assignment should indicate the fact of transfer or assignment and the reasons for the assignment or transfer,
antecedents of the assignee and terms on which assignment is made.

04. The assignment must be signed by the transferor or assignor or duly authorized agent and attested by at least one witness
.
05. The transfer of assignment shall not be operative as against an insurer until a notice in writing of the transfer or assignment and
either the said endorsement or instrument itself or copy there of certified to be correct by both transferor and transferee or
their duly authorised agents have been delivered to the insurer.

06. Fee to be paid for assignment or transfer can be specified by the Authority through Regulations.

07. On receipt of notice with fee, the insurer should Grant a written acknowledgement of receipt of notice. Such notice shall be
conclusive evidence against the insurer of duly receiving the notice.

08. If the insurer maintains one or more places of business, such notices shall be delivered only at the place where the policy is
being serviced.

09. The insurer may accept or decline to act upon any transfer or assignment or endorsement, if it has sufficient reasons to believe
that it is
a. not bonafide or
b. not in the interest of the policyholder or
c. not in public interest or
d. is for the purpose of trading of the insurance policy.

10. Before refusing to act upon endorsement, the Insurer should record the reasons in writing and communicate the same in
writing to Policyholder within 30 days from the date of policyholder giving a notice of transfer or assignment.

11. In case of refusal to act upon the endorsement by the Insurer, any person aggrieved by the refusal may prefer a claim to IRDAI
within 30 days of receipt of the refusal letter from the Insurer.

12. The priority of claims of persons interested in an insurance policy would depend on the date on which the notices of
assignment or transfer is delivered to the insurer; where there are more than one instruments of transfer or assignment, the
priority will depend on dates of delivery of such notices. Any dispute in this regard as to priority should be referred to
Authority.

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13. Every assignment or transfer shall be deemed to be absolute assignment or transfer and the assignee or transferee shall be
deemed to be absolute assignee or transferee, except
a. where assignment or transfer is subject to terms and conditions of transfer or assignment OR
b. where the transfer or assignment is made upon condition that
i. the proceeds under the policy shall become payable to policyholder or nominee(s) in the event of assignee or transferee
dying before the insured OR
ii. the insured surviving the term of the policy

Such conditional assignee will not be entitled to obtain a loan on policy or surrender the policy. This provision will
prevail not withstanding any law or custom having force of law which is contrary to the above position.

14. In other cases, the insurer shall, subject to terms and conditions of assignment, recognize the transferee or assignee named in
the notice as the absolute transferee or assignee and such person
a. shall be subject to all liabilities and equities to which the transferor or assignor was subject to at the date of transfer or
assignment and
b. may institute any proceedings in relation to the policy
c. obtain loan under the policy or surrender the policy without obtaining the consent of the transferor or assignor or making
him a party to the proceedings

15. Any rights and remedies of an assignee or transferee of a life insurance policy under an assignment or transfer effected before
commencement of the Insurance Laws (Amendment) Act, 2015 shall not be affected by this section.

[ Disclaimer : This is not a comprehensive list of amendments of Insurance Laws (Amendment), 2015 and only a simplified
version prepared for general information. Policy Holders are advised to refer to Original Gazette Notification for complete and
accurate details. ]

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Annexure II
Section 39 - Nomination by policyholder

Nomination of a life insurance Policy is as below in accordance with Section 39 of the Insurance Act, 1938 as amended by
Insurance Laws (Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this regard are as follows:

01. The policyholder of a life insurance on his own life may nominate a person or persons to whom money secured by the policy
shall be paid in the event of his death.

02. Where the nominee is a minor, the policyholder may appoint any person to receive the money secured by the policy in the
event of policyholder’s death during the minority of the nominee. The manner of appointment to be laid down by the insurer.

03. Nomination can be made at any time before the maturity of the policy.

04. Nomination may be incorporated in the text of the policy itself or may be endorsed on the policy communicated to the insurer
and can be registered by the insurer in the records relating to the policy.

05. Nomination can be cancelled or changed at any time before policy matures, by an endorsement or a further endorsement or a
will as the case may be.

06. A notice in writing of Change or Cancellation of nomination must be delivered to the insurer for the insurer to be liable to such
nominee. Otherwise, insurer will not be liable if a bonafide payment is made to the person named in the text of the policy or in the
registered records of the insurer.

07. Fee to be paid to the insurer for registering change or cancellation of a nomination can be specified by the Authority through
Regulations.

08. On receipt of notice with fee, the insurer should grant a written acknowledgement to the policyholder of having registered a
nomination or cancellation or change thereof.

09. A transfer or assignment made in accordance with Section 38 shall automatically cancel the nomination except in case of
assignment to the insurer or other transferee or assignee for purpose of loan or against security or its reassignment after repayment.
In such case, the nomination will not get cancelled to the extent of insurer’s or transferee’s or assignee’s interest in the policy. The
nomination will get revived on repayment of the loan.

10. The right of any creditor to be paid out of the proceeds of any policy of life insurance shall not be affected by the nomination.

11. In case of nomination by policyholder whose life is insured, if the nominees die before the policyholder, the proceeds are
payable to policyholder or his heirs or legal representatives or holder of succession certificate.

12. In case nominee(s) survive the person whose life is insured, the amount secured by the policy shall be paid to such survivor(s).

13. Where the policyholder whose life is insured nominates his

a. parents or
b. spouse or
c. children or
d. spouse and children
e. or any of them

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the nominees are beneficially entitled to the amount payable by the insurer to the policyholder unless it is proved that policyholder
could not have conferred such beneficial title on the nominee having regard to the nature of his title.

14. If nominee(s) die after the policyholder but before his share of the amount secured under the policy is paid, the share of the
expired nominee(s) shall be payable to the heirs or legal representative of the nominee or holder of succession certificate of such
nominee(s).

15. The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance policies maturing for payment after
the commencement of Insurance Laws (Amendment) Act, 2015.

16. If policyholder dies after maturity but the proceeds and benefit of the policy has not been paid to him because of his death, his
nominee(s) shall be entitled to the proceeds and benefit of the policy.

17. The provisions of Section 39 are not applicable to any life insurance policy to which Section 6 of Married Women’s Property
Act, 1874 applies or has at any time applied except where before or after Insurance Laws (Amendment) Act, 2015, a nomination is
made in favour of spouse or children or spouse and children whether or not on the face of the policy it is mentioned that it is made
under Section 39. Where nomination is intended to be made to spouse or children or spouse and children under Section 6 of MWP
Act, it should be specifically mentioned on the policy. In such a case only, the provisions of Section 39 will not apply.

[ Disclaimer : This is not a comprehensive list of amendments of Insurance Laws (Amendment), 2015 and only a simplified
version prepared for general information. Policy Holders are advised to refer to Original Gazette Notification for complete and
accurate details. ]

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 SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Annexure III

Section 45 – Policy shall not be called in question on the ground of mis-statement after three years

Provisions regarding policy not being called into question in terms of Section 45 of the Insurance Act, 1938, as amended by
Insurance Laws (Amendment) Act, 2015 dated 23.03.2015 are as follows:

01. No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3 yrs from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy

whichever is later.

02. On the ground of fraud, a policy of Life Insurance may be called in question within 3 years from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy

whichever is later.
For this, the insurer should communicate in writing to the insured or legal representative or nominee or assignees of insured, as
applicable, mentioning the ground and materials on which such decision is based.

03. Fraud means any of the following acts committed by insured or by his agent, with the intent to deceive the insurer or to induce
the insurer to issue a life insurance policy:
a. The suggestion, as a fact of that which is not true and which the insured does not believe to be true;
b. The active concealment of a fact by the insured having knowledge or belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be fraudulent.

04. Mere silence is not fraud unless, depending on circumstances of the case, it is the duty of the insured or his agent keeping
silence to speak or silence is in itself equivalent to speak.

05. No Insurer shall repudiate a life insurance Policy on the ground of Fraud, if the Insured / beneficiary can prove that the
misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-
statement of or suppression of material fact are within the knowledge of the insurer. Onus of disproving is upon the policyholder,
if alive, or beneficiaries.

06. Life insurance Policy can be called in question within 3 years on the ground that any statement of or suppression of a fact
material to expectancy of life of the insured was incorrectly made in the proposal or other document basis which policy was issued
or revived or rider issued. For this, the insurer should communicate in writing to the insured or legal representative or nominee or
assignees of insured, as applicable, mentioning the ground and materials on which decision to repudiate the policy of life
insurance is based.

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 SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

07. In case repudiation is on ground of mis-statement and not on fraud, the premium collected on policy till the date of repudiation
shall be paid to the insured or legal representative or nominee or assignees of insured, within a period of 90 days from the date of
repudiation.

08. Fact shall not be considered material unless it has a direct bearing on the risk undertaken by the insurer. The onus is on insurer
to show that if the insurer had been aware of the said fact, no life insurance policy would have been issued to the insured.

09. The insurer can call for proof of age at any time if he is entitled to do so and no policy shall be deemed to be called in question
merely because the terms of the policy are adjusted on subsequent proof of age of life insured. So, this Section will not be
applicable for questioning age or adjustment based on proof of age submitted subsequently.

[ Disclaimer : This is not a comprehensive list of amendments of Insurance Laws (Amendment) Act, 2015 and only a simplified
version prepared for general information. Policy Holders are advised to refer to Original Gazette Notification for complete and
accurate details

Page 36 of 48 Policy No. 2Q303356802 613/625

 SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Annexure IV

D. List of Ombudsman Centres with Address

Office of the Contact Details Jurisdiction of Office

Ombudsman Union Territory, District)
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Gujarat,
Tilak Marg, Relief Road,
AHMEDABAD Dadra & Nagar Haveli,
Ahmedabad – 380 001.
Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@ecoi.co.in
Office of the Insurance Ombudsman,
Jeevan SoudhaBuilding,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
BENGALURU JP Nagar, Ist Phase, Karnataka.
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@ecoi.co.in
Office of the Insurance Ombudsman,
JanakVihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
BHOPAL Near New Market, Madhya Pradesh
Bhopal – 462 003. Chattisgarh.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@ecoi.co.in
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
BHUBANESHWAR Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@ecoi.co.in
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor, Punjab,
Batra Building, Sector 17 – D, Haryana,
CHANDIGARH Chandigarh – 160 017. Himachal Pradesh,
Tel.: 0172 - 2706196 / 2706468 Jammu & Kashmir,
Fax: 0172 - 2708274 Chandigarh.
Email: bimalokpal.chandigarh@ecoi.co.in
Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet, Tamil Nadu,
CHENNAI CHENNAI – 600 018. Pondicherry Town and
Tel.: 044 - 24333668 / 24335284 Karaikal (which are part of Pondicherry).
Fax: 044 - 24333664
Email: bimalokpal.chennai@ecoi.co.in
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
DELHI Asaf Ali Road, Delhi.
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504

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 SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Email: bimalokpal.delhi@ecoi.co.in

Office of the Insurance Ombudsman, Assam,

Jeevan Nivesh, 5th Floor, Meghalaya,
Nr. Panbazar over bridge, S.S. Road, Manipur,
GUWAHATI
Guwahati – 781001(ASSAM). Mizoram,
Tel.: 0361 - 2632204 / 2602205 Arunachal Pradesh,
Email: bimalokpal.guwahati@ecoi.co.in Nagaland and Tripura.
Office of the Insurance Ombudsman,
6-2-46, 1st floor, "Moin Court",
Lane Opp. Saleem Function Palace, Andhra Pradesh,
A. C. Guards, Lakdi-Ka-Pool, Telangana,
HYDERABAD
Hyderabad - 500 004. Yanam and
Tel.: 040 - 67504123 / 23312122 part of Territory of Pondicherry.
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@ecoi.co.in
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
JAIPUR Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: Bimalokpal.jaipur@ecoi.co.in
Office of the Insurance Ombudsman,
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road, Kerala,
ERNAKULAM Ernakulam - 682 015. Lakshadweep,
Tel.: 0484 - 2358759 / 2359338 Mahe-a part of Pondicherry.
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@ecoi.co.in
Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue, West Bengal,
KOLKATA KOLKATA - 700 072. Sikkim,
Tel.: 033 - 22124339 / 22124340 Andaman & Nicobar Islands.
Fax : 033 - 22124341
Email: bimalokpal.kolkata@ecoi.co.in
Office of the Insurance Ombudsman, Districts of Uttar Pradesh :
6th Floor, Jeevan Bhawan, Phase-II, Laitpur, Jhansi, Mahoba, Hamirpur,
Nawal Kishore Road, Hazratganj, Banda, Chitrakoot, Allahabad, Mirzapur,
Lucknow - 226 001. Sonbhabdra, Fatehpur, Pratapgarh,
Tel.: 0522 - 2231330 / 2231331 Jaunpur,Varanasi, Gazipur, Jalaun,
Fax: 0522 - 2231310 Kanpur, Lucknow, Unnao, Sitapur,
LUCKNOW Email: bimalokpal.lucknow@ecoi.co.in Lakhimpur, Bahraich, Barabanki,
Raebareli, Sravasti, Gonda, Faizabad,
Amethi, Kaushambi, Balrampur, Basti,
Ambedkarnagar, Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur,
Chandauli, Ballia, Sidharathnagar.
Office of the Insurance Ombudsman, Goa,
MUMBAI 3rd Floor, Jeevan SevaAnnexe, Mumbai Metropolitan Region
S. V. Road, Santacruz (W), excluding Navi Mumbai & Thane.

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 SBI Life –Saral Jeevan Bima Policy Document (UIN: 111N128V01)
An Individual Non-Linked Non-Participating Life Insurance Pure Risk Premium Product

Mumbai - 400 054.

Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
Email: bimalokpal.mumbai@ecoi.co.in

Office of the Insurance Ombudsman, State of Uttaranchal and the following

BhagwanSahai Palace Districts of Uttar Pradesh:
4th Floor, Main Road, Agra, Aligarh, Bagpat, Bareilly, Bijnor,
Naya Bans, Sector 15, Budaun, Bulandshehar, Etah, Kanooj,
Distt: Gautam Buddh Nagar, Mainpuri, Mathura, Meerut, Moradabad,
NOIDA U.P-201301. Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Tel.: 0120-2514250 / 2514252 / 2514253 Farrukhabad, Firozbad,
Email: bimalokpal.noida@ecoi.co.in Gautambodhanagar, Ghaziabad, Hardoi,
Shahjahanpur, Hapur, Shamli, Rampur,
Kashganj, Sambhal, Amroha, Hathras,
Kanshiramnagar, Saharanpur.
Office of the Insurance Ombudsman,
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road,
Bihar,
PATNA Bahadurpur,
Jharkhand.
Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@ecoi.co.in
Office of the Insurance Ombudsman,
Jeevan Darshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198, Maharashtra,
PUNE N.C. Kelkar Road, Narayan Peth, Area of Navi Mumbai and Thane
Pune – 411 030. excluding Mumbai Metropolitan Region.
Tel.: 020-41312555
Email: bimalokpal.pune@ecoi.co.in

Page 39 of 48 Policy No. 2Q303356802 613/625

Page 40 of 48 Policy No. 2Q303356802 613/625
 KEY PERSONAL INFORMATION

Policy Number : 2Q303356802

Customer ID : 752754760

Dear Policyholder,

Given herein is information critical for us to service your policy. You are requested to kindly note this information. In case of errors,
you are requested to bring the same to our notice immediately by contacting any SBI Life branch office for effecting corrections.

1 C-KYC Number N.A

2 PAN Number DNNPP3019K
3 PEP* Status None
4 Resident Status India
5 Proof of Document Received
a Age Proof Pan card
b Identity Proof AADHAAR Card No.
c Address Proof AADHAAR Card No.
Bank Account Information
6 (Any credits such as refund of premium or payment of maturity benefits will be remitted to this account. In case you wish to
update this information at a later date, please contact us.)
a Accountholder Name BRIJ BHUSHAN PAL
b Account Number 20266108253
c IFSC Code SBIN0000519
eInsurance Account Information
7 (Dematerialized Policy Document will be credited to this account. Please contact us in case you require a physical copy of the
same.)
a eInsurance Account Number 5000036859377
b Repository Name CAMS Repository Services Ltd
FATCA/ CRS Declaration
(Based on authorization given by you, we may be required to report all or part of this information to tax authorities. Please
8 update us in case of any changes.)
Tax Residency Status (Countries other than India)
N.A
9 Other Document Received (Yes/No)
a Benefit Illustration No
b Revised Benefit Illustration (if any) No
c Need Analysis No

*Politically Exposed Person

In the above table, “N.A.” stands for Not Available.
Note: In case there is a change of status or information; please notify us immediately.

Regards,

New Business Processing

SBI Life Insurance Co. Ltd.

Page 41 of 48 Policy No. 2Q303356802 613/625

Page 42 of 48 Policy No. 2Q303356802 613/625
SBI Life –Saral Jeevan Bima Online Proposal Form (UIN : 111N128V01) Proposal No. :2QCR114185

PROPOSAL FORM – SBI Life- Saral Jeevan Bima

(UIN: 111N128V01)
SBI LIFE INSURANCE COMPANY LIMITED
Registered & Corporate office: Natraj, M.V. Road & Western Express
Highway Junction, Andheri East, Mumbai – 400069
Website: www.sbilife.co.in | Email: info@sbilife.co.in |
Toll Free No.: 1800 267 9090(9 am to 9 pm)

CIN: L99999MH2000PLC129113
IRDAI Registration No. 111

PRODUCT DETAILS
Basic Sum Assured : Rs.500,000 Policy Term : 5

Premium Payment : Regular Premium Premium Payment Frequency : Monthly

Term
Date of Birth : 16/MAY/1992 Gender : Male

Age : 29 Staff : No

If Premium Payment Frequency is “Monthly”, then display:# For monthly mode, upto 3 months premium is to be paid in advance and renewal premium payment
is allowed only through Electronic Clearing System (ECS) or NACH (where payment is made either by direct debit of Bank Account or Credit Card)

BASIC DETAILS
First Name : Mr. Brij Middle Name : Bhushan Last Name : Pal

Mobile No. : 8319845220 Email ID : brijpal457@gmail.com

State / UT : MADHYA PRADESH

Are you an No
existing SBI Life
customer?
Do you want to assign this policy on issuance? No

R I accept SBI Life's Privacy Policy, and by submitting my contact details here, I override my NDNC registration and authorise SBl Life and it’s authorised
representatives to contact me by phone/email/SMS/Whatsapp or any other form of electronic communication for further assistance and information about this
proposal and resulting policy.

QUOTE INFORMATION
Policy Term (Years) Premium Payment Term (Years) Basic Sum Assured (Rs.) Premium excluding
applicable taxes
5 5 Rs. 500,000 Rs. 141

Monthly Premium payable (Rs.)(Excluding Taxes) : Rs. 141

Applicable Taxes (Rs.) : Rs. 26

Total Premium Payable (Rs.) : Rs. 167

The taxes shall be applicable as mandated by Government of India from time to time.

e-INSURANCE ACCOUNT DETAILS

R I want to receive the Insurance policy and all the information related to the proposed insurance policy
through insurance repository?

Do you already have an e-Insurance Account? No

Request to select any one Insurance Repository from below options Repository Name: CAMS Insurance
Repository Ltd

PERSONAL DETAILS
First Name : Mr. Brij Middle Name : Bhushan Last Name : Pal

Electronically signed by Page No. :- 1

Brij Bhushan Pal
through One Time Password on 16-JAN-22 05:56 PM

Page 43 of 48 Policy No. 2Q303356802 613/625

SBI Life –Saral Jeevan Bima Online Proposal Form (UIN : 111N128V01) Proposal No. :2QCR114185

Marital Status : Single

Father’s Name : Ram lakhan pal Mother's Name Shakun pal

Spouse's Name : :

PAN Card No * : DNNPP3019K Domicile : Urban

Nationality : INDIAN Current : India C-KYC No : NA

Country Of
Residence
Please indicate whether you or your spouse is working/ retired from State Bank Group If Yes, Please state: No

Self: PF/ Pension Index/ Employee No.

Spouse: PF/ Pension Index/ Employee No.

CONTACT DETAILS (For NRI, Indian Permanent address to be provided)

Permanent : H.no 20 State / UT : MADHYA PRADESH
Address
Piyush nagar City : BHOPAL

Awadhpuri Pincode : 462022

Address Proof : Aadhar Card

Is your permanent address same as your mailing address? Yes

COMMUNICATION ADDRESS
Address : H.no 20 State : MADHYA PRADESH

Piyush nagar City : BHOPAL

Awadhpuri Pincode : 462022

Address Proof : Aadhar Card

Resident Status : Resident Indian

Mobile No. : 8319845220 Email ID : brijpal457@gmail.com

Tel. No. (Home) : NA Tel. No. (Office) : NA

GSTIN of : N/A
Policyholder

You will be required to submit the relevant proofs (self attested) for Address, Age, Identity and Income

Identity Proof : Aadhar Card Income Proof : Appointment letter

Age Proof : Aadhar card with complete DOB Qualifications : Graduate

NOMINEE DETAILS
Nominee is the person nominated by the policyholder to receive the amount under the policy and give a valid discharge to the insurer on settlement
of claim under a life insurance policy.

S.No Name Date of Birth Gender Relationship with Percentage Address same as Life
Life to be Assured Share Assured’s Address (Yes/No)
If No, then please provide

1 Mr. Ram Lakhan pal 10/JUN/1944 Male Father 100 H.no 20,Piyush
nagar,Awadhpuri,BHOPAL,MADHY
A PRADESH,India,462022
The percentage of entitlement should be total 100%.

APPOINTEE DETAILS

Electronically signed by Page No. :- 2

Brij Bhushan Pal
through One Time Password on 16-JAN-22 05:56 PM

Page 44 of 48 Policy No. 2Q303356802 613/625

SBI Life –Saral Jeevan Bima Online Proposal Form (UIN : 111N128V01) Proposal No. :2QCR114185

OCCUPATIONAL DETAILS
Occupation Service

Name & Address of Bel Bangalore Specify the exact Project Engineer Length of Service
4
Employer / Workplace designation (years)
Annual Income Rs. 420,000 Document Submitted Copy of PAN

Did you file your Income Tax Return (ITR) and have Form 16 from previous year? No

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 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,
No
immediate family member of above persons (would include spouse, parents, siblings, children, spouses parents or siblings and close
associates of PEPs. The definition includes foreign as well as domestic PEPs.

If No, In case your PEP status changes in future you shall inform SBI Life Insurance Co. Ltd. of such a change.

Has any FIR or Criminal complaint ever been registered or lodged against you? No

Have there been any Criminal proceedings initiated against you either in the past or in the present? No

Do you have any history of conviction under any criminal proceedings in India or abroad?
No

Do you have any other individual life insurance policy (from SBI Life or any other life insurer) or have you applied for one ? No

MEDICAL AND OTHER DETAILS OF THE LIFE TO BE ASSURED

I. a) Height 169cms. b) Weight 72 kgs.

II. In the last 5 years, have you :

(a) Undergone hospitalization for 3 or more days No

(b) Undertaken any medical treatment or required regular monitoring for more than 14 consecutive days on account of any ailment/accident or
No
injury
For each yes in the above points, please identify the question and provide full details, of the illness and the treatment i.e conditions, dates, duration,
results, and medication taken or being taken and share the Details

III. Do you have any physical deformity or disability or any congenital condition? No

IV. Has a proposal for life/health/accident insurance ever been declined, postponed, withdrawn, or accepted with extra premium? No

V. Have you ever had symptoms of, been treated for, been advised to receive treatment or have undergone any investigations/hospitalisation for any of
the following (tick wherever applicable)?

a. Hypertension / High Blood Pressure No

b. Diabetes / High Blood Sugar No

c. Chest pain/Heart attack/Angina/ any other ailment pertaining to heart disease, Vascular problem or Angiography No

d. Mental disorder ( Depression, Anxiety, etc ) or Psychiatric problems No

e. Lung /Respiratory disease ( Asthma, TB, Pneumonia, Bronchitis, etc) No

Electronically signed by Page No. :- 3

Brij Bhushan Pal
through One Time Password on 16-JAN-22 05:56 PM

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SBI Life –Saral Jeevan Bima Online Proposal Form (UIN : 111N128V01) Proposal No. :2QCR114185

f. Brain / Nervous system disorder/ Stroke/Paralysis/Epilepsy/Parkinson’s (shaking)/multiple sclerosis No

g. Liver disease (Jaundice, Fatty Liver, Cirrhosis Hepatitis B or C, etc) No

h. Kidney disease( Stone, Blood in urine, etc or Prostate or Urinary System disease), history of kidney failure or Dialysis No

i. Digestive disorder( Ulcer, Gastric Bleeding, Ulcerative colitis, Pancreatitis, Piles etc), undergone endoscopy or colonoscopy No

j. Goiter/Thyroid/Other hormone related disorders. No

k. Cancer /Tumor/ unusual growth or cyst of any kind, undergone chemotherapy/radiotherapy , FNAC or Biopsy, CT scan or MRI scan No

l. HIV infection / AIDS or Any Sexually Transmitted Disease(STD) No

m. Blood Disorder like Thalassemia, Anaemia, Chronic infection or blood circulation disorder No

n. Bone/ Joint/ Back Disorders/ Arthritis/ Autoimmune disorder like lupus or Rheumatoid Arthritis ( RA) etc No

o. Any disorder related to Eye, ear, nose, throat No

VI a. Do you consume any of the following? if yes given details:

Substance Consumed Yes/No Quantity Since when(Years)

Tobacco No Sticks/packets Per day 0 0

(cigs, cigar, gutkha etc)

Alcohol No Kind of alcohol i.e whisky, beer, etc NA 0

Per Week 0

Any Narcotics No NA 0

VI. b. If you have quit any of the above, in the last 1 year, kindly provide details. No

VII. Are any of your family members (include parents, brothers, sisters, spouse and children) suffering from/have suffered from/have died of No
heart disease, high blood pressure, diabetes, stroke, cancer, kidney disease or any other hereditary/familial disorder, before 55 years of age?

DETAILS OF HOBBIES AND PASTIMES :

VI. Do you take part in or have you any intention of taking part in any hazardous sports, hobbies, activities or pursuits? (Eg. mountaineering, No
Diving, racing or aviation other than as a fare paying passenger) that could be dangerous in any way?

Electronically signed by Page No. :- 4

Brij Bhushan Pal
through One Time Password on 16-JAN-22 05:56 PM

Page 46 of 48 Policy No. 2Q303356802 613/625

SBI Life –Saral Jeevan Bima Online Proposal Form (UIN : 111N128V01) Proposal No. :2QCR114185

BANK ACCOUNT DETAILS OF LIFE TO BE INSURED (Mandatory if premium payment is through modes other than Credit
Card/ Debit Card/ Net Banking)
Please provide accurate details to avoid wrong payments as all future payouts from SBI Life shall be based on the information furnished here.

Bank type : SBI

Account Number : 20266108253

Account Type * : Savings

Bank Name* : STATE BANK OF INDIA

Bank Branch Name* : HET BHOPAL

Name Of A/C Holder* : Brij bhushan pal

IFSC : SBIN0000519

Please submit any of the below listed documents for Direct Credit of any Refunds / Payout if any, to this account

Copy of Bank Statement

* Optional for SBI Account Holders

R I declare that the information given above is true and correct. I hereby authorize SBI Life to directly credit payout/refund, if any, to the
above mentioned account.

Note: Please ensure that the Bank details provided are correct and complete. Please note that SBI Life shall not be responsible if any
payments to the Bank account number provided by you fail on the ground that the bank details provided are incorrect.

TERMS AND CONDITIONS

I hereby declare that the above statements, answers and/or particulars given by me are true and complete in all respects to the best of my knowledge. I
understand that the information provided by me will form the basis of the insurance policy
I understand that, the PROPOSAL WILL NOT BE CONSIDERED UNTIL THE FULL PREMIUM INCLUDING TAXES, IS PAID BY ME.
I also understand that I am liable to pay all the Applicable Taxes and/or any other statutory levy/duty/ surcharge, at the rate notified by the State
Government or Central Government of India from time to time, as per the applicable tax laws on premium and/or other charges (if any) as per the product
features.

I understand and agree that risk cover and other benefits will not commence until a written acceptance of this proposal is issued by the company and
THAT THE BENEFITS UNDER THE POLICY shall be strictly as per the policy.

I agree that the amount held in proposal/policy deposit shall not earn any interest except as may be provided in the relevant regulations

I understand and agree that the statements in this proposal constitute warranties. 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 that the insurance contract will be governed by the provisions of all the applicable Statutes, as amended from time to time.

I undertake to undergo all medical tests as may be required by the Company for the grant of insurance.

I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer with others for the sole
purpose of underwriting the proposal and/or for the purpose of settlement of claims and with any Governmental and/or Regulatory authority.”

I hereby authorize the Company to provide my details to banks, financial institutions, credit bureaus, insurance repository, third party service providers
that the Company may have tie-ups with and insurance intermediary for this proposal/resulting policy for verification of the details of this proposal and
for servicing my policies or settlement of claims.

Electronically signed by Page No. :- 5

Brij Bhushan Pal
through One Time Password on 16-JAN-22 05:56 PM

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SBI Life –Saral Jeevan Bima Online Proposal Form (UIN : 111N128V01) Proposal No. :2QCR114185

I hereby give my consent to receive any information relating to this proposal/resulting policy from SBI LIFE through SMS/Email/Phone /Letter and
hereby authorize SBI LIFE to send any communication pertaining to my policies through SMS/email/phone/letter . This consent shall hold good even if I
register my number with the National Customer Preference Register (NCPR).

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, administrator or
any other person or persons having interest of any kind whatsoever in the life insurance cover provided to me, hereby agree that such authority, having
such knowledge or information, shall be at any time at liberty to divulge any such knowledge or information to the Company

I am aware that SBI Life - Saral Jeevan Bima is a Regular Premium Policy and I am aware that I would need to pay premium for 5 years (Premium
Payment Term)

I agree that by submitting this application, I will be bound by all the statements/disclosures of material facts made through the Online process 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 accept and agree to affix my
signature (in electronic mode/tablet/mobile) here

R I agree to the above declaration.

I further declare that the premium is paid from my credit / debit card / internet bank account.

R I hereby authorize SBI Life to consider details furnished in the proposal number specified above and in this declaration for the purpose of Central KYC
Registry and to provide my details to CERSAI in the prescribed format. I further hereby consent to receiving information from CKYC Registry through
SMS/Email or registered mobile number/email address mentioned in the proposal no. specified above.

Prohibition of Rebates
Section 41 of Insurance Act 1938, as amended from time to time, states:

a) 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 prospectuses or tables of the insurer.

b) 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.

Non-Disclosure:
Extract of Section 45, as amended from time to time, states:
a) No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy. A policy of life
insurance may be called in question at any time within three years from the date of the 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 the legal representatives or
nominees or assignees of the insured, the grounds and materials on which such decision is based.
b) 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 a 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 misstatement or suppression are
within the knowledge of the insurer. In case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive.
c) 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.
d) 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.

Place :- Bhopal

Date :- 16-Jan-2022

Electronically signed by Page No. :- 6

Brij Bhushan Pal
through One Time Password on 16-JAN-22 05:56 PM

Page 48 of 48 Policy No. 2Q303356802 613/625