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This is to certify that in consideration of the premium payment
and subject to all provision of Group Master Policy No: __________
the
person named hereunder(here in called the Insured Member) is
insured under _________________________ policy.SARVE SHAKTI
SURAKSHA
Insured Member Name : Mr Gangapur Abhishak Kumar
Door No : Srt-1047
Bluilding Name :
Area :
Street Name : Near Shivasi Statue~
Place : Sanathnagar
City & Pin Code : Hyderabad - 500025
District :
State : Andhra Pradesh
Master Policy Holder Details
Policy Holder Name : Citi Bank N.A.
Policy Holder No : 0177206484 Date of Commencement : 6/01/10
Individual Coverage Details :
Insured Member Name : Mr Gangapur Abhishak Kumar
Membership Number : 0226795874
Sum Assured (Rs.) : 720000
Date of Birth : 4/24/84
Premium (Rs.) : 1500
Branch code : P00
Premium Paying Term : Years
Date of Commencement : 6/28/11
Gender : Male
Rider SA (Rs.) :Age at Entry : 27
Premium Payment Mode : MONTHLY
Branch Location : HEAD OFFICE - PUNE
Application Number : 5600018069
Nominee Details/Proposer Detail
Nominee Name/Proposer Name : Jagan Mohan Rao Gangapur
Relation : Father
For and behalf of Bajaj Allianz Life Insurance Company
Limited.
Authorized Signature
__________________________________
Bajaj Allianz Life Insurance Company Limited
WEST HUB, 2ND FLOOR, BAJAJ FINSERVE, SURVEY #208/1-B
BEHIND WEIKFIELD IT BUILDING, VIMAN NAGAR,
NAGAR ROAD, PUNE
MAHARASHTRA, PIN CODE - 411 014
Tel. No. : 020 41016820
0177206484
Membership No : 0226795874
Date of Commencement : 6/28/11
Basic SA : 720000
Premium : 1500
Frequency : MONTHLY
Date of Risk :
Proposer detail applicable if insured person is minor
CERTIFICATE OF INSURANCE
0177206484226795874
0177206484
0226795874
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MASTER POLICYCOVER CONDITIONS
2. The regular premiums are payable on the specified due dates.
The coverage would lapse in case of non payment of premiums in due
time.
3. The term opted by the Member is years subject to regular
payment of premium on due dates and the Master Policy being kept in
force.
4.The Master Policy contract of this scheme is available at
corporate office of Bajaj Allianz Life Insurance Co Ltd, GE Plaza,
Airport Road,
Yerawada,Pune - 411006.
5. The Benefits Payable are as given below
b) On an individual Member reaching to the Maturity Date, the
individual members account value can be withdrawn. The minimum
maturity
guarantee is the total net premiums paid till maturity date less
sum of Scheme Administration Fee deducted till maturity date,
provided all
due premiums have been paid by the policyholder for the
respective Member.
c) On surrender of the Policy, Individual Account of all Members
shall be closed and the Account Value, subject to the Market
Value
Adjustment as applicable on the date of such closure, of all
such Individual Accounts less Surrender Penalty, if any, as per
Section 8
below, shall be paid. For surrender of the Policy, the
Policyholder will be required to give at least three-month prior
notice to the Company.
d) Lapsed Coverage: Account value as on date of death is
payable.
6. Surrender Value: The surrender value is the account value of
the members individual account, subject to the market value
adjustment as
applicable on the date of such closure less Surrender
Penalty.
7. Subject to the other provisions of the Act, ' Premiums paid
are eligible for tax benefits under Section 80C of the Income Tax
Act and
Death Benefit, Maturity Benefit and Surrender Value are eligible
for tax benefits under Section 10(10D) of the Income Tax Act'.
8. The coverage would get terminated on happening any of the
following events
I. Discontinuation of the premium
II. Member reaching the coverage end date
III. The insurer terminating the contract by giving 90 days
notice to master policyholder
IV. Surrender of Policy by Policy holder
V. The date on which the policy holder terminates the Policy or
Individual Account of the member is surrendered.
VI. The date on which the member ceases to be a member of the
scheme.
CLAIMS PROCESS
1. Claims will be intimated to MASTER POLICY HOLDER who in turn
will intimate the insurer
2. Claims have to be intimated by a written notice within 180
days of the death, and the circumstances resulting in the
death.
3. The documents required to be submitted by the nominee for the
processing of the claim are as given below.
a) Claimant Statement with complete details.
b) Original Certificate of Insurance
c) Original death certificate of the Member certified by the
competent authority.
d) Medical cause of death certificate from the doctor last
attending or the hospital in which the death occurred.
e) Original / Attested copy of the postmortem report, FIR,
Police Inquest Report in case of accidental death.
f) Any other relevant documents or information as may be
required by the insurer for the processing of the claim depending
upon the
cause of death.
1. Citi Bank N.A.,The Master Policy Holder has proposed for
SARVE SHAKTI SURAKSHA policy on the life of its members And the
same
has been agreed and accepted by the insurer Bajaj Allianz Life
Insurance Co Ltd. The risk premium component would be subject
to
revision at annual renewal date.
a) On Death Of individual Member:
On death of an individual Member before attaining age 7 years:
The death benefit equal to the Account Value of the individual
member
as on date of receipt of intimation of death at the office of
the Company.
On death of an individual Member on or after attaining age 7
years: The death benefit equal to the amount of Sum Assured for
which
the individual Member was assured plus the Account Value of the
individual member as on date of receipt of intimation of death at
the
office of the Company.
9. The minimum term of the policy would be 5 Years.
SARVE SHAKTI SURAKSHA
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