Exide Life Insurance Proposal Form PDF

Application No Product Code Product Name Plan Option For SBI Life - Smart Elite SBI Life - Smart Horizon and wherever applicable COMMON ULIP PROPOSAL FORM SBI LIFE INSURANCE COMPANY LTD. ARE YOU AN EXISTING SBI LIFE CUSTOMER If Yes provide Customer ID/ Policy No. HUF NRI Employer Employee Scheme State Bank Group Staff Insurance Advisor s Own Life If any option is selected please submit relevant questionnaire/annexure/ supporting documents along with the Proposal Form as applicable 3. 100. Allocation to different Plans/ Funds should be in multiple of 1. If the allocation percentage is not equal to 100 the Proposal form will be returned to define new allocation. Fund Options allocation should total to 100 Plan Name Index Fund Top 300 Fund Balanced Fund Equity Fund P/E Managed Fund Bond Fund Equity Elite Fund II Money Market Fund Return Guarantee Fund Equity Optimiser Fund Growth Fund 1 0 0 Guaranteed Pension Fund 9. 3 DETAILS OF PREMIUM REMITTANCE If Premium is Remitted through Draft/ Cheque then the same should be issued in favour of SBI Life Insurance Co. 3 DETAILS OF PREMIUM REMITTANCE If Premium is Remitted through Draft/ Cheque then the same should be issued in favour of SBI Life Insurance Co. Ltd. - Proposal Form No. Draft/ Cheque No. Date Amount Drawn on Bank/ Branch Bank Name Branch Name Branch Code Customer A/c Number Date of EFT Please note that SBI Life branches and its sales team are not authorised to collect cash from its customers Is deposit for premium under this proposal paid by you No If answer is NO please provide required information under Point 19 of the proposal form 10. I hereby confirm that I have followed and completed all the Know Your Customer KYC norms as prescribed in the Anti Money Laundering Policy of SBI Life and in the IRDA Anti Money Laundering Guidelines. I also certify that I have taken all possible precautions to ensure compliance with the Anti Money Laundering Guidelines and prospect is not an anonymous fictitious and / or a benami person. Further I certify that I have not accepted any premium or deposit towards procuring insurance in cash. Moral Hazard Report above. I have discussed the Proposal with the Sales Representative. I have scrutinized the Proposal Form the Sales Representative Report and on the basis of my independent enquiries I recommend the Proposal for acceptance. By the Proposer and that the Proposer has affixed his/her thumb impression on the proposal form in my presence after fully understanding the contents thereof. I Mr. /Mrs. /Ms. Name of Proposer/Life to be Assured husband/wife/father/mother/partner/employer of have given the cheque/DD towards the consideration amount under this policy and have also submitted the income proof. Designation Address the Person/ Organisation Paying the Premium Section 41 of the Insurance Act 1938 1 No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take or renew or continue an insurance in respect of any kind of risk relating to lives or property in India any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer Provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer. 2 Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer or referee or friend of the insured or in any other document leading to the issue of the policy was inaccurate or false unless the insurer shows that such statements was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policyholder and that the policyholder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose Provided that nothing in this secton 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. CONFIDENTIAL REPORT OF SALES REPRESENTATIVE To be completed by the Sales Representative after receiving the completed Proposal Form Name of the Life to be Assured Bank Name For CIF Only Branch Name Address For CIF Only Bank Code For CIF Only Branch Code For CIF Only Tel. No./ Fax No. Name of the Sales Representative Sales Representative Code No. Have you fully explained the terms and conditions of the Proposed Insurance plan to the Proposer How long has the Proposer been a customer of the branch or known to you Financial status of the Proposer a. Gross Annual Income b.