New_Policy Document 25-05-18

YOUR POLICY KIT


























































Protection Solutions
Tata AIA Life Insurance
Sampoorna Raksha

Non Linked Non Participating Term Assurance Plan

Your policy kit includes



• Policy Contract

• Policy Benefits

• Key Features

• First Premium Receipt

• Term & Conditions

• Proposal Form

• Benefit Illustration



We are always there to listen to you



18602669966
[email protected] sms HELP to 5676799 www.tataaia.com
local charges apply

Mr. ABC Malholtra
Landscape CHS Ltd. Ghodbunder Road, Thane
(West) - Pin: 000000 Phone No.: 9199999 99999
e-mail id: [email protected]


Dear Mr. ABC,
We are delighted to welcome you to Tata AIA Life family and thank you for choosing us as your life insurance partner
to protect the financial well-being of your loved ones.
Your policy is of utmost importance for you and your loves ones, and thus it’s important for us to help you understand
your policy better. This policy kit explains all features, benefits and terms and conditions of your policy in detail. We
request you to please read all the details carefully.

Plan Name: Tata AIA Life Insurance Sampoorna Raksha Inception Date:
Policy No.: Next Premium Amount: Rs. 25,000
Sum Assured: Next Premium Date: 10/05/2019
Nominee Name: Payment Frequency: Yearly

Things to remember
 Please read “Policy Information Page” carefully and check for all your personal details are correctly captured
such as Name, Address, Date of Birth etc.
 Please go through “Key Featured Document” and “Frequently Asked Questions” to understand the benefits
available to your under this policy.
 Please inform us if your Mobile Number and/or E-mail ID mentioned above is incorrect or needs to be updated.
 Keep our contact details our (given on the back of cover page) handy.

 Explain all relevant details of this policy to your nominee.
Free Look Period

If You are not satisfied with the terms & conditions/features of the Policy, You have the right to cancel the Policy by
giving written notice to Us signed by You and received directly by Us within 15 days after You or person authorized
by you receives the Policy. This period of 15 days shall stand extended to 30 days, if the policy is sourced through
electronic or distance marketing mode*.
*Distance Marketing includes every activity of solicitation and sale of Insurance products through any means of
communication other than in person.
We look forward to a long and cherishing relationship with you.
Best Wishes,

Naveen Tahilyani
Managing Director and CEO

First Premium Receipt


Name:
Policy Number: C000000000000
Life Insured: Receipt Date:

Policy Holder: Agent Name:
Address of Policy Holder: Agent Code:
Branch Code:






Payment Mode: Payment Method:
Basic Plan Name: Premium Amount: Rs.
GST: Rs.
Rider Name (if any): Total Premium Due: Rs



Receipt No. Date Amount (Rs.)
TataCXXX0000XX 15-Jun-2018 50,000






Next Premium Due on:
Next Premium Due Amount: Rs.
Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. Any excess premium will be
deposited in Future Policy Deposit Fund (FPDF). The amount lying in FPDF shall not bear any interest and will be adjusted towards future premiums (if any)
Tax benefits** on life insurance policies u/s 80C, on Pension u/s 80CCC & Health Policies / Health Riders u/s 80D of Income Tax Act, 1961.
Tax benefit u/s 80D is not available for premium payment in cash.
Tax benefits u/s 80CCC and 80D are not available for premium payment through automatic loans from Cash Value of the policy, if any, as per the policy
provisions.
This is a computer generated receipt and does not require signature
This receipt is null and void ab initio, if the cheque / any other valid negotiable instrument as per the Negotiable Instruments Act, 1881, as receipted by the
Company vide this receipt, is reported as dishonored by the Company’s bank or any other Financial Institution on which the Negotiable Instrument is drawn or is
not acceptable to the company due to any reason deemed fit by the Company.
* All taxes, duties, surcharge, cesses or levies, (including but not limited to Service Tax and TDS), as may be imposed by Government or any statutory authority
from time to time, on the premiums payable and benefits secured under Policy, shall be borne and paid by the Policy holder.
Registration Number: AABCT3784CST001
Category of Service: Life Insurance Service and / or Management of Investment under ULIP Services
** Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfilment of conditions stipulated therein. Tata AIA Life Insurance
Company Ltd. does not assume responsibility on tax implication mentioned anywhere in this document.
Please contact your own tax consultant to know the tax benefits available to you.
Consolidated Revenue Stamp Duty paid vide challan no. MH007310906201617M dated on 3rd January, 2017

Policy Information Page


THIS DOCUMENT MUST BE READ WITH THE ACCOMPANYING POLICY DOCUMENT AND IS PART OF THE LIFE INSURANCE CONTRACT
Name of Policy: Tata AIA Life iRaksha Supreme (UID: 110N131V01)
Policy Type: Non Linked Non Participating Term Insurance Plan
Policy No.: C155714649

Policy Holder Details Life Insured Details
Name of Policy Holder : Amogh Jawa Name of Policy Holder : Amogh Jawa
Date of Birth : 06/12/1995 Date of Birth : 06/12/1995
Gender: Male Gender: Male
Client ID of Policy Holder : C10193993 Client ID of Policy Holder : C10193993
PAN : BHEPJ3898R Age : 22 yrs
Address : A-26, Naraina Vihar, Age Admitted : Yes
This and That lane, Address : A-26, Naraina Vihar
New Delhi, Delhi – 110028 This and That lane,
Mobile No. : 9752096867 New Delhi, Delhi – 110028
Email Id : [email protected] Mobile No. : 9752096867
Relationship with life insured : Same Person Email Id : [email protected]
Relationship with life insured : Same Person
Policy Details
Sum Assured (R) : 1,00,00,000.00 Mode of Premium Payment : Annual
Income Term : 30 yrs Premium Paying Term : 10 yrs
Policy Term : 40 yrs Next Premium Due Date : 14/07/2030
Date of Commencement of Policy : 12/07/2029 Annualised Premium (Excl. taxes) (R) : 1,62,000.00
Date of Commencement of Risk : 12/07/2029 Modal Premium (Excl. taxes) (R) : 1,62,000.00
Date of Maturity of Policy : 12/07/2069 Taxes, Cesses & Levies (R) : 1,543.00
Total Modal Premium (Incl. taxes) (R) : 1,67,543.00

Nominee Details (under section 39 of the Insurance Act 1938) Appointee Details (Applicable incase the nominee is a minor)
Name of Nominee : Sanskriti Jawa Name of Appointee : NA
Age : 53 Date of Birth of Appointee : NA
Relationship with Life Insured : Mother Age : NA
Nomination % : 100% Relationship with Appointee : NA

Base Plan/Rider Sum Assured Modal Premium Maturity Date Date of Last Term (Years) Premium Payment
(R) (Incl. taxes) (R) Premium Payment Term (Years)
Tata AIA Life Insurance
Gold Income Plan 1,00,00,000.0 1,67,543.0 14/07/2069 14/07/2029 40 10
Tata AIA Life Insurance
Waiver of Premium Plus (WOPP) 1,50,000.0 35,000.0 14/07/2039 14/07/2029 10 5
Rider (UIN 110B029V01)

Bene ts Payable
Maturity Bene t (R) 4,00,000.00
Total Income Bene t Post Maturity (R) 80,00,000.00
Death Bene t (R) 1,00,00,000.00
Special Provisions
1. Premium includes staff discount of 0% for the1st year
2. The premium has been charged extra for medical / occupation / NSAP loading amount of 0

Other Endorsements

Key Feature Document


This document helps you understand the key features available under the plan adopted by you. This document is not a substitute for the
policy contract. Please carefully go through all the details in the life insurance policy contract accompanying this document.

Policy Name Tata AIA Life Insurance iRaksha Supreme (UIN: 110N104V02)
Policy at a Glance This is a fully online Pure Term Insurance Plan that provides financial protection against the unfortunate
demise of the life insured. The coverage is available up to the age of 80 years with the option of Regular,
Single or Limited premium paying term.
Eligibility Criteria Only self-proposed policies allowed on individual lives
Entry Age 6 to 65 years for Limited Pay of 5 years (GIP)
(age as on last birthday) 3 to 55 years for Limited Pay of 12 years (GIP)
Maximum Maturity Age 77 years for Limited Pay of 5 years (GIP)
(age as on last birthday) 70 years for Limited Pay of 12 years (GIP)
Premium Payment Mode Annual / Half Yearly / Quarterly
Death Benefit In case of the unfortunate demise of the life insured, provided the policy is still in force and all due
premiums have been paid, the Sum Assured on Death as defined below, shall be payable:
Death benefit will be the highest of the following:
a) Sum Assured
b) 10 times the annualized premium
c) 105% of the Total Premiums Paid
Refer to pt. B.1.1 in Policy Terms and Conditions
Maturity Benefit There is no maturity or survival benefit provided under this policy.
Refer to pt. B.1.2 in Policy Terms and Conditions
Surrender Benefit a) Surrender Benefit is not applicable under Regular Pay Policies
b) Policies can be Surrendered any time after commencement of policy in case of Single Pay Policies
c) Policy can be surrendered provided all 3 and 7 years premium have been paid for 5 and 10 year Limited
Pay policies
Refer to pt. E.2 in Policy Terms and Conditions
Paid-up Benefit In case of non-payment of premiums within the grace period, the policy will acquire a Paid-up Value,
provided full 3 and 7 year premiums have been paid for 5 and 10 year Limited Pay Policies. Paid up benefit
is not available under Regular Pay policies.
Refer to pt. E.1 in Policy Terms and Conditions
Free Look Period You have the right to cancel the policy, by following required procedure and submitting the documents,
within 30 days after you receive the policy document.
Refer to pt. C.15 in Policy Terms and Conditions
Grace Period A grace period of 30 days from the due date, for all modes, will be allowed for payment of each subsequent
premium. The policy will remain in force during this period. At the end of the grace period, if any premium
remains unpaid, the policy shall lapse.
Refer to pt. D.4 in Policy Terms and Conditions
Policy Revival If a premium is in default beyond the grace period, it may be reinstated / revived, within two years from the
due date of the first unpaid premium and before the date of maturity, subject to the required procedures.
Refer to pt. D.6 in Policy Terms and Conditions
Policy Loan (GIP) Policy Loan is available in Tata AIA Life Insurance Gold Income Plan provided that the policy
acquired Surrender Value, you may apply for a Policy Loan for such an amount, within the extent of 80%
of Surrender Value.
Refer to pt. D.7 in Policy Terms and Conditions
Rider (GIP) You have further flexibility to customize your product by adding the following riders:
a) Tata AIA Life Insurance Accidental Death and Dismemberment (Long Scale) (ADDL) Rider
(UIN: 110B028V01)
b) Tata AIA Life Insurance Waiver of Premium Plus (WOPP) Rider (UIN: 110B029V01)
The riders can be attached only at policy inception.
Claims You can visit the nearest Tata AIA Life Branch or contact us on the details provided in the document.
Refer to pt. C.10 in Policy Terms and Conditions
Exclusion In case of death, due to suicide by the insured, whether sane or insane, within 12 months from the policy
issue date or date of commencement, the nominee shall be entitled to the relevant benefits, provided the
policy is in force.
Refer to pt. C.4 in Policy Terms and Conditions
Complaints You can visit the nearest Tata AIA Life Branch or contact us on the details provided in the document.

Claim Requirement




Requirements for Hospitalization & Requirements for Disability and Requirements for Death Claim
Critical Illness Claim Dismemberment Claim (all causes of Death)

Claim Forms Claim Forms Claim Forms
Part I: Application Form for Hospitalization/ Part I: Application Form for Disability/ Part I: Application Form for Death Claim
Critical Illness Claim (Claimant's Statement) Dismemberment Claim (Claimant's Statement) (Claimant's Statement) along with NEFT form
along with NEFT form along with NEFT form
Part II: Physician's Statement - to be lled
Part II: Con dential Medical Report -to be Part II: Con dential Medical Report -to be by last attending physician
lled by attending physician lled by attending physician
Death Certi cate issued by a local
Hospital Bills for the con nement. Attested True Copy of Indoor Case Papers government body like Municipal Corporation
of the Hospital
Attested True Copy of Indoor Case Papers Medical Records (Admission Notes,
of the Hospital Discharge Summary of Present and Past Discharge/ Death Summary, Indoor Case
Hospitalizations Papers, Test Reports etc) 1
Discharge Summary of Present and Past
Hospitalizations Photo Identity of insured with age and Original Policy document
address proof
Photo Identity of insured with age and Claimant's Photo ID with age proof &
address proof Bank Details of the claimant – Cancelled relationship with the Insured along with
cheque (with printed name and account Address proof of the claimant and
Bank Details of the claimant – Cancelled number)/bank passbook and NEFT Form Cancelled cheque with name and account
cheque (with printed name and account number printed or cancelled cheque with
number)/bank passbook and NEFT Form Disability Certi cate by attending Physician copy of Bank Passbook / Bank Statement
/ Institute for disabled If no nomination - Proof of legal title to the
Certi cate of Diagnosis claim proceeds (e.g. legal succession paper)
Rehabilitation Certi cate - if applicable
Medical Examination Certi cate (First In case of accidental death inaddition to
Consultation Notes). Employer’s written con rmation / statement the above documents, we would require
- for Disability claim the following documents –
All related clinical Reports pertaining to the
claim event - Laboratory test reports All related Medical Examination Reports, e.g. Postmortem report (Autopsy report) &
Chemical Viscera report - if performed
X-Ray / CT Scan / MRI Reports & Plates • - Laboratory test reports
Ultrasonography Report • Histopathology • X-Ray / CT Scan / MRI Reports & Plates All Police Papers – Panchnama, Inquest,
Report • Clinical / Hospital Reports • Ultrasonography Report First Information Report (FIR) and Final
• Angiography Reports & Plates. • Others Investigation Report
(please specify). • Clinical / Hospital Reports

All follow-up Consultation Notes in relation Clinical Photographs showing the injured
to the hospitalized condition areas - if available

If Claims is due to accidental causes If Claims is due to accidental causes
(submit in addition to the above) (submit in addition to the above).
All police reports- All police reports-
First Information Report First Information Report
Final Investigation Report Final Investigation Report


1. This is applicable if insured was in hospital at the time of death or any time prior to the date of death.
• Please submit copies of the following documents certi ed / attested by the issuing authority. (Original Seen Veri ed (OSV) by Branch
Personnel will also be accepted) -
• All Police papers – Panchnama, Inquest, First Information Report and Final Investigation Report
• Medical Records (Admission Notes, Discharge/Death Summary, Indoor Case Papers, Test Reports etc) 1
• Postmortem report (Autopsy report) & Chemical Viscera report (certi ed by Police / Magistrate / Court will also be accepted)
• Copies of the other documents to be submitted by self attestation of the claimant
NOTE:
- In case the claim warrants any additional requirement, TATA AIA LIFE reserves the right to call for the same.
- Noti cation of claim & submission of the claim requirements does not mean admission of the claim liability by the Company.
- No agent is authorized to admit any liabilities on behalf of the Company, nor to alter this list of documents or any claims requirements
called for by the Company.

Proposal Form

Proposal Form

Proposal Form

Proposal Form

Proposal Form











Frequently Asked Questions



Do I have an option to cancel my policy?
You have a free look period of 15 days to review your policy document from the date you receive it
(30 days in case of electronic policies or policies obtained through distance marketing.
You can write to us and return your policy document back to us.

How do I fulfill my service requirement like address/nominee change, signature, duplicate policy
document, premium certificate, fund switch, premium payment option etc.?
Register yourself on Self care portal to host of services at your Convenience Anytime, Anywhere
• Single access to all your policies • Perform online ULIP transaction on the go • Pay premium online

• Update contact details • Raise services request online • Request for information's • Generate premium
certificates online • Get grievances addressed • Save your trips to the Branch • Stay updated on new
launches
Logon to https://myinsurance.tataaia.com

How can I change my Premium Payment Mode (Annually / Monthly / Quarterly etc.)?

Please submit a duly signed copy of the Mode change form# at any of the Tata AIA Life Branches* at
least 10 days before the policy anniversary (due date of policy premium payment). For any further
queries, kindly contact one of our branches or our call center.
I have lost / damaged my Policy Document. How do I get a Duplicate Policy Document ?

Please submit a duly signed copy of the Duplicate PIP form# along with the documents needed as per
the form at any of the Tata AIA Life Branches*.

For my Unit Linked Policy, how can I request for Fund Switch, Premium Redirection & Top-Up ?
You can avail of either of the following options:

- Log into your online account through the customer portal at www.tataaia.com and perform the above
mentioned.

- Please submit a duly signed copy of the Fund Allocation, Switch and Top up form# pertaining to your
product at any of the Tata AIA Life Branches*.
* For your nearest Tata AIA Life Branch, please visit the ‘Contact Us’ section on www.tataaia.com

# You can download all the forms by visiting ‘Customer Services’ section on www.tataaia.com

You can also send any of the forms along with the required documents to the below mentioned address

Life Insurance made easy

all your policy details are now just a click away


● Log on to www.tataaia.com

● Click on Login Customer

● Register yourself and verify details





Pay Your Premium with ease

Choose premium payment options as per your convenience


Online Cash (upto Rs. 49,999) Cheque / DD IVR

NEFT Tata AIA Life Branches CAMS Service Center 1860

ECS Axis Bank Tata AIA Life Branches 266

Direct Debit SBI Axis Bank 9966

Credit Card Common Service Center SBI

Standing
Instructions South Indian Bank Suvidha




We are always there to listen to you

Contact Us


18602669966
[email protected]
local charges apply



sms HELP to 5676799 www.tataaia.com






Text us for all your queries
Customer Enquiry SERVICE 58888
Insurance/Product Enquiry LIFE 58888
Helpline Shortcodes HELP 5676799








Write to us at: Central Processing Unit: 9th Floor, Tower B, I- Think Lodha Techno Campus, Off Pokharan Road Number 2, Thane (West) - 400604.

BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS: IRDA of India clarifies to public that IRDA of India or its officials do not involve in activities like sale of any kind of
insurance or financial products nor invest premiums. IRDA of India does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along with details of phone
call, number.