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cilARGE 5?,
(Estabtished by the Life insurance corporation
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L,FE,NSU*N.EcoRpo*,oNoFrNDrA LIC'S JEEVAN SARAL (WITH - PROFITS)
THE LIFE INSURANCE CORPORATION OF INDIA (hereinafter called "The Corporation") having received a Proposal and Declaration,
and the first premium from the Proposer and the Life Assured named in the schedule referred to herein below and the said Proposal
and declaration with the staiements contained and referred to therein having been agreed to by the said Proposer and the Corporation
as basis of this assurance do by this Policy agree, in consideration of and subject to the due receipt of the subsequeni premiums as
set out in the Schedule, to pay the Sum Assured, but without interest at the Branch Office of the Corporation where this Policy is
serviced, to the person or persons to whom the same is payable in terms of the said Schedule, on proof to the satisfaction of the
Corporation of the Sum Assured having become payable as set out in the Schedule, of the title of the said person or persons claiming
payment and of the correctness of the age of the Life Assured stated in the Proposal if not previously admitted.
And it is hereby declared that the Policy of Assurance shall be subject to the conditions and privileges printed on the back hereof and
that the following schedule and every endorsement placed on the Policy by the Corporation shall be deemed part of the Policy.
SCHEDULE
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'1
. Policy No. Maturity Sum Assured (Rs.) lnstalment Premium for main Plan (Rs,)
2. Date of Commencement Death benefit Sum Assured under main plan (Rs.) lnstalment Accident Benefit Premium (Rs.)
3. Date of Commencement Risk Accident Benefit Sum Assured (Rs.) lnstalment Term Rider Premium (Rs.)
Term Rider Sum Assured (Rs.) Total lnstalment Premium (Rs,)
4. Table & Term

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Nominee under Section 39 of the lnsurance Act,1938

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Date of Last Premrum Payment
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j Date of Binh Bl
AEe of ihe Life Assured 'N
HANAPIIiGIIDA' *T L{ARA}'}GAL
Whether Age admitted
50&${}?
Proposal No 31&{JI
TJate of Prooosal
3 3./(13.r?tl.t {t

Maturity Benefit ln the event ol the Life Assured surviving the date of maturity a sum equal to Maturity Sum Assured in
force after partial sunenders, if any, along with the corresponding loyalty addition, if any, shall be payable.

Benefit on death A sum equal to the Death Benefit Sum Assured along with all premiums paid (excluding premiums paid for
the first policy year, any extra premium and premiums in respect of Rider Benefits) shall be payable
provided the policy is in lull force on the date of death. Loyalty addition, il any, shall also be payable. lf the
proposer and /or Life Assured had surrendered the policy partially, as per terms of this policy, the benefit
shall be reduced in proportion of the reduction in premium {or the main plan.

To whom Sum Assured payable The proposer or his Assignees or Nominees under section 39 of the lnsurance Act 1 938 or proving Executors
or Administrators or other Legal Representatives who should take out representations to his Estate or Limited
under this policy from any Court of any State or Territory of the Union ol lndia

Period during which premium payable Till the stipulated date of Last Payment or previous death of the Life Assured.

Dates when premium payable On the stipulated due date in

SPECIAL PBOVISIONS :

'1. Term Bider Benefil : ll option is exercised and Term Rider premium is paid, an additional amount equal t0 the Term Rider Sum assured
as shown in the Schedule will be payable on death before the date of maturity provided the policy is in full {orce.

2. Accident Benetit Rider : Para 1 1 of Conditions & Privileges ol this policy given overleaf , will be applicable if Accident Benelit is opted for
and Accident Benefit Premium is paid. Il option is not exercised, Para 1 1of Conditions and Privileges of this policy shall not apply.

3. The nonJorfeiture regulations & Participation in profits as contained in Conditions and privileges will not apply to Term Rider Benelit and
accident Benefit.
4. ln case of partial Sunenders, para-8 0f Conditions and Privileges of this policy shall apply.

Signed on behalf of the Corporation at the above mentioned Branch Office whose address is given below and to which all communications
relating to the policy should be aqqlgglgq.

Date
2 7 r4AR A0lu
:
BRANCH OFFICE ADDRESS

FLEAEE S€T
Examined by: LAST PAG€
Table No.165