Group Insurance Scheme for Pradhan Mantri Jeevan Jyoti Bima Yojana

UIN: 105G146V01

CERTIFICATE OF INSURANCE

ICICI PRUDENTIAL LIFE INSURANCE COMPANY LIMITED

ICICI Prulife Towers, 1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai- 400 025

This policy is a ONE YEAR RENEWABLE TERM Policy.

Group Insurance Scheme for Pradhan Mantri Jeevan Jyoti Bima

Name of the Scheme
Yojana
Master Policy No. 00007445
Name of the Master Policyholder
AU Small Finance Bank Limited
(Proposer)
Bank House, Mile '0', Ajmer Road, Jaipur-302001, Rajasthan
Address of the Master Policyholder
(India)
Name of the Life Assured Mahesh .
Date of birth of the Life Assured
07-01-1999
(as per KYC document)
Age of the Life Assured as on
Policy Commencement Date / Renewal 24
Date
Member Identification Number 2301229155279768P
Savings Bank Account number 2301229155279768
Aadhaar number
Sum Assured Rs. 2,00,000/-
Date of Commencement of Cover 29-12-2023
Date of Termination of Cover 31-05-2024
Annual Renewal Date of Master Policy 01-06-2024
PAN No
Folio No/Cust. Id 30294397
Nominee Hawa Kanwar
Age of the Nominee 38
Relationship of the Nominee
Mother
with the Life Assured
Name of the Appointee
(in case Nominee is a minor)

Premium 228 Premium Payment Mode IFT

The Master Policyholder has applied vide proposal dated 1st June, 2023 to ICICI Prudential Life
Insurance Company Limited (hereinafter referred to as "the Company") for grant of the Benefits
specified here in.

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 Group Insurance Scheme for Pradhan Mantri Jeevan Jyoti Bima Yojana

UIN: 105G146V01

Benefits payable and other conditions: as specified in the Master policy document and this
certificate.

Please note: The Cover to the Members will terminate if the Master Policy holder does not pay the
due premium before the Annual Renewal Date of the Master Policy. As this is a group policy,the
member's cover will cease if the member ceases to be a member of the group. The premium is
guaranteed for the period of cover and subject to change on policy’s annual renewal date.

In case there are any differences in interpretation of the benefits payable, premium, terms and
conditions mentioned in this Certificate of Insurance, the terms of the Master Policy and the
Rules of Scheme shall prevail. For complete details, please refer to the policy document and
Rules of Scheme as available with the Master Policyholder.

Signed for and on behalf of the ICICI Prudential Life Insurance Company Limited, at MUMBAI on 1st
June, 2023

Authorised Signatory

This is a summary of the Master Policy issued to the Master Proposer and contains important terms
and conditions about the Benefits.

Terms and Conditions of the Policy:

1. Definitions

Unless excluded by or repugnant to the context: -

a) "Beneficiary" means the person nominated by the Member as the recipient of the benefits
under the Rules of the Scheme.

b) "Benefits" means the Cover provided to the Members, under the Master Policy.

c) "Cover" means the Group Term Insurance provided to a Member under this Master Policy.

d) "Master Policyholder" means the Participating Bank under the Pradhan Mantri Jeevan Jyoti
Bima Yojana

e) "Company" means ICICI Prudential Life Insurance Company Limited which expression shall
include its successors and assigns.

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f) "Group" means a group of Members accepted by the Company as constituting a Group for the
purpose of the Master Policy.

g) "Date of commencement of Cover" means

i. the date of commencement of cover for the individual members under the Master Policy.
ii. at the time of issuance of the Master Policy the date of acceptance of risk subject to
receipt of member data and premium towards these members.
iii. for new members joining during the term of the Master Policy, will be the date of
acceptance of risk subject to receipt of Member data and premium towards these
members. Member Data means the necessary details of the Members required to provide
risk cover.

h) "Terminal date" means the date when a Member attains the Terminal age or the date on
which he ceases to be a Member of the Scheme whichever is earlier.

i) "Terminal Age" is the age as stipulated under Rules of Scheme, on which the Membership
ceases.

2. Eligibility for Membership

a) Persons who are of at least the minimum age at entry (last birthday) and not more than the
maximum age at entry (nearer birthday) or the Terminal Age, whichever is lower, as specified
under the Rules of Scheme, as on the Policy Commencement Date, will be eligible for
Membership of the Scheme.

b) Persons who join the Group after the Policy Commencement date shall be eligible for
Membership of the Scheme by payment of pro rata premium for prospective cover subject to
them being within the age limits specified above..

c) The eligibility of a Member to join the scheme as specified in (a) and (b) above is subject to
the Company receiving an intimation of eligibility of the Member and premium amount preferably
within 30 days of the Member becoming eligible.

d) The cover of a Member shall terminate on an annual renewal date upon the happening of any
of the following events and no benefit will become payable thereunder:-

i. On attaining Terminal age on annual renewal date.

ii. Closure of account with Master Policy holder or insufficiency of balance to keep the
insurance in force.
iii. If Master Policy is terminated/discontinued for any reason
iv. he/she ceases to satisfy any of the eligibility criteria.

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v. he/ she ceases to be a Member for whatsoever reason;

vi. his/her relationship with the Master Policyholder ceases for any reason whatsoever.

3. Benefits payable under the Policy

a) Provided the cover is in force, on death of a member during policy term, death benefit equal to
the sum assured will be payable to the nominee of such member.

b) For new members enrolling into the scheme the risk will not be covered during the first 45
from the date of enrolment into the scheme (lien period) and in case of death (other than due to
accident) during lien period, no claim would be admissible.

c) No benefit shall be payable on maturity of the policy.

4. Premium

a) Premium under the Master Policy is payable in advance for each Member.

b) Premium shall be payable with respect to each member covered under the Policy. The Master
Policyholder shall be responsible for such premium payment.

5. Termination of Life Insurance

The cover of a Member shall terminate on an annual renewal date upon the happening of any of the
following events and no benefit will become payable thereunder:-

a) On attaining Terminal age (as specified under the Rules of scheme) on annual renewal date.
b) Closure of account with Master Policy holder or insufficiency of balance to keep the insurance
in force.
c) If Master Policy is terminated/discontinued for any reason
d) he/she ceases to satisfy any of the eligibility criteria.
e) he/ she ceases to be a Member for whatsoever reason.
f) his/her relationship with the Master Policyholder ceases for any reason whatsoever.

In case a Member is covered under this Scheme through more than one Bank account, and premium
is received inadvertently, insurance cover will be restricted to Rs. 2 (two) Lakh and the premium shall
be liable to be forfeited.

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In the event of any other factor relating to the insurability of a life not being to the satisfaction of the
Company, it may terminate the Cover for such a person/ Member.

The decision of the Company thereon shall be final and binding on the Master Policyholder and the
Member.

The Master Policyholder and the Company reserve the right to discontinue the scheme at any time or
to amend the Rules thereof on any annual renewal date subject to giving 1 (one) months’ notice. Any
amendment to the Rules of the Scheme will be done based on mutual agreement between the Master
Policy holder and the Company. On discontinuance of Scheme by the Government, the Master
Policyholder and the Company may decide to terminate the policy.

6. Payment of Claim

The claim payment will be as per Scheme Rules. The Master Policyholder will raise claims to avail
Benefits with the following documents:

a) Claim intimation form

b) Member Policy Schedule, as applicable
c) Death certificate issued by the local authority in case of death claim
d) Any other documents or information as may be required by the Company for processing of the
claim depending on the cause of the claim
e) The Company reserves the right to call for additional information, documents or particulars, in
such form and manner as the Company would prescribe, and the Benefits would be paid only
after receipt of such additional information, documents or particulars.
f) The claim payment will be made to the account of the member.
g) All claims payments will be made in Indian currency in accordance with the prevailing
exchange control regulations and other relevant laws and regulations in India.
h) The settlement of claim is subject to correct information provided by the member related to his
/her personal information, if applicable. The Company reserves the right to reject the claim of a
member in case incorrect information related to member is provided for the Cover. The decision
of the Company regarding the settlement of the Cover shall be binding on the Master
Policyholder.

7. Exclusions

The members are covered only for accidental death in the first 30 days of joining and re-joining the
Policy. If a member dies due to any reason other than accident in this period, the premium paid shall
be refunded after deducting proportional expenses incurred for the issue of the cover.

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8. Non-disclosure and Fraud

In case of non-disclosure and fraud, the policy shall be cancelled immediately, subject to the non-
disclosure/fraud being established by the Company in accordance with Section 45 of the Insurance
Act, 1938 as amended from time to time.

9. Customer service

If at any time you need any clarification or assistance, please contact your relationship manager.

By mail at:

Address: ICICI Prudential Life Insurance Co. Ltd.,

Group Service Desk
Ground Floor Upper Basement,
Unit No. 1A 2A, RahejaTipco Plaza,
Rani Sati Marg, Malad (East),
Mumbai- 400097
Maharashtra.
E-mail: [email protected]

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