Please check your contact details and

Mr. Batchu Sathish ensure it is up- to-date.

Batchu Satheesh , Amangal, Vemulapally Mandal,
Nalgonda
Mobile No. : 9177172550
Telangana
India
508374
Mobile No :9177172550 E-mail ID : BACHUSATHEESH806@GMAIL.COM
Tel No :

Tel. :

Welcome to the world of Aditya Birla Capital!

Dear Mr. Batchu Sathish,

We thank you for the trust you have shown by making us your preferred choice for your PROTECTING needs. It’s our pleasure to have you as a
valued customer.

Aditya Birla Capital's PROTECTING solutions enable you to protect what you value the most.

Your decision to choose Aditya Birla Sun Life Insurance SecurePlus Plan will safeguard not only your future but also that of your loved ones.

Your policy details :

Plan Name : ABSLI SecurePlus Plan Policy Number : 009375579

Premium Payment Term : 10 Years Premium Payment Frequency : Semi Annual

Instalment premium : ` 135,196.86 Policy Term : 10 Years

Meeting your life’s money needs

Aditya Birla Capital offers a wide range of solutions that enable you to fulfill all your life’s needs regarding money, throughout your life.

While you have availed our PROTECTING solution from Aditya Birla Sun Life Insurance, Aditya Birla Capital also offers to help you with
INVESTING in your aspirations and FINANCING your life’s dreams, needs and desires.

The ease of ONE WINDOW

We enable you to manage your money with confidence and ease by offering the convenience of one window and one point of contact for all
your money needs.

You now have one number, 1-800-270-7000 you can call, or one website, https://lifeinsurance.adityabirlacapital.com, you can visit, for any of
your money needs.

You can also create your ONE Login ID by registering on the above website.

This ID will enable you to login to your account across all businesses of Aditya Birla Capital including Aditya Birla Sun Life Insurance.

It will enable you to securely and conveniently transact and service all your PROTECTING, INVESTING and FINANCING needs.

Looking forward to a long and successful journey ahead!

Yours sincerely,

Chief Operations Officer

Aditya Birla Sun Life Insurance Company Limited
Please note that this is an electronically generated document and does not require a signature.

Page 1
 Our service philosophy
ABSLI SecurePlus Plan Part A
Our service philosophy is to be transparent and responsive that will enable us to empower you to make the right financial decisions.
Transparency - Review Your Policy
We request You to go through the enclosed Policy document in detail and check the accuracy of information provided herein. You will have the
right to return Your Policy to Us within 30 days from the date of receipt of the Policy in case You disagree with the terms & conditions of Your
Policy. We will refund the premium paid post receipt of written notice of cancellation ( along with reasons thereof) together with the original
Policy document from Your end. We may reduce the amount of the refund by proportionate risk premium for the period of cover and expenses
incurred by us on medical examination, if any and stamp duty charges while issuing Your Policy in accordance to IRDAI (Protection of
Policyholders Interest) Regulations, 2017.

Where the date of receipt of Policy shall be determined basis the below:
- 30 days in case of receipt of Policy document for policies purchased through mode of Distance Marketing or in case of electronic policies; the
delive date of the email confirming the credit of the Insurance policy by the IR to the eIA.

For clarity, Distance Marketing includes eve activity of solicitation (including lead generation) and sale of insurance products through voice
mode, SMS, electronic mode, physical mode ( like postal mail) or any other means of communication other than in person. While handing over
the original Policy document, it is critical that You collect a valid written acknowledgement on submission of the same, as the said
acknowledgment would be required for all future references.
Health Evaluation
Further, for Your reference, we are sharing the results of Your medical examination, if applicable, conducted for assessment of Your proposal
for insurance. The medical examination report was obtained for assessment of Your health conditions, which is relevant to take a decision on
the proposal to obtain insurance cover from Us. The results of the tests are only indicative in nature. Aditya Birla Sun Life Insurance Company
Limited expresses no opinion on the matters contained in the medical reports.
Responsiveness
We are committed towards addressing all customer queries within a maximum of 10 days of receipt of the same.
Claims Connect
We understand that settlement of Claims is of utmost importance. Hence, in order to make claims a hassle-free experience, we have streamlined the
process and assure our customers that we are there in the hour of need.
Empower
A single Log-in ID and Password that will enable you to securely and conveniently transact and service all your PROTECTING needs.
Here you can :
 Track and manage your policy with ease for lifetime
 Set alerts - Obtain timely and important information regarding your policy through the Set Alerts feature
 Download feature - Instant download of policy document, statements and receipts pertaining to your policy
 Convenience to pay premium - Easy and varied premium payment options to suit your convenience
 Manage your policy - Submit your policy servicing requests online
 Stay updated - Track your policy details and service request status online
Convert your policy into an E-Insurance Account (EIA) and experience convenience like never before.
⦁ SMS alerts : Access a host of policy and fund related information on your phone by sending a simple text message.
⦁ Call center / IVRS : Call our toll free number 1800-270-7000 and follow the IVR (Interactive Voice Response) flow to ensure that you have
easy and quick resolution of your queries. For NRI, call +91 22 66917777 (Call charges apply) between 9 am and 9 pm, Monday to
Saturday.
"You can submit Policy related request or documents at any of our branch near to you. To know your nearest branch,visit our website OR send
Hi to 8828800040 on whatsapp OR contact our call center OR connect with your agent".

For any queries or clarifications, please contact

your advisor at the touch points mentioned
below –
Advisor Name : Mr. Madhu Boppani
Advisor Code : ZK9160
Advisor Mob. No. : 9666140250
Advisor Email :
Advisor Res. No. :
Advisor Off. No. :
Branch Name : Nalgonda
Branch Contact : 08682307216

Page 2
 First premium receipt
Name of Life Insured : Mr. Batchu Sathish

Name of Policyholder : Mr. Batchu Sathish

Address of Policyholder : Batchu Satheesh , Amangal, Vemulapally Mandal,

Nalgonda 508374
Telangana India

Client ID : P100763019

Policy No. : 009375579 GSTIN : 36AABCB4623J1ZT

Policy Identification Type : General State Code : 36

Date of Policy Issue : 28/03/2024 Receipt No. : 300461291

Coverage Details
Coverage No. Coverage Name Date of Issue Modal Premium (`)

01 ABSLI Secure Plus Plan 28/03/2024 129,375.00

Premium Details

Description Amount (`)

First Premium 129,375.00

Goods and Services Tax (GST) 5,821.86

Instalment Premium (Total) 135,196.86

⦁ Any sum paid on an insurance policy with Aditya Birla Sun Life Insurance Company would be eligible for applicable tax benefits, under the Income
Tax Act, 1961, as amended from time to time.
⦁ For specific suitability, you are requested to consult your tax advisor.
⦁ The charges are/shall be subject to applicable taxes and levies, prevailing from time to time, during the validity of the policy contract.

This is not a Tax invoice, a separate tax invoice will be sent to you on your registered email id.

Branch Name : Nalgonda SAC Desc : Life Insurance

Branch Address : 1st Floor, No. 61, Above More Super Market, SAC Code : 00440186
Hyderabad Road Near Market Yard Nalgonda
TELANGANA 508001
Insurance Advisor Code : ZK9160 State Code : 36
This is a digitally signed document and does not require a signature. GSTIN : 36AABCB4623J1ZT

Page 3
Your policy details
Must read
ABSLI SecurePlus Plan Part A
A Non-Linked Non-Participating Individual Life Insurance Savings Plan Policy Preamble | Policy Schedule
This Policy is the evidence of a contract between Aditya Birla Sun Life Insurance Company Limited (‘‘We’, ‘Our’, ‘Us’ or ‘the Company’) and the
Policyholder (‘You’, ‘Your’ or ‘Policyholder’) as described in the Policy Schedule. 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, benefit illustration and other
information received by the Company from the Policyholder, Life Insured or on behalf of the Policyholder. This Policy is written under and will
be governed by the applicable laws in force in India and all Premium and benefits expressed are payable in Indian Rupees.

Policy Information
Product Unique Identification Number : 109N102V09 Policy Issue Date : 28/03/2024
Policy Number : 009375579 Date of Commencement of Risk : 28/03/2024
Premium Payment Term : 10 years Maturity Date : 28/03/2034
Policy Term : 10 years
Policyholder Name : Mr. Batchu Sathish
Address : Batchu Satheesh , Amangal, Vemulapally Mandal,
Premium Payment Term : Nalgonda 508374
Telangana India
DOB : 15/03/1993 Gender : Male
Age Admitted : Yes
Life Insured Name : Mr. Batchu Sathish
Address : Same as Policyholder Address
DOB : 15/03/1993 Gender : Male
Age Admitted : Yes

Nominee Details Nominee Gender Age Relationship with Life Insured Allocation Percentage
VENKANNA BATCHU Male 49 Years Father 100%

Appointee Relationship
Appointee in case Nominee is a Minor : Gender : with Nominee :

Page 4
 Your policy details
Must read
ABSLI SecurePlus Plan Part A
A Non-Linked Non-Participating Individual Life Insurance Savings Plan Policy Schedule

Benefit Information
Sum Assured : ` 3,225,000.00 Loyalty Addition percentage* : 51.25
Sum Assured on Death at inception : ` 3,225,000.00 Survival Benefit : 220,484.68
Benefit Payout Period : 10 Years First Income Benefit Payment Date : 27/09/2034
Benefit Payout Frequency : Semi Annual
Income Benefit : ` 145,775.00
*Percentage of Income Benefit. Payable only when all due premiums have been paid during the Premium Paying Term

Policy Premium
Annualized Premium : ` 250,000.00 Modal Loading Factor : 3.50 %
Underwriting Extra Premium : ` Installment Premium : ` 135,196.86
GST : ` 5,821.86 Instalment Premium due on the 28th of eve September,
March
Premium Payment Frequency : Semi Annual Last Premium due on : 28/09/2033
Total Installment Premium including : ` 135,196.86
taxes

Signed for and on behalf of Aditya Birla Sun Life Insurance Company Limited.

Chief Operations Officer

Aditya Birla Sun life Insurance Compnay Limited.
Please note that this is an electronically generated document and does not require a signature.

Please read Your Policy Schedule carefully to verify that it correctly reflects the policy you applied for. If you notice any discrepancies, do return this
policy document to us for correction immediately.
To claim a benefit or request a change in Your Policy Schedule, contact your advisor or write to our nearest Branch Office or Customer Service Team.
Please notify us promptly of change in any of your contact details.

Stamp Duty Details

Stamp Duty of Rs 645.00 is paid as provided under Article 47(D) 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 his Order
No. (LOA/ENF-1/CSD/40/2024 Validity Period Dt. 15/01/2024 To 14/10/2024 / (O/w No 0) Date : 11/01/2024)

Page 5
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

PART B – DEFINITIONS

GENERAL
The Company may amend or place endorsement/s to this Policy from time to time for any changes agreed to by the Policyholder and the
Company or issued by the Company and any such amendments or endorsement/s will form part of this Policy.

In this Policy, the words or terms below that appear in initial capitals will have the specifics meaning assigned to them below. These defined
words or terms will, where appropriate to the context, be read so that the singular includes the plural, and the masculine includes the feminine.
Any capitalized term used and not defined herein shall have the same meaning as is ascribed to them under the Rider Terms and Conditions if
the Rider has been provided for and is in-force under the Policy. In case of any common terms in the Rider Terms and Conditions and this
Policy, for the purpose of this Policy the meaning ascribed to such terms in this Policy shall prevail.

DEFINITIONS
1. “Act” refers to the Insurance Act 1938 as amended from time to time and shall include the Insurance Laws (Amendment) Act 2015.

2. “Age” corresponds to the age last birthday of the Life Insured on the Policy Issue Date and then incremented by one on each policy
anniversary.

3. “Annualized Premium” is the amount specified in the Policy Schedule and means 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.

4. “Appointee” is the person who is appointed by You and as named in the Policy Schedule, who is authorized to receive benefits under the
Policy on behalf of the Nominee(s), in case where Nominee is less than Age 18 on the date of claim payment.

5. “Assignee” means the person to whom the rights and benefits are transferred by virtue of an assignment.
6. “Assignment” means a provision wherein the Policyholder can assign or transfer a Policy in accordance with Section 38 of the Insurance
Act, 1938 as amended from time to time.

7. “Benefit Payout Frequency” means either annual, semi-annual, quarterly or monthly frequency in which the Income Benefit shall be
payable under the Policy, as specified in the Policy Schedule. The Benefit Payout Frequency chosen can be changed anytime during the
Policy Term or during the Benefit Payout Period. In case the Benefit Payout Frequency is changed during the Benefit Payout Period, the
change will be effective from the subsequent Policy Anniversary.

8. “Benefit Payout Period” means the period commencing after the end of the Policy Term during which the Income Benefit, as applicable,
shall be payable as per the chosen Benefit Payout Frequency. Benefit Payout Period once chosen cannot be changed later on during the
Policy Term.

9. “Claimant” means You, Nominee(s) (if valid nomination is effected), assignee(s) or their heirs, legal representatives, or holders of a
succession certificate in case Nominee(s) or assignee(s) is/are not alive at the time of claim.

10. “Date of Commencement of Risk” or “Risk Commencement Date” is the date as shown in the Policy Schedule when risk cover on the life
of the Life Insured begins under this Policy.

11. “Death Benefit” means the benefit payable on death of the Life Insured as specified in Part C of this Policy.

12. “Free-Look Period” means the period as specified in Part D of the Policy, during which You have an option to return the original Policy to
Us by stating the objections/reasons for such disagreement in writing.

13. “Grace Period” means a period of 15 (Fifteen) days from the due date of the unpaid Premium under monthly Premium payment frequency
and 30 (Thirty) days from the due date of unpaid Premium for all other Premium payment frequencies.

14. “Guaranteed Surrender Value” means the Surrender Value as computed in Part D of the Policy, which is guaranteed by Us.

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 6
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

15. “Income Benefit” is a percentage of Annualized Premium and varies by Premium Payment Term, Policy Term, Benefit Payout Period, Life
Insured’s Age at inception of the Policy and Annualized Premium. The Income Benefit is paid at the end of the period (monthly, quarterly,
half yearly or annually) as per the Benefit Payout Frequency chosen.

16. "In-force" policy means a Policy where all due premiums are paid on the due date.

17. “Installment Premium” is the premium as payable by You on the due dates in a Policy Year, as specified in the Policy Schedule for effecting
and continuing risk cover under this Policy.

18. “IRDAI” or “Authority” means the Insurance Regulatory and Development Authority of India.

19. “Lapse” or “Lapsed Policy” means a Policy where the Policy has not acquired a Surrender Value and Premium due is not paid till the expiry
of the Grace Period.

20. “Life Insured” is the person on whose life the insured contingent events have to occur for the benefits to be payable and as named in the
Policy Schedule.

21. “Loan” means an amount granted by the Company, at a specified interest rate, to the Policyholder against the Surrender Value available
under the Policy as specified in Part D of the Policy.

22. “Loyalty Addition” is a percentage of the Income Benefit and is payable if all due premiums have been paid, as specified in Part C of this
Policy.

23. "Maturity Benefit" means the benefit, which is payable on the Maturity Date, as specified in Part C of the Policy.

24. “Major” is a person who is aged 18 years and above.

25. “Minor” is a person who has not completed 18 years of age.

26. “Nomination” is the process of nominating a person who is named as “Nominee” 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.

27. “Nominee” is the person who is nominated by You in accordance with Part F and whose name is mentioned in the Policy Schedule, to
receive the Death Benefit under this Policy. Nomination can only be effected if You are also the Life Insured under the Policy.

28. “Policy” means the contract of insurance entered between You and Us as evidenced by this document, the Proposal Form, the Policy
Schedule and any additional information/document(s) provided to Us in respect of the Proposal Form along with any written instructions
from You, subject to Our acceptance of the same and any endorsement issued by Us.

29. “Policy Anniversary” means the date which corresponds numerically with the Policy Issue Date in every calendar year until Maturity Date.

30. “Policyholder” or “You” or “Your” means the owner of the Policy at any point of time.

31. “Policy Issue Date” is the date specified in the Policy Schedule on which this Policy is issued and Your rights, benefits and risk cover begins
under the Policy.

32. “Policy Maturity Date” or “Maturity Date” is the date on which the Policy Term concludes and is specified as such in the Policy Schedule.

33. “Policy Month” is the period of one calendar month from the Policy Issue Date.

34. “Policy Schedule” means the Policy schedule and any annexures, tables, and/or endorsements attached to it from time to time and forming
part of the Policy.

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 7
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

35. “Policy Term” means the number of Policy Years for which the Policy is in-force, commencing from the Date of Inception and ending on
the Maturity Date as specified in the Policy Schedule. Policy Term once chosen at policy inception, cannot be changed thereafter.

36. “Policy Year” is the period of twelve calendar months from the Policy Anniversary.

37. “Proposal Form” means the form filled in and completed by You, for the purpose of obtaining insurance coverage under this Policy.

38. “Premium Payment Term” means the term specified in the Policy Schedule, during which the premiums are payable by You. Premium
Payment Term once chosen at policy inception, cannot be changed thereafter.

39. “Reduced Paid Up (RPU)” means the state of the Policy due to failure to pay due Premium within the Grace Period after payment of
Premiums for at least first 2 consecutive Policy Years. Benefits are reduced as per the terms and conditions of the Policy.

40. “Revival” means restoration of the Policy, which was discontinued due to the non-payment of premium, by Us with all the benefits
mentioned in the Policy, with or without rider benefits if any, upon the receipt of all the premiums due and other charges or late fee if any,
as per the terms and conditions of the Policy, upon being satisfied as to the continued insurability of the insured or Policyholder on the
basis of the information, documents and reports furnished by You, in accordance with Board Approved Underwriting Policy.

41. “Revival Period” means a period of five (5) consecutive years from the due date of first unpaid installment Premium, during which period
You will be entitled to revive the Policy which was discontinued due to the non-payment of premium.

42. “Special Surrender Value” means the value as specified in Part D of this Policy.

43. “Sum Assured” is equal to a multiple of the Annualized Premium and has been specified in the Policy Schedule.

44. “Sum Assured on Death” means the amount payable on death in accordance with Part C of this Policy. The Sum Assured on Death payable
shall be higher of (i) 150% of the Total Premiums Paid up to the date of death and (ii) Sum Assured.

45. “Survival Benefit” refers to an amount, as specified in Part C of this Policy, which is payable during the chosen Benefit Payout Period.

46. “Surrender” means complete withdrawal/termination of the Policy by the Policyholder.

47. “Surrender Value” means an amount, if any, that becomes payable in case of Surrender in accordance with the terms and conditions of
the Policy.

48. “Total Premiums Paid” means total of all the premiums received, excluding any underwriting extra premium, any rider premium, taxes
and loadings for modal premiums, if any.

49. “Vesting” means the transfer of Policy benefits to the Life Insured on attainment of majority in case the Policy is issued to a Minor.

50. “We” or “Our” or “Us” or “Company” means Aditya Birla Sun Life Insurance Company Limited.

ABSLI ASC Ver 09 October/2023 POL/10/23-24/2372 109N102V09

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 8
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

PART C – POLICY FEATURES, BENEFITS AND PREMIUM PAYMENT

1. Death Benefit
In the event of death of the Life Insured during the Policy Term, provided that the Policy is in-force and not under Lapsed or Reduced
Paid Up mode, We will pay the “Sum Assured on Death” to the Claimant.

Staggered Death Benefit Option

The Claimant shall have an option to receive the Death Benefit in annual/monthly installments payable at the end of the year/month,
as specified in the table below, over a period of 5 years instead of the lump sum payment as specified above.

Installment Frequency Annual Monthly

Installment
21.758% 1.8492%
(as % of Death Benefit)
Total payments
108.792% 110.952%
(as % of Death Benefit)

The above percentages are determined at an interest rate of 4.40% p.a. We may revise the installment based on the then prevailing
market conditions subject to prior approval from IRDAI. Any change in the methodology/formula for calculating the installment shall
also be subject to prior approval from IRDAI.

Once the Installment mode has been opted by the Claimant, it cannot be changed thereafter. However, the Claimant shall, at any
point, have an option to receive the remaining Death Benefit as a lump sum, then a discounted value of the outstanding Death Benefit
amount shall be paid as a lump sum. This lump sum will be at least equal to the lump sum Death Benefit less any installments already
paid.

2. Survival Benefit

2.1 Income Benefit

On survival of Life Insured till the end of Policy Term, provided all due premiums are paid, Income Benefit is payable to You
during the Benefit Payout Period, as per the Benefit Payout Frequency chosen by You.

2.2 Loyalty Addition

The Income Benefit payable is enhanced by Loyalty Addition, if all due premiums have been paid during the Premium Paying
Term.

In case of death of the Life Insured during the Benefit Payout Period, the Income Benefit and Loyalty Addition, will continue to be paid
to the Claimant. No additional benefit is payable to the Claimant.

3. Maturity Benefit

a) At the end of the Policy Term, the Policyholder shall have the flexibility to use the commutation option wherein, at any time
on or after end of the Policy Term, if the Policyholder would like to get a lump sum instead of the Income Benefits, the
commuted value of the outstanding benefits shall be paid as a lump sum.
b) This lump sum will be at least equal to the Total Premiums Paid less any Survival Benefit already paid.
c) The commutation option can also be exercised by the Claimant after the death of the Policyholder.
d) The lump sum benefit is calculated using factors determined by a discount rate of 9.28%. We may revise the factors based on
the then prevailing market conditions subject to prior IRDAI approval. However, any change in the methodology/formula for
calculating the factors shall also be subject to IRDAI approval.

4. Policy Premium

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 9
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

a) Your Policy Schedule specifies the Annualized Premium, the Premium Payment Frequency, the Installment Premium and its
due dates, as applicable, subject to the Policy Discontinuance, Reduced Paid-up (RPU) and Revival provisions.
b) We must receive Installment Premiums in full as and when due in order for this Policy to be valid and to remain in-force.
c) You can pay Premium at any of Our offices or through Our website http://lifeinsurance.adityabirlacapital.com or by any other
means, as informed by Us.
d) Any Premium paid will be deemed to have been received by Us only after the same has been realized and credited to Our bank
account.
e) The Premium payment receipt will be issued in Your name, which will be subject to realization of cheque or any other
instrument/medium.

5. Grace Period

a) If the Installment Premium is not received by Us by the due dates specified in the Policy Schedule, You will be given a Grace
Period of 30 days (15 days in case of monthly frequency) to make the payment of due Premium(s), during which time the risk
cover and all benefits under the Policy will continue to remain in force.
b) If We do not receive the Installment Premium in full within the Grace Period, the Policy benefits may Lapse fully or be changed
to Reduced Paid-up in accordance with the Premium Discontinuance and Reduced Paid-Up provisions as specified in Part D. On
death during the Grace Period, the due unpaid Installment Premium(s) will be deducted from the claim amount payable.

6. Risk coverage for Minor and Vesting on attaining majority

a) For Policies issued on Minor life, the Date of Commencement of Risk shall be the Date of Commencement of the Policy. In case
the Life Insured is a Minor, the Policy will automatically Vest in him/her on his/her attaining the Age 18 years.
b) On the Life Insured attaining the Age 18 years, we will require all the requisite information, including his/her address, contact
details, bank account details, and other documents as may be specified by Us from time to time to enable Us to pay the benefits
under this Policy.
c) Where the Life Assured (whether major or minor) and the Proposer/Policyholder is different, on the death of the
Proposer/Policyholder, the legal heirs of the deceased Proposer/Policyholder in accordance with the prevailing laws in India,
will be considered as new Proposer/Policyholder.
d) In the event of death of the Proposer/Policyholder, no Death Benefit is payable under the Policy.

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 10
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

PART D – POLICY TERMS AND CONDITIONS

1. Free-look Period

You have a free look period of 15 days from the date of receipt of the policy document and period of 30 days in case of electronic
policies(1) and the policies issued under the provisions of IRDAI Guidelines on Distance Marketing (2) of Insurance products, to review
the terms and conditions of the Policy and where you disagree to any of those terms or conditions, You have the option to return the
original policy document to Us for cancellation, stating in writing the reasons for your objection, You shall be entitled to a refund of
the premium paid subject to a deduction of a proportionate risk premium for the period of cover and the expenses incurred by Us on
medical examination and stamp duty charges in accordance to IRDAI (Protection of Policyholders Interest) Regulations, 2017.
(1)
In case of electronic issuance of policies, the date of receipt or date of credit of electronic policies shall be determined as below:
a) For New Electronic Insurance Account (EIA): Date of receipt of the "Welcome Kit" from the Insurance Repository with the
credentials to log into the EIA or delivery date of the e-mail confirming credit of the Insurance Policy by the Insurance
Repository into the EIA, whichever is later.
b) For existing EIA: Delivery date of the e-mail confirming credit of the Insurance Policy by the Insurance Repository into the
EIA.
(2)
Distance Marketing includes every activity of solicitation (including lead generation) and sale of insurance products through voice
mode, SMS, electronic mode, physical mode (like postal mail) or any other means of communication other than in person.

2. Premium Discontinuance

a) If at least first two (2) full Policy Years’ Installment Premiums are not received by Us under a Policy, the Policy will immediately
and automatically Lapse at the expiry of the Grace Period, and no benefits will be payable under the Policy thereafter.
b) If at least first two (2) full Policy Years’ Installment Premiums have been received in full under a Policy, then, the Policy will be,
immediately and automatically, converted to a Reduced Paid Up (RPU) Policy at the expiry of the Grace Period.

The Policyholder may revive a Lapsed/Reduced Paid Up Policy during the Revival Period, subject to the conditions mentioned in the
Revival clause below.

3. Reduced Paid-Up (RPU) Benefits

Where the Policy has become a Reduced Paid Up Policy/is in RPU status, the benefits payable will be amended as mentioned below:

The RPU Sum Assured on Death and RPU Income Benefit shall be equal to the Sum Assured on Death and Income Benefit respectively,
multiplied by the RPU Factor.

Where, “RPU Factor” means the ratio of the number of Installment Premiums paid and received as on date, over the total number of
Installment Premiums originally payable during the Policy Term.

Your Policy will not be entitled for any Loyalty Addition once it has been converted into a Reduced Paid-Up Policy.

Once the Policy has become an RPU Policy, Rider benefit, if any, will cease.

a) Death Benefit for RPU Policies

In the event of death of the Life Insured during the Policy Term after the Policy has become an RPU Policy, the RPU Death Benefit will
be RPU Sum Assured on Death, if any under the Policy.

The RPU Death Benefit shall be subject to the minimum of 150% of Total Premiums Paid up to date of death.

b) Survival Benefit for RPU Policies

• On survival of the Life Insured until the end of the Policy Term, the RPU Income Benefit shall be payable during the Benefit Payout
Period.
• In case of death of the Life Insured during the Benefit Payout Period, the RPU Income Benefit will continue to be paid to the Claimant.
The Claimant can also opt to receive a lump sum instead of the Income Benefit.
Aditya Birla Sun Life Insurance Company Limited
One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 11
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

c) Maturity Benefit for RPU Policies:

At any time on or after the completion of the Policy Term, the Policyholder can opt to get a lump sum instead of the RPU Income
Benefits, the commuted value of the outstanding benefits shall be paid in lump sum. This lump sum will be at least equal to the Total
Premiums Paid less Survival Benefit, if any, already paid.

4. Surrender Benefit

This Policy shall acquire a Surrender Value provided all the due Installment Premiums for the first two (2) Policy Years have been
received by Us. The Policyholder can Surrender the Policy any time before the end of Policy Term. The Policy will terminate after
payment of the Surrender Value and thereafter no other benefits under this Policy shall be payable.

On Surrender of the Policy, the Surrender Value payable, as applicable, will be the higher of the Guaranteed Surrender Value (GSV) or
the Special Surrender Value (SSV).

The GSV shall be a percentage of Total Premiums Paid. GSV factors as a percentage of Total Premiums Paid are given below:

Year of PT - 6 PT - 7 PT - 8 PT - 9 PT - 10 PT - 11 PT - 12 PT - 13 PT - 14 PT - 15 PT - 16 PT - 17
Surrender years years years years years years years years years years years years
1 - - - - - - - - - - - -
2 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%
3 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%
4 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
5 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
6 90% 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
7 - 90% 90% 50% 50% 50% 50% 50% 50% 50% 50% 50%
8 - - 90% 90% 63% 60% 58% 57% 56% 55% 54% 54%
9 - - - 90% 90% 70% 66% 63% 61% 60% 59% 58%
10 - - - - 90% 90% 74% 70% 67% 65% 63% 62%
11 - - - - - 90% 90% 77% 73% 70% 68% 66%
12 - - - - - - 90% 90% 79% 75% 72% 70%
13 - - - - - - - 90% 90% 80% 77% 74%
14 - - - - - - - - 90% 90% 81% 78%
15 - - - - - - - - - 90% 90% 82%
16 - - - - - - - - - - 90% 90%
17 - - - - - - - - - - - 90%

Your Policy also acquires a Special Surrender Value (SSV). Special Surrender Value is not guaranteed and may be revised by the
Company from time to time. Any change in method/ formula for calculating the SSV is subject to prior approval from IRDAI.

To know the Surrender Value applicable to Your Policy, You can get in touch with Your advisor, or the nearest Branch Office or Our
Customer Service Team.

5. Revival

The Company shall consider requests from the Policyholder to revive a Policy which has Lapsed or has become a Reduced
Paid-up Policy for non-payment of Installment Premium, within a Revival Period of five (5) years from the due date of first
unpaid premium and subject to the following conditions:

a) Such requests to be submitted by the Policyholder before the Policy Maturity Date.
b) The Life Insured is required to furnish, at his / her own expense, satisfactory evidence of health and continuity of insurability as
may be applicable. We may call for additional information /documents to process the Revival request.
c) All due Installment Premiums till the date of Revival along with interest and/or late fees, if any, at prevailing rate of interest
along with applicable taxes, if any shall be paid in full. The Company may revise this interest rate from time to time. The
provisions of Sec 45 of the Insurance Laws (Amendment) Act, 2015, as amended from time to time will also be applicable in case
of Revival of the Policy. Refer Annexure C.

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 12
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

d) The monthly interest is determined at June 1st of every calendar year as (x+1%)/12 rounded to the nearest 0.5%, where x is the
base rate of the State Bank of India. Currently, as declared on June 1st, 2023, the Company is charging a compound interest of
1% per month. Any change in basis of determination of interest rate for Revival can be done only after prior approval of IRDAI.
e) The Company may revive or refuse to revive the Policy, based on the prevailing Board approved underwriting policy. The Revival
will take effect only on it being specifically communicated by the Company to Policyholder.
f) The Revival of the Policy may be on terms different from those applicable to the Policy before it Lapsed/became Reduced Paid-
Up Policy, based on prevailing board approved underwriting guidelines.
On Revival, all the benefits under the Policy, which prevailed before the date of first unpaid premium will automatically be reinstated
and restored to their full value.

6. Policy Loan

The Policyholder can take Policy Loan under the Policy provided that the Policy has acquired Surrender Value at the time of
request for Loan, subject to the following conditions:

a) The minimum Loan amount is Rs.5,000 and the maximum amount of Loan that may be granted under the Policy is up to 80%
of the Surrender Value available less any outstanding Policy Loan as on that date.
b) The outstanding Loan balance is the amount of Loan unpaid plus all accrued but unpaid Loan interest as on a particular date.
c) At any time during the Policy Term when the Policy is inforce (premium paying) or all due Installment Premiums under the
Policy have been paid, and if the outstanding Loan plus Loan interest becomes equal to or exceeds the Surrender Value available
under the Policy as on that date, the Policy will not be terminated. The Company will inform the Policyholder of the same with
a 90-days advance notice to repay such outstanding Loan balance along with applicable interest.
d) If a Policy is a Reduced Paid-up Policy, and if the outstanding Loan plus Loan interest exceeds the Surrender Value available
under the Policy as on that date, then ABSLI shall send a 90 days advance notice to the Policyholder. If Policyholder doesn’t
repay the Loan or fail to respond to the notice, ABSLI shall terminate the Policy.
e) The interest on Loan applicable on the Loan amount will be declared by the Company on June 1st of every calendar year and
is equal to the base rate of the State bank of India plus 100 basis points. The current Loan interest rate, applicable on June 1st
2023, is 11.10% p.a. (compounded) Any change in basis of determination of interest rate for Policy Loan can be done only after
prior approval of IRDAI.
f) Any payment due under the Policy on the death of the Life Insured, Survival or the Maturity Date or withdrawal of Accrued
Paid Up Additions, (if any) or as Surrender Value shall be reduced by any outstanding Policy Loan balance and interest thereon
at that time and the residual value shall be paid to the Nominee or Policyholder as the case may be.
g) The Company shall issue a Loan Statement to the Policyholder as and when required for the Loan against Policy.
h) You may repay all or part of Your outstanding Policy loan subject to the prevailing administration guidelines issued by the
Company.

7. Termination of Policy

Your Policy shall immediately and automatically terminate on the earliest occurrence of any of the following events:

a) On date of payment of Free Look cancellation amount; or

b) the date of payment of the Surrender Value; or
c) the date of settlement of the Death Benefit; or
d) end of the Benefit Payout Period; or
e) the date on which the revival period ends after Your policy has lapsed if fewer than two full years of premiums have been paid;
or
f) the date on which the Policy is terminated due to outstanding loan amount exceeds the surrender value in case of Reduced
Paid Up (RPU) Policy

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 13
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

PART E – POLICY CHARGES

This Policy is a non-linked non-participating individual life insurance savings plan and therefore, Part E is not applicable to this Policy.

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 14
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

PART F – GENERAL TERMS AND CONDITIONS

1. Contract

Your contract includes this Policy Document, the proposal for the Policy and any endorsements agreed upon in writing after the Policy
is issued. The contract also includes declarations given by the Policyholder and written statements and answers furnished as evidence
of insurability. We are bound only by statements that are part of the contract. Only our authorized officers can agree to any change in
the contract and then only in writing.

This contract can be issued in cases where the Life Insured is different from the Policyholder. In all situations, it is ensured that the
Policyholder has an insurable interest in the Life Insured. This contract does not provide for participation in the distribution of profits
or surplus declared by us.

All the communication/ documents including the Contract document will be sent to Your registered address. It shall be Your
responsibility to confirm Your address, email ID, mobile no, bank account details (contact information) or update any change in such
contact information. In the event of non- receipt of the Contract You should contact Our Customer Care Unit before expiry of the Free-
Look Period.

We encourage You to open E- Insurance Account. For more details on E-Insurance Policy, please visit our website or contact our
Relationship Manager.

In case of purchase of Policy by electronic mode through online or E-app, the Application form and Sales Illustration shall be validated
through One-time password (OTP) sent on Your mobile number/e-mail ID and undertaking obtained in the Client Declaration form if
any or through any other means as may be notified by the Company from time to time.

2. Suicide Exclusion

In the event of death of Life Insured due to suicide within 12 months from the Date of Commencement of Risk under the Policy or from
the date of Revival of the Policy, as applicable, the Policy shall terminate immediately and the Company shall pay the following to the
Nominee or beneficiary of the Policyholder, provided the Policy is in-force and all due Installment Premiums under the Policy have
been paid:
• Where the Policy has acquired the Surrender Value, higher of Surrender Value or (Total Premiums Paid plus underwriting extra
premiums paid plus loadings for modal premiums paid excluding applicable taxes) till date of death.
• Where the Policy hasn’t acquired the Surrender Value, Total Premiums Paid plus underwriting extra premiums paid plus loadings for
modal premiums paid excluding applicable taxes) till date of death.
3. Claim Procedures

The Policyholder/Nominee should notify the claim with proof of claim at the nearest Aditya Birla Sun Life Insurance Co. Ltd. branch
office or through our Customer Portal https://lifeinsurance.adityabirlacapital.com/customer-service/claim-procedure/online-claim or
to the 'Claims Department' at claimsnotification.lifeinsurance@adityabirlacapital.com and the claim documents to be simultaneously
sent at Aditya Birla Sun Life Insurance Company Limited, G- Corp Tech Park, 5th & 6th Floor, Kasar Vadavali, Near Hypercity Mall,
Ghodbunder Road, Thane (West) – 400601.

The claim is required to be intimated to us within a period of 90 days from the date of death. However, we may condone the delay in
claim intimation, if any, and the delay is proved to be for reasons beyond the control of the claimant. We will be able to proceed with
the claim intimation request only on receipt of the following mandatory claim documents:

For processing a Death claim under this Policy, we will require the following documents:

Mandatory Claim Requirements:

1) Claimant Statement Form
2) Death Certificate issued by Municipal Corporation/Gram Panchayat (Self attested copy)
3) Original Policy Document
4) KYC Document of beneficiary (Self attested copy)
5) Relationship of beneficiary with Life Insured
Aditya Birla Sun Life Insurance Company Limited
One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 15
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

6) Bank details of the beneficiary

Additional Requirements: (Claims within 3 years from date of issue/Revival)

1) Medical Attendant's Certificate, if any
2) Hospital or treatment records, if any (Self attested copy)
3) Employer's Certificate (if applicable)

Additional Requirements for Accidental/Unnatural Death:

1) FIR & Final Police Closure Report
2) Post mortem Report
3) Policy Inquest Report/Inquest Panchnama
4) News Paper Cutting (if any)

For processing Maturity claim under this Policy, Maturity proceeds shall be credited in Policyholder’s bank account as per the bank
details available in our records. In case of any change in the bank details You are requested to update the bank details by submitting a
request at the nearest Aditya Birla Sun Life Insurance Co. Ltd. branch office or through our website
https://lifeinsurance.adityabirlacapital.com/or Customer Portal or any other mode as allowed by the company.

Any other relevant information/ document as may be required by ABSLI depending on the circumstances of the death or illness needs
to be provided.

Beneficiary can download the claim documents from our website https://lifeinsurance.adityabirlacapital.com/or can obtain the
same from any of ABSLI branches. In case You are unable to provide any or all the above documents, in exceptional circumstances such
as a natural calamity, we may at our own discretion conduct an investigation/verification and accord a claim decision. For any further
queries, You can call us at our toll free no. 1800 270 7000 or email us at Aditya Birla Capital - Life Insurance
“claims.lifeinsurance@adityabirlacapital.com”

Claimant/Beneficiary may intimate Us about Death claim via the following ways:
• Online intimation through ABSLI Website (https://lifeinsurance.adityabirlacapital.com/)
• Through e-mail on claims.lifeinsurance@adityabirlacapital.com
• Visit nearest ABSLI Branch Office

4. Taxation

All Premiums are subject to Goods and Services tax (GST), other applicable taxes, cesses, and levies, if any which will entirely be borne
by You and will always be paid by You along with the payment of Premium. If any imposition (tax or otherwise) is levied by any statutory
or administrative body under the Policy, ABSLI reserves the right to claim the same from You. Alternatively, ABSLI has the right to
deduct the amount from the benefits payable by Us under the Policy.

Tax benefits and liabilities under the Policy may be available as per prevailing tax laws. Tax laws and the benefits arising thereunder
are subject to change. You are advised to seek an opinion of Your tax advisor in relation to the tax benefits and liabilities applicable to
You.

5. Currency and Place of Payment

All payments to or by us will be in accordance with the prevailing Exchange Control regulations and other relevant laws and regulations
of India. Indian Rupee (INR) is the currency of this Policy. We will make or accept payments relating to this Policy at any of Our offices
in India or such other locations as determined by Us from time to time.

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 16
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

6. Governing Laws

This Policy shall be interpreted in accordance with and governed by the laws of India and only competent courts at the place of issue
of this Policy shall have jurisdiction to entertain legal action.

7. Assignment

Allowed as per the provisions of Section 38 of the Insurance Act, 1938 as amended from time to time. For more details on the
Assignment, please refer to Annexure A.

8. Nomination

Allowed as per the provisions of Section 39 of the Insurance Act, 1938 as amended from time to time. For more details on the
nomination, please refer to Annexure B.

9. Forfeiture - Fraud and Mis-statement

Fraud and mis-statement would be dealt with in accordance with provisions of Section 45 of the Insurance Act, 1938, as amended from
time to time. For more details on Section 45 of the Insurance Act, 1938, as amended from time to time, please refer to Annexure C.

10. Loss of Policy Document

The Policyholder can make an application for duplicate Policy on payment of ₹ 250/- upon loss of Policy document along with other
requirements as may be prescribed by the Company.

11. Modifications

This Policy document constitutes the complete contract of insurance. This Policy document cannot be changed or varied except by a
written endorsement to the Policy, signed by an officer of the Company authorized for the purpose.

12. Legislative Changes

The terms and conditions under this Policy including the premiums and benefits payable are subject to variation in accordance with
the applicable laws and regulations.

Aditya Birla Sun Life Insurance Company Limited

One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road
Mumbai – 400013
Reg. No. 109 – Toll free no. : 1-800-270-7000 – Website: https://lifeinsurance.adityabirlacapital.com/
Corporate Identity Number: U99999MH2000PLC128110

Policy Contract V09_October 2023

Page 17
 PART G – GRIEVANCE REDRESSAL MECHANISM AND OMBUDSMAN DETAILS

Grievance or Complaint

You may register Your grievance or complaint with any of Our nearest branches or with Our Grievance Officer at Customer Care Unit, Aditya
Birla Sun Life Insurance Company Ltd., at G- Corp Tech Park, 5th & 6th Floor, Kasar Vadavali, Near Hypercity Mall, Ghodbunder Road, Thane
(West) – 400601 or at Company’s registered address at One World Centre, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat
Marg, Elphinstone Road, Mumbai – 400013. You may also lodge your grievance or compliant complaint with any of our nearest branches or
also call our toll free no. 1-800-270-7000 or on WhatsApp no. 8828800040 or email: email: care.lifeinsurance@adityabirlacapital.com
and for NRI Customers - absli.nrihelpdesk@adityabirlacapital.com

In case You are dissatisfied with the decision of the above office or have not received any response within 7 days, You may contact Head
Service Assurance at Customer Care Unit, / Aditya Birla Sun Life Insurance Company Ltd. / at G- Corp Tech Park, 5th & 6th Floor, Kasar Vadavali,
Near Hypercity Mall, Ghodbunder Road, Thane (West) – 400601 or at Company’s registered address at One Indiabulls Centre, Tower 1, 16th
Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai – 400013. You may also call Our toll free no. 1-800-270-
7000 (Timings: Daily 10 a.m. to 7 p.m.) on WhatsApp no. 8828800040 or email: grievance.lifeinsurance@adityabirlacapital.com
For senior citizens, we provide priority redressal of grievances and complaints. Please email us at:
ABSLI.SeniorcitizenLifeinsurance@adityabirlacapital.com

The complaint should be made in writing duly signed or through registered email by the complainant or by his/her legal heirs with full details
of the complaint and the contact information of complainant.

If You are not satisfied with the response or do not receive a response from Us within 15 days, You may approach the IRDAI’s Integrated
Grievance Management System (IGMS)on the following contact details:

IRDAI Grievance Call Centre Bima Bharosa Shikayat Nivaran Kendra (IGCC) TOLL FREE NO: 155255
Email ID: complaints@irdai.gov.in
You can also register your complaint online at
https://bimabharosa.irdai.gov.in
Address for communication for complaints by paper:
By Toll Free Number : 155255 or 1800 4254 732

Insurance Regulatory and Development Authority of India,

Policyholder's protection & Grievance Redressal Department – Grievance Redressal Cell.
4th Floor, Sy No. 115/1, Financial District,
Nanakramguda, Gachibowli, Hyderabad – 500032
Ph: (040) 20204000

Insurance Ombudsman
For redressal of Claims related grievances, claimants can also approach Insurance Ombudsman who provides for low cost, speedy arbitration
to customers.
The Ombudsman, as per Insurance Ombudsman Rules, 2017, can receive and consider complaints or disputes relating to the matters such as:

(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;
(d) Misrepresentation of Policy terms and conditions at any time in the Policy document or Policy contract;
(e) Legal construction of insurance policies insofar 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 resulting from the violation of provisions of the Insurance Act, 1938, as amended from time to time, or the
regulations, circulars , guidelines or instructions issued by IRDAI from time to time or the terms and conditions of the Policy contract,
in so far as they relate to issues mentioned at clauses (a) to (f).

As per provision 14(3) of the Insurance Ombudsman Rules 2017, the complaint to the Ombudsman can be made:
− only if the grievance has been rejected by the grievance redressal machinery of the insurer;
− within a period of one year from the date of rejection by the insurer; and
− if it is not simultaneously under any litigation.

Policy Contract V09_October/2023

Page 18
Risk Factors / Disclaimers

This Policy is underwritten by Aditya Birla Sun Life Insurance Company Limited (ABSLI) and is a non-linked non-participating individual life
insurance savings plan issued in accordance with the IRDAI (Non- Linked Insurance Products) Regulations 2019. All terms & conditions are
guaranteed throughout the Policy term. The remuneration payable to the intermediaries is in accordance to the IRDAI (Payment of
Commission) Regulations 2023 and as per Board-approved ‘Policy for Payment of Commission or Remuneration or Reward to insurance agent
and insurance intermediaries. ABSLI reserves the right to recover levies such as the GST levied by the authorities on insurance transactions. If
there be any additional levies, they too will be recovered from you. Tax benefits are subject to changes in the tax laws.

NOTWITHSTANDING ANYTHING CONTAINED IN THIS POLICY DOCUMENT, THE PROVISIONS HEREIN SHALL
STAND ALTERED, AMENDED, MODIFIED OR SUPERCEDED TO SUCH EXTENT AND IN SUCH MANNER AS MAY BE
REQUIRED BY ANY CHANGE IN THE APPLICABLE LAW (INCLUDING BUT NOT LIMITED TO ANY REGULATIONS
MADE OR DIRECTIONS / INSTRUCTIONS OR GUIDELINES ISSUED BY THE IRDAI) OR ANY OTHER COMPETENT
AUTHORITY OR AS MAY BE NECESSARY UNDER A JUDGEMENT OR ORDER /DIRECTION/ INSTRUCTION OF A
COURT OF LAW.

Policy Contract V09_October/2023

Page 19
Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

List of Ombudsman

Office Details Jurisdiction of Office (Union Territory, District)

AHMEDABAD - Shri Collu Vikas Rao Gujarat,
Office of the Insurance Ombudsman, Dadra & Nagar Haveli,
Jeevan Prakash Building, 6th floor, Daman and Diu.
Tilak Marg, Relief Road,
Ahmedabad – 380 001.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU – Shri Vipin Anand Karnataka.
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL – Shri R M Singh Madhya Pradesh
Office of the Insurance Ombudsman, Chattisgarh.
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR - Shri Manoj Kumar Parida Orissa
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in
CHANDIGARH - Shri Atul Jerath Punjab,
Office of the Insurance Ombudsman, Haryana (excluding Gurugram, Faridabad, Sonepat and
S.C.O. No. 101, 102 & 103, 2nd Floor, Bahadurgarh)
Batra Building, Sector 17 – D,
Himachal Pradesh, Union Territories of Jammu &
Chandigarh – 160 017.
Kashmir,
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274 Ladakh & Chandigarh.
Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI - Shri Segar Sampathkumar Tamil Nadu,
Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453, Puducherry Town and
Anna Salai, Teynampet,
Karaikal (which are part of Puducherry).
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in
DELHI - Ms. Sunita Sharma Delhi &
Office of the Insurance Ombudsman, Following Districts of Haryana - Gurugram, Faridabad,
2/2 A, Universal Insurance Building, Sonepat & Bahadurgarh.
Asaf Ali Road,
New Delhi – 110 002.

Policy Contract V09 _October/2023

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Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

Office Details Jurisdiction of Office (Union Territory, District)

Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in
GUWAHATI - Shri Somnath Ghosh Assam,
Office of the Insurance Ombudsman, Meghalaya,
Jeevan Nivesh, 5th Floor, Manipur,
Nr. Panbazar over bridge, S.S. Road, Mizoram,
Guwahati – 781001(ASSAM). Arunachal Pradesh,
Tel.: 0361 - 2632204 / 2602205 Nagaland and Tripura.
Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD - Shri N Sankaran Andhra Pradesh,
Office of the Insurance Ombudsman, Telangana,
6-2-46, 1st floor, "Moin Court", Yanam and
Lane Opp. Saleem Function Palace, part of Union Territory of Puducherry.
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR – Shri Rajiv Dutt Sharma Rajasthan.
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM - Shri G. Radhakrishnan Kerala,
Lakshadweep,
Office of the Insurance Ombudsman, Mahe-a part of Union Territory of Puducherry.
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in
KOLKATA - Ms Kiran Sahdev West Bengal,
Office of the Insurance Ombudsman, Sikkim,
Hindustan Bldg. Annexe, 4th Floor, Andaman & Nicobar Islands.
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in
Districts of Uttar Pradesh :
LUCKNOW - Shri. Atul Sahai
Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
Office of the Insurance Ombudsman,
Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
6th Floor, Jeevan Bhawan, Phase-II,
Jaunpur, Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao,
Nawal Kishore Road, Hazratganj,
Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,
Lucknow - 226 001.
Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti,
Tel.: 0522 - 2231330 / 2231331
Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar,
Fax: 0522 - 2231310
Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur,
Email: bimalokpal.lucknow@cioins.co.in
Chandauli, Ballia, Sidharathnagar.

Policy Contract V09 _October/2023

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Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

Office Details Jurisdiction of Office (Union Territory, District)

MUMBAI – Shri Bharatkumar S Pandya Goa,
Office of the Insurance Ombudsman, Mumbai Metropolitan Region
3rd Floor, Jeevan Seva Annexe, (excluding Navi Mumbai & Thane).
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in
NOIDA - Shri Bimbadhar Pradhan State of Uttaranchal and the following Districts of Uttar
Office of the Insurance Ombudsman, Pradesh:
Bhagwan Sahai Palace Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar,
4th Floor, Main Road, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad,
Naya Bans, Sector 15, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad,
Distt: Gautam Buddh Nagar, Firozbad, Gautambodhanagar, Ghaziabad, Hardoi,
U.P-201301. Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal,
Tel.: 0120-2514252 / 2514253 Amroha, Hathras, Kanshiramnagar, Saharanpur.
Email: bimalokpal.noida@cioins.co.in
PATNA - Ms Susmita Mukherjee Bihar,
Office of the Insurance Ombudsman, Jharkhand.
2nd Floor, Lalit Bhawan,
Bailey Road,
Patna 800 001.
Tel.: 0612-2547068

Email: bimalokpal.patna@cioins.co.in
PUNE - Shri Sunil Jain Maharashtra,
Office of the Insurance Ombudsman, Area of Navi Mumbai and Thane
Jeevan Darshan Bldg., 3rd Floor, (excluding Mumbai Metropolitan Region).
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in

Policy Contract V09 _October/2023

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Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

ANNEXURE A

Section 38 - Assignment and Transfer of Insurance Policies

Assignment or transfer of a Policy should be in accordance with Section 38 of the Insurance Act, 1938 as amended by the Insurance
Laws (Amendment) Act, 2015. The extant provisions in this regard are as follows:
a. This Policy may be transferred/assigned, wholly or in part, with or without consideration.
b. An Assignment may be effected in a Policy by an endorsement upon the Policy itself or by a separate instrument under notice
to the Insurer.
c. The instrument of assignment should indicate the fact of transfer or assignment and the reasons for the assignment or transfer,
antecedents of the assignee and terms on which assignment is made.
d. The assignment must be signed by the transferor or assignor or duly authorized agent and attested by at least one witness.
e. The transfer of assignment shall not be operative as against an insurer until a notice in writing of the transfer or assignment
and either the said endorsement or instrument itself or copy there of certified to be correct by both transferor and transferee
or their duly authorised agents have been delivered to the insurer.
f. Fee to be paid for assignment or transfer can be specified by the Authority through Regulations.
g. On receipt of notice with fee, the insurer should Grant a written acknowledgement of receipt of notice. Such notice shall be
conclusive evidence against the insurer of duly receiving the notice.
h. If the insurer maintains one or more places of business, such notices shall be delivered only at the place where the Policy is
being serviced.
i. The insurer may accept or decline to act upon any transfer or assignment or endorsement, if it has sufficient reasons to believe
that it is
i. not bonafide or
ii. not in the interest of the Policyholder or
iii. not in public interest or
iv. is for the purpose of trading of the insurance Policy.
j. Before refusing to act upon endorsement, the Insurer should record the reasons in writing and communicate the same in
writing to Policyholder within 30 days from the date of Policyholder giving a notice of transfer or assignment.
k. In case of refusal to act upon the endorsement by the Insurer, any person aggrieved by the refusal may prefer a claim to IRDAI
within 30 days of receipt of the refusal letter from the Insurer.
l. The priority of claims of persons interested in an insurance Policy would depend on the date on which the notices of assignment
or transfer is delivered to the insurer; where there are more than one instruments of transfer or assignment, the priority will
depend on dates of delivery of such notices. Any dispute in this regard as to priority should be referred to Authority.
m. Every assignment or transfer shall be deemed to be absolute assignment or transfer and the assignee or transferee shall be
deemed to be absolute assignee or transferee, except
1. where assignment or transfer is subject to terms and conditions of transfer or assignment OR
2. where the transfer or assignment is made upon condition that
i. the proceeds under the Policy shall become payable to Policyholder or Nominee(s) in the event of assignee or
transferee dying before the insured OR
ii. the insured surviving the term of the Policy. Such conditional assignee will not be entitled to obtain a loan on Policy
or Surrender the Policy. This provision will prevail notwithstanding any law or custom having force of law which is
contrary to the above position.
n. In other cases, the insurer shall, subject to terms and conditions of assignment, recognize the transferee or assignee named in
the notice as the absolute transferee or assignee and such person
i. shall be subject to all liabilities and equities to which the transferor or assignor was subject to at the date of transfer
or assignment and
ii. may institute any proceedings in relation to the Policy
iii. obtain loan under the Policy or Surrender the Policy without obtaining the consent of the transferor or assignor or
making him a party to the proceedings
o. Any rights and remedies of an assignee or transferee of a life insurance Policy under an assignment or transfer effected before
commencement of the Insurance Laws (Amendment) Act, 2015 shall not be affected by this section.

[Disclaimer: This is not a comprehensive list of amendments of the Insurance Laws (Amendment) Act, 2015 and only a simplified
version prepared for general information. Policy Holders are advised to refer to Original Act Gazette Notification dated March 23,
2015 for complete and accurate details. ]

Policy Contract V09 _October/2023

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Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

ANNEXURE B

Section 39 - Nomination by Policyholder

Nomination of a life insurance Policy is as below in accordance with Section 39 of the Insurance Act, 1938 as amended by the Insurance
Laws (Amendment) Act, 2015. The extant provisions in this regard are as follows:
1. The Policyholder of a life insurance on his own life may nominate a person or persons to whom money secured by the Policy shall
be paid in the event of his death.
2. Where the Nominee is a minor, the Policyholder may appoint any person to receive the money secured by the Policy in the event
of Policyholder’s death during the minority of the Nominee. The manner of appointment to be laid down by the insurer.
3. Nomination can be made at any time before the maturity of the Policy.
4. Nomination may be incorporated in the text of the Policy itself or may be endorsed on the Policy communicated to the insurer and
can be registered by the insurer in the records relating to the Policy.
5. Nomination can be cancelled or changed at any time before Policy matures, by an endorsement or a further endorsement or a will
as the case may be.
6. A notice in writing of Change or Cancellation of nomination must be delivered to the insurer for the insurer to be liable to such
Nominee. Otherwise, insurer will not be liable if a bonafide payment is made to the person named in the text of the Policy or in
the registered records of the insurer.
7. Fee to be paid to the insurer for registering change or cancellation of a nomination can be specified by the Authority through
Regulations.
8. On receipt of notice with fee, the insurer should grant a written acknowledgement to the Policyholder of having registered a
nomination or cancellation or change thereof.
9. A transfer or assignment made in accordance with Section 38 shall automatically cancel the nomination except in case of
assignment to the insurer or other transferee or assignee for purpose of loan or against security or its reassignment after
repayment. In such case, the nomination will not get cancelled to the extent of insurer’s or transferee’s or assignee’s interest in
the Policy. The nomination will get revived on repayment of the loan.
10. The right of any creditor to be paid out of the proceeds of any Policy of life insurance shall not be affected by the nomination.
11. In case of nomination by Policyholder whose life is insured, if the Nominees die before the Policyholder, the proceeds are payable
to Policyholder or his heirs or legal representatives or holder of succession certificate.
12. In case Nominee(s) survive the person whose life is insured, the amount secured by the Policy shall be paid to such survivor(s).
13. Where the Policyholder whose life is insured nominates his
(a) parents or
(b) spouse or
(c) children or
(d) spouse and children
(e) or any of them
14. If Nominee(s) die after the Policyholder but before his share of the amount secured under the Policy is paid, the share of the
expired Nominee(s) shall be payable to the heirs or legal representative of the Nominee or holder of succession certificate of such
Nominee(s).
15. The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance policies maturing for payment after the
commencement of the Insurance Laws (Amendment) Act, 2015.
16. If Policyholder dies after maturity but the proceeds and benefit of the Policy has not been paid to him because of his death, his
Nominee(s) shall be entitled to the proceeds and benefit of the Policy.
17. The provisions of Section 39 are not applicable to any life insurance Policy to which Section 6 of Married Women’s Property Act,
1874 applies or has at any time applied except where before or after the Insurance Laws (Amendment) Act, 2015, a nomination is
made in favour of spouse or children or spouse and children whether or not on the face of the Policy it is mentioned that it is made
under 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 the Insurance Laws (Amendment) Act, 2015 and only a simplified
version prepared for general information. Policy Holders are advised to refer to Original Act Gazette Notification dated March 23,
2015 for complete and accurate details.

Policy Contract V09 _October/2023

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Aditya Birla Sun Life Insurance
SecurePlus Plan
A non-linked non-participating individual life insurance savings plan POLICY CONTRACT

ANNEXURE C

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 the
Insurance Laws (Amendment) Act, 2015 are as follows:
1. No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3 years from
b. the date of issuance of Policy or
c. the date of commencement of risk or
d. the date of Revival of Policy or
e. the date of rider to the Policy
whichever is later.
2. On the ground of fraud, a Policy of Life Insurance may be called in question within 3 years from
a. the date of issuance of Policy or
b. the date of commencement of risk or
c. the date of Revival of Policy or
d. the date of rider to the Policy
whichever is later.
For this, the insurer should communicate in writing to the insured or legal representative or Nominee or assignees of insured,
as applicable, mentioning the ground and materials on which such decision is based.
3. Fraud means any of the following acts committed by insured or by his agent, with the intent to deceive the insurer or to
induce the insurer to issue a life insurance Policy:
a. The suggestion, as a fact of that which is not true and which the insured does not believe to be true;
b. The active concealment of a fact by the insured having knowledge or belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be fraudulent.
4. Mere silence is not fraud unless, depending on circumstances of the case, it is the duty of the insured or his agent keeping
silence to speak or silence is in itself equivalent to speak.
5. No Insurer shall repudiate a life insurance Policy on the ground of Fraud, if the Insured / beneficiary can prove that the
misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such
mis-statement of or suppression of material fact are within the knowledge of the insurer. Onus of disproving is upon the
Policyholder, if alive, or beneficiaries.
6. Life insurance Policy can be called in question within 3 years on the ground that any statement of or suppression of a fact
material to expectancy of life of the insured was incorrectly made in the proposal or other document basis which Policy was
issued or revived or rider issued. For this, the insurer should communicate in writing to the insured or legal representative or
Nominee or assignees of insured, as applicable, mentioning the ground and materials on which decision to repudiate the
Policy of life insurance is based.
7. In case repudiation is on ground of mis-statement and not on fraud, the premium collected on Policy till the date of
repudiation shall be paid to the insured or legal representative or Nominee or assignees of insured, within a period of 90 days
from the date of repudiation.
8. Fact shall not be considered material unless it has a direct bearing on the risk undertaken by the insurer. The onus is on insurer
to show that if the insurer had been aware of the said fact, no life insurance Policy would have been issued to the insured.
9. The insurer can call for proof of Age at any time if he is entitled to do so and no Policy shall be deemed to be called in question
merely because the terms of the Policy are adjusted on subsequent proof of Age of Life Insured. So, this Section will not be
applicable for questioning Age or adjustment based on proof of Age submitted subsequently.

[Disclaimer: This is not a comprehensive list of amendments of the Insurance Laws (Amendment) Act, 2015 and only a simplified
version prepared for general information. Policy Holders are advised to refer to Original Act Gazette Notification dated March 23,
2015 for complete and accurate details.]

Policy Contract V09 _October/2023

Page 25
 APPLICATION NO LA00110650 FORM ID 111001

Nature of Business/Duties Mission bhagirath d Designation Irrigation departmen Nature of Business/Duties Designation
epartment t
LIFE INSURANCE *Annual Income Rs 900000
*Annual Income Rs
*Proof is mandatory only where annualized 1 year premium acrossed all policies
*Proof is mandatory only where annualized 1 year premium acrossed all policies held by Single individual is > held by Single individual is > Rs. 1,00,000
Rs. 1,00,000
Aditya Birla Sun Life Insurance Company Ltd. Are you a registered person under GST Law Yes No
If not earning, state Parent's / Spouse's Annual Income Rs.
If yes provide your GST registration number
For Student/Non earning (Single), state Parents Insurance cover Rs.
(please share a copy of GST registration Certificate)
COMMON PROPOSAL FORM PROPOSAL NO: LA00110650 For House wife, state Spouse Insurance cover Rs.
IN UNIT LINKED POLICIES, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER
CA Ref A: CA Ref B: Are you a registered person under GST Law Yes ✔ No
If yes provide your GST registration number
Insurance Advisor No. ZK9160 Agency Mgr. No ZK9160 (please share a copy of GST registration Certificate)
Broker/Corp. Agent No. Specified Person -
Officer of CA/Initiator Code Please paste recent 3 AGE PROOF of Life to be Insured (Please self-attest)
For internal use

photograph(3cmx3cm) of the
proposer self-attested by Passport Pan Card Driving License Municipal Birth Certificate School / College Certificate
Broker Verifier Code CA Branch Code
him/her
Others
only

USM Code AAC742 Verifier Code

4 MANDATORY DETAILS IN ACCORDANCE WITH ANTI MONEY LAUNDERING GUIDELINES AS PRESCRIBED BY IRDAI

APPLICATION FOR INSURANCE ON OWN LIFE / ANOTHER LIFE AGE 18 years & ABOVE A Identification Proof of the Proposer (any one) Pan Card Passport Driving License Others
a) This form to be filled in BLOCK LETTERS WITH A BLACK PEN. b) Any cancellation/alteration in this form to be authenticated by the proposer and all documents
submitted with this Proposal Form must be self attested by the Proposer. c) Insurance contract is based upon utmost good faith between Insurer and the Insured B Address proof of the Proposer (any one) Voter Card Passport Driving License Others
which requires the Proposer and Life to be Insured to disclose all material facts. d) Please attach an extra sheet, where any additional information needs to be
given. Address Type ✔ Residential/Business Residential Business Registered Office Unspecified

1 LIFE to be INSURED 2 PROPOSER (if not the LIFE to be INSURED)

C Income Proof of the Proposer (any one) (mandatory only if total annual policy premiums to ABSLI is Rs. 1 Lac or above) ITR Others

Do you have an existing policy with ABSLI or have currently Yes ✔ No Do you have an existing policy with ABSLI or have currently Yes No D PEP - State whether the Proposer or the Life to be Insured or Nominee are Politically Exposed Person @ Yes ✔ No ✔ No
applied simultaneously If yes, please quote applied simultaneously If yes, please quote
Policy/Proposal Number/Client ID Policy/Proposal Number/Client ID E E PAN Card copy is mandatory along with the proposal form if the customer pays Rs. 50,000 or more in a financial year ~
Permanent Account Number (PAN) ROLPS0181C Permanent Account Number (PAN) @ PEP: "Individuals who are or have been entrusted with prominent public functions domestically or by a foreign country or by an international organization, for

ABHA Number (Ayushman Bharat Health Account) : ABHA Number (Ayushman Bharat Health Account) example Heads of State or government, senior politicians, senior government, judicial or military officials, senior executives of state-owned corporationsand important
political party officials OR Family members /close associates who are related or have business relationships with PEP's.".
Mobile Number 9177172550 Mobile Number
~ Form 60 is to be fil ed and signed by the person who is exempted from the requirement of PAN.
CKYC Number CKYC Number
FOR CORPORATE AND OTHER ENTITIES Please fil up and attach "Annexure - I" available separately, as required.
Title ✔ Mr. Mrs. Ms. Dr. Mx. Master Title Mr. Mrs. Ms. Dr. Mx. M/S.
5 ELECTRONIC INSURANCE ACCOUNT DETAILS of PROPOSER
First Name BATCHU First Name
Middle Name Middle Name e-INSURANCE A/C details (email address is mandatory) bachusatheesh806@gmail.com
Last Name SATHISH Last Name ✔ Yes No I would like to receive my insurance policy and all the information related to the proposed insurance policy through insurance repository.
Father/Spouse's Name Venkanna batchu Father/Spouse's Name If opted for the above, please submit requisite annexure with the proposer form
Date of Birth 15-03-1993 Date of Birth If you already have e-insurance A/C number, please provide the same
Country of Birth India Country of Birth e-insurance A/C No Repository Name Central Insurance Repository Limited
Gender ✔ Male Female Transgender Relationship with Life to be Insured Would you like to apply. If yes, please mention your preferred Insurance Repository (IR) KARVY NSDL ✔ CDSL CAMS
Marital Status ✔ Single Married Widowed Divorced Relationship If Other 6 ADDRESS for COMMUNICATION with PROPOSER # (all fields are mandatory)
Mother's Name Sambhamma Maiden's Name Gender Male Female Transgender
Address1 Batchu Satheesh , Amangal, Vemulapally mandal,
Nationality ✔ Indian NRI PIO Marital Status Single Married Widowed Divorced
Address2
FNIO Others Mother's Name Maiden's Name
Address3
Are you holding citizenship of any other country?* Yes ✔ No Nationality Indian NRI PIO
Area
If yes please provide country name FNIO Others
City/Town/Village NALGONDA
Are you a tax resident of any other country?* Yes ✔ No Are you holding citizenship of any other country?* Yes No
State TELANGANA Pin 508374
If yes please provide unique tax identification number If yes please provide country name Proof is mandatory only where annualized 1 year premium acrossed all policies held by Single individual is > Rs. 10,000
*If the response to any of the above questions is yes a detailed NRI questionnaire will Are you a tax resident of any other country?* Yes No Tel. No. Res./Office Alternate Mobile
have to be provided
If yes please provide unique tax identification number Email Address bachusatheesh806@gmail.com
Qualification Graduate Postgraduate & above ✔ Diploma
*If the response to any of the above questions is yes a detailed NRI questionnaire will
Your preferred language for communication (select only one)
12th 10th Below Uneducated have to be provided English Hindi Marathi Tamil ✔ Telegu
Pass Pass 10th Qualification Graduate Postgraduate & above Diploma
Occupation ✔ Service Professional Business Kannada Bengali Gujrati Malayalam Punjabi Others
12th Pass 10th Pass Below 10th Uneducated
Army/Navy/Police Skil ed Worker Retired Occupation Service Professional Business Details where we can send you updates regarding your policy, renewal reminders and ongoing services
Housewife Student Agriculture Army/Navy/Police Skil ed Worker Retired Please tick on the below box if you wish to receive the renewal reminders, policy statements, ongoing services, various notifications etc. in electronic form
Others Housewife Student Agriculture Do you wish to receive policy doucment in physical mode? ✔ Yes No
Name of Employer/Business Assistant executive engineer Others Do you wish to receive the renewal reminders, ✔ Yes No
Type of Organization ✔ Govt. Public Ltd. Private Ltd. Name of Employer/Business policy statements, ongoing services, various
Partnership Proprietorship HUF notifications etc in physical mode ?
Type of Organization Govt. Public Ltd. Private Ltd.
Trust Society NGO ✔ I request you to send my policy documents in electronic form at above email id.
Partnership Proprietorship HUF
Charity Trust Society NGO I request you to send information on my policy regarding renewal reminders, policy statements, ongoing services in electronic form at above email id and
Type of Proposal ✔ General HUF Keyman Whatsapp as a medium of communication.
Charity
Employer-Employee MWP Partnership # If the address of life insured is different than the proposer, please fil in the details in "Annexure for Life Insured Address" which forms part of proposal.

1 2

Page 26
 APPLICATION NO LA00110650 FORM ID 111001 APPLICATION NO LA00110650 FORM ID 111001

Transter Fund % % % %

7 PERMANENT ADDRESS for COMMUNICATION with PROPOSER (If different from communication address) (In increments of 5% with minimum of 5% and maximum of 100% in any fund option. Total must be 100%)

Address1 Batchu Satheesh , Amangal, Vemulapally mandal,

Address2
Address3 Self-Managed Option (In increments of 5% with minimum of 5% and maximum of 100% in any fund option. Total must be 100%)
Area
Liquid Plus % Income Advantage % Assure % Protector %
City/Town/Village NALGONDA Builder % Enhancer % Creator % Magnifier %
State TELANGANA Pin 508374 Capped Nifty Index % Asset Allocation % Maximiser % Multiplier %
Tel. No. Res./Office Alternate Mobile Super 20 % Pure Equity % Value & Momentum % MNC %
ESG % Small Cap Fund %
8 NOMINEE (under Section 39 of Insurance Act, 1938)
(Note: For the Segregated Fund Identification Number (SFIN) please refer the product brochure / leaflet or Benefit Illustration. You may also logon to our website www.adityabirlasunlifeinsurance.com
Nominee(if Life to be Insured and Proposer are the same person) If the above mentioned values are not legible, missed or mismatch found with proposal form, then values from Signed Benefit Illustration will be considered)

Sr Nominee Name Relationship with Life to be

Date of Birth (dd/mm/yyyy) Nomination Share*(in %) Riders ABSLI Waiver of Premium(applicable only if Life to be Insured and Proposer are same)
No. First Name LastName Insured
1 Venkanna Batchu 01-07-1974 Father 100 Name ABSLI
Sum Assured Rs.
Appointee (if Nominee is a minor --- Appointee cannot be Life to be Insured) 9 PURPOSE OF INSURANCE
First Name Policy Premium Rs. 129375.00 Instalment Premium Rs. 135196.88 Mode# A✔S Q M
Protection ✔ Savings Child's Education Child's Marriage
Last Name # Payout mode for Annuity Plan
Retirement Planning Legacy Planning
Gender Male Female Transgender 11 INSURANCE PLAN DETAILS
Date of Birth Others
For the below mentioned products, Simplified Proposal Form is mandatory
Relationship with Nominee

Premium Basic Premium /

10 INSURANCE PLAN details Policy Term (in Instalment Premium Sum Assured (in
Sr No. Product Name Paying Term (in Purchase Price* (in
years) / Payout* (in Rs.) Rs.)
Plan ABSLI SecurePlus Plan Option Option 1 Policy Term 10 years or Whole life years) Rs.)
Basic Premium Rs 129375.00 Pay Term 10 years or Regular Pay
Basic Sum Assured Rs 3225000.00 Income Benefit Term/Education Deferment Period 0 years 1 year 5 years 10 years *
applicable only in case of ABSLI Immediate Annuity Plan
Milestone Benefit Period Note: For every product mentioned in the above table, please provide a duly filled Simplified Proposal Form. All relevant details of the above mentioned products are captured in the
Income Variant Level Income with Level Income with Enhanced Increasing Income with Level Income with Return of Income Only Simplified Proposal Form. In case of any discrepancy in the above mentioned details and the ones provided in the Simplified Proposal Form, values from the signed benefit illustration
will be considered final.
Lumpsum Lumpsum Lumpsum Premium Benefit Benefit
Marriage Milestone 100% 150% 200% If you have an existing First Year Premiun Discount Income Enhancement 11 (a) PREMIUM PAYMENT DETAILS
benefit Multiple policy with ABSLI, choose
Payment Method Direct Bil NACH / Direct Debit Credit Card Salary Deduction Single Premium ✔ Others E-Mandate/E-NA
existing customer
CH
discount as (applicable
for ABSLI Nishchit Payment Mode Anually ✔ Semi-Annually Quarterly* Monthly* *not eligible for Direct Bil
Aayush Plan)
Initial Premium Rs. 135196.88 In case of NACH / Direct Debit, Preferred Draw Date 1st 8th 15th 22nd
*only applicable in case 'Education and Marriage Milestone Benefit' is chosen in ABSLI Child's Future Assured Plan
Top-up Premium Rs. (Incase date is not chosen, policy issuance date wil be considered as draw date)
Benefit Payout Period# 20 years 25 years 30 years Others, (please specify) 10 years
Total Amount Rs.
Benefit Income Income with Paid
Option# only Lumpsum Benefit
Benefit (Cheque / DD should be drawn on a local branch of a bank made payable to "ADITYA BIRLA SUN LIFE INSURANCE COMPANY LTD APP NO LA00110650")

Benefit Option~ Short Term Income Long Term Income Whole Life Income - ToAge 85 Whole Life Income - ToAge 100 Cash (upto Rs. 50,000) Cheque / DD No. Issuing Bank
Applicable for ABSLI Vision LifeIncome Plus Plan &ABSLI Akshaya Plan (Only Long Term & Whole Life Income Options applicable) & ABSLI Nishchit Aayush Plan (Only Long Term Income & Whole Life Income - To Age 100 Date Payable at (Branch)
Options applicable)B
You are requested to pay cash premium only at ABSLI branches or at authorised collection points and not to the advisor or employee. The company wil not be
Benefit Payout Frequency# Annual ✔ Semi-Annual Quaterly Monthly responsible for any loss in this regard.
# only applicable if chosen ABSLI Assured Income Plus Source of Funds ✔ Salary Business Income Others
Retirement Age^ 60 Years 65 Years 70 Years 75 Years Assured Benefit Payment Term 11 (b) POLICY PAYOUT DETAILS
Sum Assured Escalation Rate^ 5% 10% Sum Assured Reduction Factor^ 50% 25% Payment Mode ✔ NEFT ABSLI wil make payout(s) to the Proposer, in accordance and subject to the terms and conditions of the policy.
Enhanced Lifestage Protection^ Yes No ACI Benefit^ Yes No ACI Sum Assured Rs. Bank Name INDIAN BANK Bank Address MIRYALAGUDA
^only applicable in case of ABSLI DigiShield Plan Monthly Income^ Level Increasing @ 5% p.a Increasing @ 10% p.a. Account Holder's Name BATCHU SATHISH
(Income Escalation Rate) (Income Escalation Rate)$$
Account Type ✔ Saving Current Account No 7486268590
Plan Option$$ ✔ Life Cover Life Cover with ROP Fixed Income Cover Increasing Income Cover
IFSC Code IDIB000M305 (Mandatory)
Income Benefit Period$$
Please provide a cancelled blank cheque leaf. In case the cheque does not bear the pre printed name of the account holder /bank account number,we wil need
Terminal Illness Benefit$$
photocopy of the bank statement showing account holder name, address and account number. The bank statement has to be self attested by customer & attested
$$only applicable in case of ABSLI Salaried Term Plan by ABSLI authorized personnel. In case of any changes in the above bank details in future , please fil up the payout option form available separately along with
Purchase Price* Rs. Annuity Option* copy of cancelled cheque and submit the same at your nearest branch.

Increasing Sum 5% 10% (for applicable plans only) ABG EMployee/Partner Discount Yes ✔ No 12 INSURANCE HISTORY OF THE LIFE to be INSURED (Mandatory)
Assured
A Is there any concurrent application and any existing insurance on your life for Life / Health / Accident / Critical Illness and other riders Yes ✔ No
Enhanced Insurance 50% 100% 200% ABG Partner Name in effect with ABSLI and any other insurer in India or abroad? If Yes, give details.
Cover
*Mention year of Lapse/ Revival applied for
Investment Option LifeCycle Option Smart Option Risk Profile Conservative Moderate Aggressive
Return Optimser Option Policy /
Sum Assured (in Annual Premium (in Base Plan /Rider Medical Policy In Force /
Proposal Name of Insurer
Systematic Transfer Option Frequency Monthly Weekly Transfer Date 1st 8th 15th 22nd Rs.) Rs.) Decision (Y/N) Lapsed*
No
(Applicable only for monthly mode)

3 4

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 APPLICATION NO LA00110650 FORM ID 111001 APPLICATION NO LA00110650 FORM ID 111001

B Has any of your new proposal/ application for revival/reinstatement for life, accident, medical, health related insurance or riders or Yes ✔ No
critical il ness been refused, withdrawn, declined, postponed or offered with restricted benefits or with an increased premium or made
any claim under any such policy of insurance with ABSLI or any other insurer in India or abroad? If Yes, give details.

Name of the Insurer Sum Assured (in Rs.) Reasons

C Consent for sharing medical records with Other Insurers and TPAs through ABHA (Ayushman Bharat Health Account) (Life Yes No
Insured/Secondary Life) Details of treating
Doctor / Surgeon Date of Diagnosis Date of last Consultation
13 LIFESTYLE, PERSONAL AND MEDICAL DETAILS OF THE LIFE to be INSURED Question Exact Diagnosis and details of (Name, Qualification,
No. current symptoms Contact No.) and
A Personal Details List of medication being Details and date of hospitalization and surgery done
consumed currently
i (a) Height 170.18 cms Weight 50 kgs
(b) Is there any weight change during the past one year over 5 kg? Yes ✔ No
(c) Increase / Decrease Reason :
B Consent for sharing medical records with Other Insurers and TPAs through ABHA (Ayushman Bharat Health Account) Yes No
B LIFE STYLE INFORMATION & FAMILY MEDICAL HISTORY (Proposer/Primary Life)

i Do you intend to live or travel outside India for a period of more than 180days ? If Yes, submit appropriate questionnaire. Yes ✔ No 15 DECLARATION BY THE LIFE to be INSURED (and PROPOSER if not the Life to be Insured) These declarations would apply to the application for insurance and the
details as contained in the application for insurance duly filled and signed by the Life to be insured and proposer if not the life to be insured, through this
i Are you involved or do you intend to involve in any hazardous occupation or avocation? (for e.g. flying other than a fare-paying passenger, Yes ✔ No common proposal form and aforementioned supplemetary proposal form (s).
diving, mountaineering, working at heights, underground or offshore, using explosives or any other dangerous activity) If Yes, submit
appropriate questionnaire. I (we) authorize any medical practitioner, hospital, employer, institution or any other person, to disclose to Aditya Birla Sun Life Insurance Company Limited ("ABSLI")
any information relating to my health or employment now or at any time in the future.
i i Do you consume or have you ever consumed any narcotic substance? If Yes, give details. Yes ✔ No
I (we) understand and agree that no agent or medical examiner has the authority to waive or vary any stipulations or requirements set by ABSLI. I (we) understand
iv Do you consume alcohol ? If Yes, give details. Yes ✔ No and agree that the statements and answers given by me (us) during the medical examination (if any) to the medical examiner acting on behalf of ABSLI and any
other documents, medical reports and financial reports required in this application and simplified application (s) for insurance and addendum, if any, shall be deemed
Quantity per Have you ever been advised to stop consumption of the substance by a Physician? to be incorporated in this application.
Substance In the form of day | week | If Yes, specify the reason. I (we) agree and consent to ABSLI for seeking medical information from any doctor or from a hospital who at anytime has attended on the life to be
month insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to be assured/proposer and
seeking information from any insurance company to which an application for insurance on the life to be assured/proposer has been made and any other authorities
as may be required for the purpose of underwriting the proposal and/or claim settlement.
v Do you consume cigarettes/bidis/cigars or used any other tobacco/nicotine products in any form? If Yes, when was it last consumed Yes ✔ No
I (we) confirm that the premiums have not been and wil not be generated from proceeds of crime related to any of the offences listed in the Prevention of Money
Last 12 months During 13 to 60 months Before 60 months Laundering Act 2002 and any other applicable statutory provisions as may be in force from time to time.
Quantity per No. of Have you ever been advised to stop consumption of the substance by a I (we) have not made any statement to the agent, medical examiner or any other person associated with ABSLI, which in any way modifies the statements and
Substance In the form of answers in this application or the simplified applications for insurance and addendum, if any. I (we) are not involved in any criminal proceedings nor have any history
day years Physician? If Yes, specify the reason.
of conviction in India or abroad.
I (we) understand and agree that in case of any fraud or misrepresentation, the policy shall be treated in accordance with Section 45 of the Insurance Act, 1938 as
vi Has any of your parents, brothers or sisters been diagnosed with / suffering from / have died due to any hereditary or chronic disorder, heart Yes ✔ No amended from time to time.
ailment, stroke, high blood pressure/Hypertension, Diabetes, mellitus/High blood sugar, cancer, kidney disease, paralysis, other disease not
stated above prior to age 60? If Yes, specify details. I (we) understand and agree that ABSLI must be notified of any changes in my / our health and circumstances and any application of insurance with any other
insurer in India or abroad logged between the date of this application including the simplified applications for insurance submitted along with this common application
If deceased, age at and prior to the acceptance of the risk.
Age (if living) State of Health Cause of Death
death I (we) understand and agree that completion of this application, simplified application (s) submitted for insurance along with this application for insurance and further
Father 49 OK/Good addendums, if any, in no way implies that a policy / policies for insurance on the Life to be Insured wil be issued by ABSLI. Further, the application for insurance
Mother 43 OK/Good submitted through this form and along with this application of insurance as simplified application for insurance wil be underwritten and processed as separate
applications for insurance and issuance of any one of the application for insurance should not imply the issuance of the other applications of insurance. Each
14 MEDICAL HISTORY application as mentioned herein shall be underwritten and reviewed for processing and issuance / rejection separately and independently.

A Applicable for All Life Insurance Plans I (we) hereby declare that the contents of this application and the contents of the simplified applications for insurance submitted as a part of this common proposal
form have been fully explained to me including the significance of the proposed contract of insurance.
l) Have you remained absent from place of work on grounds of health for a continuous period of more than 10 days for reasons other than Yes ✔ No I (we) hereby declare that the particulars of the bank account details are true and correct and shall be made applicable for payout(s) if any under this applications
pregnancy, minor fracture, cold or flu? including the simplified application for insurance duly signed and submitted along with this application for insurance. I (we) hereby understand that the payout ( if any)
l ) In the past five years, have you ever undergone any surgical operation at a hospital or clinic or undergone any investigations with other than Yes ✔ No shall be received via NEFT mode against the details provided from my end in the proposal form.
normal or negative results (including X-rays, ECG, blood tests, biopsies etc.)? I (we) understand and agree that this proposal form containing my personal information wil be shared by ABSLI with its service providers for processing purpose
l l) Have you ever sought advice or suffered from any of the following? including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority for the
resulting policy only.
(a) Chest pain, low or high blood pressure, high cholesterol, heart attack, heart murmur or other heart disorders? Yes ✔ No
I (we) hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are
(b) Asthma, chronic cough, pneumonia, shortness of breath, tuberculosis (TB) or other respiratory or lung disorders ? Yes ✔ No true and complete in all respects to the best of my knowledge and that I/We am/are authorized to propose on behalf of these other persons.
(c) Diabetes / elevated blood sugar or sugar in the urine? Yes ✔ No I (we) understand that the information provided by me/us wil form the basis of the insurance policy, and is subject to the Board approved underwriting policy of the
(d) Ulcer, colitis, chronic diarrhoea, hepatitis or jaundice or other liver or any gastrointestinal disorders? Yes ✔ No insurance company and that the policy wil come into force only after full receipt of the premium chargeable.
(e) Cancer, tumour, abnormal growth, cyst, enlarged glands or enlarged lymph nodes? Yes ✔ No 16 SECTION 41 AND 45 OF THE INSURANCE ACT, 1938
(f) Dizziness / fainting spells, epilepsy, paralysis, stroke, mental/ psychiatric disorder or any other neurological disorder? Yes ✔ No
Section 41 of Insurance Act, 1938, as amended from time to time: No person shall allow or offer to allow either directly or indirectly, as an inducement to any
(g) Kidney, urinary, bladder, reproductive organ, prostate or any genitourinary disorders? Yes ✔ No person to take out or renew or continue an insurance in respect of any kind of risk relating to Iives 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
(h) Arthritis, gout or joint pain, muscle disorder, bone fracture or any other musculoskeletal disorders? Yes ✔ No
such rebates as may be allowed in accordance with the published prospectus or tables of the Insurer. Any person making default in complying with the provisions of
(i) Disorder of eyes (such as cataract, glaucoma etc.) or throat or ears? Yes ✔ No this section shall be punishable with a fine which may extend to ten lakh rupees.
(j) Any other il ness, surgery, ailment or injury which is specifically not mentioned above? Yes ✔ No Extract of Section 45 of the Insurance Act, 1938, as amended from time to time: No policy of Life Insurance shall be called into question on any ground
If any of question is answered as Yes, please submit the appropriate questionnaire whatsoever after the expiry of three years from the date of policy. A policy of life insurance may be called into question at any time within three years from the date of
policy, on the ground of fraud or on the ground that any statement of or suppression of a fact material to the expectancy of the life of the insured was incorrectly
lV) Do you have any congenital anomaly/disorder, physical defects, impairment, deformities and / or any condition affecting mobility, sight and / or Yes ✔ No made in the proposal or other document on the basis of which the policy was issued or revived or rider issued. The insurer shall have to communicate in writing to the
hearing? Insured or legal representative or nominees or assignee of the insured, the grounds and materials on which such decision is based. no insurer shall repudiate a life
V) Have you or your spouse received any medical advice, testing or treatment for any sexually transmitted disease or Hepatitis B or C? Yes ✔ No insurance policy on the ground of fraud if the insured can prove that the misstatement or suppression of 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 misstatement or suppression are within the knowledge of the insurer. In case of
VI) Do you have any health symptoms or complaints for which a physician has not been consulted or treatment received? (persistent fever, Yes ✔ No fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive. In case of repudiation of the policy on the ground of misstatement or
unexplained weight loss, loss of appetite, pain, swelling etc.) suppression of a material fact and not on the grounds of fraud, the premiums colected on the policy til the date of repudiation shall be paid. Nothing in this section
Vll) For female lives only: 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. For complete details of the section and
1) Are you pregnant? If Yes, number of weeks Yes ✔ No the definition of date of policy, please refer Section 45 of the Insurance Act, 1938, as amended from time to time.
2) Have you suffered from or do you have any gynaecological problems or il ness related to uterus / ovaries or breasts? Yes ✔ No
Dated 24-03-2024 Place NALGONDA IA / Broker / SP of CA Code: ZK9160

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Page 28
 APPLICATION NO LA00110650 FORM ID 111001
Life Insurance
MADHU BOPPANI Aditya Birla Sun Life Insurance Company Ltd.
Signature or Thumb Impression of the LIFE to Name of IA / Broker / SP of CA Code
be INSURED

Signature or Thumb Impression of the Signature of IA / Broker / SP of CA Code CELL1 CELL2

PROPOSER (if not Life to be Insured)

VERNACULAR DECLARATION ABSLI SecurePlus Plan - Your Benefit Illustration

A Non-Linked Non-Participating Individual Life Insurance Savings Plan
I, (full name of declarant) hereby declare that I have explained the contents of the proposal form to the Life to be Insured /
Proposer in language and that I have read out to the answers to the questions dictated by me to the Life Insured/Proposer and This shall form a part of the policy contract
that the Life to be Insured/Proposer has/have put his/her thumb impresssion after fully understanding the contents thereof.
Life Insured :Mr. BATCHU SATHISH Age : 31 Years Gender : Male

This benefit illustration is intended to show year wise premiums payable and benefits under the policy:
Name & Signature of Declarant Policy Details
UIN : 109N102V09 Annualized Premium : Rs 250000
I, BATCHU SATHISH (Proposer) confirm that I have been explained the contents of the proposal form in my language and the information recorded
Premium Payment Term : 10 Years Mode of Payment of Premiums : Semi-Annual
are as provided by me. I have fully understood the significance of the proposed contract for insurance Policy Term : 10 Years Benefit Payout Frequency : Semi-Annual
Benefit Payout Period : 10 Years GST Rate Year 1 : 4.5%
GST Rate Year 2 onwards : 2.25%
Signature/Thumb Impression of the PROPOSER/LIFE to be INSURED signing in vernacular language
Sum Assured Details
Sum Assured : Rs 3225000
Sum Assured on Death (at inception of policy) : Rs 3225000

Rider Details
Premium Payment Annualized
Rider Name Sum Assured Rider Term
Term Premium
ABSLI Critical Illness Rider (109B019V03) 0 0 0 0.00
ABSLI Surgical Care Rider (109B015V03) 0 0 0 0.00
ABSLI Hospital Care Rider (109B016V03) 0 0 0 0.00
ABSLI Accidental Death Benefit Rider Plus 0 0 0 0.00
(109B023V02)
ABSLI Wavier of Premium Rider (109B017V03) 0 0 0 0.00

Premium Summary (in Rs.) Base Plan Riders Total Installment Premium
Annualized Premium 250000 0 250000
Installment Premium before Modal 125000 0 125000
Loading (A)
Modal Loading Factor (B) 3.5% 0% 3.5%
Installment Premium without GST after 129375 0 129375
Modal Loading {(A*B) + A}
First years GST 5821.88 0 5821.88
Installment Premium including First Year 135196.88 0 135196.88
GST
Installment Premium including GST 2nd 132285.94 0 132285.94
Year onwards

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 NEED ANALYSIS AND PRODUCT SUITABILITY MATRIX

Amount in Rupees
Non CUSTOMER PROFILER
Guaranteed
Cumulative Guaranteed
Policy Annualized Single/
Year Premium Annualized Survival
Minimum
Special Name: Mr. BATCHU SATHISH Gender: Male
Income Loyalty Guaranteed
Premium* Benefit Death Benefit Surrender
Benefit (A) Addition (B)
(A) + (B)
Surrender
Value Proposer Date of Birth: 15/03/1993 Proposer Age: 31
Value
Occupation: Service PAN: ROLPS0181C
(BOY) (EOY) (EOY) (EOY) (EOY) (EOY) (EOY)
1 250,000 250,000 0 0 0 3,225,000 0 0 Marital Status: Single Investment Goal: Savings/Wealth Creation
2 250,000 500,000 0 0 0 3,225,000 150,000 150,000 Annual Income: Rs. 9,00,000 Proposer's Relationship with Same
3 250,000 750,000 0 0 0 3,225,000 262,500 262,500 Life Insured:
4 250,000 1,000,000 0 0 0 3,225,000 500,000 500,000
5 250,000 1,250,000 0 0 0 3,225,000 625,000 588,931 INVESTMENT RISK PROFILE
6 250,000 1,500,000 0 0 0 3,225,000 750,000 771,441
a.) Conservative (Not wil ing to risk capital & returns)
7 250,000 1,750,000 0 0 0 3,225,000 875,000 983,690
8 250,000 2,000,000 0 0 0 3,225,000 1,260,000 1,229,175 b.) Moderate (wil ing to bear minimal risk on returns but not on capital)
9 250,000 2,250,000 0 0 0 3,375,000 2,025,000 1,511,395 c.) Aggressive (wil ing to bear risk on capital & returns both)
10 250,000 2,500,000 0 0 0 3,750,000 2,250,000 2,795,746
11 0 0 291,550 149,419 440,969 0 0 0 EXISTING INSURANCE PORTFOLIO
12 0 0 291,550 149,419 440,969 0 0 0
13 0 0 291,550 149,419 440,969 0 0 0 Plan Type Sum Assured
14 0 0 291,550 149,419 440,969 0 0 0 ULIP
15 0 0 291,550 149,419 440,969 0 0 0
Traditional
16 0 0 291,550 149,419 440,969 0 0 0
17 0 0 291,550 149,419 440,969 0 0 0 Protection
18 0 0 291,550 149,419 440,969 0 0 0
Health
19 0 0 291,550 149,419 440,969 0 0 0
20 0 0 291,550 149,419 440,969 0 0 0
PRODUCT RECOMMENDATIONS BASIS GOAL
"BOY" = refers to cash flows payable at the "Beginning Of the Year", "EOY" = refers to cash flows payable at the "End Of the Year"
Notes:
(1) "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. I/We hereby certify that I/we believe that the product/s recommended by me/us above is suitable for the proposer, based on Savings/Wealth Creation
(2) "Total Premiums Paid" means total of all the premiums received, excluding the taxes, rider premiums, underwriting extra premiums and loadings for the information submitted by him/her, as recorded above.
modal premiums, if any. I/We declare that the policy recommended has been fully explained to the proposer, including about the terms and conditions, ABSLI SecurePlus Plan
(3) "Sum Assured" means a multiple, depending upon Life Insured’s age at inception of the Policy, of the Annualized Premium.
exclusions, premium commitments and various charges, as applicable.
(4) The Survival benefits (Income Benefit & Loyalty Addition) will be payable at the end of the period (monthly, quarterly, half yearly or annually) as per
the Benefit Payout Frequency chosen.
(5) In the event of death of the Life Insured during the Policy Term, Sum Assured on Death shall be payable. The Sum Assured on Death is the highest of: Agent/SP/Employee Name & Code Mr. MADHU BOPPANI - ZK9160 Date & Time 24/03/2024 19:14:27
• 150% of the Total Premiums Paid up to the date of death Agent/SP/Employee Signature ____________________ Place ____________________
• Sum Assured
In the event of death of the life insured during the Benefit Payout Period, the Survival Benefit will continue to be paid to the nominee/legal heir.
The above recommendation is based on the information provided by me. I have been explained about the features of the product and believe it would be suitable for
me based on my insurance needs and financial objectives.
Disclaimers
- The above information must be read in conjunction with the product brochure and policy document. I am not in agreement with the above recommendation and I have opted for the ABSLI SecurePlus Plan as per my wish.
- GST would be levied as per applicable tax laws.
Proposer Name Mr. BATCHU SATHISH Date & Time ____________________
Proposer Signature ____________________ Place ____________________

I, ….........., have explained the premiums and benefits I, ….........., having received the information with

under the policy fully to the prospect/policyholder. respect to the above, have understood the above
Place: statement before entering into the contract.
Date: Date:

______________________________________ ______________________________________
Signature of Agent/Intermedia/ Official Signature of Prospect/Policyholder

Prepared for: Dear Mr. BATCHU SATHISH

VO8 - 24/03/2024
For further details please refer to the product brochure.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Aditya Birla Sun Life Insurance Company Limited Reg. No. 109

Page 30
Page 31
 GRIEVANCE REDRESSAL PROCEDURE

At Aditya Birla Sun Life Insurance, it is our constant endeavour to ensure that your queries and concerns are resolved on priority.

In case you have any concern or complaint, please feel free to get in touch with us on the
contact points mentioned below:
 Call our toll free customer care number 1-800-270-7000 between 9 am to 9 pm, Monday
to Saturday
Step 1
or
 Please write to us at the address mentioned below
or
 Please email us at care.lifeinsurance@adityabirlacapital.com
or
 Visit our website www.adityabirlasunlifeinsurance.com and register your complaint

We will respond to you within 15 days from the date of receipt of your communication.

If our response is not as per your expectations please feel free to write to our Grievance
Redressal Officer (GRO) by visiting our website www.adityabirlasunlifeinsurance.com and
Step 2
the tab ‘register your complaint’

We will respond to you within 7 days from the date of receipt of your communication.

If our response is not as per your expectations please feel free to write to our Chief
Grievance Redressal Officer(CGRO) by visiting our website
Step 3 www.adityabirlasunlifeinsurance.com and the tab ‘register your complaint’
GRO contact number 022-39961116 GRO email id - gro.lifeinsurance@adityabirlacapital.com

We will respond to you within 5 days from the date of receipt of your communication.

For any correspondence addressed to Aditya Birla Sun Life Insurance, please write to us at:

Insurance Ombudsman
In case you are dissatisfied with the decision/resolution of the company, you may approach the Insurance Ombudsman located nearest to you
(please refer to the contact details mentioned at the end of this Policy Document or visit our website lifeinsurance.adityabirlacapital.com ) if your
grievance pertains to;

 Insurance claim that has been rejected or dispute of a claim on legal construction of the policy;
 Delay in claim settlement;
 Dispute with regard to premium; or

 Non-receipt of your policy document.

As per provision 14(3) of the Redressal of Public Grievances Rules 2017, the complaint to the Ombudsman can be made:
 Only if the grievance has been rejected by the grievance redressal machinery of the insurer;
 Within a period of one year from the date of rejection by the insurer; and
 If it is not simultaneously under any litigation.

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