Part A

Ref no.: 28371239 PSCDECH-D2C_BlueDart-4383486-4465260

CRK/CRK / 830 33547021900

Ms. SILOCHANA DEVI

M C COLONY NEAR WARE HOUSE 29th November 2024
ROAD WARD NO 2- CH DADRI
DADRI(147) BHIWANI
C

Bhiwani 127306
Haryana
India
Tele.Nos - 9812323781
Mobile No : 919812323781
Email -
R

SINGHRAJBIR099@GMAIL.COM

Dear Ms. SILOCHANA DEVI,

Sub: Your Policy no. 28371239
We are glad to inform you that your proposal has been accepted and the HDFC Life Sanchay Par Advantage Policy (“Policy”) has
been issued. We have made every effort to design your Policy Document in a simple format. We have highlighted items of importance
so that you may recognize 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. We are also enclosing alongside a copy of your
proposal form and other relevant documents submitted by you 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 Document (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 for medical examination (if any)
and stamp duty charges.

Contacting us:
The address for communication is specified below. To enable us to serve you better, you are requested to quote your Policy number in
all correspondences. In case you are keen on knowing more about our products and services, we would request you to talk to your
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 @ onlinequery@hdfclife.in.
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 of this Policy Document. In case you are not satisfied with our response,
you can also approach the Insurance Ombudsman in your region whose address is available on our website www.hdfclife.com.

Thanking you for choosing HDFC Life Insurance Company Limited and looking forward to serving you in the years ahead,
Digitally signed by DS HDFC
Yours sincerely, LIFE INSURANCE
COMPANY LIMITED 4
Date: 2024.11.29 16:45:23
+05:30

Authorised Signatory
Branch Address:HDFC Life Rewari-Brass Market, 2nd floor SCO-123, Brass Market,, Rewari, 123401

Agent details
Name : HDFC BANK, Address : HDFC Bank Ltd, Sandoz House, 2nd Floor, Shiv Sagar
Estate, Dr.Annie Besant Road, Worli, Mumbai, Maharashtra -400018 Agent No. : 01545770
License No. : CA0010 Contact Details :7015106189
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PSCDECH-D2C_BlueDart-4383486-4465260
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: service@hdfclife.com| nriservice@hdfclife.com
(For NRI customers only) | Helpline number: 022-68446530 (Call charges apply) | NRI Helpline number +91 89166 94100 (Call charges apply)

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PSCDECH-D2C_BlueDart-4383486-4465260
 POLICY DOCUMENT- HDFC LIFE SANCHAY PAR ADVANTAGE
Unique Identification Number:101N136V04
Your Policy is an Individual Non Linked Participating Savings Life Insurance Plan. This Policy is the evidence of a contract between
HDFC Life Insurance Company Limited (‘We’/ ‘Company’) and the Policyholder (‘You’) 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 Short Medical Questionnaire (SMQ) 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. 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: 28371239
Client ID: ASB74537
Policyholder Details

Name Ms. SILOCHANA DEVI

M C COLONY NEAR WARE HOUSE

ROAD WARD NO 2- CH DADRI
DADRI(147) BHIWANI
Address Bhiwani
Haryana
127306

Life Assured Details

Name Ms. SILOCHANA DEVI

M C COLONY NEAR WARE HOUSE

ROAD WARD NO 2- CH DADRI
DADRI(147) BHIWANI
Address
Bhiwani
Haryana
127306
Date of Birth 7th May 1971

Age 53 Years

Age Admitted Yes

Policy Details

Plan Option Immediate Income

Survival Benefit Payout Mode Survival Benefit Payout
Guaranteed Income (Applicable
0.00
only for Deferred Income Option)
Survival Benefit Frequency Annually
Timing of Payment of Survival
Arrear
Benefit*
Survival Benefit Payout Date 16/11
Date of Risk Commencement 16th November 2024
Date of Issue/Inception 28th November 2024

Premium Due Date(s) 16th November

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Death Multiple times Annualized ` 990,433.00
Premium

Sum Assured on Death ` 990,433.00

Sum Assured on Maturity ` 956,940.00

Annualized Premium ` 95,694.00

Policy Term 47 years

Premium Paying Term 10 years

Premium Paying Frequency Annual

Premium per Frequency ` 95,694.00

Underwriting Extra Premium ` 0.00

Frequency

Total Premium per Frequency ` 95,694.00

Grace Period 30 days

Final Premium Due Date 16/11/2033

Maturity Date 16/11/2071

The Premium amount is excluding any applicable taxes and levies on the Premium. Amount of applicable taxes and levies will be
charged at actuals as per prevalent rate.
*When Timing of Payment of Survival Benefit is chosen as "Advance", the survival benefits are payable at the beginning of the
Survival Benefit Frequency. First payout shall be made within 7 working days from i) the realization of the first premium or ii) Policy
issuance, whichever is later. Subsequent payouts shall be made within 7 working days from i) realization of renewal premium or ii)
Survival Benefit Payout Date, whichever is later.

HDFC Life Insurance Company Limited

11th Floor, Lodha Excelus,
Apollo Mills Compound,
Address for Communication N. M. Joshi Road,
Mahalaxmi,
Mumbai - 400 011.
Email: service@hdfclife.com

Stamp Duty of ` 198.20/- 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

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

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 NOMINATION SCHEDULE

Nominee’s Name Mr. RAHUL

Nominee’s Relationship with the Life Son

Assured

Date of Birth of Nominee 13th January 1993

Nominee’s Age 31 Years
Percentage share of nominee 100.00

M C COLONY NEAR WARE HOUSE

ROAD WARD NO 2- CH DADRI
Nominee's Address DADRI(147) BHIWANI
Bhiwani - 127306
Haryana

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 29th November 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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PSCDECH-D2C_BlueDart-4383486-4465260
 (24) Par products" or "Products with participation in profits" means
Part B
products where policies are entitled to share in surplus (profits)
during the term of the policy as per section 49 of the Act
1. Definitions (25) Policy Anniversary–means the annual anniversary of the Date of
(1) Annualized Premium (AP)–means the premium amount payable in Risk Commencement;
a year excluding the taxes, rider premiums, underwriting extra (26) Policyholder, You, you, your–means or refers to the Policyholder
premiums and loadings for modal premiums, . stated in the Policy Schedule.
(2) Appointee–means the person named by you and registered with us (27) Policy Term–means the term of the Policy as stated in the Policy
in accordance with the Nomination Schedule, who is authorized to Schedule;
receive the Death Benefit under this Policy on the death of the Life
(28) Policy year - is the period between two consecutive policy
Assured while the Nominee is a minor;
anniversaries. This period includes the first day and excludes the
(3) Assignee–means the person to whom the rights and benefits under
next policy anniversary day.
this Policy are transferred by virtue of assignment under section38
of the Insurance Act,1938;as amended from time to time (29) Premium(s)–means an amount stated in the Policy Schedule,
(4) Assignment- means a provision wherein the Policyholder can assign payable by you to us for every Policy Year by the due dates, and in
or transfer a Policy in accordance with Section 38 of the Insurance the manner stated in the Policy Schedule, to secure the benefits
Act, 1938 as amended from time to time; under this Policy, excluding any applicable taxes and other statutory
(5) Authority/IRDAI– means Insurance Regulatory and Development levies;
Authority of India; established under the provisions of section 3 of (30) Premium Paying Term (PPT)–means the period as stated in the
the Insurance Regulatory and Development Authority Act, 1999 Policy Schedule, in years, over which Premiums are payable;
(6) Cash Bonus –is expressed as a percentage of the Annualized (31) 25) Regulations – means IRDAI (Insurance Products)
Premium as declared from time to time. No guarantee shall be Regulations, 2024 as amended from time to time and applicable to
applicable to the declaration of future rates of cash bonus; this Policy, including without limitation the Regulations and
(7) Company, company, Insurer, Us, us, We, we, Our, our–means or directions issued by the Insurance Regulatory and Development
refers to HDFC Life Insurance Company Limited. Authority of India (‘IRDAI’) from time to time.
(8) Date of Risk Commencement–means the date, as stated in the (32) Revival of a Policy-means restoration of the Policy, which was
Policy Schedule, on which the insurance coverage under this discontinued due to the non- payment of Premium, by the insurer
Policy commences; with all the benefits mentioned in the Policy document, with or
(9) Death Benefit - means the benefit which is payable on death of without rider benefits, if any, upon the receipt of all the Premiums
life assured, as stated in policy document due and other charges/late fee, if any, during the revival period, as
(10) Exit date – means date on which the coverage ceases due to per the terms and conditions of the Policy, upon being satisfied as to
occurrence of any of the following events: i. Death, ii. Policy the continued insurability of the insured/Policyholder on the basis
being terminated or lapsed, iii. Free Look Cancellation; iv. of the information, documents and reports furnished by the
Payment of Maturity benefit, v. Surrender Policyholder, in accordance with Board approved Underwriting
(11) Free Look period – means the period specified under Part D clause Policy.
7 from the receipt of the Policy during which Policyholder can (33) Revival Period-means the period of five consecutive complete years
review the terms and conditions of this Policy and where if the from the date of first unpaid premium.
Policyholder is not agreeable to any of the provisions stated in the (34) Survival Benefit – means the benefit payable, as per the terms and
Policy, he/ she has the option to return this Policy. conditions of the plan option chosen under the policy, until death of
(12) Frequency of Premium Payment–means the period, as stated in the the Life Assured or end of the policy term, whichever is earlier
Policy Schedule, between two consecutive Premium due dates for (35) Sum Assured on Maturity – Sum Assured on Maturity means the
the Policy; absolute amount which is guaranteed to become payable on maturity
(13) Grace Period for other than single premium policies - means the of the policy, as per the terms and conditions of the policy. Sum
time granted by the insurer from the due date of payment of Assured on Maturity is calculated as: Annualized Premium x
premium, without any penalty or late fee, during which time the Premium Paying Term
policy is considered to be in-force with the risk cover without any (36) Sum Assured on Death- means an absolute amount of benefit which
interruption, as per the terms & conditions of the policy. The grace is guaranteed to become payable on death of the life assured in
period for payment of the premium for all types of life insurance accordance with the terms and conditions of the policy.
policies shall be fifteen days, where the policyholder pays the (37) Surrender-means complete withdrawal/ termination of the entire
premium on a monthly basis and 30 days in all other cases. Policy contract.
(14) Guarantee Period – means the period which is lower of 25 years, or (38) Surrender Value-means an amount, if any, that becomes payable on
Policy Term minus (Premium Payment Term + 1 year). Surrender of the Policy during its term , in accordance
(15) In-force Policy–means the policy for which all due premiums have with the terms and conditions of the Policy.
been paid on or before the due date or within the Grace Period. (39) Timing of Payment of Survival Benefit - means payment of Survival
(16) Interim Survival Benefit- means Survival Benefit x Benefit at the beginning or at the end of the chosen Survival Benefit
(Months elapsed from last Survival Benefit Pay-out date/12) Frequency.
(17) Life Assured-means the person as stated in the Policy Schedule on (40) Total Premiums paid (TP) – means total of all the premiums paid
whose life the contingent events have to occur for the Benefits to be under the base product, excluding any extra premium and taxes, if
payable. The Life Assured may be the Policyholder. collected explicitly.
(18) 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..
(19) Maturity Date–means the date stated in the Policy Schedule, on
which the Policy Term expires and this Policy terminates;
(20) Minor – means for purpose of this Policy any person who is below
18 years of age.
(21) 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.
(22) Nominee–means the person named by the Policyholder (who is also
the Life Assured) under this policy and registered with us in
accordance with the Nomination Schedule, who is
authorized to receive the Death Benefit under this Policy, on the
death of the Life Assured;
(23) Non-Linked insurance products” are the products other than Linked
insurance products

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PSCDECH-D2C_BlueDart-4383486-4465260
 Part C

1. Benefits

The Plan options available under HDFC Life Sanchay Par Advantage product are:

Plan Option Description

Immediate Income Regular cash bonus starting from the 1st Policy Year

Deferred Income Guaranteed Income plus regular cash bonus starting one year after the end of the Premium Paying Term

Detail of benefits under each Plan option is as provided below:

(1) Death Benefit–For both the Plan Options - i) On death of the Life Assured before the Maturity Date and provided all Premiums which have fallen due
are paid, the Death Benefit, shall be equal to:
• Sum Assured on Death; plus

• Accrued cash bonuses, if not paid earlier, and guaranteed income, if applicable and if not paid earlier; plus

• *Interim Survival Benefit; plus

• Terminal Bonus, if any.

ii) The minimum Death Benefit shall be 105% of the Total Premium Paid as on date of death.
iii) Sum Assured on Death is the highest of:
• 10 times the Annualized Premium
• Sum Assured on Maturity
• Death Multiple times Annualized Premium
*Interim Survival Benefit shall not be applicable where Timing of Payment of Survival Benefit is chosen as “Advance” and as mentioned in
the Schedule.

Death Multiple:
Age at Entry Death Multiple Age at Entry Death Multiple Age at Entry Death Multiple Age at Entry Death Multiple

<=5 15 19 13.6 33 12.2 47 10.8

6 14.9 20 13.5 34 12.1 48 10.7

7 14.8 21 13.4 35 12 49 10.6

8 14.7 22 13.3 36 11.9 50 10.5

9 14.6 23 13.2 37 11.8 51 10.45

10 14.5 24 13.1 38 11.7 52 10.4

11 14.4 25 13 39 11.6 53 10.35

12 14.3 26 12.9 40 11.5 54 10.3

13 14.2 27 12.8 41 11.4 55 10.25

14 14.1 28 12.7 42 11.3 56 10.2

15 14 29 12.6 43 11.2 57 10.15

16 13.9 30 12.5 44 11.1 58 10.1

17 13.8 31 12.4 45 11 59 10.05

18 13.7 32 12.3 46 10.9 >=60 10

iv) On death of the Life Assured during the policy term, the Death Benefit payable shall not be reduced by the survival benefits already paid.
v) For minor lives where risk commences from the first policy anniversary and death of the Life Insured takes place prior to the risk commencement date,
only the basic premiums paid to date (excluding taxes and levies, if any) shall be payable as the Death Benefit.
vi) The Death Benefit is subject to the exclusions set out in Clause 4 of Part F (Exclusions).
vii) Upon the payment of the Death Benefit, the Policy terminates and no further Benefits are payable.
viii) For a paid-up Policy, the Death Benefit payable shall be as described in Clause2 of Part D.
The recipients of Benefits under this Policy shall be as specified below:
(1)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 Assured
is other than the Policyholder.
All other Benefits shall be payable to the Policyholder.

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PSCDECH-D2C_BlueDart-4383486-4465260
 (2)Terminal bonus rates and cash bonus rates will be declared at the end of valuation period (currently end of financial year) and will be paid out to the
eligible policyholders during the next year on Policy termination date and as per the date chosen by the Policyholder during the Policy term
(2) Maturity Benefit- For both the Plan Options -On survival of the Life Assured till the Maturity Date, the Policy matures and the policyholder will
receive the aggregate of:
• Sum Assured on Maturity;
• Accrued cash bonuses, if not paid earlier, and accrued guaranteed income, if applicable and if not paid earlier;
• *Interim Survival Benefit, if any;
• Terminal Bonus, if any.
*Interim Survival Benefit shall not be applicable where Timing of Payment of Survival Benefit is chosen as “Advance” and as mentioned in the
Schedule.

Sum Assured on Maturity is equal to the sum of Annualized Premiums payable under the Policy.

Where, Interim Survival benefit is defined as:

For Immediate Income option: Interim cash bonus rate * Annualized Premium * Months elapsed from last Survival Benefit Pay-out date/12

For Deferred Income option: [(interim cash bonus rate * Annualized Premium) + Guaranteed Income] * Months elapsed from last Survival Benefit Pay-
out date/12

(3) Survival Benefit– For Immediate Income Option - The Survival Benefits payable from the 1st Policy Year as per the Timing of payment of Survival
benefit chosen until death or end of Policy term, whichever is earlier, shall be equal to:
Cash bonus rate multiplied by Annualized Premium, if any
For Deferred Income Option- The Survival Benefits payable starting one year after the end of the Premium Payment Term as per the Timing of Payment
of Survival benefit chosen, shall be equal to:
Cash bonus rate multiplied by Annualized Premium, if any, plus Guaranteed Income.
Guaranteed Income shall be equal to Guaranteed Income Rate multiplied by the Annualized Premium.
Guaranteed Income Rate is the percentage of Annualized Premium that is guaranteed to be paid out under Deferred Income Option starting one year
after the end of the premium payment term during the Guarantee Period subject to the Policyholder surviving during that period. The Guaranteed Income
Rate (% of Annualized Premium) for various ages and Premium Payment Terms (PPT) shall be as below:

Age at entry PPT 7 years PPT 8 years PPT 9 years PPT 10 years PPT 12 years

Up to 25 years 22% 28% 34% 40% 50.8%

26 to 35 years 22% 28% 34% 40% 50%

36 to 40 years 22% 28% 34% 40% 50%

41 to 45 years 22% 28% 34% 40% 50%

46 to 50 years 22% 28% 34% 40% 50%

51 to 55 years 21.4% 27.6% 33.8% 40% 50%

56 years and above NA NA 33.8% 40% 50%

For both the plan options, the Policyholder can opt to receive the future payouts at a monthly, quarterly or semi-annual frequency in arrears instead of yearly
as per below Timing of Payment of Survival benefit:

1.Advance – Survival Benefit shall be paid at the beginning of the Payout frequency chosen
2.Arrear – Survival Benefit shall be paid at the end of the Payout Frequency chosen

The default Timing of Payment of Survival Benefit is in “Arrear”. However, the policyholder also has an option to take the payments in “Advance”. This
option is only available to be chosen at Policy inception and once chosen the same cannot be changed during the entire Policy Term.

This option is only available to be chosen at Policy inception and once chosen the same cannot be changed during the entire Policy Term.

Cash Bonus & Guaranteed Income for frequencies other than annual shall be arrived at by multiplying the annual Cash Bonus/ Guaranteed Income by
the conversion factor given below, and will be paid out over the subsequent year as per the Timing of Payment of Survival Benefit:

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PSCDECH-D2C_BlueDart-4383486-4465260
 Frequency Cash bonus/ Guaranteed Income in Arrears, Cash bonus/ Guaranteed Income in Advance, Instalment (per
Instalment (per frequency) frequency)

Annual 100% of Annual Survival Benefit 91% of Annual Survival Benefit

Semi-annually 98% of Annual Survival Benefit x 1/2 93% of Annual Survival Benefit x 1/2
Quarterly 97% of Annual Survival Benefit x 1/4 94.5% of Annual Survival Benefit x 1/4
Monthly 96% of Annual Survival Benefit x 1/12 95% of Annual Survival Benefit x 1/12

The Policyholder will have an option to change the Survival Benefit Frequency on any Policy Anniversary, however the Timing of Payment of Survival
Benefit will not change.
Where Timing of Payment of Survival Benefit is selected as “Advance”, the Survival Benefit Frequency can not be lower than Premium Payment
Frequency.

(4)Payment and cessation of Premiums

(1)The first Premium must be paid along with the submission of your completed application. Subsequent Premiums are due in full on the due dates as
per the frequency set out in your Policy Schedule.
(2)Premiums under the Policy can be paid on yearly, half-yearly, quarterly or monthly basis as per the chosen frequency and as set out in the Policy
Schedule or as amended subsequently.
(3)If you have chosen monthly premium payment frequency, we may collect first 3 months premium along with the proposal form.
(4)Any Premiums paid before the Due Date will be deemed to have been received on the Due Date for that Premium.

(5)Advance Premium:
The Premiums that fall due in the same financial year can be paid in advance. However, where the premium due in one financial year is paid in
advance in earlier financial year, we may collect the same for a maximum period of three months in advance of the due date of the premium.

(6)Grace Period:
The grace period of 15 days (where the premium is paid on a monthly basis) and 30 days (where the premium is paid in quarterly/half-yearly/annual
basis) is available on the premium due date, to pay the premium. We will not accept part payment of the Premium. The policy is considered to be
in-force with the risk cover during the grace period without any interruption as per the terms and conditions of the policy. (7)A Premium will be
deemed to remain unpaid if the Premium amount has not been realised by us. If any Premium remains unpaid after the expiry of the grace period,
your Policy may lapse or become Paid-Up, as described in Part D Clause 2, with effect from the due date of the first unpaid Premium. In that event,
the Benefits under such Policy shall be payable in accordance with Part D Clause 2.
(8)Premiums are payable by you without any obligation on us to issue a reminder notice to you.
(9)The application of the Premiums received is conditional upon the realisation of the proceeds of the instrument of payment, including electronic
mode.
(10)The Benefits payable under this Policy will be paid after deduction of the Premium fallen due during the then current Policy year, if such
Premium has remained unpaid.
(11)If you suspend payment of Premium for any reason whatsoever, Clause 2 of Part D (Lapsed Policies and Paid –Up Policies) may apply and we
shall not be held liable for any loss of Benefits.

2. Flexible Benefit Payout Options:

(1) Deferral of Survival Benefits:
At any point during the Policy term, the Policyholder shall have an option to defer the Survival Benefit, arising out of declared Cash Bonuses and/ or
Guaranteed Income, if applicable, and accrue them instead.
The accrued Cash Bonuses and/ or Guaranteed Income payouts will be accumulated monthly at Reverse Repo Rate published by RBI on its website and
this rate will be reviewed at the beginning of every month and will be aligned with the latest reverse-repo rate published on RBI’s website. The current
Reverse Repo Rate is 3.35%.
The Policyholder can withdraw the accrued Cash Bonuses/ Guaranteed Income partly/ fully at any point during the Policy Term.
If the unpaid survival benefits are not taken by the Policyholder during the policy Term, the same shall be payable along with Benefits payable at the time
of termination of the Policy in the form of death or maturity of Policy or surrender of Policy. This option can be availed under an in-force as well as a
paid-up Policy. The Policyholder can withdraw the accrued cash bonuses / guaranteed income pool partly/fully at any time during the Policy.
The Policyholder can choose to opt in or opt out of this feature at any point during the Policy Term.
(2) Survival Benefit Payout Dates:
Survival Benefit will by default be paid on the policy anniversary. Alternatively, the Policyholder can choose to receive the survival benefit on any one
date as per their choice.

In case the Policyholder opts for a survival benefit date other than the policy anniversary, the survival benefit applicable for the first year when it is due,
would be calculated by pro-rating the annual rate by the no of days between the policy anniversary and the date chosen by the Policyholder.

This option needs to be selected at policy inception and cannot be changed during the policy tenure.

This option cannot be opted along with “Advance” Timing of Payment of Survival Benefit.

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PSCDECH-D2C_BlueDart-4383486-4465260
 rates will be in accordance with the following formula: Average
Part D
Annualised 10-year benchmark G-Sec Yield (over last 6
months & rounded upto the nearest 50 bps) + 2%, at the time
1. Surrender Value of the review. The source of 10-year benchmark G-sec yield
shall be RBI Negotiated Dealing System-Order Matching
The Policyholder may surrender the policy during the Policy Term. segment (NDS-OM).
During revival campaigns, the Company may offer reduced
The Surrender Benefit will be higher of GSV (Guaranteed interest rates, subject to the rules of the special revival
Surrender Value) and SSV (Special Surrender Value). campaign. The rebates offered during the revival campaign
may vary from year to year. The maximum interest rate rebate
(1) The Policy will acquire a Guaranteed may be set up to the prevailing revival interest rate. Once the
Surrender Value (GSV)upon the payment of the fi rst t wo ye ars ’ Policy is revived, you are entitled to receive all contractual
premi ums Benefits.
(2) Any accrued survival benefit, if not paid earlier plus interim survival
benefit shall be paid in addition. The accrued survival benefit 4. Bonus
shall be applicable if in case ‘Deferral of Survival Benefits’ option is 1) The profits will be distributed in the form of cash bonus, interim
chosen by the Policyholder. discretionary cash bonus and terminal bonus (if any).
(3) The GSV shall be computed as: 2) All eligible policies shall receive the terminal bonus on maturity
Max (applicable GSV factor * Total premiums paid – Survival or on exit due to death or surrender based on the terminal bonus
benefits applicable till date, 0). rates declared by the company. The cash bonus, interim cash bonus
(4) Special Surrender Value (SSV) shall become payable after completion and terminal bonus declared at the end of financial year shall be
of first policy year provided one full year premium has been received. payable to the eligible policies in the year following the declaration
(5) SSV shall be at least equal to the expected present value of the (for cash bonus) or the time of exit by surrender or maturity or death
(a) paid-up sum assured on all contingencies covered and (for interim cash bonus and terminal bonus) in the year following
(b) paid-up future benefits (such as income benefits), if any, and the declaration.
(c) accrued/vested benefits, duly allowing for survival benefits already
paid, if any 5. Alterations
(6) For the purpose of computing Surrender Benefit, the Premiums shall The Policyholder is permitted to alter the premium paying frequency
exclude the loading for modal premiums, taxes and statutory levies, to any of the frequencies available under the product option subject
rider premiums, if any. to the minimum premium conditions.
(7) The applicable GSV factors are as specified in Appendix 1. The Annualized Premium cannot be decreased or increased at any
(8) Upon the payment of the Surrender Benefit, the Policy terminates and point of time except due to a change in premium paying frequency
no further Benefits are payable. and only to that extent

2. Lapsed Policies and Paid-Up policies 6. Loans

(1) If any Premium remains unpaid after the expiry Once a policy has acquired a surrender value, loans will be
Of the Grace Period and your Policy has not acquired a Surrender permitted on this product, subject to such terms and conditions as
Value, your Policy’s status will be altered to lapsed status and the the Company may specify from time to time. Our current terms and
cover will cease. conditions are stated below:
(2) No Benefits would be payable under a lapsed Policy. • The loan amount will be subject to maximum 80% of the
(3) If any Premium remains unpaid after the expiry of the grace period surrender value;
and your Policy has acquired a Surrender Value, your Policy’s status • The interest rate on loan is currently 9.5% p.a. It shall be
will be altered to paid-up status. calculated as the Average Annualised 10-year benchmark G-
(4) Once your Policy is altered to paid-up status, all guaranteed benefits, Sec Yield (over last 6 months & rounded up to the nearest 50
including guaranteed income under Deferred Income Option, will be bps) + 2%. The interest rate shall be reviewed half-yearly and
scaled down by a ratio of number of premiums paid to the number any change in the interest rate shall be effective from 25th
of premiums payable (as chosen by the Policyholder at inception) February and 25th August each year. In case upon review the
under the Policy. interest rate is revised, the same shall apply until next revision.
(5) Under Immediate Income Option, after the Policy becomes reduced The source of 10-year benchmark G-sec yield shall be RBI
paid-up the Cash Bonus payouts shall be stopped until the end of the Negotiated Dealing System-Order Matching segment (NDS-
original Premium Payment Term. However, the Cash Bonus payouts OM).Before any benefits are paid out, loan outstanding,
will start again after the end of the original Premium Payment Term. together with the interest thereon, will be deducted and the
(6) The Cash Bonus payouts for all options will be scaled down by the balance amount will be payable.
ratio of the number of Premiums paid to the number of Premiums • Where the loan outstanding including interest exceeds 90% of
payable and will be expressed as: the surrender value for a reduced paid-up policy, then the
Cash bonus rate multiplied by Annualized Premium multiplied by policy will be foreclosed and the Policyholder will be paid the
(Number of Premiums paid/ Number of Premiums Payable), if any surrender value less loan outstanding including interest.
(7) A lap sed or paid-up Policy m ay be revived subje ct to • An in-force or fully paid-up policy shall not be foreclosed for
the terms and conditions as described non re-payment of loan.
under Clause 3 of Part D.
7. Free Look Cancellation
3. Revival of the Policy In case the Policyholder is not agreeable to any of the provisions
If your Policy has been discontinued due to the non-payment of stated in the Policy, the Policyholder has an option to return the
Premium, it would be revived/restored by the Insurer with all the Policy to the Company stating the reasons thereof, within 30 days
benefits mentioned in the Policy document, with or without rider from the date of receipt of the Policy. whether received
benefits, if any, upon the receipt of all the Premiums due and other electronically or otherwise. On receipt of the Policyholder’s letter
charges/late fee, if any, during the revival period, as per the terms along with the original Policy document(original Policy Document
and conditions of the Policy, upon being satisfied as to the is not required for policies in dematerialised form or where policy
continued insurability of the insured/Policyholder on the basis of is issued only in electronic form) , the Company shall arrange to
the information, documents and reports furnished by the refund the Premium paid, subject to deduction of the proportionate
Policyholder; in accordance with Board approved Underwriting risk Premium for the period on cover and the expenses incurred by
Policy. Currently, the application for the revival should be made the Company for medical examination (if any) and stamp duty
within five years from the due date of the first unpaid Premium charges.
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

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 • The Policy has matured and the Life Assured is alive on the
Maturity Date,
Part E • No claim has been made on the Policy, except survival
benefit, if any,
• The Policy has not been d i s c o n t i n u e d o r
1. Additional Servicing Charges surrendered, cancelled or terminated; and
No additional servicing charges are applicable in this policy. • All relevant documents including the original Policy
document in support of your claim have been provided to the
Company.
Part F
Basic documentation for maturity claims:
1. Assignment a) Original Policy Document
The Policyholder can assign or transfer of a policy in accordance b) NEFT mandate / discharge voucher
with Section 38 of the Insurance Act, 1938 as amended from time c) NEFT supporting
to time. Simplified version of the provisions of Section 38 is d) KYC documents
enclosed in Annexure I for reference.
2. Nomination (2) Death Benefit–The Death Benefit will be paid if
The Policyholder can nominate a person/ persons in accordance • The death of the Life Assured has occurred before the
with Section 39 of the Insurance Act, 1938 as amended from time Maturity Date,
to time. Simplified version of the provisions of Section 39 is • The Policy provisions specified in Clause 4 of Part F
enclosed in Annexure II for reference (Exclusions) and Clause 5 of Part F(Incorrect Information
3. Age Admitted and Non Disclosure) are not attracted,
The Company has calculated the Premiums under • The Policy has not been discontinued or surrendered or
The Policy on the basis of the age of the Life Assured as declared cancelled or terminated; and
in the Proposal. In case you have not provided proof of age of the
• All relevant documents in support of the claim have been
Life Assured with the Proposal, you will be required to furnish such
provided to the Company.
proof of age of the Life Assured as is acceptable to us and have the
age admitted. In the event the age so admitted (“Correct Age”) Basic documentation if death is due to Natural Cause:
during the Policy term is found to be different from the age declared a. Completed claim form, (including NEFT details and bank
in the Proposal, without prejudice to our rights and remedies account proof as specified in the claim form);
including those under the Insurance Act,1938,as amended from b. Original Policy;
time to time, we shall take one of the following actions (i) if the c. Original or copy Death Certificate issued by Municipal
Correct Age makes the Life Assured ineligible for this Policy, we Authority/ Gram Panchayat / Tehsildar (attested by issuing
will offer him suitable plan as per our underwriting norms. If you authority);
do not wish to opt for the alternative plan or if it is not possible for e. Claimant’s identity and residence proof.
us to grant any other plan, the Policy will stand cancelled from the
date of issuance and the Premiums paid under the Policy will be Basic documentation if death is due to Un-Natural Cause:
returned subject to the deduction of expenses incurred by the a. Completed claim form, (including NEFT details and bank
Company and the Policy will terminate thereafter; or (ii) if the account proof as specified in the claim form);
Correct Age makes the Life Assured eligible for the Policy, the
b. Original Policy;
difference between the revised premium, as per the Correct Age and
the original premium, with interest, will be due on the next Policy c. Original or copy Death Certificate issued by Municipal
anniversary date and the revised premium will continue for the rest Authority/ Gram Panchayat / Tehsildar (attested by issuing
of the Premium payment term. The provisions of Section 45 of the authority);
Insurance Act, 1938, as amended from time to time, shall be d. Claimant’s identity and residence proof.
applicable. e. Original or copy of First Information Report, Police
4. Suicide Exclusion Panchnama report attested by Police authorities; and
In case of death due to suicide within 12 months from the date of f. Original or copy of Postmortem report attested by Hospital
commencement of risk under the policy or from the date of revival authority.
of the policy, as applicable, the nominee or beneficiary of the Note:
policyholder shall be entitled to at least 80% of the total premiums a. In case original documents are submitted, attestation on the
paid till the date of death or the surrender value available as on the document by authorities is not required.
date of death whichever is higher, provided the policy is in force. b. Depending on the circumstances of the death, further
5. Incorrect Information and Non-Disclosure Fraud and documents may be called for as we deem fit.
misstatement would be dealt with in accordance with
• The claim is required to be intimated to us within a period
provisions of Section 45 of the Insurance Act 1938 as amended
of 90 days from the date of death. However, we may condone
from time to time. Simplified version of the provisions of
the delay in claim intimation, if any, where the claim is
Section 45 is enclosed in Annexure III for reference.
genuine and the delay is proved to be for reasons beyond the
6. Policy on the life of a Minor
control of the claimant.
Where the Policy has been taken for the benefit of
The Life Assured who is a minor, the Policy shall automatically 9. Modification, Amendment, Re-enactment of or to the
Insurance laws and rules, regulations, guidelines,
vest to the Life Assured on his attaining majority. The
Policyholder should ensure that while the Life Assured is still clarifications, circulars etc there under
(1) This Policy is subject to
a minor, the Income Payouts are used for the benefits of the
(i) The Insurance Act 1938, as amended from time to time,
minor life.
•
7. Tax and other levies
(1)Indirect Taxes • Amendments, modifications (including re- enactment) as may be
Taxes and levies shall be levied as applicable. Any taxes and levies made from time to time, and
becoming applicable in future may become payable by you by any • Other such relevant Regulations, Rules, Laws, Guidelines,
method including by levy of an additional monetary amount in Circulars, Enactments etc as may be introduced there-under from
addition to premium and or charges. time to time.
(2)Direct Taxes (2) We reserve the right to change any of these Policy Provisions /
Tax, if any will be deducted at the applicable rate from the payments terms and conditions in accordance with changes in applicable
made under the Policy, as per the provisions of the Income Tax Act, Regulations or Laws and where required, with IRDAI’s
1961 as amended from time to time. approval..
8. Claims Procedure (3) We are required to obtain prior approval from the IRDAI or
(1) Maturity Benefit - The Maturity Benefit will be paid if any success or body before making any material changes to

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 these provisions, except for changes of regulatory/ statutory
nature.
(4) We reserve the right to require submission of such documents
and proof at all life stages of the Policy including at the time of
payment of Benefits as may be necessary to meet the
requirements under Anti-money Laundering/Know Your
Customer norms and as may be laid down by IRDAI and other
regulators from time to time.
10. 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.
11. Notice
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:
HDFC Life Insurance Company Limited, 11th Floor, Lodha
Excelus, Apollo Mills Compound, N.M. Joshi Marg,
Mahalaxmi, Mumbai -400011.
RegisteredOffice: Lodha Excelus, 13 th Floor, Apollo Mills
Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai-400011.
E-mail:
service@hdfclife.com
Or any of our HDFC Life Branches and such other address as may
be informed by Us. Similarly, any notice, direction or instruction to
be given by Us, under the Policy, shall be in writing and delivered
by hand, post, courier, facsimile or registered electronic mail ID to
the updated address in the records of the Company.
You are requested to communicate any change in address, to the
Company supported by the required address proofs to enable the
Company to carry out the change of address in its systems. The
onus of intimation of change of address lies with the
Policyholder. An updated contact detail of the Policyholder will
ensure that correspondences from the Company are correctly
addressed to the Policyholder at the latest updated address.

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 Appendix 1: Surrender Value Factors

Guaranteed Surrender Value Factors as percentage of Total Premiums paid

Policy Year Premium Paying Term

5 years 6 years 7 years 8 years 9 years 10 years 12 years

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

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

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

4 50% 50% 50% 50% 50% 50% 50%

5 50% 50% 50% 50% 50% 50% 50%

6 60% 60% 50% 50% 50% 50% 50%

7 70% 65% 60% 50% 50% 50% 50%

8 80% 75% 65% 60% 60% 65% 58%

9 80% 80% 75% 65% 70% 70% 65%

10 80% 80% 80% 75% 75% 75% 73%

11 90% 80% 80% 80% 80% 80% 80%

12+ 90% 90% 90% 90% 90% 90% 90%

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PSCDECH-D2C_BlueDart-4383486-4465260
 Annexure I to Insurance Laws (Amendment) Act, 2015 dated 23.03.2015 for
complete and accurate details
Section 38 - Assignment or Transfer of Insurance Policies

Assignment or transfer of a policy should be in accordance with Section Annexure II

38 of the Insurance Act, 1938 as amended by Insurance Laws
(Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this Section 39 - Nomination by policyholder
regard are as follows: Nomination of a life insurance Policy is as below in accordance with
(1) This policy may be transferred/assigned, wholly or in part, with or Section 39 of the Insurance Act, 1938 as amended by Insurance Laws
without consideration. (Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this
(2) An Assignment may be effected in a policy by an endorsement upon regard are as follows:
the policy itself or by a separate instrument under notice to the (1) The policyholder of a life insurance on his own life may nominate
Insurer. a person or persons to whom money secured by the policy shall
(3) The instrument of assignment should indicate the fact of transfer or be paid in the event of his death.
assignment and the reasons for the assignment or transfer, (2) Where the nominee is a minor, the policyholder may appoint any
antecedents of the assignee and terms on which assignment is made. person to receive the money secured by the policy in the event of
(4) The assignment must be signed by the transferor or assignor or duly policyholder’s death during the minority of the nominee. The
authorized agent and attested by at least one witness. manner of appointment to be laid down by the insurer.
(5) The transfer or assignment shall not be operative as against an (3) Nomination can be made at any time before the maturity of the
insurer until a notice in writing of the transfer or assignment and policy.
either the said endorsement or instrument itself or copy there of (4) Nomination may be incorporated in the text of the policy itself or
certified to be correct by both transferor and transferee or their duly may be endorsed on the policy communicated to the insurer and
authorised agents have been delivered to the insurer. can be registered by the insurer in the records relating to the
(6) Fee to be paid for assignment or transfer can be specified by the policy.
Authority through Regulations. (5) Nomination can be cancelled or changed at any time before
(7) On receipt of notice with fee, the insurer should Grant a written policy matures, by an endorsement or a further endorsement or a
acknowledgement of receipt of notice. Such notice shall be will as the case may be.
conclusive evidence against the insurer of duly receiving the notice. (6) A notice in writing of Change or Cancellation of nomination must
(8) If the insurer maintains one or more places of business, such notices be delivered to the insurer for the insurer to be liable to such
shall be delivered only at the place where the policy is being nominee. Otherwise, insurer will not be liable if a bonafide
serviced. payment is made to the person named in the text of the policy or
(9) The insurer may accept or decline to act upon any transfer or in the registered records of the insurer.
assignment or endorsement, if it has sufficient reasons to believe (7) Fee to be paid to the insurer for registering change or cancellation
that it is a. not bonafide or b. not in the interest of the policyholder of a nomination can be specified by the Authority through
or c. not in public interest or d. is for the purpose of trading of the Regulations.
insurance policy. (8) On receipt of notice with fee, the insurer should grant a written
(10) Before refusing to act upon endorsement, the Insurer should record acknowledgement to the policyholder of having registered a
the reasons in writing and communicate the same in writing to nomination or cancellation or change thereof.
Policyholder within 30 days from the date of policyholder giving a (9) A transfer or assignment made in accordance with Section 38
notice of transfer or assignment. shall automatically cancel the nomination except in case of
(11) In case of refusal to act upon the endorsement by the Insurer, any assignment to the insurer or other transferee or assignee for
person aggrieved by the refusal may prefer a claim to IRDAI within purpose of loan or against security or its reassignment after
30 days of receipt of the refusal letter from the Insurer. repayment. In such case, the nomination will not get cancelled to
(12) The priority of claims of persons interested in an insurance policy the extent of insurer’s or transferee’s or assignee’s interest in the
would depend on the date on which the notices of assignment or policy. The nomination will get revived on repayment of the loan.
transfer is delivered to the insurer; where there are more than one (10) The right of any creditor to be paid out of the proceeds of any
instruments of transfer or assignment, the priority will depend on policy of life insurance shall not be affected by the nomination.
dates of delivery of such notices. Any dispute in this regard as to (11) In case of nomination by policyholder whose life is insured, if the
priority should be referred to Authority. nominees die before the policyholder, the proceeds are payable
(13) Every assignment or transfer shall be deemed to be absolute to policyholder or his heirs or legal representatives or holder of
assignment or transfer and the assignee or transferee shall be succession certificate.
deemed to be absolute assignee or transferee, except a. where (12) In case nominee(s) survive the person whose life is insured, the
assignment or transfer is subject to terms and conditions of transfer amount secured by the policy shall be paid to such survivor(s).
or assignment OR b. where the transfer or assignment is made upon (13) Where the policyholder whose life is insured nominates his a.
condition thati. the proceeds under the policy shall become payable parents or b. spouse or c. children or d. spouse and children e. or
to policyholder or nominee(s) in the event of assignee or transferee any of them the nominees are beneficially entitled to the amount
dying before the insured OR ii. the insured surviving the term of the payable by the insurer to the policyholder unless it is proved that
policy policyholder could not have conferred such beneficial title on the
Such conditional assignee will not be entitled to obtain a loan on nominee having regard to the nature of his title.
policy or surrender the policy. This provision will prevail (14) If nominee(s) die after the policyholder but before his share of the
notwithstanding any law or custom having force of law which is amount secured under the policy is paid, the share of the expired
contrary to the above position. nominee(s) shall be payable to the heirs or legal representative of
(14) In other cases, the insurer shall, subject to terms and conditions of the nominee or holder of succession certificate of such
assignment, recognize the transferee or assignee named in the notice nominee(s).
as the absolute transferee or assignee and such person a. shall be (15) The provisions of sub-section 7 and 8 (13 and 14 above) shall
subject to all liabilities and equities to which the transferor or apply to all life insurance policies maturing for payment after the
assignor was subject to at the date of transfer or assignment and b. commencement of Insurance Laws (Amendment) Act, 2015
may institute any proceedings in relation to the policy c. obtain loan (i.e23.03.2015).
under the policy or surrender the policy without obtaining the (16) If policyholder dies after maturity but the proceeds and benefit of
consent of the transferor or assignor or making him a party to the the policy has not been paid to him because of his death, his
proceedings. nominee(s) shall be entitled to the proceeds and benefit of the
(15) Any rights and remedies of an assignee or transferee of a life policy.
insurance policy under an assignment or transfer effected before (17) The provisions of Section 39 are not applicable to any life
commencement of the Insurance Laws (Amendment) Act, 2015 insurance policy to which Section 6 of Married Women’s
shall not be affected by this section. Property Act, 1874 applies or has at any time applied except
Disclaimer: This is not a comprehensive list of amendments of where before or after Insurance Laws (Amendment) Act, 2015, a
Insurance Laws (Amendment) Act, 2015 and only a simplified version nomination is made in favour of spouse or children or spouse and
prepared for general information. Policy Holders are advised to refer children whether or not on the face of the policy it is mentioned

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 that it is made under Section 39. Where nomination is intended to
be made to spouse or children or spouse and children under Section
6 of MWP Act, it should be specifically mentioned on the policy.
In such a case only, the provisions of Section 39 will not apply.

Disclaimer: This is not a comprehensive list of amendments of Insurance

Laws (Amendment) Act, 2015 and only a simplified version prepared for
general information. Policy Holders are advised to refer to Insurance
Laws (Amendment) Act, 2015 dated 23.03.2015 for complete and accurate
details.
Annexure III

Section 45 – Policy shall not be called in question on the ground of mis-

statement after three years

Provisions regarding policy not being called into question in terms of Section
45 of the Insurance Act, 1938, as amended by Insurance Laws (Amendment)
Act, 2015 dated 23.03.2015 are as follows:

(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 misstatement 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 questioning age or
adjustment based on proof of age submitted subsequently.
Disclaimer: This is not a comprehensive list of amendments of Insurance
Laws (Amendment) Act, 2015 and only a simplified version prepared for
general information. Policy Holders are advised to refer to Insurance
Laws (Amendment) Act, 2015 dated 23.03.2015 for complete and accurate
details.

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 Office Copy
FIRST PREMIUM RECEIPT
Date: 28/11/2024
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. 28371239 Client Id : ASB74537

Plan HDFC Life Sanchay Par Advantage

Policy Holder Ms. SILOCHANA DEVI

Premium Amount
(Including Taxes and ` 100,000.00
Levies as applicable)
Premium Adjusted
16th November 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 Rewari-Brass Market, 2nd floor SCO-123, Brass Market, Rewari, 123401
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 Par Advantage UIN:101N136V04

Option& UIN
HDFC Life Sanchay Par Advantage is a participating life insurance plan that provides an option to avail cover for whole of life (till the age
Aim of the plan 100 years). The plan provides a holistic solution for you to generate a regular income and to build a corpus to achieve the planned goals and
secure your loved one’s future.
Type of the Plan It Is An Individual Non-Linked, Participating, Savings Life Insurance Plan

PPT PT
Immediate Income Option Deferred Income Option
5 years 7 years (100–Age at Entry)
Premium Payment 6 years 8 years
Term (PPT),/ Policy 7 years 9 years Or
Term (PT) 8 years 10 years
9 years 12 years Fixed term of 20 to 40 years
10 years
12 years
Frequency Minimum

Annual 25,000
Half Yearly 12,750
Premiums
Quarterly 6,500
Monthly 2,188
There is no limit on the maximum premium amount. However, the acceptance of any case is subject to Board approved underwriting policy.
Sum Assured on
Sum Assured on Maturity is total Annualized Premium payable under the policy during the premium payment term.
Maturity
Immediate Income:
For a policy where all due premiums have been paid, the maturity benefit payable at the end of the policy term is defined as:
1. Sum Assured on Maturity plus
2. Accrued Cash Bonuses, if not paid earlier plus
3. Interim Survival Benefit, if any plus
4. Terminal Bonus, (if declared)
Deferred Income:
Maturity Benefit For a policy where all due premiums have been paid, the maturity benefit will be the aggregate of:
1. Sum Assured on Maturity plus
2. Accrued Guaranteed Income and Cash Bonuses (if declared), if not paid earlier plus
3. Interim Survival Benefit(if any) plus
4. Terminal Bonus, if declared

On payment of the Maturity Benefit, the policy will terminate and no more benefits will be payable.
The death benefit shall be equal to
 Sum Assured on Death plus
 Accrued cash bonuses and guaranteed income (if applicable) if not paid earlier plus
 Interim Survival Benefit(if any) plus
 Terminal bonus(if declared)

The minimum death benefit shall be105%of Total Premiums Paid as on date of death

Sum Assured on Death is an absolute amount of benefit which is guaranteed to become payable on death of the life assured. It is the highest
of the:
Death Benefit  10times the Annualized Premium
 Sum Assured on Maturity
 Death Multiple x AP

On payment of Death Benefit during the policy term, the policy will terminate and no future payouts will be payable.

^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.
• 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
Recipient of Life Assured is other than the Policyholder.
Benefits • All other benefits shall be payable to the Policyholder.
• If the policy has been assigned, all benefits shall be payable to the Assignee.
Once the policy has acquired a Surrender Value, you can take a policy loan up to maximum 80% of the surrender value of your policy,
Policy Loans subject to the applicable terms and conditions.

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PSCDECH-D2C_BlueDart-4383486-4465260
 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

Annual mode Half-yearly mode Quarterly mode Monthly mode

Grace Period
30days 30days 30days 15days

If You don’t pay the due premiums before the expiry of the grace period, your Policy will:
1. Lapse if it has not acquired a Surrender Value (SV). Once your Policy lapses, all the benefits including the risk cover will
Premium 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
Paid-up reduce 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 The revival period shall be as specified by the regulations. Currently, the period is five (5) years.
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 value payable shall be higher of:
Surrender  Guaranteed Surrender Value(SV)or
 Special Surrender Value(SSV)
Plus, any accrued survival benefit, if not paid earlier plus interim survival benefit.

18 of 33

PSCDECH-D2C_BlueDart-4383486-4465260
 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: service@hdfclife.com | nriservice@hdfclife.com (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
th
Chief Manager or above– 10 working 11 Floor, Lodha Excelus,
1st Level escalation1@hdfclife.com
Customer Relations days Apollo Mills Compound,
N.M. Joshi Marg,
2nd Level (for response not VP or above– Customer 7 working
escalation2@hdfclife.com 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: complaints@irdai.gov.in
• 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: bimalokpal.ahmedabad@cioins.co.in
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: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR Office of the Insurance Ombudsman, 62, Forest park, Bhubaneshwar Odisha.
– 751 009.
Tel.: 0674 - 2596461 /2596455
Email: bimalokpal.bhubaneswar@cioins.co.in
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: bimalokpal.bengaluru@cioins.co.in
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: bimalokpal.chandigarh@cioins.co.in Jammu & Kashmir, Ladakh &
Chandigarh.

19 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: bimalokpal.chennai@cioins.co.in
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: bimalokpal.delhi@cioins.co.in 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: bimalokpal.guwahati@cioins.co.in
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: bimalokpal.hyderabad@cioins.co.in
JAIPUR Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Rajasthan.
Floor, Bhawani Singh Marg, Jaipur - 302 005.
Tel.: 0141 – 2740363/ 2740798
Email: bimalokpal.jaipur@cioins.co.in
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: bimalokpal.ernakulam@cioins.co.in
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: bimalokpal.kolkata@cioins.co.in
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: bimalokpal.lucknow@cioins.co.in 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: bimalokpal.mumbai@cioins.co.in
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: bimalokpal.noida@cioins.co.in 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: bimalokpal.patna@cioins.co.in
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: bimalokpal.pune@cioins.co.in

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;

20 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.

21 of 33
 PROPOSAL FORM/ELECTRONIC PROPOSAL
FORM FOR SINGLE/JOINT LIFE
Linked and Non Linked Individual Life Full Underwriting Plans

For Office use only

Consultant Name & Code: . KOMAL VERMA 01545770
License No: License Expiry Dt: Bancassurance Code: RBB
Company Lead: Lead Reference No: 1-216911005227 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 Ms. SILOCHANA DEVI
space between First, Middle &
Last Name)
2. Maiden Name:(for married woman SILOCHANA DEVI
only)

3. Date of Birth (DD/MM/YYYY): 07/05/1971

4. Gender(M/F/Tg): Female
5. Marital Status: Married
6. Nationality: Indian
7. Education: SSC
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 M C COLONY NEAR WARE HOUSE, ROAD WARD NO 2- CH DADRI, DADRI(147)
Address: BHIWANI Bhiwani, Haryana-127306 India
13. Permanent Address (If M C COLONY NEAR WARE HOUSE, ROAD WARD NO 2- CH DADRI, DADRI(147)
different from BHIWANI Bhiwani, Haryana-127306 India
correspondence address)/
Overseas residential
address for NRI / PIO / OCI :
14. Mobile: 919812323781
Telephone No(R):
Telephone No(O):
E - mail ID: SINGHRAJBIR099@GMAIL.COM
Email ID if provided, will be
considered as preferred mode of
communication

15. Preferred language of Hindi

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

Industry Type (cement,

baking, etc.):
Exact Nature of work
(clerical, mechanical,
supervisory job, etc.):
Nature of Occupation
(architect, etc.):
17. Income Proof (proposer): Identity Proof (Proposer):
Address Proof Age Proof (Life Assured):
(Proposer):
PAN* (Proposer): FTLPS6378L
18. PAN Photocopy FTLPS6378L
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: 16-11-2024 Page 1

22 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% 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 Ms. SILOCHANA DEVI
blank space between First,
Middle & Last Name)
2. Maiden Name:(for married SILOCHANA DEVI
woman only)

3. Father/Husband Name:
4. Mother's Maiden Name:
5. Relationship with
Primary Life Assured:
6. Date of Birth (DD/MM/ 07/05/1971
YYYY) :
7. Gender(M/F/Tg): Female
8. Marital Status: Married
9. Nationality: Indian
10. Education: SSC
11. 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:
12. Mobile: 919812323781
Telephone No(R):
Telephone No(O):
E - mail ID: SINGHRAJBIR099@GMAIL.COM
Email ID if provided, will be
considered as preferred mode of
communication

Preferred language of
communication:
13. Present Occupation: Housewife
14. ABHA:
15. Gross Yearly Income
(INR):
16. Workplace Name and
Address:
^ please provide name of last
organisation

17. Industry Type (cement,

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

22. 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
23. 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 Policy No. and Name of Husband's / Parent's
inforce life insurance Company Occupation / Income
policies

Personal Details of Life to be Assured (Primary) (Proposer in case of Click 2 Wealth for Premium Waiver Option)
1 Do you have any existing insurance cover of premium paying and/ or paid-up policies? N
2 Have you submitted any simultaneous applications for life insurance to another life insurance company, which is still pending Neither of these
or are you likely to revive lapsed policies.
3 Has any application for insurance on your life been postponed? N
4 Has any application for insurance on your life been accepted with extra premium? N
5 Has any application for insurance on your life been accepted on other special terms? N

Date: 16-11-2024 Page 2

23 of 33
6 Has any application for insurance on your life been declined? N
7 Has any application for insurance on your life been withdrawn by you? N
8 Have you resided overseas for more than six months continuously during the last five years? N
9 Do you intend to reside overseas in the next six month N
10 Do you take part in any hobbies/ activities that could be considered dangerous in any way? E.g. aviation (other than as a fare- N
paying passenger), mountaineering, deep sea diving or any form of racing.
11 Have you ever suffered from: Diabetes/ high blood sugar/ sugar in urine,High blood pressure/ hypertension,Heart N
disease,Stroke
12 Have you ever suffered from:Respiratory disorders,Arthritis,Back problems,Tuberculosis,Any recurrent medical condition, N
disability. (Including eye/ ear disorder)
13 Have you ever suffered from: Liver disorder,Kidney disorder,Disorder of the digestive system,Abnormality of thyroid,Blood N
disorder?
14 Have you ever suffered from: Epilepsy, Any nervous disorder or mental condition, Paralysis or multiple sclerosis, Depression N
or psychiatric disorder,Cancer or a tumor.
15 Are you presently pregnant? N
16 Do you have a history of past Abortion, Miscarriage, Caesarian section or complications during pregnancy? Or have you given N
birth to a child with any congenital disorder like Down syndrome?
17 Have you ever had any disease of uterus, cervix, or ovaries? N
18 Have you ever undergone hysterectomy? N
19 Do you have any physical disability which is affecting your day to day activities? N
20 Are you currently suffering from any illness, impairment or taking any medication or pills or drugs? N
21 Have you ever been tested positive for HIV/ AIDS or Hepatitis B or C, or have you been tested/ treated for other sexually N
transmitted disease or are you awaiting the results of such a test?
22 Do you have/ had any recurrent medical condition or physical disability or illness or injury that has kept you from working for N
more than one week in last 5 years?
23 During last 5 years have you undergone or been recommended to undergo hospitalisation? N
24 During last 5 years have you undergone or been recommended to undergo operation? N
25 During last 5 years have you undergone or been recommended to undergo X-ray any other investigation (excluding check-ups N
for employment/ insurance/ foreign visit)?
26 State the name, address, and telephone number of your usual doctor who attends you in the event of illness, or if you have NA
been consulting with this doctor for less than three months, the name and contact details of your previous doctor.
27 We may require you to undergo medical examinations/tests. Some of the medical tests may require you to observe fasting. Residence
Please indicate your preference of location, near which the medical tests can be conducted.
28 What is your height? 5ft 2ins = 157cms
29 What is your weight (in kg)? 65
30 Do you consume alcohol? N
31 Do you use tobacco products? N
32 Are you currently consuming or have you ever consumed narcotics or any such other substance whether prescribed or not? N
33 Are any of your family members suffering from / have suffered from / have died of Heart Disease or High Blood Pressure or N
Stroke or Diabetes or Kidney disease or Cancer or HIV/AIDS?
34 Have you ever suffered or been diagnosed or been treated for Dengue or Swine Flu or Encephalitis ? N
Signature/Thumb impression of
proposer/ primary/ secondary life
assured/Policyholder. Signature should
match with signature on ECS/SI
mandate

Previous Policy Details

1. Have you submitted any simultaneous applications for life insurance at any of our offices or to another life insurance company, which is still pending OR are No
you likely to revive lapsed policies?
Name of the Sum Assured Types of Purpose of Proposed To be revived
company/ies payable on products cover
death (INR)

2. Please provide the details of any existing insurance cover of premium paying and/or paid up policies accepted at standard rate excluding group term insurance No
plan taken by your employer. (Also provide the details of any such proposals on your life / application for instatement ever accepted with extra premium, accepted
on other special terms, postponed, declined or withdrawn by self)
Policy / Company Year of Basic Sum Annual Base Medical Inforce /
Proposal Name Issue / Assured Premium Plan / Policy Lapsed*
No. Application (INR) (INR) Rider
Decision

* Mention Year of Lapse / Revival applied for

3. Name of your family doctor: NA

Address:
Contact No:

Nominee Details (To be filled only if Proposer and Life to be assured are same)
Nominee Full Name Date of Birth(DD/ Gender(M/F/Tg) Relationship Contact No % Share
MM/YYYY) with Life to be
Assured
1 Mr. RAHUL 13/01/1993 Male Son 100

Details of Products Applied For

1. Objective of Insurance: Savings

2. Frequency:(for regular / limited Annual
premium paying plan)

3. Premium Payment Option:

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

5a. Product Details:

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

HDFC Life Sanchay Par Immediate Income 47 10 9,90,433 95,694

Advantage

Date: 16-11-2024 Page 3

24 of 33
5b.For Click 2 Protect 3D Extra Life
Plus: Income Option/ Extra Amount of Annual Increasing cover/ Increasing % (if Income Period(in
Amount of Lumpsum Benefit(in INR) Income(in INR) Level cover Increasing cover is chosen years) Lumpsum Benefit
Life Income Option/ Income - Only applicable for (for Extra Life Income
Income & Extra Life Income
Replacement Option: Option) Option only)

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 Plus,choose
Income Payout Mode :
6g. For Sanchay Par Survival Benefit
Advantage, choose survival
benefit payout option :
6h. For Sanchay Par Annual
Advantage, also choose
survival benefit payout
frequency :
6i. For Sanchay Par 16/11
Advantage, also choose
survival benefit payout date :
7. Rider Details: Product Name Rider Name Coverage Type Rider Option Rider Policy Rider Premium Pay Term(in years) Rider Sum Modal
(with additional premium) Term(in years) Assured(in INR) Premium (in INR)

8. Top-up Premium (INR): NIL Top-up Sum Assured (INR): NIL Total Premium (INR): 1,00,000

9. Commencement date^: Backdation Charges (INR):

(^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%

Details of First Premium Deposit.

Payor Details: Self
Payment Details: Amount in (INR): 1,00,000
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 50100480718851 4 Bank Branch: HDF-HDFC BANK LTD KILLA-PARDI
Number:
5 IFSC Code: HDFC0001968

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.

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

Date: 16-11-2024 Page 4

25 of 33
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 out 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
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

Date: 16-11-2024 Page 5

26 of 33
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: 16-11-2024 Page 6

27 of 33
 16-11-2024

Quote No : qcgl0kv8njk38,Application No : 1100113244507

Benefit Illustration for HDFC Life Sanchay Par Advantage

This illustration has been produced by HDFC Life Insurance Company Limited to help you understand the benefits of your HDFC Life Sanchay Par
Advantage policy

Name of the Prospect /Policy holder: SILOCHANA DEVI Proposal No:

Age: 53 Name of the Product: HDFC Life Sanchay Par Advantage
Name of the Life Assured: SILOCHANA DEVI A Non-Linked, Participating,
Tag Line:
Life Insurance Plan
Age: 53
Unique Identification No: 101N136V04
Policy Term 47 year(s)
GST Rate: 4.5%* for first year
Premium Payment Term: 10 year(s)
2.25%* second year onwards
Amount of Installment Premium: 95694
Mode of Payment of Premium: Annual
Mode of Payment of Survival Benefit: Annual
Timing of Payment of Survival Benefit: Arrear

How to read and understand this benefit illustration?

This benefit illustration is intended to show year wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a.

"Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. If your policy offers guaranteed
benefits then these will be clearly marked "guaranteed" in the illustration table on this page. If your policy offers variable benefits then the illustrations on this page will show two different rates of
assumed future investment returns, of 8% p.a. and 4% p.a. These assumed rates of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your
policy is dependent on a number of factors including future investment performance."

Policy Details
Policy Option Immediate Income Sum Assured on Maturity Rs. 9,56,940
Sum Assured on Death (at inception of the
Bonus Type Cash Bonus 9,90,433
policy) Rs.

Premium Summary
Total
Base CI IB
PP Rider (PAC) PP Rider (ADC) HPR Rider (CCI) HPR Rider (CC) WOP Rider Installment
Plan Rider Rider
Premium
Instalment
Premium 95694 0 0 0 0 0 0 0 95694
without GST
Instalment
Premium with 100000 0 0 0 0 0 0 0 100000
First Year GST
Instalment
Premium with
97847 0 0 0 0 0 0 0 97847
GST 2nd Year
Onwards

28 of 33
 (Amounts in Rupees.)
Total Benefits
Guaranteed Benefits Non Guaranteed Benefits @ 4% p.a. Non-Guaranteed Benefits @ 8% p.a. including Guaranteed and Non-
Guaranteed Benefits
Guaranteed Guaranteed Total Total
Single / Total Total
Policy Surrender Surrender Death Death
Annualized Surrender Surrender Maturity Maturity
Year Value Value Benefit Benefit
Premium Special Value Special Value Benefit, Benefit,
Survival Surrender Death Maturity Cash (Net of Cash (Net of incl of incl of
GA RB Surrender Payable RB Surrender Payable incl TB, incl TB,
Benefit Benefit Benefit Benefit Bonus Cash Bonus Cash TB, if TB, if
Value# (Higher of Value# (Higher of if any, @ if any, @
Bonus Bonus any, @ any, @
10 & 11) 15 & 16) 4% 8%
already already 4% 8%
(7+TB) (7+TB)
paid) paid) (6+TB) (6+TB)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 95,694 0 0 0 9,90,433 0 0 15,790 0 14,358 14,358 0 30,144 0 14,358 14,358 0 0 9,90,433 9,90,433

2 95,694 0 0 57,416 9,90,433 0 0 15,790 25,836 30,254 30,254 0 30,144 0 30,254 30,254 0 0 9,90,433 9,90,433
3 95,694 0 0 1,00,479 9,90,433 0 0 15,790 53,109 62,128 62,128 0 30,144 10,047 48,731 48,731 0 0 9,90,433 9,90,433

4 95,694 0 0 1,91,388 9,90,433 0 0 15,790 1,28,228 1,04,334 1,28,228 0 30,144 70,812 85,195 85,195 0 0 9,90,433 9,90,433
5 95,694 0 0 2,39,235 9,90,433 0 0 15,790 1,60,285 1,58,892 1,60,285 0 30,144 88,515 1,34,012 1,34,012 0 0 9,90,433 9,90,433

6 95,694 0 0 2,87,082 9,90,433 0 0 15,790 1,92,342 2,24,964 2,24,964 0 30,144 1,06,218 1,95,299 1,95,299 0 0 9,90,433 9,90,433

7 95,694 0 0 3,34,929 9,90,433 0 0 15,790 2,24,399 3,04,594 3,04,594 0 30,144 1,23,921 2,70,144 2,70,144 0 0 9,90,433 9,90,433
8 95,694 0 0 4,97,609 9,90,433 0 0 15,790 3,71,289 3,96,011 3,96,011 0 30,144 2,56,457 3,60,604 3,60,604 0 0 9,90,433 9,90,433

9 95,694 0 0 6,02,872 9,90,433 0 0 15,790 4,60,762 5,02,239 5,02,239 0 30,144 3,31,576 4,67,789 4,67,789 0 0 9,90,433 9,90,433
10 95,694 0 0 7,17,705 10,04,787 0 0 15,790 5,59,805 6,23,326 6,23,326 0 30,144 4,16,265 5,93,661 5,93,661 0 0 10,04,787 10,04,787

11 0 0 0 7,65,552 10,04,787 0 0 15,790 5,91,862 6,78,456 6,78,456 0 30,144 4,33,968 6,57,403 6,57,403 0 0 10,04,787 10,04,787

12 0 0 0 8,61,246 10,04,787 0 0 15,790 6,71,766 6,88,141 6,88,141 0 30,144 4,99,518 6,77,615 6,77,615 0 0 10,04,787 10,04,787
13 0 0 0 8,61,246 10,04,787 0 0 15,790 6,55,976 6,97,367 6,97,367 0 30,144 4,69,374 7,00,238 7,00,238 0 0 10,04,787 10,04,787

14 0 0 0 8,61,246 10,04,787 0 0 15,790 6,40,186 7,08,048 7,08,048 0 30,144 4,39,230 7,24,316 7,24,316 0 0 10,04,787 10,04,787
15 0 0 0 8,61,246 10,04,787 0 0 15,790 6,24,396 7,18,268 7,18,268 0 30,144 4,09,086 7,50,804 7,50,804 0 0 10,04,787 10,04,787

16 0 0 0 8,61,246 10,04,787 0 0 15,790 6,08,606 7,28,973 7,28,973 0 30,144 3,78,942 7,78,734 7,78,734 0 0 10,04,787 10,04,787
17 0 0 0 8,61,246 10,04,787 0 0 15,790 5,92,816 7,40,155 7,40,155 0 30,144 3,48,798 8,09,055 8,09,055 0 0 10,04,787 10,04,787

18 0 0 0 8,61,246 10,04,787 0 0 15,790 5,77,026 7,51,799 7,51,799 0 30,144 3,18,654 8,42,708 8,42,708 0 0 10,04,787 10,04,787

19 0 0 0 8,61,246 10,04,787 0 0 15,790 5,61,236 7,63,887 7,63,887 0 30,144 2,88,510 8,78,720 8,78,720 0 0 10,04,787 10,04,787

20 0 0 0 8,61,246 10,04,787 0 0 15,790 5,45,446 7,75,444 7,75,444 0 30,144 2,58,366 9,18,028 9,18,028 0 0 10,04,787 10,04,787
21 0 0 0 8,61,246 10,04,787 0 0 15,790 5,29,656 7,88,361 7,88,361 0 30,144 2,28,222 9,59,653 9,59,653 0 0 10,04,787 10,04,787

22 0 0 0 8,61,246 10,04,787 0 0 15,790 5,13,866 8,01,658 8,01,658 0 30,144 1,98,078 10,03,573 10,03,573 0 0 10,04,787 10,04,787

23 0 0 0 8,61,246 10,04,787 0 0 15,790 4,98,076 8,16,267 8,16,267 0 30,144 1,67,934 10,52,631 10,52,631 0 0 10,04,787 10,52,631

24 0 0 0 8,61,246 10,04,787 0 0 15,790 4,82,286 8,30,247 8,30,247 0 30,144 1,37,790 11,03,931 11,03,931 0 0 10,04,787 11,03,931

25 0 0 0 8,61,246 10,04,787 0 0 15,790 4,66,496 8,46,438 8,46,438 0 30,144 1,07,646 11,59,357 11,59,357 0 0 10,04,787 11,59,357
26 0 0 0 8,61,246 10,04,787 0 0 15,790 4,50,706 8,61,942 8,61,942 0 30,144 77,502 12,19,837 12,19,837 0 0 10,04,787 12,19,837

27 0 0 0 8,61,246 10,04,787 0 0 15,790 4,34,916 8,78,641 8,78,641 0 30,144 47,358 12,83,427 12,83,427 0 0 10,04,787 12,83,427

28 0 0 0 8,61,246 10,04,787 0 0 15,790 4,19,126 8,96,502 8,96,502 0 30,144 17,214 13,52,962 13,52,962 0 0 10,04,787 13,52,962

29 0 0 0 8,61,246 10,04,787 0 0 15,790 4,03,336 9,14,539 9,14,539 0 30,144 0 14,27,459 14,27,459 0 0 10,04,787 14,27,459

30 0 0 0 8,61,246 10,04,787 0 0 15,790 3,87,546 9,32,722 9,32,722 0 30,144 0 15,07,843 15,07,843 0 0 10,04,787 15,07,843
31 0 0 0 8,61,246 10,04,787 0 0 15,790 3,71,756 9,51,023 9,51,023 0 30,144 0 15,94,086 15,94,086 0 0 10,04,787 15,94,086

32 0 0 0 8,61,246 10,04,787 0 0 15,790 3,55,966 9,71,333 9,71,333 0 30,144 0 16,86,167 16,86,167 0 0 10,04,787 16,86,167

33 0 0 0 8,61,246 10,04,787 0 0 15,790 3,40,176 9,90,764 9,90,764 0 30,144 0 17,85,982 17,85,982 0 0 10,04,787 17,85,982

34 0 0 0 8,61,246 10,04,787 0 0 15,790 3,24,386 10,11,227 10,11,227 0 30,144 0 18,92,568 18,92,568 0 0 10,11,227 18,92,568

35 0 0 0 8,61,246 10,04,787 0 0 15,790 3,08,596 10,32,728 10,32,728 0 30,144 0 20,08,806 20,08,806 0 0 10,32,728 20,08,806
36 0 0 0 8,61,246 10,04,787 0 0 15,790 2,92,806 10,54,339 10,54,339 0 30,144 0 21,32,811 21,32,811 0 0 10,54,339 21,32,811

37 0 0 0 8,61,246 10,04,787 0 0 15,790 2,77,016 10,77,078 10,77,078 0 30,144 0 22,65,597 22,65,597 0 0 10,77,078 22,65,597

38 0 0 0 8,61,246 10,04,787 0 0 15,790 2,61,226 11,00,086 11,00,086 0 30,144 0 24,10,137 24,10,137 0 0 11,00,086 24,10,137

39 0 0 0 8,61,246 10,04,787 0 0 15,790 2,45,436 11,23,525 11,23,525 0 30,144 0 25,64,677 25,64,677 0 0 11,23,525 25,64,677

40 0 0 0 8,61,246 10,04,787 0 0 15,790 2,29,646 11,48,602 11,48,602 0 30,144 0 27,31,381 27,31,381 0 0 11,48,602 27,31,381
41 0 0 0 8,61,246 10,04,787 0 0 15,790 2,13,856 11,73,782 11,73,782 0 30,144 0 29,10,628 29,10,628 0 0 11,73,782 29,10,628

42 0 0 0 8,61,246 10,04,787 0 0 15,790 1,98,066 11,99,637 11,99,637 0 30,144 0 31,03,948 31,03,948 0 0 11,99,637 31,03,948

43 0 0 0 8,61,246 10,04,787 0 0 15,790 1,82,276 12,27,043 12,27,043 0 30,144 0 33,12,216 33,12,216 0 0 12,27,043 33,12,216

44 0 0 0 8,61,246 10,04,787 0 0 15,790 1,66,486 12,54,469 12,54,469 0 30,144 0 35,36,771 35,36,771 0 0 12,54,469 35,36,771

45 0 0 0 8,61,246 10,04,787 0 0 15,790 1,50,696 12,84,000 12,84,000 0 30,144 0 37,79,699 37,79,699 0 0 12,84,000 37,79,699
46 0 0 0 8,61,246 10,04,787 0 0 15,790 1,34,906 13,15,105 13,15,105 0 30,144 0 40,41,427 40,41,427 0 0 13,15,105 40,41,427

47 0 0 0 0 10,04,787 9,56,940 0 15,790 0 0 0 0 30,144 0 0 0 14,86,128 47,90,442 14,86,128 47,90,442

Notes:
1. Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods & Service Tax. Refer Sales Literature for
explanation of terms used in this illustration.
2. When Timing of Payment of Survival Benefit is "Arrear", the survival benefits shown above are payable at the end of the Mode of Payment of Survival Benefit.

When Timing of Payment of Survival Benefit is chosen as "Advance", the survival benefit shown above are payable at the beginning of the Mode of Payment of Survival Benefit. First payout shall be
made within 7 working days from i) the realization of the first premium or ii) policy issuance, whichever is later. Subsequent payouts shall be made within 7 working days from i) realization of renewal
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premium or ii) survival benefit payout date, whichever is later
3. The death benefits shown above are at the end of the year. Upon payment, of death benefit the policy terminates and no further benefit is payable.
4. The surrender benefits shown above are at the end of the year. Upon payment of surrender benefit, the policy terminates and no further benefit becomes payable.
5. The maturity benefit shown above is payable at the end of the Policy Term. Upon payment of maturity benefit, the policy terminates and no further benefits become payable.
6. The Premium and the Sum Assured on Maturity stated above is based on the information provided. They may vary as a result of underwriting.
7. Any statutory levy or charges (such as Goods and Service tax) including any indirect tax may be charged to the Policyholder either now or in future by the company and such amount so charged
shall become due and payable and shall be subject to the same terms and conditions as applicable to payment of premium.
8. RB - Reversionary Bonus, TB - Terminal Bonus, GA - Guaranteed Additions
# Special Surrender Value is subject to change incase of change in G-Sec yields

I NEERAJ 0, have explained the premiums and benefits under the product fully to the prospect / I SILOCHANA DEVI,having received the information with respect to the above, have understood
policy holder. the above statement before entering into the contract.

Place:

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

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 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 Par Advantage
1 Welcome
Identification Number UIN - 101N136V04
Letter
(UIN)

Part A –
Policy Welcome
1100113244507
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

Instalment Premium - 95694

Mode of premium payment - Annual
Part A –
Sum Assured on Death – 990433
4 Basic Policy Details Policy
Sum Assured on Maturity – 956940
Schedule
Premium Payment Term - 10
Policy Term - 47

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 – Survival Benefit
refers to the periodic payouts to the policyholder on survival of Life
Assured during the policy term which does not include the final payout at
policy maturity.
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 –
Policy conditions of the policy. Clause 1 &
5 Coverage/benefits Options to policyholders for availing benefits, if any, covered under 2
payable the policy, if opted at inception – Part D –
Plan Options: Clause 1
1. Immediate Income
2. Deferred Income
Other Benefits available
1. Timing of Payment of Survival Benefit
2. Deferral of Survival Benefit(s)
3. Survival Benefit Pay-out Dates
Other benefits/options payable, specific to the policy, if any –
Policyholder can alter the Frequency of Premium Payment and Survival
Benefit. 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)
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 Policy
Sl. Description in Simple Words
Title Clause
no. (Please refer to applicable Policy Clause Number in next column)
Number

Option available (in Not

7 case of Annuity Not Applicable Applicable
product)

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 4
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 Part A –
by the insurer from the due date of payment of premium, without any penalty Policy
or late fee, during which time the policy is considered to be in-force with the Schedule
11 Grace period risk cover without any interruption, as per the terms & conditions of the policy. Part B –
The grace period for payment of the premium for all types of life insurance (Definitions)
policies shall be 15 days, where the policyholder pays the premium on a Part C -
monthly basis and 30 days in all other cases. Clause 1(6)

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
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 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 Helpline number: +91 89166 94100 (Call charges apply) Part F –
15
Procedure Clause 8
Contact details of the insurer: You can email us atservice@hdfclife.com |
nriservice@hdfclife.com (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 atservice@hdfclife.com | Clause 8
nriservice@hdfclife.com (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 service@hdfclife.com | nriservice@hdfclife.com (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:Haryana
(Signature of the Policyholder)
Date:16/11/2024

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

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