Personal Information

1. Name(As appearing on PAN) : Ms. GAYATHIRI CHANDRASEKAR Applicant Photograph

2. Father's Name : CHANDRASEKAR
3. Permanent Account Number(PAN): DFZPC3949M
4. Gender : Female

5. Marital Status: Married

6. Full Name Before Marriage : CHANDRASEKAR
7. Date of Birth: 14-04-2005 Applicant Signature
8. Mobile Number: 9842475443
9. Residence Number: 9842475443
10. Email ID: chandranmahendran1970@gmail.com

11. Caste: GEN

12. Permanent Address

NO 3/23 MALAVARAYAR CHATHIRAM KEEZHAVALA DI VALADY PUDUKKUDI
Pin: 621218

13. Address for communication

I herewith confirm that Communication Address shared in application form is my current residence address and same is different from my
Permanent Address.
NO 3/23 MALAVARAYAR CHATHIRAM KEEZHAVALA DI VALADY PUDUKKUDI
Pin : 621218

Educational Details

14. Basic Qualification: Class X

Passing Details:
15. Roll Number : 4519235
16. Board / University : STATE BOARD
17. Year Passing : 08-2020
18. Professional Qualification : Graduate

Nomination Details

Name: Mr. CHANDRASHEKAR M

Date of Birth: 09-15-1960

Gender: Male

Percentage: 100%

Relationship with nominee: Father

Address: NO 3/23 MALAVARAYAR

621218

Is the sign of application in any language other than in English? : No

Bank Details

Bank Account Type: NEFT

Bank Account Number: 5233108001700

Bank IFSC Code: CNRB0005233

Account Holder Name as per Bank: GAYATHIRI C

Occupation Details

Employment Details

19. Whichever Applicable: Unemployed

20. Are Self employed? : No

21. Area Of Operation : Rural

22. Annual Income (Self + Spouse) : <1,00,000 Rs.

23. Do you hold agency with any Life/General Insurance company / Health /Mono line insurer (YES / NO) (If yes, please provide details) : None

24. Have you ever surrendered your license/agency or has your license/agency ever been cancelled : (YES / NO) (if yes, please give details along
with cessation certificate): No

25. Do you have any tie up with any other insurer as an employee or director or promoter Or hold any insurance activity related license or hold
any position with any Corporate Agent / Broker/ TPA / Insurance Marketing Firm/ any other insurance intermediary: (YES /NO) (if yes, please
give details): No

26. Are you one of the promoter or partner or director or employee in any firm or company which is associated with SBI Life Insurance Co Ltd?:
No

27. Are you associated/empaneled with SBI Life in capacity of a vendor Or employee of any such vendor Or landlord of any premises which is
rented to SBI Life?: No

28. Are you related to any employee of SBI Life Insurance Co. Ltd or State Bank of India (SBI)/any of SBI Associates: No

29. Whether you are ex-employee of SBI or its associate banks: No

Terms & Conditions on Appointment Of Insurance Agent

The Insurance Agent of the SBI LIFE INSURANCE COMPANY LTD, on his appointment as the Insurance Agent of the Company, has to strictly
adhere to the terms and conditions as laid down below and also as amended from time to time by the Company.

The SBI LIFE INSURANCE COMPANY LTD, [hereinafter called as the Company], incorporated under the Companies Act, 1956 for carrying on the
business of life insurance and is desirous of obtaining the services of the agent for the purpose of soliciting and procuring life insurance
business for the Company and for performing

such other functions which are incidental to his acting as an Insurance agent and as may be entrusted to him by the Company from time to
time, has framed the following terms and conditions to be strictly followed by its Insurance Agents.

The Agent, who holds a valid appointment letter to act as an Insurance Agent of the Company, has to strictly follow the following terms and
conditions:

1. Definitions:

The following words and expressions used in terms & conditions shall have the meaning assigned to them as under and any words or
expressions used herein but not defined shall have the meaning assigned to them in the Insurance Act, 1938, the Insurance Regulatory and
Development Authority Act, 1999 or the rules and regulations made under those enactments.

a) “Act” means the Insurance Act, 1938;

b) “Unit Manager” means the employee of the Company under whose supervision and control the Agent is for the time being placed;

c) “Agent” means the person appointed to act as an Insurance agent of the Company in terms of this Agreement;

d) “Company” means the SBI Life Insurance Company Limited;

e) “IRDAI” means the Insurance Regulatory and Development Authority o f I n d i a established under the IRDA Act;

f) “IRDA Act” means the Insurance Regulatory and Development Authority Act, 1999 (41 of 1999).
 g) “Rules and Regulations” means the rules and regulations made under the Act and the IRDA Act and include the orders, directives,
circulars, guidelines and notifications issued by the IRDAI from time to time.

2. Appointment:

The appointment of Insurance Agents shall be subject to the review conducted by SBI Life Insurance Co. Ltd from time to time, except for
termination due to fraud or non-performance.

a) The terms and conditions shall govern the appointment of an Agent for the purposes of soliciting and procuring life insurance
business (“business”) for the Company in such areas as may be determined by the Company and notified to the Agent and to perform
such other functions as are incidental to his acting as an Insurance Agent and as may be entrusted to him by the Company from time to
time. The Agent has to accept the said appointment and the terms and conditions governing such appointment and the agent will be
designated as “Insurance Agent”.
b) The Agent shall not solicit or procure business from person resident outside of the area notified to him/her.
c) The appointment of the Agent in the area mentioned in clause 2(a) shall not preclude the Company from appointing any other person
or persons to act as insurance Agent or Corporate Agent of the Company in such area; nor shall such appointment abridge or derogate
from the obligations of the Agent under the terms & conditions laid down here.
d) The Company may, at its sole discretion, decide on the Insurance products for which the Agent may solicit and procure proposals and
to change, add or discontinue any such product at any time.
e) Agency appointment may be refused to the applicant if he/she does not fulfill any of the conditions prescribed for appointment of
insurance agents.
f) An applicant aggrieved by the decision of refusal to grant agency appointment, may submit a review application to VP – Channel
Administration for review of the decision.

3. Obligations of the Agent:

During the tenure the Agent shall serve the Company as an Insurance Agent with all due and proper diligence, act dutifully and in good faith,
observe all instructions given by the Unit Manager or generally by the Company to all it’s Insurance Agents, as to his activities as an Insurance
Agent of the Company, and use his best endeavors in the discharge of his obligations under these terms and conditions.

a) Without prejudice to the generality of the foregoing and, in particular, the Agent shall fulfill such minimum business requirements and
persistency criteria as may be prescribed by the Company from time to time, in the matter of procurement of new life insurance business,
premium income, number of lives to be assured, number of policies to be sold or in the matter of conversation and preservation of
business or in relation to policy- servicing. Agent’s appointment is liable for termination for not meeting the requirements/criteria as may
be defined and communicated by the Company from time to time.

b) In order to satisfactorily discharge his obligations under these terms and conditions, the Agent shall fully familiarize himself with all
the insurance products offered for sale by the Company including the rate of premium charged for each such product, and the policies
and practices followed by the Company in the matter of customer service and conservation of business.

c) The Agent shall not allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue
an insurance policy, any rebate of the whole or part of the commission payable to him or otherwise, except as may be allowed under the
Rules and Regulations, of the premium shown on the policy.

d) The Agent shall familiarize himself with all the statutory requirements as may relate to the discharge of his obligations as an
Insurance Agent and shall fully conform to, comply with and observe and follow such requirements and in the event of his/her failure to
do so, the Agent shall be personally liable for all consequences thereto and shall also indemnify the Company in respect of any loss or
injury caused to or suffered by it as a result of such failure.

e) The Code of Conduct as prescribed by Clause VIII of the IRDAI Guidelines on Appointment of Insurance Agents, 2015 dated March 16,
2015 and/or as amended from time to time, any statutory modification or substitution thereof and any Code of Conduct as prescribed by
the Company shall be deemed to have been set out in and be part of these terms and conditions. The Agent shall scrupulously follow
and comply with the same. The Code of Conduct is incorporated in the letter of appointment issued to you by the Company.

f) Without prejudice to the generality of the obligations under Clause 3.5, and in particular the Agent shall strictly observe, conform to and
comply with the, requirements in relation to customer service, insurance advertisements and on any matter relating to Insurance Agents
as prescribed by the Rules & Regulations for insurance agents, from time to time.

g) All communications and all information whether written, verbal or visual and all other material supplied to or obtained by the Agent in
the course of or as a result of the discharge of his obligations under these terms and conditions and all information in relation to any
particular assurance obtained by him as Agent shall be treated by the Agent as confidential and shall not be disclosed by him to any third
party without prior written consent of the Company.

h) The Agent shall hold in trust for the company any application, report, form, security or other property received by him in the course of
his duties as the Agent of the Company and shall, dispatch, makeover to the Company all such applications, reports, forms, securities or
other properties within twenty four hours of such receipt excluding public holidays. The Agent shall not have the authority, either
expressed or implied to receive any payment except the premium towards proposal deposit from the public on behalf of the Company. If,
however, the agent receives any payment whatsoever, the same shall be remitted to the company within 24 hours of its receipt. Under no
circumstances, shall the payment made to the agent be deemed to be a payment made to the Company.

i) The Agent shall attend all meetings, conventions, workshops or the like called for by the Company and shall also observe, follow and
comply with any directive or direction, issued by the Company generally in relation to its insurance agents or with particular reference to
the Agent.
 j) The Agent shall keep true, full and correct records of all the transactions entered into by him as Agent of the company, and if so
required by the Company, furnish for its inspection (including making of copies thereof) all or any such records, early.

k) During the continuance of his Agency, the Agent will engage in activities as an Insurance Agent exclusively of the Company and not of
any other insurer carrying on life insurance business or in soliciting or selling of even other than insurance products or products, which
are similar to or identical to the insurance products of the Company. The Agent also undertakes not to have any tie up with any other
insurer as an employee or director or promoter and not to hold any insurance activity related license or hold any position with any
Corporate Agent/ Broker/ TPA / Insurance Marketing Firm/ any other insurance intermediary.

l) The Agent has no authority to and shall not take part in any dispute or institute or defend any proceedings or settle or attempt to settle
or make any admission concerning any dispute, proceeding or other claim relating to the business or affairs of the Company except with
the prior written permission of the Company.

m) If so required by the Company, the Agent shall open and maintain a bank account in his own name (only) to which the Company may
credit the commission, remuneration or reward or any other amount due and payable to the Agent. All the expenses for opening and
maintaining the account shall be borne by the Agent.

n) The Agent shall indemnify and keep indemnified the Company against loss or injury or costs or expenses suffered or incurred by the
Company in consequence of any act or omission of the Agent tantamounting to a breach of these terms and conditions.

o) Nothing in these terms and conditions or otherwise shall entitle the Agent to make any representation or warranties on behalf of the
Company or to enter into any contract or agreement on behalf of the Company or bind the Company in any manner whatsoever by his/her
acts of commission or omission.

p) The Agent covenants with the Company that he is qualified to act as an Insurance Agent under law and does not suffer any
disqualification rendering invalid his appointment as Agent.

4. Remuneration:

As consideration for soliciting and procuring insurance business for the Company the Agent shall be paid by way of commission /
remuneration on such scale as may be notified by the Company from time to time subject to IRDAI Regulations or Guidelines issued and/or the
Company’s Board approved policy for ‘Appointment of Insurance Agents’.

The commission / remuneration shall be payable to the Agent only for life insurance business procured by him which results in policies issued
by the Company and not in respect of any incomplete or invalid transaction or proposal.

Subject to the Rules and Regulations, The Act and the IRDA Act, the Company shall have absolute freedom to revise the scale of commission
in respect of one or more of the insurance products offered for sale by the Company, provided that the Agent shall be given notice of not less
than 30 days of such revision through one or more methods of communication generally employed by the Company for internal
communication. The revised rates shall be made applicable prospectively and shall not be applicable to policies issued in pursuance of
proposals already registered with the Company, unless otherwise, stipulated by the Act, the IRDA Act or Rules and Regulations.

In the event of any change in the scale of commission, brought about by reason of amendment/changes/issuance of the Rules and
Regulations or the Act or the IRDA Act or the Company’s Board approved policy for ‘Appointment of Insurance Agents’, the Company’s liability
to pay commission to the Agent in respect of any policies issued by it shall be limited to what is permissible under such law, rules, regulations,
order or directive.

The Agent shall not be entitled to any commission in respect of the sale of a policy effected through him which is declared null and void by the
Company for any reason or which has been cancelled for any reason whatsoever.

Payment of commission or remuneration or reward to Insurance Agents shall be made as per the Reward & Recognition schemes designed
and approved by the Company from time to time with an objective to appropriately incentivize high performance. The above payments will be
subject to limits prescribed as per extant applicable Guidelines/Regulations issued by IRDAI from time to time.

Where so ordered by a court of law or a statutory or other authority who is empowered by law to so order, the Company may withhold or retain
the commission or remuneration or reward or any other amount due and payable to the Agent or to recover and remit to such court or statutory
or other authority the amount so ordered to be remitted.

All payments made to the Agent shall be subject to deduction of taxes as per the applicable tax laws.

The Company shall pay the standard renewal commission as prescribed in the product even in case of his agency getting cancelled in
accordance with the Company’s Board approved policy on ‘Appointment of Insurance Agents’, provided the agent is eligible for such renewal
commission as per the prevailing rules, regulations and policies. However, the Company reserves the right to forfeit commission in certain
cases like fraud, forgery, misconduct, etc. on grounds of disciplinary action as approved by the disciplinary authority of the Company.

In case of unfortunate event of death of an Agent, hereditary commission will continue to be paid to the nominee or heirs of the Agent for so
long as such commission would have been payable had the Insurance Agent been alive, in accordance with the Company’s Board approved
policy on ‘Appointment of Insurance Agents’ subject to the guidelines, rules and regulations of the IRDAI and the Company..

The Company reserves the right to recover any commission, remuneration or reward paid wrongly, or in excess of what is due and payable to
the Agent from any amount due and payable to the Agent.
Without prejudice to the generality of what is stated in the above clause, the Company shall have the absolute right to recover or retain from
any amount due and payable to the Agent, any commission, remuneration or reward paid to him under one or more of the following situations:

a) Where any policy issued in pursuance of a proposal procured by the Agent is declared null and void by the Company.
b) Where any cheque or other instrument tendered or any payment effected through the ECS or similar mode of payment towards
premium is dishonored or as the case may be reversed or countermanded for any reason;
c) Where a policyholder cancels a policy by exercising the “Free Look Option”. Explanation: For the purpose of this clause “Free Look
Option” shall mean the option referred to in sub regulation (2) of Regulation 6 of the Insurance Regulatory and Development Authority
(Protection of Policyholder’s Interest) Regulation 2002.
d) W here the Company has been directed to repay or refund any premium paid under a Policy on account of any order, judgment or
direction of any court, Tribunal, Consumer forum or Insurance Ombudsman or where the Company is satisfied that such repayment or
refund is in the best interest of the Company.
e) If any Policy issued in pursuance of a proposal proceed by the Agent is allowed to lapse within months of its issue
f) Where on a complaint by a Policyholder, the Company or, as the case may be, a court, tribunal or other authority empowered by law to
adjudicate the complaint, holds that the Policyholder has been sold a Policy not opted for by him or under a plan of insurance different
from or on terms other than those agreed to by him, resulting in the cancellation of the Policy, the Company shall be entitled to recover
from the commission, remuneration or reward or any other amount due and payable to the Agent, the commission paid to him in respect
of that Policy, besides withdrawing the credit of the business allotted to the Agent for any other purpose in relation to the said Policy.

5. Suspension or Cancellation of Agency:

As per terms and conditions laid down here, Company holds the rights to suspend or cancel the appointment in any of the following events:-

5.1 Suspension or cancellation of Appointment:

Appointment may be suspended or cancelled after due notice and after giving the Agent reasonable opportunity of being heard:--
a) where the Agent does not hold a valid appointment letter;
b) where the appointment to act as an Insurance Agent issued to the agent is cancelled for any reason; upon the death of the Agent;
c) where a petition to declare the Agent as an insolvent is presented to a court of competent Jurisdiction;
d) where on account of any change in law the operation of these terms and conditions has become unlawful;
e) where the Company is convinced that the Agent is guilty of an act involving moral turpitude and that it would reflect poorly on the fair
name or the conduct of affairs or of business of the Company;
f) where the Agent is convicted of an offence and sentenced to any term of imprisonment by a court of competent jurisdiction.
Note: - The fact that the Agent has preferred an appeal against such conviction or sentence shall not derogate from the operation of this
provision during the pendency of such appeal. Further that the Agent has been acquitted in any proceeding or in any appeal initiated
against him on a compliant made to or by the Company shall not entitle him to claim any compensation or damages against the
Company
g) violates the provisions of the Insurance Act,1938, Insurance Regulatory and Development Authority Act, 1999 or rules or regulations,
made there under as amended from time to time;
h) attracts any of the disqualifications mentioned in Guidelines/Regulations issued by IRDAI from time to time..
i) fails to comply with the code of conduct stipulated in the Company’s Policy for Appointment of Insurance Agents and notified from
time to time.
j) violates terms of appointment.
k) fails to furnish any information relating to his/her activities as an agent as required by the Company or the Authority;
l) fails to comply with the directions issued by the Authority;
m) furnishes wrong or false information; or conceal or fail to disclose material facts in the application submitted for appointment of
Agent or during the period of its validity.
n) does not submit periodical returns as required by the Company/Authority;
o) does not co-operate with any inspection or enquiry conducted by the Authority;
p) fails to resolve the complaints of the policyholders or fails to give a satisfactory reply to the Authority in this behalf;
q) On failure to perform any other duties or obligation lawfully required of him or under these terms and conditions generally as an
insurance agent of the Company,
r) Where there is allegation of fraud, dishonesty or misdemeanor against the agent by any policy holder of the Company or an officer or
employees of the Company.
s) Further the Company shall also have the right to suspend/cancel the agency if the Company feels that the continuation of the agency
may be against the public interest

Where the suspension / cancellation of the appointment of the Agent is being contemplated or is in process, or pending enquiry into the
allegations of fraud, misappropriations etc against the Agent, the Company may, by notice in writing, direct the Agent not to procure
business or to perform his functions as the Agent of the Company for such period as may be specified. Any breach by the Agent of any
such direction shall, besides disentitling the Agent to any remuneration for any business brought in by him during the period of operation
of prohibition or for any other benefit pertaining to such business, also be construed as a breach of this terms and conditions. W here,
however, the Company does not initiate or proceed with the termination , the Agent shall not be entitled to any compensation or damages
on the ground of loss of business or of profit or on any other ground whatsoever in respect of any such direction as is referred to above
against the Company.

5.2 Manner of holding enquiry before/after suspension of appointment of the Insurance Agent:
a) The appointment of an Insurance Agent shall be cancelled only after an enquiry has been conducted in accordance with the procedure
specified by Guidelines/Regulations issued by IRDAI from time to time.
b) For the purpose of holding an enquiry, the Company may appoint an Officer as an Enquiry Officer within 15 days of the issue of the
suspension order;
c) The Enquiry Officer shall issue a show cause notice to the Insurance Agent at the registered address of the insurance agent calling for
all information / data as deemed necessary to conduct the enquiry and grant the insurance agent a time of 21 days from date of receipt
of the show cause notice, for submission of his/her reply and such information / data called for;
d) The insurance Agent may, within 21 days from the date of receipt of such notice, furnish to the enquiry officer a reply to the Show
cause notice together with copies of documentary or other evidence relied on by him or sought by the Enquiry Officer;
e) The Enquiry Officer shall give a reasonable opportunity of hearing to the insurance agent to enable him to make submissions in
support of his/her reply;
f) The Insurance Agent may either appear in person or through any person duly authorised by him to present his case, provided however
that the prior approval of the Company is obtained for the appearance of the ‘Authorised Person’;
 g) If it is considered necessary, the Enquiry Officer may require the Company to present its case through one of its officers;
h) If it is considered necessary, the Enquiry Officer may call for feedback/information from any other related entity during the course of
enquiry;
i) If it is considered necessary, the Enquiry Officer may call for additional papers from the Insurance Agent;
j) The Enquiry Officer shall make all necessary efforts to complete the proceeding at the earliest but in no case beyond 45 days of the
commencement of the enquiry
k) Provided that in case the enquiry cannot be completed within the prescribed time limit of 45 days as mentioned in (10) above; the
enquiry officer may seek additional time from the Company stating the reason thereof;
l) The Enquiry Officer shall, after taking into account all relevant facts and submissions made by the Insurance Agent, shall furnish a
report making his/her recommendations to the Designated Official. The Designated Official shall pass a final order in writing with
reasons. The order of designated official shall be signed and dated and communicated to the agent.

5.3 Procedure for Cancellation of Agency:

On the issue of the final order for cancellation of agency of the Insurance Agent, the agent shall cease to act as an Insurance Agent from
the date of the final order. Registration of new business by the suspended/cancelled agent will be stopped.

5.4 Effect of suspension/cancellation of Agency appointment:

On and from the date of suspension or cancellation of the agency, the Insurance Agent, shall cease to act as an Insurance Agent.
a) The Appointment letter and Identity card has to be submitted to the Company by the agent whose appointment has been cancelled by
the Company within 7 days of issuance of final order effecting cancellation of appointment.
b) The Company shall black list the agent and enter the details of the agent whose appointment is suspended/cancelled into the black
listed agents database maintained by the Authority and the centralized list of agents database maintained by the Authority, in online
mode, immediately after issuance of the order effecting suspension/cancellation. Further, the Company also reserves the right to display
the order of suspension/cancelation of appointment of Insurance Agent on its W ebsite.
c) In case a suspension is revoked in respect of any agent on conclusion of disciplinary action by way of issuance of a speaking order by
Designated Official, the details of such agent shall be removed from list of black listed Agents as soon as the Speaking Order revoking
his/her suspension is issued.
d) The Company shall also inform other insurers, Life or General or Health Insurer or mono line insurer with whom he/she is acting as an
agent, of the action taken against the Agent for their records and necessary action.

5.5 Appeal Provision:

An agent who is aggrieved by the order of cancellation can appeal to the Company within 45 days of the order. The Company shall
appoint an Appellate Officer who shall examine the appeal and give his decision in the matter in writing within 30 days of receipt of the
appeal.

5.6 Procedure to be followed in respect of resignation/surrender of appointment by an Insurance Agent:

a) In case an insurance agent appointed by the Company wishes to surrender his agency with the Company, he/she shall surrender his
appointment letter and identity card to the designated official of the Company.

b) The Company shall issue the cessation certificate as detailed in Form 1-C within a period of 15 days from the date of resignation or
surrender of appointment.

c) An agent who has surrendered his appointment may seek fresh appointment with other insurer. In such a case, the agent has to
furnish to the new insurer all the details of his/her previous agency and produce Cessation Certificate issued by the previous insurer
issued in Form I-C, along with his agency application form.

d) Upon the cancellation of the Agency as per terms and conditions, the Agent shall not for a period of ninety days thereafter solicit or
procure, directly or indirectly, any life insurance business for any other life insurance company or be engaged, in any manner, in any
competing activity against the Company.

Upon the cancellation of the Agency as per the terms and conditions, the Agent shall forthwith return to the Company all materials (including
printed materials) and stores belonging to the Company which are in his possession or custody. On the neglect or failure of the Agent to do so,
the Company shall be entitled, without being accused of trespass, to enter any premises occupied by the Agent for the purpose of recovering
such materials and stores.

Upon the cancellation of the Agency as per terms and conditions, the Agent shall not in any manner represent himself as the Agent of the
Company.

Upon the cancellation of the Agency as per terms and conditions, the Company shall be at liberty to publish notices of such cancellation in any
newspaper or other publications or to communicate the same together with the grounds for such cancellation to the policyholders, other
offices and Agents of the Company or to any other insurance Company or to the general public and of the fact that the Agent is not
empowered to act for or on behalf of the Company or bind or represent the Company in any manner whatsoever.

6. Agent not an employee:

Nothing in this terms and conditions shall imply or be construed to constitute the relationship between the Company and the Agent as
anything other than that of an insurer and Insurance Agent.

It shall not be open to the Agent to raise any claim of being an employee of the Company or for preference in the matter of recruitment to the
service of the Company.

7. MISCELLANEOUS:
As per these terms and conditions, unless the context requires, words importing the singular shall include the plural and vice-versa and words
importing a gender shall include every gender and reference to persons shall include bodies incorporate and unincorporated. These terms and
conditions shall be operative from the date of appointment of the agent and binding on them.

No waiver, alteration, variation or addition to this laid terms and conditions shall be effective unless made in writing on or after the date of
appointment and / or otherwise accepted by the Agent and the authorized representative of the Company.

The Company shall have a first lien upon all sums payable to the Agent in respect of any indebtedness of the Agent to the Company. The
Company is entitled to set off, adjust or otherwise recover from the moneys due and payable to the Agent all such sums as are due to the
Company, on account of such indebtedness of the Agent, including any indebtedness arising out of breach of any covenants as per terms and
conditions on appointment of Agent.

The interpretation, construction and effect of any of the provisions of these terms and conditions on appointment of Agent laid down by the
Company and amended time to time shall be final and binding on the Agent.

All notices, documents, consents, approvals or other communications (“Notice”) to be given hereunder shall be in writing and shall be
transmitted by registered post or by facsimile or other electronic means in a form generating a record copy to the party being served at the
relevant address for that party. Notice sent by mail shall be deemed to have been duly served not later than four working days after the date of
posting. Any Notice sent by facsimile or other electronic means shall be deemed to have been duly served at the time of transmission (if
transmitted during normal business hours at the location of the recipient and if not so transmitted then at the start of normal business hours
on the next day which is a business day for the company).

If any term or provision in these terms and conditions on appointment of Agent shall be held to be illegal or unenforceable, in whole or in part,
under any enactment or rule or law, such term or provision or part shall to that extent be deemed not to form part of these terms and
conditions but the validity and enforceability of the remainder of these terms and conditions shall not be affected.

The waiver or forbearance or failure of the Company in any one or more instances upon the performance of any provisions of these terms and
conditions on appointment of agent shall not be construed as a waiver or relinquishment of the Company’s rights and the Agent’s obligations
in respect of due performance of obligations shall continue in full force and effect.

The Agency shall be governed by all the related regulations, Acts and Statutes besides these terms and conditions. These terms and
conditions shall not substitute any of the statutory provisions but they are in addition to the statutory provisions governing the appointment of
Insurance Agents.
 Conditions Applicable To Nomination

• A Nomination will not be effective unless it is communicated to SBI Life Insurance Co Ltd and registered by SBI Life Insurance Co Ltd.

• Any change in Nomination shall be duly informed to SBI Life Insurance Co Ltd and registered by it in its records. SBI Life Insurance Co
Ltd shall not be liable in any manner whatsoever for payment made to the registered nominees as per its records.

• By registering a nomination , SBI Life Insurance Co Ltd makes no admission and expresses no opinion whatsoever as to the validity or
effect of the nomination , it being understood that the parties satisfy themselves as to the form of nomination and all other points
relating to the nomination before sending it to SBI Life Insurance Co Ltd .

• By registering a nomination, SBI Life Insurance Co Ltd does not Admit any liability for payment of commission or any other sum in the
event of death of the Insurance Advisor.

• The liability of SBI Life Insurance Co Ltd for payment of commission or any other sum in the event of death of the Insurance Advisor
would be determined solely by the fact of whether the said Insurance Advisor is qualified for such payment in accordance with the laws
in force in India and the applicable regulations at the time of his/ her death
PAN Document
 ப ேவ எ / Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:25/06/2025

காய .ச
Gayathiri. C
D/O Chandrasekar
NO 3/23
MALAVARAYAR CHATHIRAM
KEEZHAVALADI
VTC: Pudukkudi
PO: Valady
District: Tiruchirappalli
State: Tamil Nadu
PIN Code: 621218
Issue Date:19/09/2012

Signature Not Verified

Digitally signed by
Sandeep Bhardwaj
Date: 2025.06.25
19:13:50 IST

XXXX XXXX 4511

கவ :
காய .ச D/O ச ரேசக , எ 3/23, மழவராய
Download Date:25/06/2025

Gayathiri. C ச ர , ழவாளா , ,
Issue Date:19/09/2012

ற த நா /DOB: 14-04-2005 ரா ப ,
ெப / FEMALE த நா , 621218
Address:
D/O Chandrasekar, NO 3/23,
MALAVARAYAR CHATHIRAM,
KEEZHAVALADI, Pudukkudi, PO: Valady,
Dist: Tiruchirappalli,
Tamil Nadu, 621218

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Basic Qualification Document
Others Document
 Declaration to be signed by the applicant

“I hereby agree to abide by the terms and conditions of Appointment as an Insurance Agent.”

I hereby declare that :-

a) The information/details furnished herein are true to the best of my knowledge and belief. I further declare that I have not suppressed
or concealed any detail sought herein.
b) I have not been found guilty of criminal misappropriation or criminal breach of trust or cheating or forgery or an abetment of or
attempt to commit any such offence by a court of competent jurisdiction.
c) I have not been found guilty of or to have knowingly participated in or connived at any fraud, dishonestly or mis-representation against
an insurer or an insured in the course of any judicial proceeding relation to any policy of insurance or the winding up of an insurance
company or in the course of an investigation of the affairs of an insurer and
d) I undertake to inform SBI Life of any change in the above information.
e) I authorise the company to verify, check, investigate and share or reveal any or all the information provided by me in this application to
any other person or insurer or entity or authority as the company may deem fit,.
f) The terms & conditions mentioned in the application form are acceptable to me and shall abide by the same.
g) I hereby agree that if any information/details provided herein is found by the company to be misstated or concealed, the company may
take any action deemed fit, including but not limited to denial of appointment as an agent and if subsequently detected after granting
agency or appointment as an Agent, initiate such penal actions which the company may deem fit which may include [ but not limited to ]
levy of Financial Penalty or Suspension / Cancellation of my appointment.
h) I hereby give my voluntary consent to SBI Life Insurance Company Limited (SBI Life) and authorize the Company to obtain necessary
details like Name, DOB, Address, Mobile Number, Email, Photograph through the copy of Aadhar card/QR code available on my Aadhar/
XML file shared using the offline verification process of UIDAI or Aadhar Number/Virtual ID, Name, Date of Birth, Fingerprint/Iris and my
Aadhar details used for authentication either through Yes/No authentication facility or e-KYC facility in accordance with the Aadhar
(Target Delivery of Financial and other Subsidies , Benefits and Services) Act, 2016 and all other applicable laws/regulations. I
understand that this information shall be used by SBI Life only for KYC purpose. I have duly been made aware that I can also use
alternative KYC Options like CKYC or documents like Passport, Voter’s Identity Card, Driving License, Identity Card with Applicant
photograph issued by State/Central Govt. Dept./Statutory/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial
Banks and Public Financial Institutions and other similar documents in lieu of Aadhar for the purpose of completing my KYC formalities. I
understand and agree that the details so obtained shall be stored with SBI Life and shared solely for the purpose of carrying out
necessary due diligence for appointment as an Insurance Agent and to meet regulatory requirement. Further I understand, my biometrics
will not be stored/shared by SBI Life. I will not hold SBI Life or any of its authorized officials responsible in case any incorrect information
is provided by me.
i) I hereby authorize SBI Life to provide/receive my details to/from banks, financial institutions, third party service providers the company
may have tie-ups with for verification of the information provided by including the bank account provided by me for payment of
commission.
j) I hereby give my consent to SBI Life to use my mobile number 9842475443 for sending One Time Password(OTP) for authentication
purposes and I hereby agree and consent that the authentication through OTP verification will be considered as my signature on the
agency application form and there is no need for my physical signatures on these documents once OTP based authentication is done.
k) I authorise SBI Life & its other related partners associated with Appointment of Insurance Agent to use my mobile number & email id
for sending alerts through SMS, WhatsApp, email and letter for communication regarding appointment as an Insurance Agent and other
related communication.