I am red

Name of the Prospect / Mr.NAGARAJAN.S Proposal No: 12965823

Policyholder:
Name of the Product: Tata AIA Life Guaranteed
Age (years) : 64 Gender:Male Return Insurance Plan

Tag Line : Individual, Non-Linked Non-Participating

Name of the Life Assured 1 : Mr.NAGARAJAN.S Life Insurance Savings Plan
Age (years) : 64 Gender:Male Unique Identification No.: 110N152V13

Name of the Life Assured 2 : NA I GST Rate: 4.5% for first year
am
Age (years) : red I am red 2.25% second year onwards
NA Gender:NA
I am red I am red
Policy Term (years) : 21
I am red I am red
Premium Payment Term (years) : 12
I am red I am red
Amount of Instalment Premium 316250
(Rs.): I am red I am red

Mode of Payment of Premium : Annual I am red I am red

This benefit illustration is intended to show year-wise premiums payable and

benefits under the policy.

Policy Details
Basic Sum Assured (First Death) Rs. 2460000
Policy Option Endowment
Basic Sum Assured (Second Death, if any) Rs. NA

Sum Assured on First Death (at inception of the policy) Rs. 4168440
Guaranteed Annual Income (GAI)* NA
Sum Assured on Second Death, if any (at inception of the policy) Rs. NA

Rider Details

Tata AIA Vitality

No
(Wellness Program)

Details of Life Insured/Partner Premium

Benefit Payout Return
Rider Name/UIN^ under the Benefit Option Benefit Premium Sum p.a. Year 1
of
(Benefit Option/Benefit Income premium Option Payment Assured without Discount
Payout Option) Lumpsum Income
Name Age(yrs) Gender Duration option Term Term (Rs.) GST (Rs.)
(Rs.) p.a.(Rs.) (Rs.)
(yrs)
CPR- Accidental death
benefit (Lump Sum & Mr.NAGARAJAN.S 64 M 2460000 NA NA No 21 12 2460000 1648 NA
Fixed income)

CPR - Accidental Total

and Permanent Disability
Mr.NAGARAJAN.S 64 M 2460000 NA NA No 21 12 2460000 984 NA
Benefit (Lump Sum &
Fixed income)

^CfPR: Tata AIA Life Insurance Non-Linked Comprehensive Protection Rider, UIN:110B033V03

Premium Summary
I am red Base Plan Riders Total Instalment Premium

Instalment Premium without GST (Rs.) 300000 2632 302632

Instalment Premium with First year GST (Rs.) 313500 2750 316250

Instalment Premium post applicable discount with First year GST (Rs.) 313500 2750 316250

Instalment Premium with GST 2nd year onwards (Rs.) 306750 2691 309441
 (Amount in Rupees)
Guaranteed Non - Guaranteed
Other Benefits,
Survival if any Death
Policy Single/ Annualized Death
Benefit / (Guaranteed Benefit
Year Premium Maturity Benefit Min Guaranteed Special Surrender
Accrued Maturity (Second
Benefit (First Surrender Value Value
Guaranteed Benefit/ Death, if
Death)
Additions Guaranteed any)
Annual Income)
1 300000 208422 0 0 4168440 NA 0 0

2 300000 416844 0 0 4376862 NA 191046 216759

3 300000 625266 0 0 4585284 NA 339177 379328

4 300000 833688 0 0 4793706 NA 640017 564129

5 300000 1042110 0 0 5002128 NA 808358 771161

6 300000 1250532 0 0 5210550 NA 980242 1000426

7 300000 1458954 0 0 5418972 NA 1155045 1288743

8 300000 1667376 0 0 5627394 NA 1406224 1568028

9 300000 1875798 0 0 5835816 NA 1680405 1917482

10 300000 2084220 0 0 6044238 NA 1978214 2300284

11 300000 2292642 0 0 6252660 NA 2298191 2775486

12 300000 2501064 0 0 6461082 NA 2642629 3230541

13 0 2709486 0 0 6669504 NA 2810654 3601532

14 0 2917908 0 0 6877926 NA 3022808 3989197

15 0 3126330 0 0 7086348 NA 3207716 4464399

16 0 3334752 0 0 7294770 NA 3402003 4960444

17 0 3543174 0 0 7503192 NA 3609628 5477330

18 0 3751596 0 0 7711614 NA 3831844 6092175

19 0 3960018 0 0 7920036 NA 4069899 6811231

20 0 4168440 0 0 8128458 NA 4325045 7559466

21 0 4376862 4168440 8545302 8336880 NA 0 0

Note: Annualized premium excludes underwriting extra premium, frequency loadings on premiums, the premium paid towards the riders, if any, and Goods
and Services Tax.

*Under Option III: The policyholder shall also be given the option to receive the Guaranteed Annual Income (GAI) on a monthly basis. This option has to be
chosen at inception and cannot be altered once chosen. The GAI illustrated above is the total amount payable in a year on selection of monthly mode and
1/12th of this amount will be payable monthly.
Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfillment of conditions stipulated therein. Tata AIA Life Insurance
Company Ltd. does not assume responsibility on tax implication mentioned anywhere in this document. Please consult your own tax consultant to know the
tax benefits available to you.

I, ______________________________ (name), have explained I,______________________________ (name), having received the information
the premiums and benefits under the product fully to the prospect/ with respect to the above, have understood the above statement before entering
policyholder. into the contract.

Place: I am red
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect/ Policyholder

Unique Reference Number - L&C/Advt/2024/Apr/1153 (Rider- L&C/Advt/2022/Sep/2271)

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013
Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license.
For more information, Call the Tata AIA Life Insurance Company Ltd Helpline number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com

(I)V.99.00/FY2024-2025_Q1/RELEASE 01-04-24/EXPIRY 30-06-2024 005081996SPGRIPSLVBN1 16-06-2024,08:02 AM

 Tata AIA Life Insurance - IRDA of India Regn no. 110

Customer Information Sheet/Know Your Policy

This document provides key information about your policy. You are also advised to go through your policy document.

Policy
SR. Description
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
1 Name of Insurance Tata AIA Life Insurance Non-Linked Comprehensive Protection Rider (UIN Policy
Product/ Rider 110B033V03) (A Non-Linked, Non-Participating Individual Health Rider) Schedule

2 Policy Number 12965823 Policy

Schedule

3 Type of Insurance Benefit (Where your insurance policy pays fixed amount on the occurrence of a Clause of
Product/Policy covered event) Part C

4 Sum Insured Sum Lumpsum Income Income Policy

(Basis)(Along with Benefit Option Schedule
Assured (Rs.) p.a.(Rs.) Duration (Yrs)
Amount)
Accidental Death 2460000 2460000 NA NA

Accidental Total and

2460000 2460000 NA NA
Permanent Disability

In case of any change in Sum Assured after submission of proposal, please refer to
your latest Benefit Illustration Document.

5 Policy Coverage (What Benefit Option: Clause of

the policy covers) Accidental Death (AD): Part C
and Part F

The Insured Amount under this Benefit Option will be payable in the event of the
death of the Life Insured due to an accident within the Benefit Option Term,
provided the death occurs within 180 days from the date of that accident.
The benefit shall be payable even if the Accident takes place within the Coverage
Term and the death occurs beyond the Coverage Term, provided the date of
death is within 180 days of the Accident.
The benefit payable will be doubled if the death due to an accident occurs under
any of the circumstances below:

1. While the Life Insured is riding as a fare payingpassenger on commercially

licensed public landtransportation over an established route such asa bus, tram
or train. A taxi or any form of transportchartered for private travel is excluded;
2. .While the Life Insured is in an elevator car(elevators in mines, rigs and on
construction sitesexcluded) duly certified to carry passengers;
3. .As a direct result of the burning of the followingpublic buildings only: theatre,
cinema, publicauditorium, hotel, school and hospital; or
4. .When the Life Insured is on a commercialpassenger airline on a regular
scheduledpassenger trip over its established passengerroute.

This benefit is payable only once during the CoverageTerm and shall terminate
upon death of the Life Insuredor expiry of the Coverage Term, whichever earlier.

Accidental Total And Permanent Disability (ATPD):

100% of the Insured Amount under this Benefit Option will be payable in the event
of the Total and Permanent Disability of the Life Insured due to an accident within
the Benefit Option Term, provided the Total and Permanent disability occurs within
180 days from the date of that accident.
The benefit shall be payable even if the Accident takes place within the Coverage
Term and the Total and Permanent Disability occurs beyond the Coverage Term,
provided the date of disability is within 180 days of the Accident.
The benefit payable will be doubled if the Disability due to accident occurs under
any of the circumstances below:

1. While the Life Insured is riding as a fare paying passenger on commercially

 Tata AIA Life Insurance - IRDA of India Regn no. 110

1. While the Life Insured is riding as a fare paying passenger on commercially

licensed public land transportation over an established route such as a bus,
tram or train. A taxi or any form of transport chartered for private travel is
excluded;
2. While the Life Insured is in an elevator car (elevators in mines, rigs and on
construction sites excluded) duly certified to carry passengers;
3. As a direct result of the burning of the following public buildings only: theatre,
cinema, public auditorium, hotel, school and hospital; or
4. When the Life Insured is on a commercial passenger airline on a regular
scheduled passenger trip over its established passenger route.

This benefit is payable only once during the Coverage Term and shall terminate
upon Payment of benefit or expiry of the Coverage Term, whichever earlier.

Maturity Benefit:
If you have chosen Return of Premium option at inception of the rider, on survival
till end of the Coverage Term provided the rider/benefit option is notterminated,
the Total Premiums Paid (Excluding loading for Modal Rider Premiums) towards
the respective benefit option shall be returned, after deduction of any claim payout
made under the respective benefit option and
In case the payout under Return of Premium option is triggered, the premiums
waived (if any) shall be added to the Total Premiums Paid by the Policyholder for
the calculation of the Return of Balance Premium for the respective Benefit
Option.

6 Exclusions (What the Accidental Death Benefit: Clause of

policy does not cover) Part C
Accidental Death Benefit shall not be payable for any losses caused directly or and Part
indirectly, wholly or partly, by any one of the following occurrences: F.

Refer
Death as a result of any disease or infection Definition
Death arising due to any condition other than death solely and directly as a and
result of an accident Exclusions
Any pre-existing condition or disability arising out of a Pre-existing diseases or Annexure
any complication arising therefrom. Wherever the proximate cause is accident
which has occurred after the rider inception date, this exclusion shall not apply.
Suicide, attempted suicide, attempted self- destruction or self-inflicted injury,
irrespective of mental condition.
Death arising from or caused due to use, abuse or a consequence or influence
of any abuse of any substance, intoxicant, drug, alcohol or hallucinogen
Death arising out of or attributable to foreign invasion, act of foreign enemies,
hostilities, war like operations (whether war is declared or not or while
performing duties in the armed forces of any country during war or at peace
time), participation in any naval, military or air force operation, civil war, public
defense, rebellion, revolution, insurrection, military or usurped power.
Death caused by Participation by the insured person in any flying activity,
except as a bona fide, fare-paying passenger of a recognized airline on regular
routes and on a scheduled timetable.
Insured Person whilst engaging in a speed contest or racing of any kind (other
than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving,
paragliding, hang gliding, mountain or rock climbing necessitating the use of
guides or ropes, potholing, abseiling, deep sea diving using hard helmet and
breathing apparatus, polo, snow and ice sports in so far as they involve the
training for or participation in competitions or professional sports, or involving a
naval, military or air force operation and is specifically specified in the Policy
Schedule.
Working in underground mines, tunnelling or explosives, or involving electrical
installation with high tension supply, or as jockeys or circus personnel, or
engaged in Hazardous Activities.
Death arising or resulting from the Insured Person committing any breach of
law or participating in an actual or attempted felony, riot, crime, misdemeanor,
or civil commotion with criminal intent.
Death arising from or caused by ionizing radiation or contamination by
radioactivity from any nuclear fuel (explosive or hazardous form) or resulting
from or from any other cause or event contributing concurrently or in any other
sequence to the loss, claim or expense from any nuclear waste from the
combustion of nuclear fuel, nuclear, chemical or biological attack

No benefits will be payable for any condition(s) which isa direct or indirect result of
any pre-existing conditions unless Life Insured has disclosed the same at the time
of proposal or date of revival whichever is later and the Company has accepted
the same.

Accidental Total and Permanent Disability Benefit:

 Tata AIA Life Insurance - IRDA of India Regn no. 110

This Benefit shall be not payable for any losses caused directly or indirectly,
wholly or partly, by any one of the following occurrences:

Disablement as a result of any disease or infection.

Disablement arising due to any condition other than disablement solely and
directly as a result of an accident.
Any pre-existing condition or disability arising out of a pre-existing diseases or
any complication arising therefrom. Wherever the proximate cause is accident
which has occurred after the rider inception date, this exclusion shall not apply.
If the Disability has not persisted for at least 180 days and is not in the opinion
of a medical practitioner, deemed to be permanent.
Attempted suicide, attempted self-destruction or self inflicted injury, irrespective
of mental condition.
Disablement arising from or caused due to use, abuse or a consequence or
influence of an abuse of any substance, intoxicant, drug, alcohol or
hallucinogen
Disablement arising out of or attributable to foreign invasion, act of foreign
enemies, hostilities, warlike operations (whether war be declared or not or while
performing duties in the armed forces of any country during war or at peace
time), participation in any naval, military or air-force operation, civil war, public
defense, rebellion, revolution, insurrection, military or usurped power
Disablement caused by Participation by the insured person in any flying
activity, except as a bona fide, fare-paying passenger of a recognized airline on
regular routes and on a scheduled timetable.
Insured Person whilst engaging in a speed contest or racing of any kind (other
than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving,
paragliding, hang gliding, mountain or rock climbing necessitating the use of
guides or ropes, potholing, abseiling, deep sea diving using hard helmet and
breathing apparatus, polo, snow and ice sports in so far as they involve the
training for or participation in competitions or professional sports, or involving a
naval, military or air force operation and is specifically specified in the Policy
Schedule
Working in underground mines, tunnelling or explosives, or involving electrical
installation with high tension supply, or as jockeys or circus personnel, or
engaged in Hazardous Activities
Disablement arising or resulting from the Insured Person committing any
breach of law or participating in an actual or attempted felony, riot, crime,
misdemeanor, or civil commotion with criminal intent.
Disablement arising from or caused by ionizing radiation or contamination by
radioactivity from any nuclear fuel (explosive or hazardous form) or resulting
from or from any other cause or event contributing concurrently or in any other
sequence to the loss, claim or expense from any nuclear waste from the
combustion of nuclear fuel, nuclear, chemical or biological attack.

7 Waiting Period Benefit Option Waiting Period Applicable Clause of

Part C
Accidental Death Not Applicanble and Part F

Accidental Total and Permanent Disability Not Applicanble

8 Financial Limits of Not Applicable. Clause of

coverage Part C

9 Claims/Claims To register claim, please visit the Company through any service touch points Clause of
Procedure mentioned in Policy servicing section. Part C
Reimbursement Claim Process: and Part F

1. Get treatment in hospital/nursing home as per the norm.

2. After paying the bills Intimate the claim to Company for reimbursement of the
amount
3. Register and submit all relevant and mandatory claim documents.
4. Company verifies/scrutinizes the documents and claim submitted basis your
policy coverage and details.
5. If claim is approved, Payment is settled into customer's account.

Please note that,

1. If any queries, a query letter will be sent to you.

2. If claim is rejected/denied, a rejection letter mentioning the reason for rejection
will be sent to you.

10 Policy Servicing Clause of

i. E-mail us at [email protected] Part D
ii. Contact your Tata AIA Life Agent / Distributor and Part
iii. Call our helpline number 1-860-266-9966 (Call charges apply) G
 Tata AIA Life Insurance - IRDA of India Regn no. 110

iii. Call our helpline number 1-860-266-9966 (Call charges apply) G

iv. Visit the nearest the Tata AIA Life branch or CAMS Service Center
v. Log on to Online Customer Portal by visiting www.tataaia.com
vi. Write to us on the following address:
Tata AIA Life Insurance Company Limited 9th Floor, B - Wing, I-Think Techno
Campus, Behind TCS (Lodha), Pokhran Road No.2, Thane (West), Mumbai - 400
607

11 Grievances/Complaints You can register grievances through below modes: Clause of

Part G
i. Email us at [email protected]
ii. Service avenues as mentioned above for Policyholder Servicing [other than email
].

Kindly address your complaints to "Grievance Redressal Department"

For escalations, (In case not satisfied with the decision or not receipt of any
response), customers can email to [email protected] or write to - Grievance
Redressal Officer (GRO) Tata AIA Life Insurance Company Limited, 9th Floor, B -
Wing, I-Think Techno Campus, Behind TCS (Lodha), Thane (West), Mumbai - 400
607.
Insurance Ombudsman:
Where the redressal is not satisfactory despite the escalations, you may represent to
the Ombudsman. For contact details, contact number and email of the relevant
Ombudsman office, kindly refer the policy document or visit the IRDA of India
website http://www.policyholder.gov.in - Ombudsman / List of Insurance
Ombudsmen or our website www.tataaia.com.

12 Things to remember Freelook Period Clause of

Within a free look period of 30 days from the date of receipt of the Policy whether the Part C
policy is sourced electronically or otherwise You can return the policy for and Part
cancellation stating the reasons for the same, if You disagree to any of the terms or D
conditions of the Policy. Within Freelook You are entitled to a refund of the premium
paid without interest after deduction of proportionate risk premium stamp duty and
medical examination cost along with applicable taxes and cesses or levies, if any.
In respect of a linked insurance product, You shall receive the non-allocated
Premium plus charges levied by cancellation of Units plus Fund Value at the date of
cancellation less the deductions mentioned above.

Fraud, Mis-statement or Suppression: Clause of

Any fraud, mis-statement or suppression of a material fact under the Policy shall be Part C
dealt in accordance with Section 45 of the Insurance Act, 1938 as amended from and Part F
time to time.

13 Your Obligations Clause of

Please disclose all pre-existing disease/s or condition/s before buying a Policy. Part C
Non-disclosure may result in claim not being paid. and Part F
All information sought in the Proposal form is Material for issuance of the policy and
and settlement of claim. Annexure
Disclosure of Material Information and any changes therein during the Policy 1/
period should be communicated to us by Annexure
Sending an email to [email protected] from your email id registered A
with us
Submission of the Request for Change form* (filled and signed) at any Tata
AIA Life Insurance Branch or Service Centre

*Request for Change form is available on our website - www.tataaia.com

"We", "Us", "Our", "Insurer" or "Company" refers to Tata AIA Life Insurance Company Limited.

Declaration by the Policy Holder:

I have read the above and confirm having noted the details. I further confirm the below that:

a. In case of any change to the Sum Insured/ Rider after submission of the proposal, the details in the revised Benefit
Illustration and Customer Information Sheet would be applicable.
b. I have received a copy of the CIS through the download utility/ through my Salesperson.
c. I am aware that on request I can avail of the CIS in local language.

Place:
Date:
(Signature of Policy)