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L. i. C. cF INDIA
.,.,ar: llr-f: EAZ6R
',,-..i:i .il.iAL - 906007
fife Jnsuronce Corporotion of Tndio
THE LIFE INSURANCE CORPORATION OF INDIA (hereinafter called "the Corporation")'having received a Proposal
and Declaration and the first premium from the Proposer and the Life Assured named in th.e Schcdr-r1e and tl're said Proposal
and Declaration rvith the statements contained and referred to therein having been agreed to try the said Proposer and the
Corporation as basis of this assurance do by this Policy agree, in corrsideration of and subject to the due receipt of the
subsequent premiums, to pay the benefit/s without interest, at the Branch Office of the Corporation where this Policy is
serviced, to the person eir persons to whom the same is payable in terms of the said Schedule, on proof to the satisfaction
of the Corporation of the benefit/s having become payable, of the title of the said person or persons claiming payment and
of the correctness of the age of the Life Assured stated in the Proposal if not previously admitted. The premiums and
benefitls payable are set out in the Schedule shown herein-belorv.
And it is hereby declared that this Policy of Assurance shall be subject to the Conditions and Privileges printed on
the .back hereof and that the following Schedule and every endorsement piaced on the l'olicy by the Corporation shall be
deemed part of the Policy.


Poiicy Nc.
Ij.rtt' of
Death Bencfit (Rs.) ' M.rturity Benefit (Rs.)
' Lrsi.rlmcrrt
Due Dcte, I\lo.Jc crr,l l).rtc of Lrrst l,.rrnr,,rrt I ffil
Cr'rlrolr,rl.cnlt,nt Prt,rnitrrn (Rs.) I
3. Date t,f Nlaturrty Table & Term .\8e, lVlrctlter aijmittcd, Date of tsirtlr
1. Dl!" 9! tlggy of Freg !r,sgqange_c91g1llt.l*.":lr.:l 1"". (R:) __l
"8; 100 Uol- zs?oa.-
a+l- 28th sss 2q'.Lt.L9 |
ffi1 -

j**#+-i ffi.
2L Y n1.08.73
29.11Pa 19 L11-:5
t" 1l:^,;-:"
Nomirree under Section 39 of the lnsunuce Act,

$nt. D. Bhlgva* t{Sth'

31" j Z,q 4
i ffi':1
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sr1. r$vitl I{arsjmh:, sw6n.'4iffiry4t o'il.ii",jr,,," I

O1O. OI)"r.t j on, AF -EBrN t_V.
AAE f1r,p1,5q,1 111d I

Bt.'r,Tfli*?':ouBe$n') t* Lir'r '\ssrr:cd


The event on the happoning of If tire policy is infu1l force one of tire benefits (A) or (B) defincd hcrein-below,
rviiich berrefits are payabie will be prcvidcd sul:ject to the conditions mentioned herein.
A) Benefis on Death: A sum equal to the Death Benefit n'ith Loyalty A,idition (as
mentioned in condition 9 of the "conditiorx & privilege.s" prilted on ther back
of the policy) pavabie on the death of t1're Life Assured before the stiprdatt,d
Date of Maturity.
B) .srrrv.rril B.e,tr'l;l / ['ra, lnsurtnc,' Cot,, :

(i) Survival Btnefii : In tire eve.i'Lt of the Life Assured surviving the
Dattr of
Ivlaturity, a stun rqual to the Nleturity Benefit i.e. total alnount of prernir,rlrs
paid excl-rdirrg rll extr;r pre'niirrnrs iogcthcr rvith Loyaltv Addition sl'i.;1, re
(ii)Free Lusurance Cover: On the Life Assurtd the stip'.rlartcl Date
of l\laturity, Frco Lr:.urance Cover (rvithout Accide.nt iienelit) rvill Lre
grar-itr..d, in casr- of dclth of thc l.ife Assured, within a pc.i'iod irf 1i) years
from the L)ate of ltlatr:i'itv.
To rvhom Benefits are payabic Tire l'ropciser or his assiglx or i{rrrlrin(,cs rurier 5cc.i9 of rlic rtlsur}r1!( 1\tt ot
Frrovirrg Exccutors or .Adurinisiratols or othcr Legal Rtl.i-tsclltativr-s rvho should
take otrt rcpresellt2rtiolr tu his e::tate or limitccl to the monel,s prayalde ulcier iiils
Policv frr-m any corut of an',,, State or Territory of tlit: Union of Ildia.
Perir-,d dtuing rvhich premium pavalde T11l thc stipuiah:d tlate of Last Py-g Tll::1I1! g,iiih C,|lry 1tu 1=:1
Dates lv-heir premitrm payablc
Spccial Provisions
On thr' stipriiatcti dui: rlate in. w€rywF rfh

Signed on behaif of ihe Ccrporation at tbe al:,o..c itre;itioneci Branch Office

?1,.. tE,$ lqq5

Tab1eNo. 111
txamineo : .t--\
{.\ E}r-
Fcrm No. 8115 p.!ir. 7r Brn1]r:1t li,li'r tr ;:g:,1'