Proposal Form

Plan Details

Plan Name Plan No

LIC's Jeevan 745
Umang

UIN
512N312V03
Agency Code Supervisor Code Branch Code
02072324 6040 324

Access Id Email Id Mobile No.

2550599059 kantilalgarg57@gmail.com 8003695713
I hereby confirm that the mobile number provided by me, is registered in my own
name. By ticking this box, I hereby authorize Life Insurance Corporation of India to verify
the above information and call me back even if I am registered in the Do not call List of
TRAI

* Date of Proposal - Pertains to date when customer verified the proposal.

Proposal number is allotted only after receipt of the full proposal-deposit
amount by LIC

Details of plan proposed

Term & PPT Sum Assured Installment Premium GST

95 - 20 ₹ 2,50,000 ₹ 14,259 ₹ 642

Total Amount Mode of Payment Date of

₹ 14,901 Yearly Commencement **
16-06-2025
PWB Rider Req
No

Applicable to Police Personnel if LIC’s Accident Benefit Rider / LIC’s Accidental Death And Disability
Benefit Rider is opted for :
(i). Whether you are engaged in police duty in any police organization other than Yes No
paramilitary force?
If "Yes", (ii). Whether you wish to avail the AB/AD& DB rider while on police duty? Yes No

** Date of Commencement - This date is tentative Date of Commencement , subject to change

based on date of payment and underwriting.

Personal details of Proposer

Name
Karna Ram
Father's Name Mother's Name
SAKA RAM MUNGI DEVI
Gender
Male Female Third Gender
Martial Status Date of birth ABHA number
Married 01-01-1991
Age (in years) Residential Status
34 Years Resident Indian
Do you wish to avail the physical policy document? Yes No

please give EIA no. (e-Insurance Account) if available

 Employer-Employee Scheme/KMI/HUF

Whether proposal is under Employer-Employee

No
Scheme/KMI/HUF ?

Communication Details of Proposer

Present Address for communication

Address Line 1 Address Line 2
S/O KARNA RAM SAKA RAM GARG VILL- BORWADA VIA- ASANA
Address Line 3 City District
TEH- SAYALA, DIST- JALORE SAYALA JALORE
State Country Pin Code
RAJASTHAN INDIA 343022
Permanent Residential Address
Address Line 1 Address Line 2
S/O: Saka Ram, 123, asana marg, , Asana, Jalor, Rajasthan
borvada,
Address Line 3 City District
borvada Jalor
State Country Pin Code
Rajasthan India 343022

KYC Particulars of Proposer

Are you an It Assessee Yes No

PAN Proof of Identity Age proof submitted

BHJPG9804P ekyc ekyc

If Registered under GST Yes No

Personal details of the life to be insured

Name
ANSH KUMAR
Father's Name Mother's Name
KARNA RAM PUJA DEVI
Gender
Male Female Third Gender
Date of birth Relationship of the ABHA number
Proposer
04-07-2020
Child

Age (in years) Residential Status

5 Years Resident Indian
Do you wish to avail the physical policy document? Yes No

please give EIA no. (e-Insurance Account) if available

 Communication details of the life to be insured

Present Address for communication

Address Line 1 Address Line 2
S/O KARNA RAM SAKA RAM GARG VILL- BORWADA VIA- ASANA
Address Line 3 City District
TEH- SAYALA, DIST- JALORE SAYALA JALORE
State Country Pin Code
RAJASTHAN INDIA 343022
Permanent Residential Address
Address Line 1 Address Line 2
S/O: Saka Ram, 123, asana marg, , Asana, Jalor, Rajasthan
borvada,
Address Line 3 City District
borvada Jalor
State Country Pin Code
Rajasthan India 343022

Education Details of Minor Life

Is the child studying? Yes No

(If your answer is 'Yes', state the class and /or type of course*)
1

Occupation Details of proposer

Present Occupation Exact Nature of duties Name of the present

Self-employed Business employer
without Income
Tax
Annual income source of income Education Purpose of insurance
Qualification
₹ 4,00,000 Self Employed
SSC/10th
Are you employed in the Armed Forces Yes No
 Other Personal Details of proposer

Is your occupation associated with any specific hazard or do you take part in hazardous Yes No
activities or have hobbies that could be dangerous in any way?
Are you Politically Exposed Person ( PEP as per RBI Guidelines PEPs are the individuals Yes No
who are or have been entrusted with prominent public functions in a foreign country. )
Have you ever been or are currently being investigated, charge sheeted, prosecuted or Yes No
convicted or having pending charges in respect of any criminal/civil offences in any court
of law in India or abroad ?

Lifestyle Details of proposer

Do you smoke / Yes/No If YES, Quantity If STOPPED, Since

consume or have you consumed and how may months
ever smoked / Duration
consumed the
following

Alcoholic drinks Yes No

Narcotics Yes No

Any other drugs Yes No

Do you smoke/consume Yes No

or have you
smoked/consumed
tobacco in any form (
cigars, cigarettes,
beedis, pan masala etc)
in the past 60 months.
(in sticks /packets/
sachets/gms per day)
 Details of previous policies held / proposals applied of the life to be
insured

a) Is your life now being proposed for another assurance or an application for revival of a Yes No
policy on your life or any other proposal under consideration in any office of Life
Insurance Corporation of India or to any other insurer?": "Is any other proposal on the
Life to be assured now being made to, or is anyother proposal or an application for
revival of a policy on his life under consideration in this or any other office of the
Corporation or to any office of any other Insurer ?
b) Whether proposed simultaneously on the life of spouse and children ? Yes No

Has a proposal ( or an application for revival of a policy) on your life made to any office of the
Corporation or to any other Insurer ever been Accepted with extra or modified terms, Withdrawn,
Deferred, Dropped or Declined?, if yes give proposal number& branch / policy number / Name of
Insurer Yes No

Have you during the past one year returned any policy of the Corporation as the same was not
acceptable to you?, if yes give policy number. Yes No

I hereby declare that I do not have any existing policies in-force or lapsed policies with LIC.

I hereby declare that I do not have any existing policies in force or lapsed policies with other Insurers.
 Medical details of the life to be insured

Are you suffering from or have you ever suffered or undergone investigation in the past or have
you been advised to undergo investigation or treatment for the following ailments
1. Lungs/ Respiratory Disease / Persistent cough, asthma, bronchitis, pneumonia, Yes No
Tuberculosis/, pleurisy / spitting of blood/Covid 19etc
2. Peptic ulcer/colitis, jaundice,Hepatitis, anaemia, piles, dysentery, or any other disease Yes No
of the stomach, liver, spleen, gall bladder or pancreas/ digestive disorder
3.Hypertension, Hypotension, rheumatic fever, pain in chest, breathlessness, palpitation, Yes No
any disease of the heart or arteries?
4. Endocrine disorders such as Diabetes, Goitre, Thyroid etc or have you ever passed Yes No
sugar, albumin, pus or blood in urine
5. Any disease of kidney /prostate or urinary system? Yes No

6. Bone / Joint/ Spine Disease/ Arthritis / varicose veins /any bodily defect or deformity Yes No

7. Any disease of ear, nose, throat or eyes, including defective sight or hearing and Yes No
discharge from the ears
8. Cancer/leukemia/lymphoma/ tumour / cyst/ Any other growth / lumps/ blood disorder Yes No
/enlarged glands
9.Paralysis/epilepsy/ insanity/ tremors, numbness, double vision, dizzy or fainting spells/ Yes No
head Injury / insomnia/ nervous breakdown / Mental Disorder (Depression/ Anxiety, etc.).
/ any other disease of the brain or the nervous system
10. Chronic infections- Skin Disease/ skin eruption/ Leprosy / ,filariasis, gonorrhoea, Yes No
syphilis or any other venereal disease or AIDS&HIV related condition
11. Hernia/hydrocele, varicocele, fistula Yes No

12. Any other disease ? Yes No

 Medical History of the life to be insured

Please state exact height and weight ( without shoes)

Height (in cms) Weight (in Kgs)
103 11

During the last five years did you consult a Medical Practitioner for any Yes No
ailment requiring treatment for more than a week ?
Have you ever been admitted to any hospital or nursing home for general Yes No
check up, observation, treatment or operation?
Have you remained absent from place of work on grounds of health during the Yes No
last 5 years ?
 Family History

(Please mention specifically if suffering from or died of heart disease, stroke, high blood pressure,
diabetes mellitus, cancer, kidney disease or any hereditary disorders, Insanity, or any contagious
diseases such as tuberculosis ,hepatitis, AIDS / HIV etc)

Relationship Living/Dead Present age State of Age of Death Cause of

Health Death

Father Living 34 Good NA NA

Mother Living 29 Good NA NA

Daughter Living 1 Good NA NA

 Bank details of Proposer

Your bank account type Savings Current

Account Number IFSC Code Bank Name

42317429916 SBIN0031349 STATE BANK OF INDIA

Settlement Option

Do you Wish to avail Option for Death Benefit in installments Yes No

 Summary of Section 45 of Insurance Laws (Amendment) Act 2015

(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 the
materials on which such decision is based.
Explanation I
For the purpose of this sub section, the expression "fraud" means any of the following acts committed by the
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.
(d) Any such act or omission as the law specially declares to be fraudulent.
Explanation II
Mere silence as to facts likely to affect the assessment of the risk by the insurer is not fraud, unless the
circumstances of the case are such that regard being had to them, it is the duty of the insured or his agent,
keeping silence to speak, or unless his silence is, in itself, equivalent to speak
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 mis-statement of or suppression of a material fact was true to
the best of his knowledge and belief or that there was no deliberate intension 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.
Explanation:
A person who solicits and negotiates a contract of insurance shall be deemed for the purpose of the formation
of the contract, to be agent of the insurer.
(4) A policy of life insurance may be called in question at any time within three years from the date of issuance
of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to
the policy, whichever is later, on the ground that any statement of or suppression of a fact material to the
expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of
which the policy was issued or revived or rider issued:
Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or
nominees or assignees of the insured the grounds and materials on which such decision to repudiate the policy
of life insurance is based:
Provided further that in case of repudiation of the policy on the ground of misstatement or suppression of a
material fact, and not on 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.
Explanation:
For the purposes of this sub-section, the mis-statement of or suppression of fact shall not be considered
material unless it has a direct bearing on the risk undertaken by the insurer, the onus is on the insurer to show
that had the insurer been aware of the said fact no life insurance policy would have been issued to the insured.
(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.

Summary of Section 41 of Insurance Laws (Amendment) Act 2015

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 other 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.
Signature of the life to be
Assured
 Declaration of the Proposer

I Karna Ram .(Name of the proposer) do hereby declare that the foregoing statement and
answers have been given by me after fully understanding the questions and the same are true
and complete in every particular and that I have not withheld any information and I do hereby
agree and declare that these statements and this declaration shall be the basis of the contract of
assurance between me and the Life Insurance Corporation of India and that if any untrue
averment be contained therein the said contract shall be dealt with as per provisions of Section
45 of the Insurance Act,1938 as amended from time to time. Not-withstanding the provision of
any law, usage, custom or convention for the time being in force prohibiting any doctor, hospital
,diagnostic center and/or employer, reinsurer/ credit bureau from divulging any knowledge or
information about the Life to be assured concerning the health, insurance , financial etc. on the
grounds of privacy, I, on behalf of myself, the Life to be assured, our heirs, executors,
administrators and assignees or any other person or persons, having interest of any kind
whatsoever in this policy contract issued on the Life to be assured, hereby agree that such
authority , having such knowledge or information, shall at any time be at liberty to divulge any
such knowledge or information to the Corporation, and the Corporation to divulge the same to
any Authorized Organization / Institution / Agency / and Governmental / Regulatory Authority for
the sole purpose of underwriting / investigation / risk mitigation / fraud control and/or claim
settlement. And I further agree that if after the date of submission of the proposal but before the
issue of First Premium Receipt any change in the general health of the Life to be assured or that
of any members of his family occurs, I shall forthwith intimate the same to the Corporation in
writing to reconsider the terms of acceptance of assurance. Any omission on my part to do so
shall render this contract to be dealt with as per provisions of Section 45 of the Insurance Act,
1938 as amended from time to time. I am aware that if the information on my Tax Residency is
found to be false or untrue or misleading or misrepresenting, I may be held liable for it. I also
undertake to inform the Corporation of any change in my Tax Residency status. I undertake to
inform the Corporation immediately of any changes in KYC documents such as residence. I also
give my consent to obtain and share my data from / with Central KYC Registry respectively and to
receive phone calls , SMS/ E mail from Central KYC registry in this regard I understand that the
Corporation reserves the right to accept /Postpone/ drop/ decline or offer alternate terms on this
proposal for life insurance . I hereby give my consent to receive phone calls, SMS/ whatsapp
messages, E mail on the above mentioned registered number(s)/ E mail address from / on behalf
of the Corporation with respect to my life insurance policy/regarding servicing of insurance
policies/ notifying about the status of Claim . I also understand that the premium and benefits
under the policy are subject to taxes / duties/ charges in accordance with the laws as applicable
from time to time.

Signature of the
Proposer

Name Address Pin Code

Karna Ram S/O KARNA RAM SAKA RAM GARG VILL- 343022
BORWADA VIA- ASANA JALORE RAJASTHAN
 Declaration of the life to be insured

I hereby declare that I have fully explained the above questions to the proposer and I have truthfully recorded
the answers given by the proposer and proposer has affixed the thumb impression/ signature as below after
fully understanding the contents thereof.
Name of the Address of the Declarant Signature
Declarant: S/O KARNA RAM SAKA RAM GARG VILL- BORWADA VIA-
ANSH ASANA JALORE RAJASTHAN
KUMAR
 Suitability Analysis

Proposer Full Name Date of Birth

Karna Ram 01-01-1991

Age Maritial Status Occupation

34 Years Married Self-employed without Income Tax
Address
S/O KARNA RAM SAKA RAM GARG VILL- BORWADA VIA- ASANA SAYALA 343022

2. What is proposer'yearly income from: (if life assured is different from the proposer)
Employment Businees / Profession Other Sources H.U.F. if any

Income of life to be
assured

3. Whether income proof submitted? (if Yes, give details below)

Nature of document Is he/she Income tax Is yes, please provide Income Tax Bracket
for income verification Assessee PAN
No BHJPG9804P

4. Previous Policy Details (as per proposal form)

5. Family History (as per proposal form)
Spouse Details
Name Occupation Annual Income
NA NA NA

6. Need Analysis
Total Annual Income
₹ 4,00,000

Outstanding Liablities
Secured Loans Non-Secured Loans

based on his age and income, the maximum insurance that can be granted is:
Age Group Multiple of Avg. Maximum allowable
Annual Income Insurance

7.
Object of Insurance How would you like to pay your premiums
Yearly
Risk Profile Time frame for this invesement
8. Categorization of plans in relation to object of Insurance
Category Risk Profile Plan Name
LIC's Jeevan Umang

9. Product Chosen
Plan No Plan Name Term Sum Assured
745 LIC's Jeevan 95 ₹ 2,50,000
Umang

Mode Premium
Yearly ₹ 14,259

a) if ULIP is proposed:
1st Year 2nd Year 3rd Year onwards Life cover
charges

Policy Administration Fund Management

Charges Charges

b) if Annuity / Pension is proposed:

Target Annuity per annum Type of Annuity Annuity Amount per Defement
annum Period

Is the total insurance added to the present proposal is reasonable in relation to income
The questions above pertain to your personal condition at the time of appliction to your understanding of the
features of the product for which you are applying. This information will not be used for any other purpose and
will remain confidential.
I Karna Ram, having received the informationwith respect to the above, have understood the selection of
product befor into this contract. My plan details are as following:
Plan No Plan Name Term Sum Assured
745 LIC's Jeevan 95 ₹ 2,50,000
Umang

Mode Premium
Yearly ₹ 14,901
 KYC Details of proposer as per
E-KYC

Personal Details
Aadhaar No. / Virtual ID
********

Name Date of Birth

Karna Ram 01-01-1991

Gender
Male
Contact Details
C/o. House/ Bldg. / Apt.

Steert/ Road/ Lane Landmark

S/O: Saka Ram, 123, asana marg, , Asana, Jalor, Rajasthan
borvada,
Area/ Locality/ Sector Pincode
343022

Village/ Town/ City P.O.

borvada

District State
Jalor Rajasthan
 Addendum (for minor lives only)

I understand and agree that the policy shall automatically vest on the Life to be assured on the policy
anniversary coinciding with or immediately following the completion of 18 years of age and shall on vesting be
deemed to be a contract between the Corporation and Life to be assured.
Dated : 16-06-2025
Signature of the
Proposer
 LIC's Jeeven Umang (Plan No. 745)

Benefit Illustration

LIC's Jeeven Umang (Plan No. 745)

A Par, Non-Linked, Individual, Savings, Whole Life Insurance Plan
(Unique Identification Number - 512N312V03)

Distribution channel Offline Agency name SH.KANTI LAL Agency code 02072324
Name of Age of
KARNA RAM 34 years Date of illustration 16-06-2025
prospect/policyholder prospect/policyholder
Name of life assured ANSH KUMAR Age of life assured 5 years Benefit UID/Proposal no.
Mode of payment of
Policy term 95 years Premium payment term 20 years Yearly
premium

Basic sum assured Rs. 2,50,000 Sum assured on death1 2,50,000 Instalment premium 14,259.00
(at inception of the policy) Rs. (for base plan)

Bonus type Simple reversionary and final additional bonus

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.

Premium summary
Particular Base plan Riders2 Total instalment premium
Instalment premium without GST 14,259.00 0.00 14,259.00
Instalment premium with GST @ 4.50% (1st year) 14,901.00 0.00 14,901.00
Instalment premium with GST @ 2.25% (2nd year onwards) 14,579.83 0.00 14,579.83
GST rate shall be as applicable from time to time.

Page 1
 LIC's Jeeven Umang (Plan No. 745)

(Amount in rupees)
Total benefits (including guaranteed and
non-guaranteed benefits)
Guaranteed benefits Non-guaranteed benefits @ 4% p.a. Non-guaranteed benefits @ 8% p.a.
Maturity benefit Death benefit5
Maturity Maturity Death Death
Annualize benefit, benefit, benefit, benefit,
Policy d incl. of incl. of incl. of incl. of
year (End premium 3
of the Total Total final final final final
(cumulati Guarante
Maturity Reversion guarantee
year) Special Surrender Reversion guarantee Special Surrender additional additional additional additional
ve) Survival ed Death d surrender benefit ary bonus d surrender benefit bonus bonus bonus bonus
benefit surrender benefit benefit ary bonus surrender value surrender value (FAB), if (FAB), if (FAB), if (FAB), if
value value value any, @ any, @ any, @ any, @
4% 8% 4% 8%
(6+7+FAB (6+11+FA (5+7+FAB (5+11+FA
) B) ) B)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)

1 14259 0 0 14259 0 0 0 953 953 15000 0 953 953 0 0 14259 14259

2 28518 0 8555 28518 0 0 8555 2023 8555 30000 8555 2023 8555 0 0 28518 28518

3 42777 0 14972 250000 0 0 14972 3214 14972 45000 16637 7070 16637 0 0 250000 295000

4 57036 0 28518 250000 0 0 28518 4545 28518 60000 30942 9999 30942 0 0 250000 310000

5 71295 0 35648 250000 0 0 35648 6019 35648 75000 38933 13241 38933 0 0 250000 325000

6 85554 0 42777 250000 0 0 42777 7650 42777 90000 47025 16830 47025 0 0 250000 340000

7 99813 0 49907 250000 0 0 49907 9459 49907 105000 55220 20809 55220 0 0 250000 355000

8 114072 0 57561 250000 0 0 57561 11450 57561 120000 64041 25190 64041 0 0 250000 370000

9 128331 0 65346 250000 0 0 65346 13635 65346 135000 73095 29997 73095 0 0 250000 385000

10 142590 0 73263 250000 0 0 73263 16038 73263 150000 82383 35283 82383 0 0 250000 400000

11 156849 0 81311 250000 0 0 81311 18659 81311 165000 91904 41049 91904 0 0 250000 415000

12 171108 0 89489 250000 0 0 89489 21510 89489 180000 101657 47322 101657 0 0 250000 430000

13 185367 0 97800 250000 0 0 97800 24619 97800 195000 111645 54161 111645 0 0 250000 445000

14 199626 0 106241 250000 0 0 106241 27983 106241 210000 121865 61562 121865 0 0 250000 460000

15 213885 0 114813 250000 0 0 114813 31594 114813 225000 132318 69506 132318 0 0 250000 477500

16 228144 0 123517 250000 0 0 123517 162801 162801 240000 143005 205401 205401 0 0 250000 493250

17 242403 0 132352 250000 0 0 132352 186132 186132 255000 153925 233741 233741 0 0 254523 508750

18 256662 0 141318 250000 0 0 141318 212170 212170 270000 165078 265144 265144 0 0 269495 524500

19 270921 0 150415 250000 0 0 150415 241206 241206 285000 176464 299887 299887 0 0 284467 541250

20 285180 20000 159644 250000 0 0 159644 253592 253592 300000 188084 327082 327082 0 0 299439 558750

Page 2
 LIC's Jeeven Umang (Plan No. 745)

(Amount in rupees)
Total benefits (including guaranteed and
non-guaranteed benefits)
Guaranteed benefits Non-guaranteed benefits @ 4% p.a. Non-guaranteed benefits @ 8% p.a.
Maturity benefit Death benefit5
Maturity Maturity Death Death
Annualize benefit, benefit, benefit, benefit,
Policy d incl. of incl. of incl. of incl. of
year (End premium 3
of the Total Total final final final final
(cumulati Guarante
Maturity Reversion guarantee
year) Special Surrender Reversion guarantee Special Surrender additional additional additional additional
ve) Survival ed Death d surrender benefit ary bonus d surrender benefit bonus bonus bonus bonus
benefit surrender benefit benefit ary bonus surrender value surrender value (FAB), if (FAB), if (FAB), if (FAB), if
value value value any, @ any, @ any, @ any, @
4% 8% 4% 8%
(6+7+FAB (6+11+FA (5+7+FAB (5+11+FA
) B) ) B)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)

21 285180 20000 160956 250000 0 0 160956 253286 253286 307500 191153 335281 335281 0 0 299439 570000

22 285180 20000 162267 250000 0 0 162267 252950 252950 315000 194271 346166 346166 0 0 299439 583750

23 285180 20000 163579 250000 0 0 163579 252653 252653 322500 197474 363657 363657 0 0 299439 603750

24 285180 20000 164891 250000 0 0 164891 252308 252308 330000 200696 381330 381330 0 0 299439 623750

25 285180 20000 166203 250000 0 0 166203 251955 251955 337500 203969 399296 399296 0 0 299439 643750

26 285180 20000 167515 250000 0 0 167515 251586 251586 345000 207294 417557 417557 0 0 299439 663750

27 285180 20000 168827 250000 0 0 168827 251243 251243 352500 210669 438734 438734 0 0 299439 686250

28 285180 20000 170138 250000 0 0 170138 250845 250845 360000 214094 460151 460151 0 0 299439 708750

29 285180 20000 171422 250000 0 0 171422 250438 250438 367500 217543 481935 481935 0 0 299439 731250

30 285180 20000 172734 250000 0 0 172734 250020 250020 375000 221072 512845 512845 0 0 299439 762500

31 285180 20000 174045 250000 0 0 174045 249595 249595 382500 224650 545396 545396 0 0 299439 795000

32 285180 20000 175357 250000 0 0 175357 249163 249163 390000 228280 584600 584600 0 0 299439 833750

33 285180 20000 176669 250000 0 0 176669 248684 248684 397500 231961 624098 624098 0 0 299439 872500

34 285180 20000 177981 250000 0 0 177981 248235 248235 405000 235694 664096 664096 0 0 299439 911250

35 285180 20000 179293 250000 0 0 179293 247755 247755 412500 239477 704421 704421 0 0 299439 950000

36 285180 20000 180604 250000 0 0 180604 247275 247275 420000 243310 745155 745155 0 0 299439 988750

37 285180 20000 181916 250000 0 0 181916 246730 246730 427500 247195 786113 786113 0 0 299439 1027500

38 285180 20000 183228 250000 0 0 183228 246259 246259 435000 251132 827653 827653 0 0 299439 1066250

39 285180 20000 184540 250000 0 0 184540 245720 245720 442500 255119 869381 869381 0 0 299439 1105000

40 285180 20000 185852 250000 0 0 185852 245204 245204 450000 259157 911524 911524 0 0 299439 1143750

Page 3
 LIC's Jeeven Umang (Plan No. 745)

(Amount in rupees)
Total benefits (including guaranteed and
non-guaranteed benefits)
Guaranteed benefits Non-guaranteed benefits @ 4% p.a. Non-guaranteed benefits @ 8% p.a.
Maturity benefit Death benefit5
Maturity Maturity Death Death
Annualize benefit, benefit, benefit, benefit,
Policy d incl. of incl. of incl. of incl. of
year (End premium 3
of the Total Total final final final final
(cumulati Guarante
Maturity Reversion guarantee
year) Special Surrender Reversion guarantee Special Surrender additional additional additional additional
ve) Survival ed Death d surrender benefit ary bonus d surrender benefit bonus bonus bonus bonus
benefit surrender benefit benefit ary bonus surrender value surrender value (FAB), if (FAB), if (FAB), if (FAB), if
value value value any, @ any, @ any, @ any, @
4% 8% 4% 8%
(6+7+FAB (6+11+FA (5+7+FAB (5+11+FA
) B) ) B)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)

41 285180 20000 187164 250000 0 0 187164 244673 244673 457500 263246 955709 955709 0 0 299439 1184250

42 285180 20000 188475 250000 0 0 188475 244162 244162 465000 267386 1002019 1002019 0 0 299439 1226500

43 285180 20000 189787 250000 0 0 189787 243610 243610 472500 271577 1050007 1050007 0 0 299439 1270250

44 285180 20000 191099 250000 0 0 191099 243081 243081 480000 275819 1100329 1100329 0 0 299439 1316000

45 285180 20000 192411 250000 0 0 192411 242564 242564 487500 280112 1152679 1152679 0 0 299439 1363500

46 285180 20000 193723 250000 0 0 193723 242021 242021 495000 284457 1206920 1206920 0 0 299439 1412750

47 285180 20000 195035 250000 0 0 195035 241489 241489 502500 288852 1263383 1263383 0 0 299439 1464000

48 285180 20000 196346 250000 0 0 196346 240982 240982 510000 293297 1321582 1321582 0 0 299439 1516750

49 285180 20000 197658 250000 0 0 197658 240489 240489 517500 297794 1381951 1381951 0 0 299439 1571500

50 285180 20000 198970 250000 0 0 198970 239968 239968 525000 302343 1443838 1443838 0 0 299439 1627750

51 285180 20000 200282 250000 0 0 200282 239481 239481 532500 306942 1507653 1507653 0 0 299439 1685750

52 285180 20000 201594 250000 0 0 201594 238986 238986 540000 311592 1573242 1573242 0 0 299439 1745500

53 285180 20000 202906 250000 0 0 202906 238489 238489 547500 316293 1640351 1640351 0 0 299439 1806750

54 285180 20000 204217 250000 0 0 204217 238042 238042 555000 321045 1709135 1709135 0 0 299439 1869500

55 285180 20000 205529 250000 0 0 205529 237591 237591 562500 325848 1779422 1779422 0 0 299439 1933750

56 285180 20000 206841 250000 0 0 206841 237591 237591 570000 330702 1843030 1843030 0 0 299439 1999250

57 285180 20000 208153 250000 0 0 208153 237591 237591 577500 335607 1907888 1907888 0 0 299439 2066000

58 285180 20000 209465 250000 0 0 209465 237591 237591 585000 340564 1973746 1973746 0 0 299439 2133750

59 285180 20000 210777 250000 0 0 210777 237591 237591 592500 345571 2040853 2040853 0 0 299439 2202750

60 285180 20000 212088 250000 0 0 212088 237591 237591 600000 350628 2108711 2108711 0 0 299439 2272500

Page 4
 LIC's Jeeven Umang (Plan No. 745)

(Amount in rupees)
Total benefits (including guaranteed and
non-guaranteed benefits)
Guaranteed benefits Non-guaranteed benefits @ 4% p.a. Non-guaranteed benefits @ 8% p.a.
Maturity benefit Death benefit5
Maturity Maturity Death Death
Annualize benefit, benefit, benefit, benefit,
Policy d incl. of incl. of incl. of incl. of
year (End premium 3
of the Total Total final final final final
(cumulati Guarante
Maturity Reversion guarantee
year) Special Surrender Reversion guarantee Special Surrender additional additional additional additional
ve) Survival ed Death d surrender benefit ary bonus d surrender benefit bonus bonus bonus bonus
benefit surrender benefit benefit ary bonus surrender value surrender value (FAB), if (FAB), if (FAB), if (FAB), if
value value value any, @ any, @ any, @ any, @
4% 8% 4% 8%
(6+7+FAB (6+11+FA (5+7+FAB (5+11+FA
) B) ) B)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)

61 285180 20000 213400 250000 0 0 213400 237591 237591 607500 355737 2177319 2177319 0 0 299439 2343000

62 285180 20000 214712 250000 0 0 214712 237591 237591 615000 360898 2246427 2246427 0 0 299439 2414000

63 285180 20000 216024 250000 0 0 216024 237591 237591 622500 366109 2315784 2315784 0 0 299439 2485250

64 285180 20000 217336 250000 0 0 217336 237591 237591 630000 371371 2385642 2385642 0 0 299439 2557000

65 285180 20000 218648 250000 0 0 218648 237591 237591 637500 376684 2455250 2455250 0 0 299439 2628500

66 285180 20000 219959 250000 0 0 219959 237591 237591 645000 382048 2524858 2524858 0 0 299439 2700000

67 285180 20000 221271 250000 0 0 221271 237591 237591 652500 387463 2594215 2594215 0 0 299439 2771250

68 285180 20000 222583 250000 0 0 222583 237591 237591 660000 392929 2662823 2662823 0 0 299439 2841750

69 285180 20000 223895 250000 0 0 223895 237591 237591 667500 398446 2730681 2730681 0 0 299439 2911500

70 285180 20000 225207 250000 0 0 225207 237591 237591 675000 404015 2797789 2797789 0 0 299439 2980500

71 285180 20000 226518 250000 0 0 226518 237591 237591 682500 409701 2863396 2863396 0 0 299439 3048000

72 285180 20000 227830 250000 0 0 227830 237591 237591 690000 415372 2927754 2927754 0 0 299439 3114250

73 285180 20000 229114 250000 0 0 229114 237591 237591 697500 421066 2990612 2990612 0 0 299439 3179000

74 285180 20000 230425 250000 0 0 230425 237591 237591 705000 426838 3051470 3051470 0 0 299439 3241750

75 285180 20000 231737 250000 0 0 231737 237591 237591 712500 432662 3110077 3110077 0 0 299439 3302250

76 285180 20000 233049 250000 0 0 233049 237591 237591 720000 438537 3166685 3166685 0 0 299439 3360750

77 285180 20000 234361 250000 0 0 234361 237591 237591 727500 444463 3220793 3220793 0 0 299439 3416750

78 285180 20000 235673 250000 0 0 235673 237591 237591 735000 450440 3272151 3272151 0 0 299439 3470000

79 285180 20000 236985 250000 0 0 236985 237591 237591 742500 456468 3320508 3320508 0 0 299439 3520250

80 285180 20000 238296 250000 0 0 238296 237591 238296 750000 462546 3365866 3365866 0 0 299439 3567500

Page 5
 LIC's Jeeven Umang (Plan No. 745)

(Amount in rupees)
Total benefits (including guaranteed and
non-guaranteed benefits)
Guaranteed benefits Non-guaranteed benefits @ 4% p.a. Non-guaranteed benefits @ 8% p.a.
Maturity benefit Death benefit5
Maturity Maturity Death Death
Annualize benefit, benefit, benefit, benefit,
Policy d incl. of incl. of incl. of incl. of
year (End premium 3
of the Total Total final final final final
(cumulati Guarante
Maturity Reversion guarantee
year) Special Surrender Reversion guarantee Special Surrender additional additional additional additional
ve) Survival ed Death d surrender benefit ary bonus d surrender benefit bonus bonus bonus bonus
benefit surrender benefit benefit ary bonus surrender value surrender value (FAB), if (FAB), if (FAB), if (FAB), if
value value value any, @ any, @ any, @ any, @
4% 8% 4% 8%
(6+7+FAB (6+11+FA (5+7+FAB (5+11+FA
) B) ) B)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)

81 285180 20000 239608 250000 0 0 239608 237591 239608 757500 468676 3408224 3408224 0 0 299439 3611750

82 285180 20000 240920 250000 0 0 240920 237591 240920 765000 474857 3447082 3447082 0 0 299439 3652500

83 285180 20000 242232 250000 0 0 242232 237591 242232 772500 481089 3482439 3482439 0 0 299439 3689750

84 285180 20000 243544 250000 0 0 243544 237591 243544 780000 487372 3514047 3514047 0 0 299439 3723250

85 285180 20000 244856 250000 0 0 244856 237591 244856 787500 493706 3541905 3541905 0 0 299439 3753000

86 285180 20000 246167 250000 0 0 246167 237591 246167 795000 500090 3565763 3565763 0 0 299439 3778750

87 285180 20000 247479 250000 0 0 247479 237591 247479 802500 506526 3585870 3585870 0 0 299439 3800750

88 285180 20000 248791 250000 0 0 248791 237591 248791 810000 513013 3601728 3601728 0 0 299439 3818500

89 285180 20000 250103 250000 0 0 250103 237591 250103 817500 519551 3613586 3613586 0 0 299439 3832250

90 285180 20000 251415 250000 0 0 251415 237591 251415 825000 526140 3621194 3621194 0 0 299439 3841750

91 285180 20000 252727 250000 0 0 252727 237591 252727 832500 532780 3626801 3626801 0 0 299439 3849250

92 285180 20000 254038 250000 0 0 254038 237591 254038 840000 539470 3632409 3632409 0 0 299439 3856750

93 285180 20000 255350 250000 0 0 255350 237591 255350 847500 546212 3638017 3638017 0 0 299439 3864250

94 285180 20000 256662 250000 0 0 256662 237591 256662 855000 553005 3643625 3643625 0 0 299439 3871750

95 285180 0 256662 250000 250000 0 256662 237591 256662 862500 558537 3649232 3649232 250000 3879250 299439 3879250

Notes:

The main objective of the illustration is that the client is able to appreciate the features of the products and the flow of the benefit in different circumstances with some level of
quantification.
This illustration is applicable to a standard (from medical, life style and occupation point of view) life.

Page 6
 LIC's Jeeven Umang (Plan No. 745)

1. If age at entry of the life assured is less than 8 years, the risk will commence after completion of 2 years from date of commencement of policy or completion of 8 years of
age, whichever is earlier. In case of death of the life assured before the commencement of risk, an amount equal to the total premium(s) paid excluding underwriting extra
premium, rider premium(s), if any, and goods & service tax shall be payable.
2. It includes rider(s) premiums in respect of all the rider(s) opted by the proposer/policyholder at inception of the policy.
3. 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.
4. Surrender value is higher of guaranteed surrender value (GSV) and special surrender value (SSV). SSV shall be reviewed in line with IRDAI Master Circular on Life
Insurance Products (Ref no.: IRDAI/ACTL/MSTCIR/MISC/89/6/2024 dated 12th June, 2024) and any subsequent circulars issued by IRDAI in this regard. For surrender
value calculation, it is assumed that the bonuses shall vest upon its declaration based on experience of the Corporation under this product, in the manner as per the terms
and conditions of annual valuation results.
5. In any case, the total death benefit during the policy term shall not be less than 105% of the total premiums paid (excluding GST, extra premium and rider premiums, if
any).
6. The actual allocation to policyholders, out of the surplus emerging from the actuarial investigation, shall be in accordance with provisions in this regard under LIC Act, 1956.

I, ________________________________________ (name), having received

I, ________________________________________ (name), have explained the information with respect to the above, have understood the above statement
the premiums and benefits under the product fully to the prospect/policyholder. before entering into the contract.
Place : Place :
Date : Signature of agent/intermediary/official of the insurer Date : Signature of prospect/policyholder

Page 7
 Govt Recognised-U DISE CODE-08260523 109
G.V.V. Sec. School
iCntdhar \idhya ihar Sutsthan
Identity Card -Valid For Session 2024-2025
ANSH KUMAR
Father's Name : Karna Ram

Date of Birth: 04.07.2020

Class: Infant Scholar No. 1271

Address: 29, Gametion ki Gali,

Bhrampoe,
Udaipur-800 3695713,91191 Head Of Inst.
75, Acharya Marg. 0SChandpole. Udaipur.