Part A

Ref no.: 24XXXX25 PSCDEAD-D2C_BlueDart-4290387-4374156

NDA/NDO / Branch: 105

Mr. VXXXX XXXXXX

XXXXXXXX 26th October 2024
XXXX
NOXXXXX
XXXXXXX
C

India
Tele.Nos - 85XXXXXX25
Mobile No : 9199XXXXXX86
Email - [email protected]
R

Dear Mr. ViXXXX XXXXXX,

Sub: Your Policy no. 28XXXX84

We are glad to inform you that your proposal has been accepted and the HDFC Life Sanchay Plus Policy (“Policy”) being this Policy,
has been issued. We have made every effort to design your Policy in a simple format. We have highlighted items of importance so that
you may recognise them easily.

Policy document:
As an evidence of the insurance contract between HDFC Life Insurance Company Limited and you, the Policy is enclosed herewith.
Please preserve this document safely and also inform your Nominees about the same. A copy of your proposal form submitted by you
is enclosed for your information and record.

Cancellation in the Free-Look Period:

In case you are not agreeable to any of the terms and conditions stated in the Policy, you have the option to return the Policy to us for
cancellation stating the reasons thereof, within 30 days from the date of receipt of the Policy, whether received electronically or
otherwise. On receipt of your letter along with the original Policy (original Policy Document is not required for policies in dematerialised
form or where policy is issued only in electronic form), we shall arrange to refund the Premium paid by you, subject to deduction of the
proportionate risk Premium for the period of cover and the expenses incurred by us on medical examination (if any) and stamp duty
charges.

Contacting us:
The address for correspondence is specified below. To enable us to serve you better, you are requested to quote your Policy number
in all future correspondence. In case you are keen to know more about our products and services, we would request you to talk to our
Certified Financial Consultant (Insurance Agent) who has advised you while taking this Policy. The details of your Certified Financial
Consultant including contact details are listed below. In case you are keen to know more about our products and services, please call
us on our toll-free number 1800 266 9777 or email us @ [email protected]. You can also get in touch with us via social media:
https://plus.google.com/+hdfclife/
https://www.youtube.com/user/hdfclife10
http://www.linkedin.com/company/19117
https://twitter.com/HDFClife
https://www.facebook.com/HDFClife

To contact us in case of any grievance, please refer to Part G. In case you are not satisfied with our response, you can also approach
the Insurance Ombudsman in your region. Thanking you for choosing HDFC Life Insurance Company Limited and looking forward to
serving you in the years ahead,
Yours sincerely,

Authorised Signatory
Branch Address:HDFC Life Mumbai-Hub, 11th Floor, Lodha Excelus, Apollo Mills Compound,N. M. Joshi Marg, Mahalaxmi, Mumbai,
400011
Agent details
Name : HDFC Life, Address : HDFC Life Insurance Company Limited, 13th Floor, Apollo
Mills Compound, NM Joshi Marg, Mahalaxmi, Mumbai - 400 011. Agent No. : 01019195
License No. : Contact Details :022-68446530 (local charges apply)
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PSCDEAD-D2C_BlueDart-4290387-4374156
Address for Correspondence : HDFC Life Insurance Company Limited(“HDFC Life”), 11th Floor, LodhaExcelus, Apollo Mills Compound, N.M. Joshi Marg,
Mahalaxmi, Mumbai-400011.

Registered Office :HDFC Life Insurance Company Limited(“HDFC Life”), 13th Floor, LodhaExcelus, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi,
Mumbai- 400 011.CIN: L65110MH2000PLC128245, IRDAI Reg. No. 101 |Website: www.hdfclife.com | Email ID: [email protected]| [email protected]
(For NRI customers only) | Helpline number: 022-68446530 (Call charges apply) | NRI Helpline number +91 89166 94100 (Call charges apply)

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PSCDEAD-D2C_BlueDart-4290387-4374156
 POLICY DOCUMENT- HDFC Life Sanchay Plus

Unique Identification Number:101N134V24

Your Policy is an individual non-participating non-linked savings life insurance policy. This document is the evidence of a contract
between HDFC Life Insurance Company Limited and the Policyholder as described in the Policy Schedule given below. This Policy is
based on the proposal made by the within named Policyholder and submitted to the Company along with the required documents,
declarations, statements, any response given to medical questionnaire by the Life Assured, applicable medical evidence and other
information received by the Company from the Policyholder, Life Assured or on behalf of the Policyholder (“Proposal”). This Policy is
effective upon receipt and realisation, by the Company, of the consideration payable as First Premium under the Policy. This Policy is
written under and will be governed by the applicable laws in force in India and all Premiums and Benefits are expressed and payable
in Indian Rupees.

POLICY SCHEDULE
Policy number: 28XXXX84
Client ID: AOPXXXX6
Policyholder Details

Name Mr. Vixxxx xxxxxx

xxxxxxxxxxx
xxx xx xxxxxxxx

Address xxxxxx
xxxxx xxxxxxx
xxxxxx

Gender Male

Life Assured Details

Name Mr. ViXXXX XXXXXXX

xxxxxxxxxxx
xxx xx xxxxxxx
xxxxxx
Address
xxxxx xxxxxxx

xxxxxxx
Date of Birth 30th Jaxxxxx 19xx
Age on the Risk Commencement 29 Years
Date
Age Admitted Yes
Gender Male

Policy Details

Plan Option Guaranteed Income

Risk Commencement Date 24th October 2024

Premium Due Date(s) 24th October

Sum Assured ` 1,297,800.00

Sum Assured on Death ` 12,97,800.00

Guaranteed Sum Assured on ` 414,792.00
Maturity
Policy Term 5 years

Premium Paying Term 5 years

Frequency of Premium Payment Annual 3 of 33

Premium per Frequency of ` 100,000.00
Premium Payment

Underwriting Extra Premium per ` 0.00

Frequency of Premium Payment

Total Premium per Frequency of ` 100,000.00

Premium Payment

Annualized Premium ` 100,000.00

Guaranteed Income on Maturity ` 64,633.00

Payout Period 10 years starting from year 06

Income Payout Frequency Annually

Grace Period 30 days

Final Premium Due Date 24/10/2028

Maturity Date 24/10/2029

Policy issued on the basis of
Yes
medical questionnaire
The Premium amount is excluding any applicable Taxes and levies leviable on the Premium. Amount of Taxes and levies will be charged at actuals
as per prevalent rate.

HDFC Life Insurance Company Limited

11th Floor, Lodha Excelus,
Apollo Mills Compound,
Address for Communication N. M. Joshi Road,
Mahalaxmi,
Mumbai - 400 011.
Email: [email protected]

Stamp Duty of ` 259.60/- is paid as provided under Article 47D(iii) of Indian

Stamp Act, 1899 and included in Consolidated Stamp Duty Paid to the
Government of Maharashtra Treasury vide Order of Addl. Controller Of Stamps,
Mumbai at General Stamp Office, Fort, Mumbai - 400001., vide this Order
No.(LOA/ENF-2/CSD/96/2024/Validity Period Dt.13092024 To
Dt.31032025(O/w.No.4517)/Date :13092024)'

Proper Officer

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 NOMINATION SCHEDULE

Nominee’s Name Mrs. Mxxxxx Rxxxxx

Nominee’s Relationship with the Life Wife

Assured

Date of Birth of Nominee xx xxxxxx 19xx

Nominee’s Age 29 Years
Nomination Percentage 100.00

xx xx xxxxxxxx
xxx xx xxxxxxxx
Nominee's Address xxxxx
xxxxx xxxxxxx - xxxxxx

Appointee’s Name NA
(Applicable where the nominee is a minor)

Date of Birth of Appointee NA

Appointee's Address NA

Signed at Mumbai on 26th October 2024

For HDFC Life Insurance Company Limited (“HDFC Life”)

Authorised Signatory

In case you notice any mistake, you may return the Policy document to us for necessary correction.

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PSCDEAD-D2C_BlueDart-4290387-4374156
 Part B 19) Non-par products or products without participation in profits
(Definitions) - means products where polices are not entitled for any share
in surplus (profits) during the term of the policy.
In this Policy, the following definitions shall be applicable: 20) Policy Anniversary – means the annual anniversary of the
Risk Commencement Date;
21) Policyholder, You, you, your – means or refers to the
1) Annualized Premium shall be the premium amount payable in Policyholder stated in the Policy Schedule.
a year excluding taxes, rider premiums, underwriting extra
22) Policy Term – means the term of the Policy as stated in the
premiums and loadings for modal premiums.
Policy Schedule;
2) Appointee – means the person named by you and registered
23) Premium(s) / Single Premium – means an amount stated in
with us in accordance with the Nomination Schedule, who is
the Policy Schedule, payable by you to us in the manner
authorized to receive the Death Benefit under this Policy on
stated in the Policy Schedule, to secure the benefits under this
the death of the Life Assured while the Nominee is a minor;
Policy, excluding applicable taxes and levies;
3) Assignee – means the person to whom the rights and benefits
24) Premium Paying Term – means the period as stated in the
under this Policy are transferred by virtue of assignment
Policy Schedule, in years, over which Premiums are payable;
under section 38 of the Insurance Act, 1938, as amended
25) Regulations – means IRDAI (Insurance Products)
from time to time;
Regulations, 2024 as amended from time to time and
4) Assignment – means a provision wherein the Policyholder
applicable to this Policy, including without limitation the
can assign or transfer a Policy in accordance with Section 38
Regulations and directions issued by the Insurance
of the Insurance Act, 1938 as amended from time to time;
Regulatory and Development Authority of India (‘IRDAI’)
5) Authority/ IRDAI – means Insurance Regulatory and
from time to time.
Development Authority of India established under the
26) Revival of Policy - means restoration of the Policy, which
provisions of section 3 of the Insurance Regulatory and
was discontinued due to the non-payment of Premium, by the
Development Authority Act, 1999.
insurer with all the benefits mentioned in the Policy
6) Company, company, Insurer, Us, us, We, we, Our, our –
document, with or without rider benefits, if any, upon the
means or refers to HDFC Life Insurance Company Limited. receipt of all the Premiums due and other charges/late fee, if
7) Risk Commencement Date - means the date, as stated in the any, during the revival period, as per the terms and conditions
Policy Schedule, on which the insurance coverage under this of the Policy, upon being satisfied as to the continued
Policy commences; insurability of the insured/Policyholder on the basis of the
8) Death Benefit - means the benefit which is payable on death of life information, documents and reports furnished by the
assured, as stated in the policy document under Part C. Policyholder; in accordance with Board approved
Underwriting Policy.
9) Free Look period – means the period specified under Part D clause
27) Revival Period – means the period of five consecutive
7 from the receipt of the Policy during which Policyholder can
complete years from the date of first unpaid premium.
review the terms and conditions of this Policy and where if the
28) Savings products means those products other than Pure risk
Policyholder is not agreeable to any of the provisions stated in the
products.
Policy, he/ she has the option to return this Policy.
29) Sum Assured on Death – means an absolute amount of
10) Frequency of Premium Payment– means the period, as stated
benefit which is guaranteed to become payable on death of
in the Policy Schedule, between two consecutive Premium
the Life Assured in accordance with the terms and conditions
due dates for the Policy;
specified of the Policy.
11) Grace Period for other than single premium policies - means
30) Surrender - means complete withdrawal/ termination of the
the time granted by the insurer from the due date of payment
entire Policy contract.
of premium, without any penalty or late fee, during which
31) Surrender Value - means an amount, if any, that becomes
time the policy is considered to be in-force with the risk
payable on surrender of a policy during its term, in
cover without any interruption, as per the terms & conditions
accordance with the terms and conditions of the policy.
of the policy. The grace period for payment of the premium
32) Total Premiums Paid - means total of all the premiums paid
for all types of life insurance policies shall be fifteen days, under the base product, excluding any extra premium and
where the policyholder pays the premium on a monthly basis taxes, if collected explicitly.
and 30 days in all other cases.
12) Life Assured – means the person as stated in the Policy
Schedule on whose life the contingent events have to occur
for the Benefits to be payable. The Life Assured may be the
Policyholder.
13) Maturity Benefit - means sum assured on maturity, any
additional and accrued benefit, which is payable on maturity
in accordance with the terms and conditions of the policy.
14) Maturity Date – means the date stated in the Policy Schedule,
on which the Policy Term expires;
15) Minor – means for purpose of this Policy any person who is
below 18 years of age.
16) Nomination - is the process of nominating a person(s) who is
(are) named as “Nominee(s)” in the proposal form or
subsequently included/ changed by an endorsement.
Nomination should be in accordance with provisions of
Section 39 of the Insurance Act, 1938 as amended from time
to time.
17) Nominee(s) – means the person nominated by the
Policyholder (who is also the Life Assured) under this policy
and registered with us in accordance with the Nomination
Schedule, to whom money secured by the Policy as
mentioned under the Death Benefit shall be paid in event of
the death of the Life Assured;
18) Non-Linked insurance products” are the products other than
Linked insurance products

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PSCDEAD-D2C_BlueDart-4290387-4374156
 Part C (ii) All other Benefits shall be payable to the Policyholder.
(iii) If the Policy has been assigned, all Benefits shall be
Benefits payable to the Assignee under absolute assignment.
1. Benefits:
3. Payment and cessation of Premiums
(1) The first Premium must be paid along with the submission of
(!) Maturity Benefit – On survival of the Life Assured till the
your completed application. Subsequent Premiums are due in
Maturity Date and provided all Premiums which have fallen
full on the due dates as per the Frequency of Premium
due have been paid, the Maturity Benefit payable shall be
Payment set out in your Policy Schedule.
Guaranteed Income on Maturity payable at the end of each
Income Payout Frequency as provided under the Policy
(2) Premiums under the Policy can be paid on yearly, half-yearly,
Schedule, during the Payout Period as mentioned in the
quarterly or monthly basis as per the chosen Frequency of
Policy Schedule.
Premium Payment and as set out in the Policy Schedule or as
amended subsequently.
Maturity Benefit will be paid as Guaranteed Income for the
fixed term of 10 or 12 years starting from (Policy Term +
(3) Advance Premium
1)th year, in arrears on payment of all due premiums.
The Premiums that fall due in the same financial year can be
The amount of Guaranteed Income shall be equal to the paid in advance. However, where the Premium due in one
percentage of Annualized/Single Premium depending on the financial year is paid in advance in earlier financial year, we
Premium Payment Term and Policy Term. Please refer to the may collect the same for a maximum period of three months
Guaranteed Income on Maturity value as mentioned in your in advance of the due date of the premium.
Policy Schedule.
(4) Any Premiums paid before the Due Date will be deemed to have
On the Maturity Date, you shall have an option to receive the been received on the Due Date for that Regular Premium.
Guaranteed Sum Assured on Maturity, which shall be the
present value of future payouts, discounted at a rate of 9% (5) Grace Period:
p.a. This interest rate is not guaranteed. However, any change Grace period is not applicable for Single Premium.The grace
in the interest rate will be subject to prior approval of the period of 15 days (where the premium is paid on a monthly
Authority and will be applicable only to the policies sold basis) and 30 days (where the premium is paid in
after the date of change. quarterly/half-yearly/annual basis) is available on the
premium due date, to pay the premium. We will not accept
At any point of time during the Payout Period, you shall have part payment of the Premium. The policy is considered to be
an option to receive the future income as a lump sum, which in-force with the risk cover during the grace period without
shall be the present value of future payouts, discounted at a any interruption as per the terms and conditions of the policy.
rate which is computed using the prevailing interest rates
described in Part D Clause 4 below. (6) A Premium will be deemed to remain unpaid if the Premium
amount has not been realised by us. If any Premium remains
On death of the Life Assured during the Payout Period and unpaid after the expiry of the grace period, your Policy may
provided all Premiums which have fallen due have been paid, lapse or become Paid-Up,s as described in Part D Clause 2,
the Nominee shall continue receiving Guaranteed Income on with effect from the due date of the first unpaid Premium. In
Maturity as per Income Payout Frequency for the remaining that event, the Benefits under such Policy shall be payable in
Payout Period, however the Nominee shall, any point during accordance with Part D Clause 2.
the Payout Period, have an option to receive the future
income as a lump sum, which shall be the present value of (7) Premiums are payable by you without any obligation on us to
future payouts, discounted at a rate which is computed using issue a reminder notice to you.
the prevailing interest rates described in Part D Clause 4
below. (8) The application of the Premiums received is conditional upon
the realisation of the proceeds of the instrument of payment,
(2) Death Benefit – On death of the Life Assured during the including electronic mode.
Policy Term and provided all Premiums which have fallen
due have been paid, the Death Benefit payable shall be equal
to Sum Assured on Death which is highest of:
a) 10 times the Annualized Premium or 1.25 times
the Single Premium, or
b) 105% of Total Premiums paid, or
c) Premiums paid accumulated at an interest of 5% p.a.
compounded annually, or
d) Guaranteed Sum Assured on Maturity, or
e) an absolute amount assured to be paid on death, which
is equal to the Sum Assured as specified in the Policy
Schedule.

Sum Assured shall be equal to the applicable Death Benefit

Multiple times the Annualized/Single Premium. The
applicable Death Benefit Multiples are as specified in
Appendix 2.

Upon payment of the Death Benefit in case of death of the

Life Assured during the Policy Term, the Policy terminates
and no further Benefits are payable.

2. Recipients of Benefits
(1) The recipients of Benefits under this Policy shall be as
specified below:
(i) Death Benefit shall be payable to the registered
Nominee(s), if the Policyholder and the Life Assured are
the same; or to the Policyholder if the Life Assured is
other than the Policyholder.

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PSCDEAD-D2C_BlueDart-4290387-4374156
 Part D yield shall be RBI Negotiated Dealing System-Order Matching
segment (NDS-OM).
1. Surrender Value During revival campaigns, the Company may offer reduced interest
The Policyholder may surrender the policy during the Policy Term. rates, subject to the rules of the special revival campaign. The rebates
offered during the revival campaign may vary from year to year. The
maximum interest rate rebate may be set up to the prevailing revival
The Surrender Benefit will be higher of GSV (Guaranteed Surrender interest rate. Once the Policy is revived, you are entitled to receive
Value) and SSV (Special Surrender Value). all contractual Benefits.

(1) Guaranteed Surrender Value (“GSV”) 4. Discount rate

a) The Policy will acquire a GSV immediately on the payment The discount rate shall be computed with reference to the prevailing
of Single Premium and upon the payment of at least first two interest rates. The prevailing interest rates will be derived from yields
years’ premiums in case of a Limited / Regular Premium of G-Sec securities of 10 years. Any change in the interest rate used
Policy. will be in accordance with the formula below:
b) Upon payment of the Surrender Benefit, the Policy shall Annualized Yield on reference government bond + k rounded up to
terminate and all other Benefits shall cease. the nearest 25 basis points
c) Subject to the Policy being in-force, the minimum GSV shall
be GSV of Total Premiums paid Where k=150 basis points
where,
 GSV shall be determined as the applicable GSV The discount rates will be reviewed semi-annually and shall be
factors on Total Premiums Paid at the time of revised using the above mentioned formula and the change in the
surrender multiplied to the Total Premiums Paid discount rates shall be effective from 25th February and 25th August
to date. The premium is excluding any each year.
applicable taxes and other statutory levies paid
or any extra premiums paid. 5. Alterations
d) The GSV factors applicable for Total Premiums paid are as No alterations are permissible under the Policy except change in
specified in Appendix 1. Frequency of Premium Payment and Income Payout Frequency.
Alteration in the Frequency of Premium Payment may lead to a
(2) Special Surrender Value (“SSV”) change in the Premium. Such alteration will be in accordance with
SSV shall become payable after completion of first policy the Board approved underwriting policy.
year provided one full year premium has been received.
For single premium policies, SSV shall become payable
immediately after receipt of single premium. 6. Loans
SSV shall be at least equal to the expected present value of a) Policy loans will be available during the Policy Term subject
the to such terms and conditions as the Company may specify
(a) paid-up sum assured on all contingencies covered and from time to time. Our current terms and conditions are stated
(b) paid-up future benefits (such as income benefits), if any, below:
and  The loan amount will be subject to a maximum of 80%
(c) accrued/vested benefits, duly allowing for survival of the surrender value.
benefits already paid, if any  The current interest rate on loan is 9.5% p.a. The
interest rate on loan shall be calculated as the Average
2. Lapsed Policies and Paid-Up policies Annualised 10-year benchmark G-Sec Yield (over last 6
(1) For Single Premium Policy – Not Applicable months & rounded up to the nearest 50 bps) + 2%. The
(2) For Limited / Regular Premium Pay Policy - If any due Premium interest rate shall be reviewed half-yearly and any
is unpaid upon the expiry of the grace period and your Policy change in the interest rate shall be effective from 25th
has not acquired a Surrender Value, your Policy’s status will February and 25th August each year.
be altered to lapsed status and the cover will cease.  In case upon review the interest rate is revised, the same
(3) No Benefits shall be payable under a lapsed Policy. shall apply until next revision. The source of 10-year
(4) If any due Premium is unpaid upon the expiry of the grace benchmark G-sec yield shall be RBI Negotiated Dealing
period and your Policy has acquired a Surrender Value, your System-Order Matching segment (NDS-OM). Any
Policy’s status will be altered to reduced paid-up. change in the methodology of calculation of interest rate
(5) Once the Policy becomes reduced paid-up, the maturity and shall be done with prior approval of the Authority.
death benefit payouts shall be computed by multiplying the  Before any Benefits are paid out, loan outstanding
death/maturity payouts as specified in Part C by the ratio of together with the interest thereon will be deducted and
the Premiums paid to the Premiums payable under the Policy. the balance amount will be payable.
(6) A lapsed or paid-up Policy may be revived subject to the terms  An in-force or fully Paid-up policy shall not be
and conditions as described under Part D Clause 3. foreclosed for non re-payment of loan.
(7) If a reduced paid-up policy is subsequently surrendered, the
surrender benefit shall be computed as below: 7. Free Look Cancellation
In case the Policyholder is not agreeable to any of the provisions
3. Revival of the Policy stated in the Policy, the Policyholder has an option to return the
If your Policy has been discontinued due to the non-payment of Policy to the Company stating the reasons thereof, within 30 days
Premium, it would be revived /restored by the Insurer with all the
from the date of receipt of the Policy whether received electronically
benefits mentioned in the Policy document, with or without rider
benefits, if any, upon the receipt of all the Premiums due and other or otherwise. On receipt of the Policyholder’s letter along with the
charges/late fee, if any, during the revival period, as per the terms original Policy document (original Policy Document is not required
and conditions of the Policy, upon being satisfied as to the continued for policies in dematerialised form or where policy is issued only in
insurability of the insured/Policyholder on the basis of the electronic form), the Company shall arrange to refund the Premium
information, documents and reports furnished by the Policyholder; in paid, subject to deduction of the proportionate risk Premium for the
accordance with Board approved Underwriting Policy. Currently, the period on cover and the expenses incurred by the Company for
application for the revival should be made within five years from the
medical examination (if any) and stamp duty charges.
due date of the first unpaid Premium and before the expiry of the
Policy Term. The current rate of interest for revival is 9.5% p.a. Any
change in the revival interest rates will be in accordance with the
following formula: Average Annualised 10-year benchmark G-Sec
Yield (over last 6 months & rounded upto the nearest 50 bps) + 2%,
at the time of the review. The source of 10-year benchmark G-sec

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PSCDEAD-D2C_BlueDart-4290387-4374156
Part E

1. Additional Servicing Charges

No additional servicing charges are applicable in this policy.

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PSCDEAD-D2C_BlueDart-4290387-4374156
 Part F Basic documentation if death is due to Un-Natural Cause:
a. Completed claim form, (including NEFT details and bank
(General Terms & Conditions) account proof as specified in the claim form);
1. Suicide Exclusions b. Original Policy;
In case of death due to suicide within 12 months from the Risk c. Original or copy Death Certificate issued by Municipal
Commencement Date under the policy or from the date of revival of
Authority/ Gram Panchayat / Tehsildar (attested by issuing
the policy, as applicable, the nominee or beneficiary of the
policyholder shall be entitled to at least 80% of the total premiums authority);
paid till the date of death or the surrender value available as on the d. Claimant’s identity and residence proof.
date of death whichever is higher, provided the policy is in force. e. Original or copy of First Information Report, Police
Panchnama report attested by Police authorities; and
2. Age Admitted f. Original or copy of Postmortem report attested by Hospital
authority.
The Company has calculated the Premiums under the Policy on the
basis of the age of the Life Assured as declared in the Proposal. In
Note:
case you have not provided proof of age of the Life Assured with the
Proposal, you will be required to furnish such proof of age of the Life a. In case original documents are submitted,
attestation on the document by authorities is not
Assured as is acceptable to us and have the age admitted. In the event
required.
the age so admitted (“Correct Age”) during the Policy Term is found
b. Depending on the circumstances of the death,
to be different from the age declared in the Proposal, without
further documents may be called for as we deem
prejudice to our rights and remedies including those under the
fit.
Insurance Act, 1938 as amended from time to time, we shall take one
of the following actions:
(v) The claim is required to be intimated to us within a period of
(i) if the Correct Age makes the Life Assured ineligible for this
90 days from the date of death. However, we may condone
Policy, we will offer you an alternative plan as per our underwriting
the delay in claim intimation, if any, where the claim is
norms. If you do not wish to opt for the alternative plan or if it is not
genuine and the delay is proved to be for reasons beyond the
possible for us to grant any other plan, the Policy will stand cancelled
control of the claimant.
from the date of issuance and the Premiums paid under the Policy
will be returned(without interest) subject to the deduction of
expenses incurred by the Company and the Policy will terminate on 4. Assignment or Transfer
The Policyholder can assign or transfer of a Policy in accordance
the said payment; or (ii) if the Correct Age makes the Life Assured
with Section 38 of the Insurance Act, 1938 as amended from time to
eligible for the Policy, the revised Premium depending upon the
time. Simplified version of the provisions of Section 38 is
Correct Age will be payable on the next Policy Anniversary date and
enclosed in Annexure I for reference.
the revised Premium will continue for the rest of the Premium Paying
Term. The provisions of Section 45 of the Insurance Act, 1938 as
amended from time to time shall be applicable. 5. Nomination
The Policyholder can nominate a person/ persons in accordance with
Section 39 of the Insurance Act, 1938 as amended from time to time.
3. Claim Procedure
Simplified version of the provisions of Section 39 is enclosed in
Annexure II for reference.
(1) Maturity Benefit - The Maturity Benefit will be paid if
(i) The Policy has matured and the Life Assured is alive on
the Maturity Date, 6. Issuance of Duplicate Policy
(ii) No claim has been made on the Policy, except any The Policyholder can request for a duplicate copy of the Policy at
HDFC Life offices or through Certified Financial Consultant
survival benefit, if any,
(Insurance Agent) who advised you while taking this Policy. While
(iii) The Policy has not been discontinued or surrendered or
making an application for duplicate Policy the Policyholder is
cancelled or terminated; and
required to submit a notarized original indemnity bond on stamp
(iv) All relevant documents including the original Policy
paper. Additional charges may be applicable for issuance of the
document in support of your claim have been provided
duplicate Policy.
to the Company
7. Incorrect Information and Non-Disclosure
Fraud and misrepresentation would be dealt with in accordance with
Basic documentation for maturity claims:
provisions of Section 45 of the Insurance Act 1938 as amended from
a) Original Policy Document
b) NEFT mandate / discharge voucher time to time. Simplified version of the provisions of Section 45 is
c) NEFT supporting enclosed in Annexure III for reference.
d) KYC documents
8. Policy on the life of a Minor
Where the Policy has been taken for the benefit of the Life Assured
(2) Death Benefit - The Death Benefit will be paid if
(i) The death of the Life Assured has occurred before the who is a minor, the Policy shall automatically vest to the Life
Maturity Date, Assured on his attaining majority.
(ii) The standard Policy provisions specified in Part F Clause
1 (Exclusions) and Clause 7 (Incorrect Information and 9. Taxes
Non-Disclosure) are not attracted,
(iii) The Policy has not been discontinued or surrendered or (1) Indirect Taxes
cancelled or terminated; and Taxes and levies shall be levied as applicable. Any taxes and
(iv) All relevant documents in support of the claim have been levies becoming applicable in future may become payable by
provided to the Company. you by any method including by levy of an additional
monetary amount in addition to premium and or charges.
Basic documentation if death is due to Natural Cause:
a. Completed claim form, (including NEFT details and bank (2) Direct Taxes
account proof as specified in the claim form); Tax, if any will be deducted at the applicable rate from the
b. Original Policy; payments made under the Policy, as per the provisions of the
c. Original or copy Death Certificate issued by Municipal Income Tax Act, 1961 as amended from time to time.
Authority/ Gram Panchayat / Tehsildar (attested by issuing
10. Modification, Amendment, Re-enactment of or to the
authority); Insurance laws and rules, regulations, guidelines,
d. Claimant’s identity and residence proof. clarifications, circulars etc. thereunder

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 (1) This Policy is subject to HDFC Life Insurance Company Limited, 11th Floor, Lodha
(i) The Insurance Act 1938, as amended from time to time, Excelus, Apollo Mills Compound, N.M. Joshi Marg,
(ii) Amendments, modifications (including re-enactment) as Mahalaxmi, Mumbai - 400011.
may be made from time to time, and
(iii) Other such relevant Regulations, Rules, Laws, Registered Office: Lodha Excelus, 13th Floor, Apollo Mills
Guidelines, Circulars, Enactments etc. as may be Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai - 400011.
introduced thereunder from time to time. E-mail: [email protected]
Or any of our HDFC Life Branches and such other address as
(2) We reserve the right to change any of these Policy Provisions / may be informed by us.
terms and conditions in accordance with changes in Similarly, any notice, direction or instruction to be given by us,
applicable Regulations or Laws, and where required, with under the Policy, shall be in writing and delivered by hand,
IRDAI’s approval. post, courier, facsimile or registered electronic mail ID to the
updated address in the records of the Company.
(3) We are required to obtain prior approval from the IRDAI before You are requested to communicate any change in address, to
making any material changes to these provisions, except for the Company supported by the required address proofs to
changes of regulatory / statutory nature. enable the Company to carry out the change of address in its
systems. The onus of intimation of change of address lies with
(4) We reserve the right to require submission by you of such the Policyholder. An updated contact detail of the Policyholder
documents and proof at all life stages of the Policy as may be will ensure that correspondences from the Company are
necessary to meet the requirements under Anti- money correctly addressed to the Policyholder at the latest updated
Laundering/Know Your Customer norms and as may be laid address.
down by IRDAI and other regulators from time to time.

11. Jurisdiction:
This Policy shall be governed by the laws of India and the
Indian Courts shall have jurisdiction to settle any disputes
arising under the Policy.

12. Notices
Any notice, direction or instruction given to us, under the
Policy, shall be in writing and delivered by hand, post,
facsimile or from registered electronic mail ID to:

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 Appendix 1: Guaranteed Surrender Value Factors

Guaranteed Surrender Value Factors as percentage of Total Premiums Paid

Note: This would only be payable once the policy has acquired a guaranteed surrender value.

Single Pay
Policy Term
Policy Year 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75%
2 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80%
3 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%
4 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
5 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
6 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
7 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
8 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
9 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
10 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
11 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
12 90% 90% 90% 90% 90% 90% 90% 90% 90%
13 90% 90% 90% 90% 90% 90% 90% 90%
14 90% 90% 90% 90% 90% 90% 90%
15 90% 90% 90% 90% 90% 90%
16 90% 90% 90% 90% 90%
17 90% 90% 90% 90%
18 90% 90% 90%
19 90% 90%
20 90%

Limited / Regular Pay

Policy Term

Policy
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Year

1 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

2 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%

3 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%

4 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

5 90% 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

6 90% 90% 75% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

7 90% 90% 75% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

8 90% 90% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75%

9 90% 90% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75%

10 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

11 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

12 90% 90% 90% 90% 90% 90% 90% 90% 90%

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 13 100% 90% 90% 90% 90% 90% 90% 90%

14 100% 90% 90% 90% 90% 90% 90%

15 100% 90% 90% 90% 90% 90%

16 100% 90% 90% 90% 90%

17 100% 90% 90% 90%

18 100% 100% 100%

19 100% 100%

20 100%

Appendix 2: Death Benefit Multiple

Sum Assured will be determined based on your entry age and the Annualized/Single Premium you commit to pay in a policy year.
Single Pay
Death Benefit Death Benefit Death Benefit
Age* Age* Age* Age* Death Benefit Multiple
Multiple Multiple Multiple
0 1.5 17 1.42 34 1.33 51 1.25
1 1.5 18 1.41 35 1.33 52 1.25
2 1.49 19 1.41 36 1.32 53 1.25
3 1.49 20 1.4 37 1.32 54 1.25
4 1.48 21 1.4 38 1.31 55 1.25
5 1.48 22 1.39 39 1.31 56 1.25
6 1.47 23 1.39 40 1.3 57 1.25
7 1.47 24 1.38 41 1.3 58 1.25
8 1.46 25 1.38 42 1.29 59 1.25
9 1.46 26 1.37 43 1.29 60 1.25
10 1.45 27 1.37 44 1.28 61 1.25
11 1.45 28 1.36 45 1.28 62 1.25
12 1.44 29 1.36 46 1.27 63 1.25
13 1.44 30 1.35 47 1.27 64 1.25
14 1.43 31 1.35 48 1.26 65 1.25
15 1.43 32 1.34 49 1.26
16 1.42 33 1.34 50 1.25

Limited / Regular Pay

Age* Death Benefit Age* Death Benefit Multiple Age* Death Benefit Multiple Age* Death Benefit Multiple
Multiple
0-5 15.00 19 13.60 33 12.20 47 10.80
6 14.90 20 13.50 34 12.10 48 10.70
7 14.80 21 13.40 35 12.00 49 10.60
8 14.70 22 13.30 36 11.90 50 10.50
9 14.60 23 13.20 37 11.80 51 10.45
10 14.50 24 13.10 38 11.70 52 10.40
11 14.40 25 13.00 39 11.60 53 10.35
12 14.30 26 12.90 40 11.50 54 10.30
13 14.20 27 12.80 41 11.40 55 10.25
14 14.10 28 12.70 42 11.30 56 10.20
15 14.00 29 12.60 43 11.20 57 10.15
16 13.90 30 12.50 44 11.10 58 10.10
17 13.80 31 12.40 45 11.00 59 10.05
18 13.70 32 12.30 46 10.90 60 - 65 10.00
*Age on the Risk Commencement Date.

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 Annexure I (15) Any rights and remedies of an assignee or transferee of a life
insurance policy under an assignment or transfer effected before
Section 38 - Assignment or Transfer of Insurance Policies 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
Assignment or transfer of a policy should be in accordance with Section Insurance Laws (Amendment) Act, 2015 and only a simplified
38 of the Insurance Act, 1938 as amended by Insurance Laws version prepared for general information. Policy Holders are
(Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this advised to refer to Insurance Laws (Amendment) Act, 2015dated
regard are as follows: 23.03.2015 for complete and accurate details. ]

(1) This policy may be transferred/assigned, wholly or in part, with

or without consideration.
(2) 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.
(3) 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.
(4) The assignment must be signed by the transferor or assignor or
duly authorized agent and attested by at least one witness.
(5) The transfer or 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.
(6) Fee to be paid for assignment or transfer can be specified by the
Authority through Regulations.
(7) 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.
(8) 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.
(9) 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.
(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
notwithstanding 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

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 17) The provisions of Section 39 are not applicable to any life insurance
Annexure II policy to which Section 6 of Married Women’s Property Act, 1874
applies or has at any time applied except where before or after
Section 39 - Nomination by policyholder 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
Nomination of a life insurance Policy is as below in accordance with Section 39. Where nomination is intended to be made to spouse or
Section 39 of the Insurance Act, 1938 as amended by Insurance Laws children or spouse and children under Section 6 of MWP Act, it
(Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this should be specifically mentioned on the policy. In such a case only,
regard are as follows: the provisions of Section 39 will not apply.
[Disclaimer: This is not a comprehensive list of amendments of
1) The policyholder of a life insurance on his own life may nominate a Insurance Laws (Amendment) Act, 2015and only a simplified version
person or persons to whom money secured by the policy shall be prepared for general information. Policy Holders are advised to refer to
paid in the event of his death. Insurance Laws (Amendment) Act, 2015dated 23.03.2015 for complete
2) Where the nominee is a minor, the policyholder may appoint any and accurate details.
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.
3) Nomination can be made at any time before the maturity of the
policy.
4) 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.
5) 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.
6) 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.
7) Fee to be paid to the insurer for registering change or cancellation
of a nomination can be specified by the Authority through
Regulations.
8) 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.
9) 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; 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 (i.e.
23.03.2015).
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.

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 Annexure III questioning age or adjustment based on proof of age submitted
subsequently.
Section 45 – Policy shall not be called in question on the ground of
mis-statement after three years
[Disclaimer: This is not a comprehensive list of amendments of
Provisions regarding policy not being called into question in terms of Insurance Laws (Amendment) Act, 2015and only a simplified version
Section 45 of the Insurance Act, 1938, as amended Insurance Laws prepared for general information. Policy Holders are advised to refer to
(Amendment) Act, 2015 dated 23.03.2015are as follows: Insurance Laws (Amendment) Act, 2015dated 23.03.2015 for complete
and accurate details. ]
1) 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.
2) 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.
3) 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.
4) 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.
5) 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.
6) 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.
7) 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.
8) 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.
9) 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

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 Office Copy
FIRST PREMIUM RECEIPT
Date: 25/10/2024
We certify that the premium amount mentioned below, which was received from you as
initial deposit has, consequent to the issue of a Life Insurance policy, been accounted by
us towards First Premium payable.

Policy No. 28xxxx84 Client Id : APxxxxx6

Plan HDFC Life Sanchay Plus

Policy Holder Mr. Vxxxx Pxxxxxx

Premium Amount
(Including Taxes and ` 104,500.00
Levies as applicable)
Premium Adjusted
24th October 2024
with effect from :

*Notes :

(A) - This receipt is valid subject to realisation of payment by all modes.

(B) - The premiums paid are allowed as deduction from the Gross Total Income under Section 80 C
of the Income Tax Act,1961, subject to limits specified there in.

Yours sincerely,
For HDFC Life Insurance Company Limited.

Authorised Signatory

HDFC LIFE INSURANCE COMPANY LIMITED

Branch Address:HDFC Life Mumbai-Hub, 11th Floor, Lodha Excelus, Apollo Mills Compound, N. M. Joshi Marg,
Mahalaxmi, Mumbai, 400011
Corporate Office: 12th & 13th Floor, Lodha Excelus, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai - 400
011.
Registered Office: Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400 011.

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 YOUR POLICY AT A GLANCE

This is a document that will help you to understand the key features of this product and is not the policy document. In case of any discrepancy
between this document and your policy document, the policy document will prevail over this document.

Plan Name, Plan

HDFC Life Sanchay Plus - Guaranteed Income Option UIN: 101N134V24
Option& UIN

This is a non participating, limited paying, savings insurance plan wherein you get maturity benefits as a guaranteed income for fixed term
Aim of the plan of 10 or 12 years starting from (Policy Term+ 1)th year, in arrears. This plan emphasizes on guaranteed benefits along with flexibility to
choose your premium payment term and Policy Term.

An individual non-participating, non-linked savings life insurance plan which provides insurance coverage throughout the term of the
Type of the Plan
policy along with guaranteed maturity benefits over 10 or 12 years.

PPT Single Pay – Policy Term 5 to 20

PPT 5 – Policy Term 5 to 15
Premium PPT 6 – Policy Term 6 to 15
Payment PPT 7 years – Policy Term 7 to 15
Term (PPT)/ PPT 8 years – Policy Term 8 to 15
Policy Term (PT)
PPT 9 years – Policy Term 9 to 15
PPT 10 years – Policy Term 10 to 20
PPT 11 years – Policy Term 11 to 20
PPT 12 years – Policy Term 12 to 20

Frequency Single Annual Half Yearly Quarterly Monthly

Minimum installment premium (exclusive of taxes Rs 30,000 Rs 30,000 Rs15,000 Rs 7,500 Rs 2,500
and levies as applicable)
Premiums There is no limit on the maximum premium amount. However, the acceptance of any case is subject to Board approved underwriting
policy.
Under POS variant, there is no limit on maximum premium subject to maximum Sum Assured on Death of 25 Lacs. The acceptance of
any case is subject to Board approved underwriting policy.

Sum Assured is determined based on the life assured’s entry age and the Single/Annualized Premium committed to pay in a policy
Sum Assured
year. Please refer the policy document for the applicable Sum Assured.

Sum On Maturity Date, policyholder shall have an option to receive the future regular income as a lump sum, which shall be the present value
Assured on of future payouts, discounted at a rate of 9% p.a.. Please refer the policy document for the applicable Guaranteed Sum Assured on
Maturity Maturity.

On your survival, at end of the policy term, the Maturity Benefit payable shall be Guaranteed Income on Maturity as mentioned in the
policy schedule, payable at the end of each Income Payout Frequency as applicable, during the Payout Period.
On death during the payout period, the nominee will continue to receive the Income Benefit as per the benefit option chosen till the end of
Payout Period.
Maturity Benefit
At any point of time during the payout period, policyholder/ nominee shall have an option to receive the future income as a lump sum,
which shall be the present value of future payouts, discounted at a rate which is computed using the prevailing interest rates. For more
details, please refer to the policy document.
In cases where Life Assured is minor, the policy will automatically vest on him or her on attaining age 18 years.

On death during the policy term, provided all due premiums have been paid, we will pay Sum Assured on Death to the nominee.
Where the Sum Assured on Death is highest of the following:
1. 10 times the Annualized Premium^ or 1.25 times the Single Premium
2. 105% of Total Premiums* paid
3. Premiums paid accumulated at an interest of 5% p.a. compounded annually
4. Guaranteed Sum Assured on Maturity as applicable under this option
Death Benefit
5. An absolute amount assured to be paid on death, which is equal to the Sum Assured
Sum Assured shall be equal to the applicable Death Benefit Multiple times the Annualized Premium.
^ Annualized Premium shall be the premium amount payable in a year chosen by the policyholder, excluding the taxes, rider premiums,
underwriting extra premiums and loadings for modal premiums, if any.
* Total Premiums Paid means total of all the premiums received, excluding any extra premium, any rider premium and taxes.
On payment of the Death Benefit, the policy will terminate and no further benefits will be payable.

Death Benefit shall be payable to the nominee(s), if the Policyholder and the Life Assured are the same; or to the Policyholder if the Life
Recipient of
Assured is other than the Policyholder. All other benefits shall be payable to the Policyholder. If the policy has been assigned, all benefits
Benefits
shall be payable to the Assignee.

Once the policy has acquired a Surrender Value, you can take a policy loan up to 80% of the surrender value of your policy, subject to the
Policy Loans
applicable terms and Conditions

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PSCDEAD-D2C_BlueDart-4290387-4374156
 In case of death due to suicide within 12 months from the date of commencement of risk under the policy or from the date of revival of the
Exclusion policy, as applicable, the nominee or beneficiary of the policyholder shall be entitled to at least 80% of the total premiums paid till the date
of death or the surrender value available as on the date of death whichever is higher, provided the policy is in force.

Free Look in
30 days from the date of receipt of the original policy document.
Period

Grace period is not applicable for Single Premium. For Limited Premium payment term a grace period of 15 days from the premium due
Grace Period
date for monthly mode. 30 days from the premium due date for other modes.

If You don’t pay the due premiums before the expiry of the grace period, your Policy will:
Premium 1.Lapse if it has not acquired a Surrender Value (SV). Once your Policy lapses, all the benefits including the risk cover will cease.
discontinuance & 2.Become a reduced paid-up policy if it has acquired a SV with reduced benefits. Your Sum Assured on Death/Maturity will reduce
Paid-up to Paid-up Sum Assured on Death/Maturity
For details on maturity and death benefit of paid-up policy please refer to your policy document.

Revival A lapsed or paid up policy can be revived within 5 years subject to the conditions mentioned in the policy document.

The Policy will acquire a SV immediately on the payment of Single Premium and after completion of first policy year provided one full
year premium has been received, in case of a Limited Premium Policy.
Surrender The minimum Guaranteed Surrender Value shall be:
Applicable GSV factors on the total premiums paid at the time of surrender multiplied to the total premiums paid to date.
For details on GSV factors please refer your policy document.
The Company may pay a surrender value higher than the GSV in the form of a Special Surrender Value (SSV).

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PSCDEAD-D2C_BlueDart-4290387-4374156
 Part G
(Grievance Redressal Mechanism)

1. Complaint Resolution Process

(i) The customer can contact us at any of our touchpoints or write to us at the below mentioned address in case of any complaint/ grievance:
Grievance Redressal Officer
HDFC Life Insurance Company Limited (“HDFC Life”)
11th Floor, Lodha Excelus, Apollo Mills Compound,
N. M. Joshi Marg, Mahalaxmi, Mumbai, Maharashtra - 400011
Helpline number: 022-68446530 (Call Charges apply) | NRI Helpline number +91 89166 94100 (Call Charges apply)
E-mail: [email protected] | [email protected] (For NRI customers only)
(ii) All grievances (Service and sales) received by the Company will be responded to within the prescribed regulatory Turn Around Time (TAT) of 14 days.
(iii) Written request or email from the registered email id is mandatory.
(iv) If required, we will investigate the complaints by taking inputs from the customer over the telephone or through personal meetings.
(v) We will issue an acknowledgement letter to the customer immediately on receipt of the complaint.
(vi) The acknowledgement that is sent to the customer has the details of the complaint number, the Policy number and the Grievance Redressal Department
who will be handling the complaint of the customer.
(vii) If the customer’s complaint is addressed before the acknowledgement, the resolution communication will also act as the acknowledgment of the
complaint.
(viii) The final letter of resolution will offer redressal or rejection of the complaint along with the appropriate reason for the same.
(ix) In case the customer is not satisfied with the decision sent to him or her, he or she may contact our Grievance Redressal Officer within 8 weeks of the
receipt of the communication at any of the touch points mentioned in the document, failing which, we will consider the complaint to be satisfactorily
resolved.
(x) The following is the escalation matrix in case there is no response within the prescribed timelines or if you are not satisfied with the response. The
number of days specified in the below – mentioned escalation matrix will be applicable from the date of escalation.

Response
Level Designation Email ID Address
Time
Chief Manager or above– 10 working 11th Floor, Lodha Excelus,
1st Level [email protected]
Customer Relations days Apollo Mills Compound,
N.M. Joshi Marg,
2nd Level (for response not VP or above– Customer 7 working
[email protected] Mahalakshmi, Mumbai
received from Level 1) Relations days
400011

You are requested to follow the aforementioned matrix to receive satisfactory response from us.
(xi) If you are not satisfied with the response or do not receive a response from us within 14 days, you may approach the Grievance Cell of IRDAI on the
following contact details:
• IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: 155255/ 18004254732
• Email ID: [email protected]
• Online- You can register your complaint online at https://bimabharosa.irdai.gov.in/
• Address for communication for complaints by fax/paper:
General Manager
Consumer Affairs Department – Grievance Redressal Cell
Insurance Regulatory and Development Authority of India
Sy No. 115/1, Financial District,
Nanakramguda, Gachibowli,
Hyderabad – 500 032

2. In the event you are dissatisfied with the response provided by us, you may approach the Insurance Ombudsman in your region. The details of the
existing offices of the Insurance Ombudsman are provided at http://www.cioins.co.in/ below.

a. Details and addresses of Insurance Ombudsman -

Office of the Ombudsman Contact Details Areas of Jurisdiction

AHMEDABAD Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th Gujarat, Dadra & Nagar Haveli, Daman
floor, Tilak Marg, Relief Road, Ahmedabad – 380 001. and Diu.
Tel.: 079 - 25501201/02/05/06
Email: [email protected]
BHOPAL Office of the Insurance Ombudsman, 1st floor, "Jeevan Shikha", Madhya Pradesh & Chhattisgarh.
60-B, Hoshangabad Road, Opp. Gayatri Mandir, Bhopal – 462 011.
Tel.: 0755 - 2769201 / 2769202
Email: [email protected]
BHUBANESHWAR Office of the Insurance Ombudsman, 62, Forest park, Bhubaneshwar Odisha.
– 751 009.
Tel.: 0674 - 2596461 /2596455
Email: [email protected]
BENGALURU Office of the Insurance Ombudsman, Jeevan Soudha Building, PID Karnataka.
No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, 1st
Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: [email protected]
CHANDIGARH Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, Punjab, Haryana (excluding Gurugram,
2nd Floor, Batra Building, Sector 17 – D, Chandigarh – 160 017. Faridabad, Sonepat and Bahadurgarh),
Tel.: 0172 - 4646394/ 2706468 Himachal Pradesh, Union Territories of
Email: [email protected] Jammu & Kashmir, Ladakh &
Chandigarh.

20 of 33
 CHENNAI Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Tamil Nadu, Puducherry Town and
Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018. Karaikal (which are part of
Tel.: 044 - 24333668 / 24333678 Puducherry).
Email: [email protected]
DELHI Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Delhi &
Building, Asaf Ali Road, New Delhi – 110 002. following Districts of Haryana -
Tel.: 011 – 23237539 Gurugram, Faridabad, Sonepat &
Email: [email protected] Bahadurgarh.
GUWAHATI Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Nr. Assam, Meghalaya, Manipur, Mizoram,
Panbazar over bridge, S.S. Road, Guwahati – 781001(ASSAM). Arunachal Pradesh, Nagaland and
Tel.: 0361 - 2632204 / 2602205 Tripura.
Email: [email protected]
HYDERABAD Office of the Insurance Ombudsman, 6-2-46, 1st floor, "Moin Andhra Pradesh, Telangana, Yanam and
Court", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi- part of Union Territory of Puducherry.
Ka-Pool, Hyderabad - 500 004.
Tel.: 040 - 23312122
Email: [email protected]
JAIPUR Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Rajasthan.
Floor, Bhawani Singh Marg, Jaipur - 302 005.
Tel.: 0141 – 2740363/ 2740798
Email: [email protected]
KOCHI Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash, Kerala, Lakshadweep, Mahe – a part of
LIC Building, Union Territory of Puducherry.
Opp. to Maharaja's College, M.G. Road,
Kochi - 682 011.
Tel.: 0484 - 2358759
Email: [email protected]
KOLKATA Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th West Bengal, Sikkim, Andaman &
Floor, 4, C.R. Avenue, KOLKATA - 700 072. Nicobar Islands.
Tel.: 033 – 22124339/ 22124341
Email: [email protected]
LUCKNOW Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Districts of Uttar Pradesh: Lalitpur,
Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001. Jhansi, Mahoba, Hamirpur, Banda,
Tel.: 0522 - 4002082 / 3500613 Chitrakoot, Allahabad, Mirzapur,
Email: [email protected] Sonbhabdra, Fatehpur, Pratapgarh,
Jaunpur, Varanasi, Gazipur, Jalaun,
Kanpur, Lucknow, Unnao, Sitapur,
Lakhimpur, Bahraich, Barabanki,
Raebareli, Sravasti, Gonda, Faizabad,
Amethi, Kaushambi, Balrampur, Basti,
Ambedkarnagar, Sultanpur,
Maharajgang, Santkabirnagar,
Azamgarh, Kushinagar, Gorkhpur,
Deoria, Mau, Ghazipur, Chandauli,
Ballia, Sidharathnagar.
MUMBAI Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Goa, Mumbai Metropolitan
Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054. Region excluding (excluding Navi
Tel.: 6903880027/29/31/32/33 Mumbai & Thane).
Email: [email protected]
NOIDA Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th State of Uttarakhand and the following
Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Districts of Uttar Pradesh: Agra,
Nagar, U.P-201301. Aligarh, Bagpat, Bareilly, Bijnor,
Tel.: 0120 - 2514252 / 2514253 Budaun, Bulandshehar, Etah, Kannauj,
Email: [email protected] Mainpuri, Mathura, Meerut,
Moradabad, Muzaffarnagar, Oraiyya,
Pilibhit, Etawah, Farrukhabad,
Firozbad, Gautam Buddhnagar,
Ghaziabad, Hardoi, Shahjahanpur,
Hapur, Shamli, Rampur, Kashganj,
Sambhal, Amroha, Hathras,
Kanshiramnagar, Saharanpur.
PATNA Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhavan, Bailey Bihar, Jharkhand.
Road, Patna 800 001. Tel.: 0612 - 2547068
Email: [email protected]
PUNE Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Maharashtra, Areas of Navi Mumbai
Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, and Thane (excluding Mumbai
Pune – 411 030. Metropolitan Region).
Tel.: 020-24471175 Email: [email protected]

b. Insurance Ombudsman -
1) The Ombudsman shall receive and consider complaints alleging deficiency in performance required of an insurer (including its agents and intermediaries)
or an insurance broker, on any of the following grounds—
(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;

21 of 33
 (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 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 arising from non-observance of or non-adherence to the provisions of any regulations made by the Authority with regard to
protection of Policyholders’ interests or otherwise, or of any circular, guideline or instruction issued by the Authority, or of the terms and conditions
of the Policy contract, insofar as such matter relates to issues referred to in clauses (a) to (h).

c. Manner in which complaint is to be made -

1) Any person who has a grievance against an insurer or insurance broker, 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 office of the insurer or the insurance broker, as
the case may be, complained against or the residential address or place of residence of the complainant is located.
2) The complaint shall be in writing, duly signed or made by way of electronic mail or online through the website of the Council for Insurance
Ombudsmen, by the complainant or through his legal heirs, Nominee or Assignee and shall state clearly the name and address of the complainant,
the name of the branch or office of the insurer against whom the complaint is made, the facts giving rise to the complaint, supported by documents,
the nature and extent of the loss caused to the complainant and the relief sought from the Insurance Ombudsman.
3) No complaint to the Insurance Ombudsman shall lie unless—
(a) the complainant has made a representation in writing or through electronic mail or online through website of the insurer or insurance broker
concerned to the insurer or insurance broker, as the case may be, named in the complaint and—
i. either the insurer or insurance broker, as the case may be, had rejected the complaint; or
ii. the complainant had not received any reply within a period of one month after the insurer or insurance broker, as the case may be, received
his representation; or
iii. the complainant is not satisfied with the reply given to him by the insurer or insurance broker, as the case may be;
(b) The complaint is made within one year—
i. after the order of the insurer or insurance broker, as the case may be, rejecting the representation is received; or
ii. after receipt of decision of the insurer or insurance broker, as the case may be, which is not to the satisfaction of the complainant;
iii. after expiry of a period of one month from the date of sending the written representation to the insurer or insurance broker, as the case may
be, if the 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 calling for objections of the insurer or
insurance broker, as the case may be, against the proposed condonation and after recording reasons for condoning the delay and in case the delay is
condoned, the date of condonation of delay shall be deemed to be the date of filing of the complaint, for further proceedings under these rules.
5) No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before or
disposed of by any court or consumer forum or arbitrator.
6) The Council for Insurance Ombudsmen shall develop a complaints management system, which shall include an online platform developed for the
purpose of online submission and tracking of the status of complaints made under rule 14 of Insurance Ombudsman Rules, 2017.

d. Implementation of Ombudsman Award -

The Insurer is required to comply with the award of the Insurance Ombudsman within 30 days of receipt of award by the Insurer. In case the Insurer does not
honour the ombudsman award, a penalty of Rs. 5000/- per day shall be payable to the complainant. Such penalty is in addition to the penal interest liable to
be paid by the Insurer under the Insurance Ombudsman Rules, 2017. This provision will not be applicable in case insurer chooses to appeal against the
award of the Insurance Ombudsman.

22 of 33
 PROPOSAL FORM FOR SINGLE LIFE/JOINT LIFE

Linked and Non Linked Individual Life Limited Underwriting & Pension Plans

For Office use only

Consultant Name & Code: 01019195
License No: License Expiry Dt: Bancassurance Code:
Company Lead: Lead Reference No: 1-216749095522 Channel Partner Cust Id:
IA / CAO Emp No: IA / CAO Name: Branch Code:
Channel Code: FOS Code: Telecode:

ALL UNIT LINKED POLICIES ARE DIFFERENT FROM TRADITIONAL INSURANCE POLICIES AND ARE SUBJECT TO DIFFERENT RISK FACTORS.
IN UNIT LINKED POLICY THE INVESTMENT RISK IN YOUR CHOSEN INVESTMENT PORTFOLIO IS BORNE BY YOU. UNIT LINKED POLICIES DO Photograph of life to be assured*
to be signed across by the life to
NOT OFFER ANY LIQUIDITY DURING THE FIRST FIVE YEARS OF THE CONTRACT. YOU WILL NOT BE ABLE TO SURRENDER OR WITHDRAW be assured
THE MONIES INVESTED IN UNIT LINKED INSURANCE POLICIES COMPLETELY OR PARTIALLY TILL THE END OF THE FIFTH YEAR. * Not mandatory if life to be
assured is different from the
Proposer except if Life to be
assured is minor

1) The entire form is to be filled in black ink only by the policyholder. Use CAPITAL letters for information required in boxes with a space between
words. 2) Any cancellation / alteration is to be signed by the proposed policyholder or life to be assured as appropriate. 3) All information provided here
shall be relied on and should be accurate, complete and true in all respects for processing the proposal quickly. In case you have any doubt whether the
particular information is material or not, please disclose the information. 4) Please attach an extra sheet, wherever additional information is to be given.

Proposer (Primary Life to be Assured)/ Policy Owner Details (Proposer in case of Click 2 Wealth for Premium Waiver Option)
1. Full Name:(Leave a blank Mr. Vxxxxx xxxxxxxxxxxxxxxxx
space between First, Middle &
Last Name)
2. Maiden Name:(for married woman
only)

3. Date of Birth (DD/MM/YYYY): xxxxxxxxxx

4. Gender(M/F/Tg): Male
5. Marital Status: Married
6. Nationality: Indian
7. Education: Graduation
8. Resident status: Resident Indian
If you are NRI/PIO/OCI, Please attach
appropriate Questionnaire.

Country of Residence:
If NRI/PIO/OCI

Country of Workplace:
If NRI/PIO/OCI

Permanent Country:
9. Do you have an existing HDFC If Yes, please provide Policy NO: Annualised Premium:
Life policy:
10. Does your spouse have an If Yes, please provide Product
existing HDFC Life policy: Name:
11. Are You an employee of HDFC If Yes, please provide Employee Relationship with HDFC Group
group or Spouse/child of HDFC ID: Employee(if applicable)
Group employee:
12. Correspondence xxx xxxxxxxxxxx xxxxxxxxxxxxxxxxx India
Address:
13. Permanent Address (If xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx India
different from
correspondence address)/
Overseas residential
address for NRI / PIO / OCI :
14. Mobile: 9199xxxxxxx86
Telephone No(R):
Telephone No(O):
E - mail ID: [email protected]
Email ID if provided, will be
considered as preferred mode of
communication

15. Preferred language of English

communication:
16. Present Occupation: Salaried
Gross Yearly Income 4,60,000
(INR):
Workplace Name and xxxxxxxxxxxxxxxx
Address:
^ if Retired, please provide name of
last organisation

Industry Type (cement, Distribution

baking, etc.):
Exact Nature of work
(clerical, mechanical,
supervisory job, etc.):
Nature of Occupation Business analyst
(architect, etc.):
17. Income Proof (proposer): Identity Proof (Proposer):
Address Proof Age Proof (Life Assured):
(Proposer):
PAN* (Proposer): xxxxxxxxxxx
18. PAN Photocopy xxxxxxxxxxx
enclosed :(*Submit Form 60 if PAN
is not available)

19. ABHA(Proposer)
20. ABHA(Life Assured)
21. I wish to receive my policy document through email/WhastApp/sms bitly or any other official electronic medium of HDFC Life. Yes

Date: 25-10-2024 Page 1

23 of 33
22. I wish to receive my policy in Dematerialised Form through a new e-Insurance Account (e-IA) OR I have an e-Insurance Account (e-IA) and my e-IA No
number is and wish to receive the policy document in Dematerialised Form in the same account.
A copy of the physical policy document can be requested through our corporate WhatsApp number <8291890569> from your registered mobile number.
23. Is the Policy holder same Yes
as Life Assured
Relationship with Life to Self
be Assured
24. Are you taking the policy No
to primarily protect the
disabled person?
25. Are you a "Politically No
Exposed Person"?
Definition of a Politically Exposed Person: Politically exposed persons are individuals who are or have been entrusted with prominent public functions in a foreign country, their family members
and close relatives; for e.g. Heads of States or of Governments, Senior politicians, Senior government / judicial / military officers,Senior executives of state-owned corporations, Important
politicals party officials, etc.
26. Have you ever been or currently being investigated, charge sheeted, prosecuted or convicted or acquittal or having pending charges in respect of any criminal/civil offences in any
court of law in India or abroad? No
27. Sources of Funds: If Premium & Single Premium Top-ups, if any is equal to or more than INR 1 lakh, please enclose proof of income e.g. ITR

Salaries Business House Property Capital Gains Investments Agriculture Others Total
100% 0% 0% 0% 0% 0% 0% 100%

Details of Secondary Life to be Assured (Life Assured in case of Click 2 Wealth for Premium Waiver Option)
1. Full Name: (Leave a blank space Mr. xxxxx xxxxxxxxxxx
between First, Middle & Last Name)
2. Maiden Name:(for married woman only)
3. Father/Husband Name: xxx xxxxxxx xxxxxxxxxxxx
4. Mother's Maiden Name:
5. Relationship with Primary Life Assured:
6. Date of Birth (DD/MM/YYYY) : xxxxxxxxxxxx
7. Gender(M/F/Tg): Male
8. Marital Status: Married
9. Nationality: Indian
10. Education: Graduation
11. Resident status: Resident Indian
If you are NRI/PIO/OCI, Please attach appropriate
Questionnaire.

Country of Residence:
If you are NRI/PIO/OCI

Country of Workplace:
If you are NRI/PIO/OCI

Permanent Country:
12. Present Occupation: Salaried
13. ABHA:
14. Gross Yearly Income (INR): 4,60,000
15. Workplace Name and Address: xxxxxxxxxxx xxxxxxxxxxxx
^ please provide name of last organisation

16. Industry Type (cement, baking, etc.): Distribution

17. Exact Nature of work (clerical,
mechanical, supervisory job, etc.):
18. Nature of Occupation (architect, etc.): Business analyst
19. Have you ever been or currently being investigated, charge sheeted, prosecuted or convicted or acquittal or having pending charges
in respect of any criminal/civil offences in any court of law in India or abroad? No
20. If Life to Assured is a student/housewife, please provide insurance details regarding parents/husband/siblings.
(Please attach a separate sheet for multiple policies if required.)

Total Sum Assured of all inforce life Policy No. and Name of Company Husband's / Parent's Occupation /
insurance policies Income

Personal Details of Life to be Assured (Primary) (Proposer in case of Click 2 Wealth for Premium Waiver Option)
1 Have you suffered from or received treatment for any symptoms or medical condition(s) such as HIV, AIDS or HIV AIDS NO
related or sexually transmitted diseases?
2 Have you suffered from or received treatment for any symptoms or medical condition(s) for any of the following? NO
• Chest pain or heart attack or any other heart disease or problem or hypertension
• Stroke or paralysis
• Cancer, tumour, growth or cyst of any kind
• Diabetes or high blood sugar or sugar in urine
• Kidney problems (excluding Kidney stones) or disease of the reproductive organs
• Liver problem (excluding jaundice) or hepatitis B or C
• Muscular - skeletal disorder
• Gastro - intestinal disorders
• Nervous, psychiatric or mental disorders
• Respiratory diseases (excluding Asthma and Bronchitis)
3 Have you suffered from or received treatment for any symptoms or medical condition(s) for any of the following in last two NO
years?
• Kidney stone
• Jaundice
• Asthma

4 Apart from minor ailments, such as colds and flu, have you received any treatment from any doctor or specialist or been NO
hospitalised or undergone hospital treatment, in the last 5 years.

5 Has any proposal for assurance on your life ever been Declined, Postponed, Accepted at extra premium, Accepted on special NO
terms, and Accepted with reduced cover or withdrawn by yourself.

6 Do you have any physical disability which is affecting your day to day activities? NO

7 Please provide details, if any, regarding your occupation or business, which may render you susceptible to injury or illness. None of these
(e.g. exposure to chemical substances/hazardous materials/harmful dust or gases/ explosives/ working at heights/ handling
heavy machinery etc.)
Important Information: 1. Any false declaration in the above short medical questionnaire may be liable for rejection of the proposal form and the contract of insurance shall be treated
null & void. It may also lead to rejection of the claim on death of the life assured.
Date: Place: Signature/Thumb impression of proposer/
primary/ secondary life assured/Policyholder.
Signature should match with signature on ECS/
SI mandate

Nominee Details (To be filled only if Proposer and Life to be assured are same)

Date: 25-10-2024 Page 2

24 of 33
 % Share
Nominee Full Name Date of Birth(DD/ Gender(M/F/Tg) Relationship Contact No
MM/YYYY) with Life to be
Assured
1 Mrs. xxxxxxxxxxxxx xxxxxxxxxx Female Wife 100

Details of Products Applied For

1. Objective of Savings
Insurance:
2. Mode :(for regular / limited Annual
premium paying plan)

3. Premium Payment Regular Pay

Option:
4. Top-up Option: No ________Top up % (available only under Click 2
Protect 3D Plus )

5a. Product Details:

Product Name Cover type Plan Option Policy Term Premium Sum Modal
(Self/PPH/HUF/ (in years) Payment Assured(in Premium (in
MWPA/Business) INR) INR)
Term(in years)

HDFC Life Sanchay Plus 5 5 12,97,800 1,00,000

6a. For YoungStar
Udaan, Classic Waiver
Plan Option:
6b. For YoungStar
Super Premium, also
choose Benefit Option:
6c. For Sampoorn
Nivesh, also choose
Benefit Option :
6d. For Classic One,
choose Coverage
Variant :
6e. For Click 2 Wealth,
choose plan option :
6f. For Sanchay Annual
Plus,choose Income
Payout Mode :
6g. For Sanchay Par
Advantage, choose
survival benefit payout
option :
6h. For Sanchay Par
Advantage, also choose
survival benefit payout
frequency :
6i. For Sanchay Par
Advantage, also choose
survival benefit payout
date :
6j. For Click 2 Protect Return of Premium: WoP CI: Accidental Death
Life, choose add on Benefit:
option :
6k. For Click 2 Protect i)Return of Premium:
Super, choose option(s) :
ii)WoP CI:
iii)WoP TPD:
iv)Spouse Cover: If opted, please provide: Spouse Name:
Spouse Sum Assured:
Spouse Date of Birth:
v)Death Benefit as an If opted, choose Instalment Period:
Instalment Option:
Instalment Frequency:
Percentage of Death
Benefit to be Received
as Instalment:
vi)Life Stage Option:
vii)Parent Secure Option If opted, choose
Instalment Frequency
6l. For Click 2 Protect
Super-Life Option
choose Variant opted :
6m. For Click 2 Protect Sum Assured
Super-Life Plus Option
choose
6n. For Click 2 Protect Level Cover Period:
Super-Life Goal Option,
choose:
Amortization Factor:
6o. For Click 2 Protect Sum Assured 12,97,800
Super-Life Plus Option
choose
6p. For Smart Protect
Plan, choose plan
option:
6q. For Smart Protect Level Cover Period
Plan, Decreasing Cover
and Decreasing with
Capital Guarantee
Option choose:
6r. For Sanchay Legacy, Life ROP
choose plan option
6s. For Sanchay Death Benefit as an If opted, choose Instalment Period
Legacy, choose option Instalment option
Instalment Frequency

Date: 25-10-2024 Page 3

25 of 33
 Percentage of Death
benefit to be received as
instalment
6t. For Click 2 Achieve - Smart Student Dream Achiever
Choose Plan Option
7. Rider Details: Product Rider Name Coverage Rider Option Rider Policy Rider Premium Pay Term(in Rider Sum Modal
(with additional premium) Name Type Term(in years) years) Assured(in Premium (in
INR) INR)

8. Top-up Premium NIL Top-up Sum Assured NIL Total Premium (INR): 1,04,500
(INR): (INR):
9. Commencement Backdation Charges
date^: (INR) (if any):
(^only for non linked plan - Has to be within
the same financial year)

10.I wish to opt for Systematic Transfer Plan (STP) No

Source Fund Target Fund Amount Transfer Date

In case the Transfer Date is not selected, it will be consider

as 1st of the Month.
In order to activate/continue STP, Policyholder has to ensure
that sufficient premiums are allocated in Source Fund.

11. For unit linked plans, kindly indicate % of allocation in below mentioned funds as applicable (please check the fund for the product applied)
Income Balanced Blue chip Opportuni Equity Diversified Bond Conservat Liquid Discovery Equity Bond Plus Secure Sustaina Total
Fund Fund Fund ties Fund Plus Fund Equity Fund ive Fund Fund Fund Advantage Fund Advantage ble Equity
Fund Fund Fund Fund
% % % % % % % % % % % % % % 100%

Immediate Annuity Plan Details

8 a) Single Premium (Purchase Price) Rs.

8 b) Annuity Amount to be paid Rs.

8 c) Annuity Options (Please tick one option only in appropriate box)

Lifetime Annuity Lifetime Annuity with Return of 100% of the Purchase Price Lifetime Annuity with Guarantee
Lifetime Annuity with Return of Balance of Purchase Price 5 yrs 10 yrs 15 yrs 20 yrs
Lifetime Annuity increasing at a simple rate of 5% p.a. Lifetime Annuity with Return of Purchase Price in Parts
Lifetime Annuity with Return of 100% of the Purchase Price on Diagnosis of Critical Illness or Death
Joint Life, Last Survivor with return of 100% of the purchase price 50% 100%
Joint Life, Last Survivor 50% 100%
Frequency of Annuity Payments

Details of Spouse (applicable for joint life annuity options only)

Full Name: (Leave a blank space between
First, Middle & Last Name)
Date of Birth: Gender M F Tg

Details of First Premium Deposit.

Payor Details: Self
Payment Details: Amount in (INR): 1,04,500
Drawn on (Bank name & branch): ______________________
Cheque / DD No. ______________________ Date: ______________________ Bank A/c No. ______________________

Payout Mode(Choose any one)

Selected mode would be used by the company to make payout(s) to the Proposer. Payout would be in accordance and subject to the terms and conditions of the policy.

1 Account Type: Savings 2 Bank Name: HDFC BANK LTD

3 Account xxxxxxxxxxxxx 4 Bank Branch: HDFC BANK LTD VASANT VIHAR, DELHI
Number:
5 IFSC Code: xxxxxxxxxxxxxxxx

Declaration: 1. In case of non credit to my bank account with/without assigning any reasons there of or if the transaction is delayed or not effected at all for reasons of incomplete / incorrect information, I would not hold HDFC Life Insurance Co. Ltd
responsible. 2. In case of NRI/NRE account, cheque will be issued.

Note: Please provide a cancelled copy of your cheque.

Signature of Proposer

Declaration of the Life(s) to be Assured and Proposer / Policy Owner

I/We declare that:

i.I/We have replied to the questions, and have made the statements in respect of the matters sought for, in the proposal Form/Electronic proposal form ("Proposal Form") and I
understand and agree that the replies given and statements/declarations made in the Proposal Form together with any documents submitted by me/us for processing my/our
application for insurance shall be the basis of the contract between me/us and HDFC Life Insurance Company Limited ("the Company"). All documents submitted by me/us along with
this Proposal Form are authentic, valid, and where relevant true copies of originals for the purpose of this Proposal Form have been submitted and I/ we have not withheld any material
fact within my/ our knowledge. ii. I/We understand and agree that in case of misstatement or suppression of material facts the policy contract shall be treated in accordance with the
Sec 45 of Insurance Act,1938 as amended from time to time. iii.I/We shall be bound to notify the Company forthwith, in writing, of any change in my/our health, occupation or income
between the date of this Proposal Form and the date of acceptance of my/our proposal for insurance, as communicated in writing to me/us by the Company. iv. I/We have deposited
the first premium along with this Proposal Form, and the premiums payable under the Policy that may be issued in pursuance of this proposal for insurance, will be paid, strictly in
accordance with the law of the land. Amounts paid, otherwise than from my account shall be paid only if i/we can establish an insurable interest. v. All/any amounts paid/payable
towards the policy will be out of legally declared and assessed sources. Further,all the premiums will be paid in accordance with Prevention of Money Laundering Act 2002 (as
amended from time to time) or any other applicable laws.vi. I/we will provide information as required by the Company, on its own or under any lawful instruction/ order, regarding
sources of funds/utilization/ withdrawals.

Date: 25-10-2024 Page 4

26 of 33
I/We agree and understand:
i.That the Company will be on risk in pursuance of this proposal for insurance only after the risk under the Proposal Form is accepted by the Company and such acceptance is
communicated to me/us in writing by the Company. ii.That the Company has the right either to accept or reject my/ our proposal and I undertake that there shall be no costs, claims,
charges being raised by me/ us against the Company thereof. iii. That the Company shall be entitled to retain the premium paid along with the Proposal Form as an interest free initial
deposit to be adjusted against premium payable upon issuance of the Policy. In the event the proposal for insurance is not accepted by the Company the aforesaid deposit shall be
refunded without any interest subject to deductions for medical costs, if any. iv. That the premium payable as well as the sum assured (main as well as additional benefits) may vary
upon assessment of risk by the Company. v.That the Company may seek information from any of my/ our past or present employers/ business associates or from a doctor/medical
examiner / hospital / laboratory / clinic who at any time have attended to me/ us concerning anything which affects my/ our physical or mental health or may seek information from any
insurance office to which an application has been made for insurance on my/ our life. I/ We hereby authorize such parties to furnish information as required by the Company and also
to furnish any documents regarding my/ our employment/business, my/ our health and habits or health and habits of the Life to be Assured (without taking the prior consent of my/ our
family or of any member thereof) as it may require either for the purpose of processing my/ our proposal for insurance or at any time thereafter for any other purpose in relation to the
Policy that may be issued in pursuance of this proposal for insurance vi.In the event of I/we being medically examined, the answers given by me/ us to the medical examiner acting on
behalf of the Company shall be deemed to be incorporated in this proposal for insurance.vii. That the Company may, without any reference to me/us or my family or any member
thereof, furnish any details/ information furnished in this Proposal Form to any judicial or statutory or other authority or to any insurer or reinsurer in connection with the processing of
this proposal for insurance or servicing of this policy. viii. That the Company may contact/ communicate with me/us through postal or courier service, email, telephone, mobile, sms or
VoIP including Whats App. ix. I hereby declare and agree that the above disclosures along with the Statements and the declarations made under the proposal made by me as
Proposer and on behalf of the other/secondary life assured in case of joint life proposals will be the basis of the contract of assurance between us and HDFC Life. If any statement is
found to be untrue or inaccurate or if any fact that might influence the terms of acceptance of this proposal is not disclosed by me in my capacity as Proposer and on behalf of the other/
secondary life assured in case of joint life proposals, the contract shall be treated in accordance with the Sec 45 of Insurance Act,1938 as amended from time to time.x. That I/We have
voluntarily given my/our consent to collect, process, receive, possess, store, deal or handle my/our sensitive personal data or information [as defined in the Information Technology
(Reasonable security practices and procedures and sensitive personal data or information) Rules 2011 as amended from time to time], with third parties/ vendors associated with the
Company for various purposes and outsourced activities related to issuance/servicing/settlement of claim as required under the Policy.

Additional Declaration (Applicable for Health Rider / Product):

i. I/We hereby declare, on my/our behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me/us are true and
complete in all respects to the best of my/ our knowledge and that I/ We am/are authorised to propose on behalf of these other persons. ii. I/We understand that the information
provided by me / us will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurer and that the policy will come into force only after full
payment of the premium chargeable.iii. I/We further declare that I / We will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer
after the proposal has been submitted but before communication of the risk acceptance by the company. iv. I/We declare that I/We consent to the company seeking medical
information from any doctor or hospital who/which at any time has attended on the person to be insured/proposer or from any past or present employer concerning anything which
affects the physical or mental health of the person to be insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured /
proposer has been made for the purpose of underwriting the proposal and/or claim settlement. v. I/We authorize the company to share information pertaining to my/our proposal
including the medical records of the insured/proposer for the sole purpose of underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory
authority.

Signature/Thumb impression of proposer/ primary/ secondary life assured/Policyholder. Signature should match with signature on ECS/SI mandate

Date: Place:

Mobile:

PLEASE DO NOT SIGN ON THE BLANK PROPOSAL FORM

Declaration of good health for spouse

Name: DOB: Amount of Insurance:

Within the past 5 years from the date of signing this proposal form, I have neither been hospitalized for, required medication or treatment for, nor consulted a
physician (to include a follow-up visit) due to, or as a result of, any of the following: alcohol or drug abuse, heart or circulatory disorder, stroke, cancer or
leukemia, diabetes, high blood pressure, chronic kidney or liver disease, mental, nervous or neurological disorders, lung disorders, AIDS (acquired immune
deficiency syndrome), ARC (AIDS related complex), or had tests indicating exposure to the AIDS virus.

Yes No Date:____________________ Signature of the spouse

Declaration (If signed in Vernacular language / Thumb impression has been affixed above)

Declaration to be made by a 3rd person where: The life to be assured/proposed policyholder has affixed his/her thumb impression; OR the life to be assured/proposed
policyholder has signed in vernacular; OR the life to be assured/proposed policyholder has not filled the application OR/AND The spouse of the life to be assured/
proposed policyholder has affixed his/her thumb impression or signed in vernacular the Declaration of Good Health applicable under Elite Option of Smart Woman Plan.

I hereby declare that I have explained the contents of this application form to the life to be assured / proposed policyholder in ________________________language and have
truthfully recorded the answers provided to me. I further declare that the life to be assured/proposed policyholder has signed/affixed his/ her thumb impression in my presence.

____________________________________________________________________________________________________ ___________________________________
Name and address of Declarant Signature

Declaration made by life to be assured/proposed policyholder

I/We certify that the contents of the form have been fully explained to me by Mr. / Mrs.:______________________________

_____________________________________________________________________ ______________________________________
Signature/Thumb impression of proposer/ primary/ secondary life assured/Policyholder. Signature should match with Signature/Thumb impression of Witness
signature on ECS/SI mandate

Sections of the Insurance Act 1938 as amended from time to time

Section 41 - Prohibition of rebates: 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.

Section 45 - 1.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, i.e., from the date of
issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later. 2. A policy of life insurance may be
called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to
the policy, whichever is later, on the ground of fraud: Provided that 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. 3.Notwithstanding anything contained in sub-section (2), no insurer shall repudiate a life

Date: 25-10-2024 Page 5

27 of 33
insurance policy on the ground of fraud if the insured can prove that the misstatement of 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 mis-statement of or suppression of a material fact are within the knowledge of the insurer: Provided that in case of fraud,
the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive. 4.A policy of life insurance may be called in question at any time within three years from the date
of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, 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: Provided that 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 to repudiate the policy of life insurance is based: Provided further that in case of repudiation of the policy on the ground of misstatement
or suppression of a material fact, and not on the ground of fraud, the premiums collected on the policy till the date of repudiation shall be paid to the insured or the legal representatives
or nominees or assignees of the insured within a period of ninety days from the date of such repudiation. 5. 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.

Date: 25-10-2024 Page 6

28 of 33
 23-10-2024

Quote No : qcfckpn3r9vn2,Application No : 1200112758962

Benefit Illustration for HDFC Life Sanchay Plus(Spl)

This Illustration has been produced by HDFC Life Insurance Company Limited to help you understand the benefits of your HDFC
Life Sanchay Plus(Spl)
DETAILS
Name of the Prospect/Policyholder: xxxxx xxxxxxx Proposal No: NA
Age: 29 Name of Product: HDFC Life Sanchay Plus(Spl)

xxxxx xxxxxxx An individual non-participating non-linked

Name of Life Assured: Tag Line:
savings life insurance plan
Age: 29 Unique Identification No: 101N134V24
Policy Term: 5 Years GST Rate: 4.5%* for first year
2.25%* second year
Premium Paying Term: 5 Years
onwards
Amount of Instalment Premium
Rs.100000
(Without GST):
Mode: Annual

*0% if qualifies as zero-rated supply under GST law

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Policy Details
Policy Option Guaranteed Income Sum Assured Rs. 1297800
Guaranteed Payout Sum Assured on Death (at
Annual 1297800
Freqency inception of the policy) Rs.
Guaranteed Payout Payout Term
64633 10
Amount (years)

Premium Summary

PP HPR HPR Total

WOP
Base Plan CI Rider IB Rider PP Rider (PAC) Rider Rider Rider Instalment
Rider
(ADC) (CCI) (CC) Premium

Instalment Premium without GST 1,00,000 0 0 0 0 0 0 0 1,00,000

Instalment Premium with First Year GST 1,04,500 0 0 0 0 0 0 0 1,04,500
Instalment Premium with GST 2nd Year Onwards 1,02,250 0 0 0 0 0 0 0 1,02,250

29 of 33
 (Amount in Rupees)
Policy Year Single/ Guaranteed Non Guaranteed Surrender Value
Annualized Payable
Survival Benefits / Other benefits Maturity Benefit Death Benefit Guaranteed Special Surrender Value
Premium
Loyalty Additions (if any) Surrender
Value

1 1,00,000 0 0 0 12,97,800 0 61,829 61,829

2 1,00,000 0 0 0 12,97,800 61,800 1,33,071 1,33,071

3 1,00,000 0 0 0 12,97,800 1,08,150 2,14,821 2,14,821

4 1,00,000 0 0 0 12,97,800 2,06,000 3,08,285 3,08,285

5 1,00,000 0 0 0 12,97,800 0 0 0

6 0 0 0 64,633 0 0 0 0
7 0 0 0 64,633 0 0 0 0

8 0 0 0 64,633 0 0 0 0

9 0 0 0 64,633 0 0 0 0

10 0 0 0 64,633 0 0 0 0
11 0 0 0 64,633 0 0 0 0

12 0 0 0 64,633 0 0 0 0

13 0 0 0 64,633 0 0 0 0
14 0 0 0 64,633 0 0 0 0

15 0 0 0 64,633 0 0 0 0

Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods & Service Tax.
In the above illustration, benefits are assumed to be paid at the end of the year and premiums received at the beginning of the year.

*The death benefit payable shall be the higher of Guaranteed Death benefit (illustration above) and the surrender value applicable at the time of death.

I , have explained the premiums charges and benefits under the product fully to the Ixxxxxx xxxxxx,having received the information with respect to the above, have
prospect / policy holder. understood the above statement before entering into the contract.

Place:

Date: Signature of Agent /Intermediary / Official Date: Signature of Prospect / Policyholder

Note: Kindly note that name of the company has changed from "HDFC Standard Life Insurance Company Limited" to "HDFC Life Insurance Company Limited".

30 of 33
 CUSTOMER INFORMATION SHEET / KNOW YOUR POLICY

This document provides key information about your policy. You are also advised to go through your policy document.

Policy
Sl. Description in Simple Words
Title Clause
no. (Please refer to applicable Policy Clause Number in next column)
Number

Name of the Insurance

Part A –
Product and Unique Product Name - HDFC Life Sanchay Plus
1 Welcome
Identification Number UIN - 101N134V24
Letter
(UIN)

Part A –
Policy Welcome
1200112758962
2 Number/Application Letter and
(please refer to your policy document for your policy number)
Number Policy
Schedule

Type of Insurance
3 Non-Linked other than pure risk and pension Part A
Policy

Installment Premium - 100000

Mode of premium payment - Annual
Part A –
Sum Assured on Death at inception – 1297800
4 Basic Policy Details Policy
Sum Assured on Maturity – 414789
Schedule
Premium Payment Term - 5
Policy Term - 5

Benefits payable on maturity – Maturity benefit is the benefit payable on

maturity subject to life assured surviving till maturity, in accordance with
the terms and condition of the policy. For more details please refer to the
Policy Document.
Benefits payable on death – Death Benefit is payable as Lump sum upon
death of the life assured during the policy term.
Survival Benefits excluding that payable on maturity – Not Applicable.
Surrender Benefits – means the amount, if any, that becomes payable on
surrender of a policy during its term, in accordance with the terms and
Part C –
conditions of the policy.
Policy Clause 1
Options to policyholders for availing benefits, if any, covered under
5 Coverage/benefits Part D –
the policy, if opted at inception –
payable Clause 1 &
Plan Options:
5
1. Guaranteed Maturity
2. Guaranteed Income
3. Long Term Income
4. Life Long Income
Other benefits/options payable, specific to the policy, if any –
Policyholder can alter the Frequency of Premium Payment and Income
Payout . Alteration in the Frequency of Premium Payment may lead to a
change in the Premium. Such alteration will be in accordance with the
Board approved underwriting policy.

Options available (in

Not
6 case of Linked Not Applicable
Applicable
Insurance Products)

Option available (in

Not
7 case of Annuity Not Applicable
Applicable
product)
31 of 33
 Policy
Sl. Description in Simple Words
Title Clause
no. (Please refer to applicable Policy Clause Number in next column)
Number

Part A –
Policy
8 Riders opted, if any Not Applicable Schedule –
Rider Policy
Details

Suicide Exclusions - In case of death due to suicide within 12 months

from the Risk Commencement Date under the policy or from the date of
Part F
Exclusions (events revival of the policy, as applicable, the nominee or the beneficiary of the
(General
where insurance policyholder shall be entitled to at least 80% of the total premiums paid till
9 Terms &
coverage is not the date of death or the surrender value available as on the date of death
Conditions)
payable), if any. whichever is higher, provided the policy is in force.
– Clause 1
For exclusions related to optional benefits, if any, please refer to policy
document

Waiting /lien Period, if Not

10 Not Applicable
any Applicable

Grace period for other than single premium policies means the time granted
by the insurer from the due date of payment of premium, without any penalty Part A –
or late fee, during which time the policy is considered to be in-force with the Policy
11 Grace period risk cover without any interruption, as per the terms & conditions of the policy. Schedule
The grace period for payment of the premium for all types of life insurance Part B –
policies shall be 15 days, where the policyholder pays the premium on a (Definitions)
monthly basis and 30 days in all other cases.

In case the Policyholder is not agreeable to any of the terms and conditions
stated in the Policy, the Policyholder has an option to return the Policy to the
Part A -
Company for cancellation stating the reasons thereof, within 30 days from the
Welcome
date of receipt of the Policy, whether received electronically or otherwise. On
Letter
receipt of the Policyholder’s letter along with the original Policy (original
12 Free Look Period Part B –
Policy Document is not required for policies in dematerialised form or where
(Definitions)
policy is issued only in electronic form), the Company shall arrange to refund
Part D –
the Premium paid by the Policyholder, subject to deduction of the
Clause 7
proportionate risk Premium for the period of cover and the expenses incurred
by the Company on medical examination (if any) and stamp duty charges.

Lapse – is the status of the Policy when due premium is not paid within
the Grace Period. For policies other than single premium, if any due
premium is unpaid upon the expiry of the Grace Period and your Policy
has not acquired a Surrender Value, your Policy’s status will be altered to
lapse and the cover will cease.
Paid-up – For policies other than single premium, if any due premium is
Part B –
unpaid upon the expiry of the grace period and your policy has acquire a
(Definitions)
Lapse, paid-up and Surrender Value, your Policy’s status will be altered to reduced paid-up.
13 Part D –
revival of the Policy Revival - means restoration of the Policy, which was discontinued due to
Clause 2 &
the non-payment of Premium, by the insurer with all the benefits mentioned
3
in the Policy document, with or without rider benefits, if any, upon the
receipt of all the Premiums due and other charges/late fee, if any, during
the revival period, 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 Board approved Underwriting Policy.

Policy Loan, if Policy loans will be available during the Policy Term subject to such terms Part D –
14
applicable and conditions as the Company may specify from time to time. Clause 6

32 of 33
 Policy
Sl. Description in Simple Words
Title Clause
no. (Please refer to applicable Policy Clause Number in next column)
Number

Turn Around Time (TAT) for claims settlement and brief procedure:
https://www.hdfclife.com/content/dam/hdfclifeinsurancecompany/customer-
services/pdf/TAT-Poster.pdf
Helpline/Call Centre number: 022-68446530 (Call Charges apply) | NRI
Claims/Claims Part F –
15 Helpline number: +91 89166 94100 (Call charges apply)
Procedure Clause 3
Contact details of the insurer: You can email us [email protected] |
[email protected] (For NRI customers only)
Link for downloading claim form and list of documents required including
bank account details: https://www.hdfclife.com/customer-service/claims

Turn Around Time (TAT):

https://www.hdfclife.com/content/dam/hdfclifeinsurancecompany/customer-
services/pdf/TAT-Poster.pdf
Helpline/Call Centre number: 022-68446530 (Call Charges apply) | NRI
Helpline number: +91 89166 94100 (Call charges apply) Part F –
16 Policy Servicing
Contact details of the insurer: You can email us [email protected] | Clause 3
[email protected] (For NRI customers only)
Link for downloading applicable forms and list of documents required
including bank account details: https://www.hdfclife.com/customer-
service/forms-and-download

Contact details of Grievance Redressal Officer of the insurer: Tel: 022-

67516666, Helpline number: 022-68446530 (Call charges apply) | NRI
Helpline number +91 89166 94100 (Call charges apply) E-mail:
17 Grievances/Complaints [email protected] | [email protected] (For NRI customers only) Part G
Link for registering the grievance with the insurer’s portal:
https://www.hdfclife.com/customer-service/grievance-redressal
Contact details of Ombudsman: https://www.cioins.co.in/Ombudsman

Declaration by the
Policyholder

I have read the above and confirm having noted the details, by way of an OTP consent.

Place:NA
(Signature of the Policyholder)
Date:23/10/2024

Note: In case of any conflict, the terms and conditions mentioned in the policy document shall prevail.

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