| APPLO1§52570. GAGMOHAN SINGH SRAN, |Finacte Cust io: ne ofthe Applicant : me of the Coapplicant | SUKHVIR KAUR, NAVJOT SINGH ]Finacte custio; aos — STi SING eniE on WS] Disura anount Fev aa 1 won PROCESSING FEE 2 39000 ICICI LOMBARD. 3 asso? _AGMOWAN SINGH SRAN, HOF BANE LTO/NG NO. otoraeTEa ranionor 4 370000. HDFC BANK, LOAN AJC NO 460013974 FARIOKOT § 77903 DCB BANK LTD. FARIDKOT. cs goa | sasone JETAILS a Wious Disbursal Details ‘rst Second Third i of Disb ? fount of Dist ft | ESTING eee ann hance | a one ouoers Fem ove Dae oanuze oot3P0ee une [ore aac nch Tanoxor : Alc No_ 50100326170493. SC Code HOFC0002793. vAgptcsie-Yos/No Ske ped arn coated _Yos stand DEED YASIA ND. S40, 4e83E1 SITUATED At WARD NO, 8.08 GURU TEOBALAROUR NAGAR, ADH KALA Sea earr noes tae usar ensiced amt =I for Purchase Non # Construction Hf Construction ‘APE. Vw) porty clbll taken for loan > 60 Lakhs - Yes/No —— TY {Cost ih found in property elbll- Yes/No. = iT From, al & Technical reports are signed by credit manager ~Yes [Wo = io toga & technical deviation are approved by appropriate authori «Yes/No fr Due dligonce process followed - Yes/No {Use of Property Sell Occupation Investment /Obers 30 of BT, Tenative dato for recolving of documentaeee ‘Disbursal Request Forim ts Name. WU pists tione IA Gromnes Garon Aeaions APY Oa can Werequest DCB Bank Ltd to disburse my/our loan on’ > (DDIM MACYYY) tt wa. . ie rae aaron ener 2.9 0 ‘Yh was sanctioned vide sanction leer We have agreed for deducting necessary charges/feffom myfour loan amcunt and the remaining bance tobe disbursed vid Demand Draft / Cheque / Intemal Transfer / NEFT / RTGS and should be done as per details as follows: _— oF Disbursal in Favour of ‘ = ‘Name of the Bank | Beneficiary Ale | Payable | Amount Un No at Rs) PRecesepa PEE Youpe ICier Lek ARD Bove Se S8ETISMIS | Coupee DAGHOKAD STV Ge SPAN HORE BARK LTD on Waser WOFE Rawle Yeo R494 [FAROE 2 Aeon DeB Bark UTD. Ror] V19S, Total \95e000 1/we confirm to fully abide by the terms and conditions mentioned in the above-said Sanction Letter. ve would also like to confirm that, Ive do not have any objection for the disbursal of the loan and issuance of cheque/remitance of funds as per the above instructions. 1/We would also like to confirm that Uwe do not have any objection in the interest being charged from the requested date of disbursal (as mentioned above) or from the actual date of disbursement, whichever is later. In case, Tam/we are unable to provide the pending documents or fulfilling the terms and conditions ofthe above referred Sanction Letter within 30 days of the disbursal date, ive authorize DCB Bank "imited to cancel my/our loan along with Insurance (ifany) ‘on any subsequent date, without any prior intimation to me/us. In case of cancellation, Uwe hereby agree to bear and pay cancellation charges,(if any) and the interest charges to DCB Bank Limited forthe interim period without any demure, delay or protest. Name of Applicant Ja tenors and CinJcerr Signature Detmeku & A Name of Co-epplicant Coen si@— keut signature 1 UD ft Kaye Name of Co-applicent_A) Au JoT Cimon. sigmuwe_Afuh¥ — _ Signature Name of Co-applicant cAxwdlesT owe. £1104 | Dap a lace:Date: 27-04-2024 [Applicant name | MrJAGMOHAN SINGH SAN Co-applicant 1_[ Mrs SUKHVIR_ KAUR Co-applicant 2_| Mr NAVJOT SINGH Co-applicant 3 Guarantor 1 Guarantor 2 Guarantor 3. ‘Address 1 NEAR BALVIR PALACE BADHNI KALAN Address 2 KALAN BADHNI KALAN ‘Address 3 [MOGA SSS City MOGA State PUNJAB PIN 142037 Dear Sir / Madam, Subject: Sanction Letter includin, key Terms & Conditions (DCB Business Loan / DCB Flexi Business Loan) Loan / Credit Facii ities / Limit - Application reference number APPLO1552570 ‘Thank you for your patronage of DCB Bank. As requested by you, based on the discussions with you, and on the information / documents / representations provided by you, from time to time, we are pleased to convey our sanction letter of the Loan / Credit Faciilies / Limit, on the agreed Terms and Conditions (T&C). Please carefully read the entire sanction letter including Risk Profile and Event of Default in the sanction letter and in the loan agreement (s). This sanction letter needs to be accepted / signed by you immediately and is valid only for a petiod of 60 days from the date of this sanction letter. If the sanction expires, it can be revalidated only at the sole discretion of the Bank, at your cost, and the Bank may change the T&C of the sarcvon letter. “Key Fact Statement (s)" (KFS), Credit By signing the sanction letter, you are accepting all the T&C including KFS, Credit Risk Profile and ~ Event of Default. The:sanction letter does not vest in you or entitle you or give you any right to you or anyone to claim any damages whatsoever against the Bank for any reason whatsoever. Once the sanction letter is accepted, you also need to sign / execute loan agreement(s) / documents / forms / indemnities / undertaking as applicable for availing disbursal of Loan / Credit Faclities / Limit. The Bank needs to recelve the applicable Fees and Charges. All legal formalties / documentation that may be required needs to be completed before the Loan / Credit Facliles / Limit can be disbursed by the Bank. Also, you are required / expected to provide the Bank with any document / information as and when required by the Bank, 4 Page 1 of 17, \Version'1.8 Dated April 05, 2024 Stermeatiean ato & Registered Ofice: 6" Flor, Towa A, Peninsula Business Perk, Senapali Bapat Marg, Lower Pare, Mumbal - 400013, ‘GIN: L99899Mt 1T99SPLCO89008 Tel: +94 22: ai 7 ete wm com ~ethg Subhwin KemFor disbursal / release of Loan / Credit Facilities / Limit. The “Know Your Customer’ (KYC) docums wa Prescribed, from time to time, by the Rese! as required under Applicable Law(s) or bY Security / mortgage creation, hypothe by each security provider pursuan! guarantees or other security docume! Properly signed / authorized National mandate and requisite number of Fos! Letter (SI) or ECS favoring “DCB Bank. In case you wish to obtain input credit for GST, t Bank well in advance prior to the initiation of any be issued only in the name of the primary PI The T&C as per the sanction letter and T& indemnities / undertaking are subject to Srory requirements. excluding GST and is non-refundable, The Ben RBI guidelines / regulatory changes / stal All the Fees and Charges mentioned are fight to recover / deduct all unpai non-compliance to material T&C, In case of any query/clarification please reach out to DCB Bank In case you are not satisfied with the response given by the Bank, you may contact cation in fat t to the nt(s) thal ‘Automat {Dated Cheques fees payable at the oes eenal Charges for delayed payments, Penal of the loan, rf Charges during ihe tstral TAC, Collection Charges etc., from your Loan / Credit Facies | the Bank needs: ch other conditions, fe Bank of India (RBI) or any oth, n_ ‘he Bank, to be complied with by yo, “hy enis and su wor of the Bank, including secu, 19 stipulated security arrangement 't the Bank may require, I ed Clearing House (Nagy (PDCs), or Standiny i a 0 you should provide a valid GST ny. 5 re rrmaction, Please note that the carte plicant. “ Cas per loan agreement (S) / documents by the Bank including the changes pur, iF time of application, loan processing if haig|” Call: 022 6899 7777 or 040 681575; | Email: customercare@dcbbank xy Email for Loan related queries: loans@dcbbank.com Email to nodal. officer@dcbbankcon Key Fact Statement (KFS) ‘Sr. [Item i [ee Details [1_]Type of Loan Business Loan 2 | Stati ivi us Individual / Non-Individual / Propriet* Partnership / LLP / Private Ltd / [5 [papons Held Limited Companies a Thcan 7 Grea - Business panctionea ia) Facilities / Limit Amount|INR 19,11,000.00 (INR Nineteen lakh eleven thousand only) Version 1.8 Dated April 05, 2024 Page? DCB Bank Limited Corporate & Replatered Otic: 6! Floor, Tower A, Peninsula Busing CIN: Le@9G0MH1905PLCOBGO08, Te: 494 20 eM fed HS + (iS va, Lower Parel, Mumba! © +01 22 66580870 Website: www dcbbanke=" Subharte Wanye. Park, S[5 Insurance Amount Sanctioned (B) 6 | Total Loan Amount Sanctioned INR 39,000.00 (INR Thirty nine thousand only) (number and words) (A) + (8) INR 19,50,000.00 (INR Nineteen lakh fifty thousand only) 7 Margin As applicable Security / Collateral SALE DEED VASIKA NO. 245 DT. 14/08;2014, SITUATED AT WA RD NO. 6, B/S, SBI, GURU TEG BAHARDUR NAGAR, BADHNI KALAN, TEHSIL & DISTT. MOGA, Mdga-142037,Punjeb p |9 [Loan Tenure 180 Months 10 \EMI / instalment / Interest (Monthly /|INR 25,960.00 (INR Twenty five thousand nine Quarterly / Half Yearly / Annual / Other) _|huncred sixty nine only) 11_|EMI/ instalment Interest due date 4" of every month 12 |Loan / Credit Facilities / Limit repayment|DCB Bank Loan Account No XXX favoring 13_|EMI/ instalment payment mode NACH 14 [Repayment schedule (For Term Loans) __|Please refer to Annexure | 15 |Benchmark Reference Rate (subject to|RBLRBL (Revised Benchmark Linked Rate) change as per extant guidelines) 16_|Type of Interest Part Fixed 17__|Benchmark Interest Rate (C) 9.95% 18_|Spread including Credit Risk Premium (D)|4.05% 19 _|Total Applicable Interest Rate (C)+(D)_ [14% 20 |Duration of Fixed Interest’ rate, _If|60 Months applicable 21 |Month of Reset of Interest (iffapplicable)) |In the month of May, August, November, "Jand February (please | refer to! |www.debbank.com for further details) 22 |Mode\ of communication ofichanges|In/SMS / Letter / Email / website| interest rate Ee | ww.debbank.com Payable) (excluding) GST)) (non-|Please refer to Annexure ll & ie Fotundable) ‘ pebicen lwww.debbank.com section “Fees and! - Charges” (@)) Application|login fee INRI6,000.00 (INR Six thousand only) inclusive of applicable Version 4.8 Dated/April 05, 2024” [DCB Bank Limited Page 3 of 17 Peninsula Business Park, Senapall Bapat Marg, Lower Pare, Mumbai - 400013, oe Mabareshia. fae Sib. KeeGST 00 (INR Fourty thousang (b) Processing fee (e)_CERSAI charges () Legal opinion & search report INR 40,020. = [inclusive of applicable GST) a Il |t@)_Legat charges IN wi NIL charges en (h) Document drafting charges NIL Not Applicable (i) Registrar of Companies [As per prevailing State Government 3 () Stamp duty and registration (k)_ Asset verification IIL () Cancellation of loan charges (if| applicable) - (m) Commission Not Applicable - i juding GST) (non-|Please refer to Annexure Ssonaabie) (excluding GST) (nom ie Gebbank.com section "Fees Charges” Please refer to Annexure jj 25 [Charges for part pre-payment and full pre-payment (foreclosure) (excluding GST) (non-refundable) www.debbank.com section “Fees Charges” 26| [Conversion charges (if applicable) for switching from Floating to Fixed interest and vice versa Please refer to Annexure |i www.debbank.com section “Fees Charges” 27, [Penal charges for delayed payments Please refer to Annexure lil lwww.debbank.com section “Fees Charges” 128 |Penal charges — Others (including non- ‘compliance to material T&C) Please refer to Annexure W www.debbank.com section “Fees Charges" 29 |Service Branch 30) |Date on which annual) outstanding balance statement will be issued Please call DCB Bank's Custome’' 022-68997777 or 040-68157777 www.debbank.com "My Documents’ \Version 1.8 Dated April 05, 2024 Page 40131 |Guarantor(s) Guarantor name with Address 32. |Collection Charges (excluding GST) (non- refundable) (a) Cheque return / bounce INR 750, per instance (b) ECS / NACH / Standing Instruction] INR 750, per instance return (c)_ Cheque deposited return INR 160, per instance (a) Collection phone call INR 100, per call, maximum INR 400 per month () Collection visit INR 250, per call, maximum INR 1,000 per month, $3 |Collection & Recovery charges - Others|Piease refer to Annexe v8 (excluding GST) (non-refundable) |www.debbank.com section Special Terms & Conditions (If Any): RM Visit report with site visits mentioned on I> |2y Indemnity bond to be taken from Property owner that property is same for which valuation have to be done. proved MAP from Sarpanch : 19 with proper address and name of Owner and Ph fe and Name and Number clearly sible to be taken on record before disbursement. ‘ustomier needs to inform us on any new borrowing from other banks / financiors. j-Lion Marking in favour of DCB Bank Ltd, SV to_be taken from customer before disbursement. uired loan closure proof of Rs. 415000 from HDFC bank Son to be join as co applicant/Gurantor ‘Mauka Patwari Report with Proper di Wetted by technical vendor before any |payment release to customer iP Legal hire deciaration and Lé ‘rections and dimensions to be taken on records and same should be 9a hire NOC with proper KYC to be taken on record ) DSRA of 3 EMI to be taken, tillloan maturity (No Walver) For DCB Bank Ltd. Authorized Signatory, on h KFS (Applicants Jie hereby confirm our acceptance of the T&C inthe sanction letter including eee //Guarantors (If applicable) (rubber stamp in case of non-individuals, company, Version 1.8 Dated April 05, 2024 Page 5 of 17 eB Bank Limited Corporate & Registered Ofer: 6 Faw, Tower, Penis. Business Par, Sanapat Bae\ Marg, Lover Parl, Mumba = 40019, 7 cinétovsoons605r.cns00ce rat 01:22 os eeu 3580070 Website: www. debbank com Guehuite Kaur,r be uth SUPPLEMENTAL LOAN AGREEMENT This supplemental agreement ("Supplemental Agreement") which forms integral part and parcel of the Master General Terms Agreement Multi-Facility ‘Agreement! Business Loan Agreement / Home Loan Agreement / Vehicle Loan ‘Agreement and Loan/Facility Agreement ("Loan Agreement”), made amongst: r DCB Bank Limited, a Banking Company incorporated under the Companies Act, 1956 (CIN: L99999MH1995PLC089008) and deemed to exist within the meaning of Companies Act, 2013, having its Registered Office at Peninsula Business Park, 6th Floor, Tower A, Senapati Bapat Marg, Lower Parel, Mumbai — 400 013 and a branch / office amongst other place as mentioned in the Schedule of the Loan Agreement (hereinafter referred to as the “Bank”, which expression shall, unless the context otherwise requires, be deemed to mean and include its successors and assigns) of the First Part; AND The persons/entity named as Borrower! Co-Borrower, the details whereof are given in the Schedule of the Loan Agreement, at the end of this Supplemental A t, of the Other Part, hereinafter called "Borrower". ‘Borrower /and the) e\Bank are hereinafter collectively referred to as “Parties” and a had entere: .d J entering into the Master General facility Agreement Busine: ss Loan Agreement / Home ‘Agreement and Loan/Facility Agreement for (hereinafter referred to as "Loan Agreement") fetioned by the Bank, on the terms and conditions the Sanction’ Letter Loan Agreement. Byvide a circular bearing no. RBWV/2023-24/53 dated August 18, 2023, on “Fair Lending nt’, issued instructions to its Regulated for non-compliance of material terms Page 1of3“mn co) ld tas WS) viuoven Kata 19037 MLB, i RIGS | NEFT IFSC : HDFC0002793 es ce RB Ranle.LTB.. © rupees 58 a - = ae es paLIO8S . oO Te erenunesweon “fre So ne Cpe ion a sane ab woooo age ehe2hOOS3" aoe _ eg TT TTTT TTT TT oom [OE oP] PTT ; Seen oan cove | CITIOOOPIGW. | [cma O Moaity OD) cancat cnn cows ["G17100002000000037 | vwamewe [DOB BANRTNATED Te mon co €6/ 66/0 mone] Boke amber (Sid leo 2lalal i droldasl | LLL) we (Hoes Banke J ssomen[i[0] elc[elob BTTAB] An amount of Rupee 5 pear tee eT EeuT ouierDawewiwbeed FEM Haye | [°3S9S4[— Ef vesirom Amount _ FREQUENCY Ef Merny [3 Ovary I lotr Cl Yor Ch Ask wi poaiod ] cutoner name Flan phan Suv. CRA aan years acento ts ainsi hana gis SORTS Sef e tel ana came vaasin eae ea eee Fdtay, Suuer 1 LAG pots: Dtoe 5 uo ene eek (SADE e BAe MOM [e ola Mometanovr hiner font tiauter Dee iadeed aon Bose] [38984 J—_] DEBIT TYPE C] Fixed Amount Maximum Amount FREQUENCY [® Monthly C] Quarterty CI Hall-Yaarty C) Yeary Cl] As& when presented a ]outomerneme TAGrinnor Sib See Sacer eae ae a a eer ne ratactacaaronasteantan encanta aan sean Seem are tee en rrem [TB ITY] Te |e] ve [oolflmletyiele or LTT, etfahenttity suse prone [ATTUY BUG EL | cLamerapiamn nfaree.ja nanan = Eee 0 COCO) = Bie PEE ie ‘Sponsor Banke Code CITIOOOPIGW [rents CO) meaty CO) cance | ‘user code [C1T100002000000037 | Mweeuhorixe [DCB BANK LIMITED = ‘ont tex [af7en/c0/sare/se-uno/ovwr| tarkwerumder| Sol olpl 3 alél 1 AolMlals|_| we wname [DEC Bare sconce ole! el A alo BE | AnameuntotRupeer Fay Biber easy aud (COF4Sa)— a ‘DEBIT TYPE) Fixed Amount (2 Maxum Amount FREQUENCY [® Monthly C) Quartery CI Hail-Veary CI Yearly () As & when prosenied tans ‘umtomar Name wan Cer ‘Stusseeie ascomsnta iasanh ta sa onnan Season rom foe pute PT Ty : we (ele DTD] estonohon Gy) t or (Uniti Canceled Provena[QBIUY SUUCT] saceaaipprave Cir Lagat nara pena Spr 9 Pedant ry errand? Tae Sera Pulte BERT | Seems hate seis’ tees oe rtcening bw nares Cours satan aed sets naucts aged apcoym hese at oa omucng ou arcana inodeervice/ Claim related bard . IL LOCATION- BHATIND: EMP ID- 1008404 * Hie orate Enrollment Form - Income Protect Wa iciaa,. Ici& "aigicit Enrollment Form No. PUDELINES rancor eine OF THE FORM (To be filled by the proposer) contra ii i sa tspntoss a anol cist Biot Faith requiring the Proposer not only to disclose all material facts, but also *A material fact will mean and include alli i i | a a lude all important, essential and relevant information pertainin ‘to the questions | raised below herein, thats likely to influence the Company's acceptance or assessment of theproposa. The Policy shall become void at the option of Insurer, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in this form/personal statement, Hoclaration and connected documents or any material information having been withheld by the Proposer or any one acting on his behalf. Kindly contact the Company's Offices or Agents for any doubts or clarifications on the enrollmentform. Note: The liability of the company does not commence until this received by the company. VWe hereby agree and confirm that proposal has been accepted and premium is duly insurer's less than the premium payable for sum i icati for acceptance insured proposed Tor insurance or scope of cover desired by me, he ‘pplication shal be considered insure reed sum insured appropriate tothe premium realised by npplicatyrer and the policy shal finalised and xd according! issued accordingly. + ifthe amount realised by the it 13 correctly. Where any “to application form isto be filed in CAPITALLETTE! question doesnot apply, leasementin clearly the ques Giipeeeand Name of the Proposer: .)} Al G/M) 0) 4 8 Gondor Male 77 Female _| Third gender __) ‘ Ailing Address of Proposer: pease Bauvieiiaus Kava) JMO ga) JJ JJ JI JJ J_JJ_ JJ JI wie No: @) 8) U4) 4) 3441-0) PANNe. CUZ IIS) adit tions nt applicable. Jisaas UI gin gn JS 68S) 6 jj JJ J JI 552 nn } Pincode: _\) 4) QL0) 271) ) bmaiD: (Raw PALA Gomaids Com Ayo 78 3NVVUU Tove to SECTION I!) SECTION I: (If @ then sk N Sew) 55 U- [Name of the Prospect: Gender: Male _J Mobile No:_J_JE | Nominee Name: By) III BJ jj jj SECTION II: Date of Birth: pa) with Prospect: JTe are Dos Loan Account No. (LAN: AQ) Q)R) LEO V9 $F AS} ALO} Loon Tenure: |S) years One EMI Amount: 21919)6) 9) |_| Type of Loantobe insured: HOMELOAN | LAP J Others J Loan Sanction Date: QJ) G] Lo | || Loan Sanction Amaunt 2: Loan Disbursal Date: QJ) Oly | QLo| 2/4 | Disbursal Amount ®: Gone Id mount J Jj enum Amount bo J pD/ Cheque Amount: J tt Oy ‘ a ry \ |_| Funded J Non Funded Bank tame: | J J povChewedee T) ol | IILIcLc)— NeFrvansaciontm: J JJ JJ) fo Poliy wardigs trea poiy terms and cod : yO Slo OG) rcs Phi DKe) |) | | | EE 1, Please confit yauare suffering from Diabetes _J Hypertension _J .HighCholestrol _J tyes, Please specify the duration ofillness —_ 2, Has Prospect consulted with any doctor or other health car hospitalzetionforanyiliness orsurgery.Yes | No _| tyes, Please specify details along with the duration et current, taking medication(s)/ or taker past for any condition or medical procedures {including diagnostic Ive Sno) Policy Term |__Jyears Type: New J Renewal |. Incase avnewa lease mention paicy number Covers 1 ‘Sum Insured Coverage | Bonefit Amount | [ " — = | Seon & Bent: ness (GT-R [100% Sum Insured _ Jj _S_S_J_I_S. ‘As per Annexure A } Section 8 Benoit 3: Malo surgical rocedues MSP) | Shiney Werdng, | jj | Secon Re Keown BavePA) | woos Son wewed |] JJ J.J) Section C Benefit S : Permanent Total Disablement (PTD) 100% Sum Insured JIS Sj S| _}_J_} Applicant Signature: Registered GST: Yes _| No _) (Oe Pay Getic , oda5 lease provi JJ J J 5 | Mawrsgeeern JIS SSIS SIS II f © provider for any other condition or symptorn(s\/undergone any J wet cure Mine Critical lness/ Healt Income Protect Policy with ICICI Scompany? Yes J No | JJ Applicant signature: PAGE 20Foem Sa ree’ declare, on my behalf ang . On behalt of frepased te be insured, that thea ofall perso 7 Por parculars given by me wees elamens, answers S08 oc snp “CPS as respects to thebes! of my knowledge ang hae or bet® inal [Me Pl without assigning ny tponseonbealet hese atherpersang 12 od Suber the conga te, mes {understand that the information provided ¢ Proposal including the mea formation basis ofthe insurance policy ig subjecs a me willform the P*OPOSer forthe so sued en oe pany i ont the inderwriting pol ‘Boar And/or clair ‘ inotorce onlyatev in darn eta patente * Regulatory aunt and with any Go fthe premium cha declare th 4 | hate declare that | sl notin sun oth che and treo ac ‘understood the signifi 0. Lalsoconfim and dectare tha tthe i been mentioned inthis enrollment fom for cossene see ‘pateats)Co-appcan)/Guerarof tela ‘eteby confirm that am aware that enrolment to this produ ‘spurelyvolitary ands notinked tome valine sean faity rather ome svaingat ary er 12, thereby conti that have insurable interestin the policy and 5. Ihave been provided with the detail terms of the policy. |have thepremiumnsnatbomaby any tid pry any operon ‘ead, understood and aware of the details terms of hepoicy. 13. (We hereby give my/our consent issued t OCB Bank Ld, to 6. L have read and understood the terms and conditions of the snl me/us into Income Protect policy underwritten by ICL Folicy and confirm to abide by the same. Ihereby agiee that Lombard Generalinsurance Co Lid (IDA Reg No 115) thetrsurance coverage/rsks under tepocy ll emmence 14. We ae to aie by he Tams Conditions the policy Subject to realization of full premium, Receipt ofthis form by and provide my consent to DGB Benk U3. to share my the Company shall not be construed as acceptance of personaldetals as required, regardingmy avolmentt the proposal. Company inits sole discretion reserves therightto_poloywihhelnsure, } DECLARATION FOR ASSIGNMENT + hereby assi | Mess ils: _ “Fy > A the claim amount payable in the event of my Death / Diagnosis / Undergoing Surgical Procedures as covered under the policy issued by ICICI Lombard General insurance Company Limited against the above mentioned product(s), to and further dectare that this receipt shallbe sufficient discharge to the Company. ‘Terms & Conditions From the policy start date, the amount payable by Company to the insured and all rights, ttle, benefits and interest of the insured under this policy stand assigned in favor of the “Bank /financiel institution as named in the Schedule ofthis policy’ from all the lablty under the policy and this shall be binding on the insured and the heirs, sors of legal representatives of theinsured, WJ JJ JIIo WIN JJ fed Health Status| SP Code/License Nov Agent iD: | |_| IJ Jdate: J _J_J_J_J_J_J_ J spyagent signature: | STATUTORY WARNING | PRONIBITION OF REBATES | (Under Section 47 of insurance Law) | (Amendment Act 2015) )|o No person shall allow or offerto allow, either directly orindirectly 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 ofthe 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 ofthe Insurer, 2) Any person making default in comphyin lekhs, ig with the provisions of this section shall be liable for a penalty, which may extend to ten. ICICI GLombard libhaye Veale mm G ‘ @ Genera Insurance Company Limited ——! New tnk Road, Malad s a ed, Mad (Wes), Mumbai 400 064 Sra a Sih Vinayak Tepl, rabhade, Mums cd 025, tation ROA Reno fo 1800 2665 + Chargable No.: +91 86 55 222 666 coe rote ICLP 2 OOM ZOOOPLCT28408S