Unlocked

Part A
Ref no.: 25593025 PSCDEAD-D2C_MumPost-2297789-2380289

SPEED POST - EA011643006IN
Ms. JAYANTI SINGH

W/O SATENDRA SINGH NEAR 27th December 2022
NEHRU
CHOWK DIST DHANBAD DUMRA
DUMRA
C
Bokaro 828306
Jharkhand
India
Tele.Nos - 9431314830
Mobile No : 919431314830
R
Email -
JAYANTISINGH00000@GMAIL.COM
Dear Ms. JAYANTI SINGH,
Sub: Your Policy no. 25593025
We are glad to inform you that your proposal has been accepted and the HDFC Life Sanchay Plus Policy (“Policy”) being this Policy,
has been issued. We have made every effort to design your Policy in a simple format. We have highlighted items of importance so that
you may recognise them easily.
Policy document:
As an evidence of the insurance contract between HDFC Life Insurance Company Limited and you, the Policy is enclosed herewith.
Please preserve this document safely and also inform your Nominees about the same. A copy of your proposal form submitted by you
is enclosed for your information and record.
Cancellation in the Free-Look Period:

In case you are not agreeable to any of the terms and conditions stated in the Policy, you have the option to return the Policy to us for
cancellation stating the reasons thereof, within 30 days from the date of receipt of the Policy as your Policy is an electronic Policy /
purchased through Distance Marketing mode. On receipt of your letter along with the original Policy (original Policy Document is not
required for policies in dematerialised form), we shall arrange to refund the Premium paid by you, subject to deduction of the
proportionate risk Premium for the period of cover and the expenses incurred by us for medical examination (if any) and stamp duty
charges.
Contacting us:
The address for correspondence is specified below. To enable us to serve you better, you are requested to quote your Policy number
in all future correspondence. In case you are keen to know more about our products and services, we would request you to talk to our
Certified Financial Consultant (Insurance Agent) who has advised you while taking this Policy. The details of your Certified Financial
Consultant including contact details are listed below. In case you are keen to know more about our products and services, please call
us on our toll-free number 1800 266 9777 or email us @ onlinequery@hdfclife.in. You can also get in touch with us via social media:
https://plus.google.com/+hdfclife/
https://www.youtube.com/user/hdfclife10
http://www.linkedin.com/company/19117
https://twitter.com/HDFClife
https://www.facebook.com/HDFClife
To contact us in case of any grievance, please refer to Part G. In case you are not satisfied with our response, you can also approach
the Insurance Ombudsman in your region. Thanking you for choosing HDFC Life Insurance Company Limited and looking forward to
serving you in the years ahead,
Yours sincerely,
Authorised Signatory
Branch Address:HDFC Life Dhanbad-Shastri Naga, 2nd floor Commerce House II, Shastri Nagar Bank Mode,, Dhanbad, 826001
Agent details
Name : BANDHAN BANK LTD, Address : DN 32 Sector V, Salt Lake, , Kolkata, West
Bengal - 700091 Agent No. : 01196840 License No. : CA0530 Contact Details
:8210645740
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PSCDEAD-D2C_MumPost-2297789-2380289
Address for Correspondence : HDFC Life Insurance Company Limited, 11th Floor Lodha Excelus, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai-
400011.
Registered Office : HDFC Life Insurance Company Limited, Lodha Excelus, 13th Floor, Apollo Mills Compound, Mahalaxmi, Mumbai-400011. Help line: 1860-
267-9999 (Local charges apply ) |.022-68446530 (STD charges apply) Available Mon-Sat 10 am to 7 pm IST . DO NOT prefix any country code e.g. +91 or 00. |
Website: www.hdfclife.com. | Email – service@hdfclife.com | NRIservice@hdfclife.com (For NRI customers only) CIN: L65110MH2000PLC128245. Helpline
number: 1860-267-9999 (Local charges apply ) |.022-68446530 (STD charges apply)
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POLICY DOCUMENT- HDFC Life Sanchay Plus
Unique Identification Number:101N134V15
Your Policy is a non-participating non-linked savings insurance policy. This document is the evidence of a contract between HDFC Life
Insurance Company Limited and the Policyholder as described in the Policy Schedule given below. 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, any response given to medical questionnaire by the Life Assured, applicable medical evidence and other information
received by the Company from the Policyholder, Life Assured or on behalf of the Policyholder (“Proposal”). This Policy is effective
upon receipt and realisation, by the Company, of the consideration payable as First Premium under the Policy. This Policy is written
under and will be governed by the applicable laws in force in India and all Premiums and Benefits are expressed and payable in Indian
Rupees.
POLICY SCHEDULE
Policy number: 25593025
Client ID: QU364851
Policyholder Details
Name Ms. JAYANTI SINGH
W/O SATENDRA SINGH NEAR NEHRU

DUMRA
Address Bokaro
Jharkhand
828306
Life Assured Details
Name Ms. JAYANTI SINGH

DUMRA
Address
Bokaro
Jharkhand
828306
Date of Birth 24th December 1976
Age on the Date of Risk
45 Years
Commencement
Age Admitted Yes
Policy Details
Plan Option Long Term Income

Date of Risk Commencement 22nd December 2022
Date of Issue/Inception of Policy 26th December 2022
Premium Due Date(s) 22nd December
Sum Assured ` 526,900.00
Sum Assured on Death ` 526,900.00

Guaranteed Sum Assured on ` 269,759.00
Maturity
Policy Term 7 years
Premium Paying Term 6 years
Frequency of Premium Payment Annual
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Premium per Frequency of ` 47,900.00
Premium Payment
Underwriting Extra Premium per ` 0.00

Frequency of Premium Payment
Total Premium per Frequency of ` 47,900.00

Premium Payment
Annualized Premium ` 47,900.00
Guaranteed Income on Maturity ` 24,070.00
Payout Period 25 years starting from year 08
Income Payout Frequency Annually
Grace Period 30 days
Final Premium Due Date 22/12/2027
Maturity Date 22/12/2029

Policy issued on the basis of
Yes
medical questionnaire
The Premium amount is excluding any applicable Taxes and levies leviable on the Premium. Amount of Taxes and levies will be charged at actuals
as per prevalent rate.
HDFC Life Insurance Company Limited

11th Floor, Lodha Excelus,
Apollo Mills Compound,
Address for Communication N. M. Joshi Road,
Mahalaxmi,
Mumbai - 400 011.
Email: service@hdfclife.com
Stamp Duty of ` 105.40/- is paid as provided under Article 47D(iii) 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 this Order
No.(LOA/CSD/508/2022/Validity Period Dt.01/11/2022 To
Dt.31/03/2023(O/w.No.4605)/Date :01/11/2022)'
Proper Officer
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NOMINATION SCHEDULE
Nominee’s Name Mr. SATYENDRA SINGH
Nominee’s Relationship with the Life Husband

Assured
Date of Birth of Nominee 20th April 1974

Nominee’s Age 48 Years
Nomination Percentage 100.00%

Nominee's Address DUMRA
Bokaro - 828306
-
Jharkhand
Nominee’s Name
Nominee’s Relationship with the Life

Assured
Date of Birth of Nominee

Nominee’s Age
Nomination Percentage
Nominee's Address
- -
Appointee’s Name
(Applicable where the nominee is a minor)
Date of Birth of Appointee
Appointee's Address
-
Signed at Mumbai on 27th December 2022

For HDFC Life Insurance Company Limited
In case you notice any mistake, you may return the Policy document to us for necessary correction.
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Part B 19) Policy Anniversary – means the annual anniversary of the
(Definitions) Date of Risk Commencement;
20) Policyholder, You, you, your – means or refers to the
In this Policy, the following definitions shall be applicable: Policyholder stated in the Policy Schedule.
21) Policy Term – means the term of the Policy as stated in the
Policy Schedule;
1) Annualized Premium shall be the premium amount payable
22) Premium(s) – means an amount stated in the Policy
in a year chosen by the policyholder, excluding the taxes,
Schedule, payable by you to us for every Policy Year by the
rider premiums, underwriting extra premiums and loadings
due dates, and in the manner stated in the Policy Schedule, to
for modal premiums, if any.
secure the benefits under this Policy, excluding applicable
2) Appointee – means the person named by you and registered
taxes and levies;
with us in accordance with the Nomination Schedule, who is
23) Premium Paying Term – means the period as stated in the
authorized to receive the Death Benefit under this Policy on
Policy Schedule, in years, over which Premiums are payable;
the death of the Life Assured while the Nominee is a minor;
24) Regulations – means IRDAI (Non-Linked Insurance
3) Assignee – means the person to whom the rights and benefits
Products) Regulations, 2019
under this Policy are transferred by virtue of assignment
25) Revival of Policy - means restoration of the Policy, which
under section 38 of the Insurance Act, 1938, as amended
was discontinued due to the non-payment of Premium, by the
from time to time;
Company with all the benefits mentioned in the Policy
4) Assignment – means a provision wherein the Policyholder
document, with or without rider benefits, if any, upon the
can assign or transfer a Policy in accordance with Section 38
receipt of all the Premiums due and other charges/late fee, if
of the Insurance Act, 1938 as amended from time to time;
any, as per the terms and conditions of the Policy, upon
5) Authority/ IRDAI – means Insurance Regulatory and
being satisfied as to the continued insurability of the
Development Authority of India;
insured/Policyholder on the basis of the information,
6) Company, company, Insurer, Us, us, We, we, Our, our –
documents and reports furnished by the Policyholder.
means or refers to HDFC Life Insurance Company Limited. 26) Revival Period - means the period of five consecutive years
7) Date of Risk Commencement - means the date, as stated in from the date of discontinuance of the Policy, during which
the Policy Schedule, on which the insurance coverage under period the Policyholder is entitled to revive the Policy, which
this Policy commences; was discontinued due to the non-payment of Premium, in
8) Death Benefit - means the amount which is payable on death of life accordance with the terms of Revival of a Policy.
assured in accordance with Part C. 27) Sum Assured on Death – means the absolute amount of
9) Free Look period – means the period specified under Part D clause benefit which is guaranteed to become payable on death of
7 from the receipt of the Policy during which Policyholder can the Life Assured as per the terms and conditions specified in
review the terms and conditions of this Policy and where if the the Policy.
Policyholder is not agreeable to any of the provisions stated in the 28) Surrender - means complete withdrawal/ termination of the
Policy, he/ she has the option to return this Policy. entire Policy.
10) Distance Marketing - includes every activity of solicitation 29) Surrender Value - means an amount, if any, that becomes
(including lead generation) and sale of insurance products through payable in case of Surrender of the Policy in accordance with
the following modes: (i) Voice mode, which includes telephone- the terms and conditions of the Policy.
calling; (ii) Short Messaging service (SMS); (iii) Electronic mode
which includes e-mail, internet and interactive television (DTH);
30) Total Premiums Paid- means total of all the premiums
(iv) Physical mode which includes direct postal mail and received, excluding any extra premium, any rider premium
newspaper & magazine inserts; and, (v) Solicitation through any and taxes.
means of communication other than in person.
11) Frequency of Premium Payment– means the period, as stated
in the Policy Schedule, between two consecutive Premium
due dates for the Policy;
12) Grace Period - means the time granted by the insurer from
the due date for the payment of premium, without any
penalty / late fee, during which the policy is considered to be
in-force with the risk cover without any interruption as per
the terms of this policy.
13) Life Assured – means the person as stated in the Policy
Schedule on whose life the contingent events have to occur
for the Benefits to be payable. The Life Assured may be the
Policyholder.
14) Maturity Benefit - Maturity Benefit means the amount
payable on the Maturity Date in accordance with Part C.
15) Maturity Date – means the date stated in the Policy
Schedule, on which the Policy Term expires;
16) Minor – means for purpose of this Policy any person who is
below 18 years of age.
17) Nomination - is the process of nominating a person(s) who is
(are) named as “Nominee(s)” 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.
18) Nominee(s) – means the person nominated by the
Policyholder (who is also the Life Assured) under this policy
and registered with us in accordance with the Nomination
Schedule, to whom money secured by the Policy as
mentioned under the Death Benefit shall be paid in event of
the death of the Life Assured;
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Part C (ii) All other Benefits shall be payable to the Policyholder.
(iii) If the Policy has been assigned, all Benefits shall be
Benefits payable to the Assignee under absolute assignment.
1. Benefits:
(1) Maturity Benefit – On survival of the Life Assured till the 3. Payment and cessation of Premiums
Maturity Date and provided all Premiums which have fallen (1) The first Premium must be paid along with the submission of
due have been paid, the Maturity Benefit payable shall be your completed application. Subsequent Premiums are due in
Guaranteed Income on Maturity payable at the end of each full on the due dates as per the Frequency of Premium
Income Payout Frequency as provided under the Policy Payment set out in your Policy Schedule.
Schedule, during the Payout Period as mentioned below.
(2) Premiums under the Policy can be paid on yearly, half-yearly,
quarterly or monthly basis as per the chosen Frequency of
Maturity Benefit will be paid as Guaranteed Income for the Premium Payment and as set out in the Policy Schedule or as
fixed term of 25 or 30 years starting from (Policy Term + amended subsequently.
1)th year, in arrears on payment of all due premiums.
(3) Advance Premium
The amount of Guaranteed Income shall be equal to the The Premiums that fall due in the same financial year can be
percentage of Annualized Premium depending on the paid in advance. However, where the Premium due in one
Premium Payment Term and Policy Term. Please refer financial year is paid in advance in earlier financial year, we
“Appendix 3” to know the Guaranteed Income Payable. may collect the same for a maximum period of three months
in advance of the due date of the premium.
At the end of the Payout Period, the Policy terminates by
returning the Total Premiums paid.
(4) Any Premiums paid before the Due Date will be deemed to have
been received on the Due Date for that Regular Premium.
On the Maturity Date, you shall have an option to receive the
Guaranteed Sum Assured on Maturity, which shall be the
(5) Grace Period:
present value of future payouts, discounted at a rate of 9%
A grace period of 15 days for monthly Premium paying
p.a. This interest rate is not guaranteed. However, any change
frequency and 30 days for other Premium paying frequencies
in the interest rate will be subject to prior approval of the
is allowed for the payment of each renewal Premium after
Authority and will be applicable only to the policies sold
the first Premium. We will not accept part payment of the
after the date of change.
Premium. The policy is considered to be in-force with the
risk cover during the grace period without any interruption.
At any point of time during the Payout Period, you shall have
an option to receive the future income as a lump sum, which
(6) A Premium will be deemed to remain unpaid if the Premium
shall be the present value of future payouts, discounted at a
amount has not been realised by us. If any Premium remains
rate which is computed using the prevailing interest rates
unpaid after the expiry of the grace period, your Policy may
described in Part D Clause 4 below.
lapse or become Paid-Up, as described in Part D Clause 2,
with effect from the due date of the first unpaid Premium. In
On death of the Life Assured during the Payout Period and
that event, the Benefits under such Policy shall be payable in
provided all Premiums which have fallen due have been paid,
accordance with Part D Clause 2.
the Nominee shall continue receiving the Guaranteed Income
on Maturity per the Income Payout Frequency for the
(7) Premiums are payable by you without any obligation on us to
remaining Payout Period, however, the Nominee shall, at any
issue a reminder notice to you.
point during the Payout Period, have an option to receive the
future income as a lump sum, which shall be the present
(8) Where the Premiums have been remitted otherwise than in cash,
value of future payouts, discounted at a rate which is
the application of the Premiums received is conditional upon
computed using the prevailing interest rates described in Part
the realisation of the proceeds of the instrument of payment,
D Clause 4 below.
including electronic mode.
(2) Death Benefit – On death of the Life Assured during the
Policy Term and provided all Premiums which have fallen
due have been paid, the Death Benefit payable as a lump
sum, shall be equal to Sum Assured on Death which is higher
of:
a) 10 times the Annualized Premium, or
b) 105% of Total Premiums paid, or
c) Premiums paid accumulated at an interest of 5% p.a.
compounded annually. or
d) Guaranteed Sum Assured on Maturity, or
e) an absolute amount assured to be paid on death, which
is equal to the Sum Assured as specified in the Policy
Schedule.
Sum Assured shall be equal to the applicable Death Benefit

Multiple times the Annualized Premium. The applicable
Death Benefit Multiples are as specified in Appendix 2.
Upon the payment of the Death Benefit in case of death of

the Life Assured during the Policy Term, the Policy
terminates and no further Benefits are payable.
2. Recipients of Benefits
(1) The recipients of Benefits under this Policy shall be as
specified below:
(i) Death Benefit shall be payable to the registered
Nominee(s), if the Policyholder and the Life Assured are
the same; or to the Policyholder if the Life Assured is
other than the Policyholder.
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Part D may vary from year to year. The maximum interest rate
rebate may be set up to the prevailing revival interest rate.
1. Surrender Value Once the Policy is revived, you are entitled to receive all
(1) Guaranteed Surrender Value (“GSV”) contractual Benefits.
a) The Policy will acquire a GSV upon the payment of at least
first two years’ premiums.
b) Upon payment of the Surrender Benefit, the Policy shall 4. Discount rate:
terminate and all other Benefits shall cease. The discount rate shall be computed with reference to the
c) Subject to the Policy being in-force, the minimum GSV shall
prevailing interest rates. The prevailing interest rates will be
be GSV of Total Premiums Paid where GSV shall be
determined as the applicable GSV factors on Total Premiums derived from yields of G-Sec securities of 40 years (Where
Paid at the time of surrender multiplied to the Total 40 year G-sec bond yields are not available, the 30 year G-
Premiums Paid to date. The premium is excluding any sec bond yields will be taken into consideration for SSV
applicable taxes and other statutory levies paid or any extra factors computation). Any change in the interest rate used
premiums paid. will be in accordance with the formula below:
d) The GSV factors applicable for Total Premiums paid are as Annualized Yield on reference government bond + k rounded
specified in Appendix 1.
up to the nearest 25 basis points
(2) Special Surrender Value (“SSV”)
a) The Company may pay a surrender value higher than the Where k=150 basis points
GSV in the form of a Special Surrender Value (SSV).
b) The SSV shall be equal to the GSV in policy years 2, 3 & 4
The discount rates will be reviewed semi-annually and shall
c) From the 5th policy year onwards, SSV will be computed as
the present value of future benefits as described below: be revised using the above mentioned formula and the
change in the discount rates shall be effective from 25th
F1 * Annual Income Benefit Amount * (Premiums Paid / February and 25th August each year.
Premiums payable under the Policy)
5. Alterations
F1 is the discounting factor calculated using prevailing No alterations are permissible under the Policy except change
interest rates described in Part D Clause 4 below. in Frequency of Premium Payment and Income Payout
Frequency. Alteration in the Frequency of Premium Payment
2. Lapsed Policies and Paid-Up policies may lead to a change in the Premium. Such alteration will be
(1) If any due Premium is unpaid upon the expiry of the grace in accordance with the Board approved underwriting policy.
period and your Policy has not acquired a GSV, your
Policy’s status will be altered to lapsed status and the cover
will cease. 6. Loans
(2) No Benefits shall be payable under a lapsed Policy. a) Policy loans will be available during the Policy Term subject
(3) If any due Premium is unpaid upon the expiry of the grace to such terms and conditions as the Company may specify
period and your Policy has acquired a GSV, your Policy’s from time to time. Our current terms and conditions are
status will be altered to reduced paid-up. stated below:
 The loan amount will be subject to a maximum of 80%
(4) Once the Policy becomes reduced paid-up, the maturity and of the surrender value.
death benefit payouts shall be computed by multiplying the  The current interest rate on loan is 9.75% p.a. The
death/maturity payouts as specified in Part C by the ratio of interest rate on loan shall be calculated as the Average
the Premiums paid to the Premiums payable under the Annualised 10-year benchmark G-Sec Yield (over last
Policy. 6 months & rounded up to the nearest 50 bps) + 2%.
(5) A lapsed or paid-up Policy may be revived subject to the terms The interest rate shall be reviewed half-yearly and any
and conditions as described under Part D Clause 3. change in the interest rate shall be effective from 25th
(6) If a reduced paid-up policy is subsequently surrendered, the February and 25th August each year.
surrender benefit shall be computed as below:  In case upon review the interest rate is revised, the
same shall apply until next revision. The source of 10-
F1 * Annual Income Benefit Amount * Premiums Paid year benchmark G-sec yield shall be RBI Negotiated
/Premiums payable under the Policy Dealing System-Order Matching segment (NDS-OM).
Any change in the methodology of calculation of
F1 is the discounting factor calculated using prevailing interest rate shall be done with prior approval of the
interest rates described in Part D Clause 4 below. Authority.
 Before any Benefits are paid out, loan outstanding
3. Revival of the Policy together with the interest thereon will be deducted and
If your Policy has been paid-up or lapsed, it would be
the balance amount will be payable
revived subject to the terms and conditions that we may  An in-force or fully Paid-up policy shall not be
specify from time to time. Currently, the application for the foreclosed for non re-payment of loan.
revival should be made within five years from the due date of
the first unpaid Premium and before the expiry of the Policy 7. Free Look Cancellation
Term. The revival will be subject to satisfactory evidence of In case the Policyholder is not agreeable to any of the
continued insurability of the Life Assured and payment of provisions stated in the Policy, the Policyholder has an
option to return the Policy to the Company stating the
outstanding Premiums with interest. The current rate of
reasons thereof, within 15 days from the date of receipt of the
interest for revival is 9.5% p.a. Any change in the revival Policy. If the Policy has been purchased through Distance
interest rates will be in accordance with the following Marketing mode, this period will be 30 days. On receipt of
formula: Average Annualised 10-year benchmark G-Sec the Policyholder’s letter along with the original Policy
Yield (over last 6 months & rounded upto the nearest 50 bps) document (original Policy Document is not required for
+ 2%, at the time of the review. The source of 10-year policies in dematerialised form), the Company shall arrange
to refund the Premium paid, subject to deduction of the
benchmark G-sec yield shall be RBI Negotiated Dealing
proportionate risk Premium for the period on cover and the
System-Order Matching segment (NDS-OM). expenses incurred by the Company for medical examination
During revival campaigns, the Company may offer reduced (if any) and stamp duty (if any).
interest rates, subject to the rules of the special revival
campaign. The rebates offered during the revival campaign
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Part E a. Completed claim form, (including NEFT details and bank
account proof as specified in the claim form);
1. Additional Servicing Charges b. Original Policy;
c. Original or copy Death Certificate issued by Municipal
No additional servicing charges are applicable in this policy.
Authority/ Gram Panchayat / Tehsildar (attested by issuing
authority);
d. Claimant’s identity and residence proof.
Part F
Basic documentation if death is due to Un-Natural Cause:
(General Terms & Conditions) a. Completed claim form, (including NEFT details and bank
1. Suicide Exclusions account proof as specified in the claim form);
b. Original Policy;
In case of death due to suicide within 12 months from the
date of commencement of risk under the policy or from the c. Original or copy Death Certificate issued by Municipal
date of revival of the policy, as applicable, the nominee or Authority/ Gram Panchayat / Tehsildar (attested by issuing
beneficiary of the policyholder shall be entitled to at least authority);
80% of the total premiums paid till the date of death or the d. Claimant’s identity and residence proof.
surrender value available as on the date of death whichever is e. Original or copy of First Information Report, Police
higher, provided the policy is in force.
Panchnama report attested by Police authorities; and
2. Age Admitted f. Original or copy of Postmortem report attested by Hospital
The Company has calculated the Premiums under the Policy authority.
on the basis of the age of the Life Assured as declared in the
Proposal. In case you have not provided proof of age of the Note:
Life Assured with the Proposal, you will be required to a. In case original documents are submitted,
furnish such proof of age of the Life Assured as is acceptable attestation on the document by authorities is not
to us and have the age admitted. In the event the age so required.
admitted (“Correct Age”) during the Policy Term is found to b. Depending on the circumstances of the death,
be different from the age declared in the Proposal, without further documents may be called for as we deem
prejudice to our rights and remedies including those under fit.
the Insurance Act, 1938 as amended from time to time, we
shall take one of the following actions: (v) The claim is required to be intimated to us within a period of
i) If eligible, and if the Correct Age is found to be higher, the 90 days from the date of death. However, we may condone
benefit payable under this Policy, Rider, if any, shall be after the delay in claim intimation, if any, where the claim is
deduction of such difference of Premium (i.e. difference in genuine and the delay is proved to be for reasons beyond the
Premium paid based on age declared in the Proposal and control of the claimant.
Premium based on the Correct Age) along with interest
thereon. In such cases, before calculating the amount of 4. Assignment or Transfer
benefit payable, the Policy shall be subject to re-underwriting The Policyholder can assign or transfer of a Policy in
and the Sum Assured shall be subject to eligibility as per accordance with Section 38 of the Insurance Act, 1938 as
underwriting norms and the Premium to be deducted shall be amended from time to time. Simplified version of the
calculated proportionately on such Sum Assured payable. If provisions of Section 38 is enclosed in Annexure I for
the Correct Age is found to be lower, excess Premiums reference.
without any interest shall be refunded.
ii) If ineligible for the Policy basis the Correct Age, the 5. Nomination
Policy shall be void-ab-initio and the total Premiums paid The Policyholder can nominate a person/ persons in
shall be refunded without interest after deducting all accordance with Section 39 of the Insurance Act, 1938 as
applicable charges like medical (if any), Stamp Duty (if any), amended from time to time. Simplified version of the
risk etc. provisions of Section 39 is enclosed in Annexure II for
reference.
3. Claim Procedure
6. Issuance of Duplicate Policy
(1) Maturity Benefit - The Maturity Benefit will be paid if and only The Policyholder can request for a duplicate copy of the
if Policy at HDFC Life offices or through Certified Financial
(i) The Policy has matured and the Life Assured is alive on Consultant (Insurance Agent) who advised you while taking
the Maturity Date, this Policy. While making an application for duplicate Policy
(ii) No claim has been made on the Policy, except any the Policyholder is required to submit a notarized original
survival benefit, if any, indemnity bond on stamp paper. Additional charges may be
(iii) The Policy has not been discontinued or surrendered or applicable for issuance of the duplicate Policy.
cancelled or terminated; and
(iv) All relevant documents including the original Policy 7. Incorrect Information and Non-Disclosure
document in support of your claim have been provided Fraud, misrepresentation and forfeiture would be dealt with
to the Company. in accordance with provisions of Section 45 of the Insurance
Act 1938 as amended from time to time. Simplified version
(2) Death Benefit - The Death Benefit will be paid if and only if of the provisions of Section 45 is enclosed in Annexure III
(i) The death of the Life Assured has occurred before the for reference.
Maturity Date,
(ii) The standard Policy provisions specified in Part F Clause 8. Policy on the life of a Minor
1 (Exclusions) and Clause 7 (Incorrect Information and Where the Policy has been taken for the benefit of the Life
Non Disclosure) are not attracted, Assured who is a minor, the Policy shall automatically vest
(iii) The Policy has not been discontinued or surrendered or to the Life Assured on his attaining majority.
cancelled or terminated; and
(iv) All relevant documents in support of the claim have been
provided to the Company. 9. Taxes
(1) Indirect Taxes
Basic documentation if death is due to Natural Cause: Taxes and levies shall be levied as applicable. Any taxes and
levies becoming applicable in future may become payable by
9 of 29
you by any method including by levy of an additional Laundering/Know Your Customer norms and as may be laid
monetary amount in addition to premium and or charges. down by IRDAI and other regulators from time to time.
(2) Direct Taxes 11. Jurisdiction: This Policy shall be governed by the laws of India and
Tax, if any will be deducted at the applicable rate from the the Indian Courts shall have jurisdiction to settle any disputes arising
payments made under the Policy, as per the provisions of the under the Policy.
Income Tax Act, 1961 as amended from time to time.
12. Notices
10. Modification, Amendment, Re-enactment of or to the Any notice, direction or instruction given to us, under the
Insurance laws and rules, regulations, guidelines, Policy, shall be in writing and delivered by hand, post,
clarifications, circulars etc. thereunder facsimile or from registered electronic mail ID to:
(1) This Policy is subject to HDFC Life Insurance Company Limited, 11th Floor, Lodha
(i) The Insurance Act 1938, as amended from time to time, Excelus, Apollo Mills Compound, N.M. Joshi Marg,
(ii) Amendments, modifications (including re-enactment) as Mahalaxmi, Mumbai - 400011.
may be made from time to time, and
(iii) Other such relevant Regulations, Rules, Laws, Registered Office: Lodha Excelus, 13th Floor, Apollo Mills
Guidelines, Circulars, Enactments etc. as may be Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai - 400011.
introduced thereunder from time to time. E-mail: service@hdfclife.com
Or any of our HDFC Life Branches and such other address as
(2) We reserve the right to change any of these Policy Provisions / may be informed by us.
terms and conditions in accordance with changes in Similarly, any notice, direction or instruction to be given by
applicable Regulations or Laws, and where required, with us, under the Policy, shall be in writing and delivered by hand,
IRDAI’s approval. post, courier, facsimile or registered electronic mail ID to the
updated address in the records of the Company.
(3) We are required to obtain prior approval from the IRDAI before You are requested to communicate any change in address, to
making any material changes to these provisions, except for the Company supported by the required address proofs to
changes of regulatory / statutory nature. enable the Company to carry out the change of address in its
systems. The onus of intimation of change of address lies with
(4) We reserve the right to require submission by you of such the Policyholder. An updated contact detail of the Policyholder
documents and proof at all life stages of the Policy as may be will ensure that correspondences from the Company are
necessary to meet the requirements under Anti- money correctly addressed to the Policyholder at the latest updated
address.
10 of 29
Appendix 1: Guaranteed Surrender Value Factors
Guaranteed Surrender Value Factors as percentage of Total Premiums Paid
Note: This would only be payable once the Policy has acquired a GSV.
Policy Policy Term

Years
5 6 7 8 9 10 11 12 13
1 0% 0% 0% 0% 0% 0% 0% 0% 0%
2 30% 30% 30% 30% 30% 30% 30% 30% 30%
3 35% 35% 35% 35% 35% 35% 35% 35% 35%
4 90% 50% 50% 50% 50% 50% 50% 50% 50%
5 90% 90% 50% 50% 50% 50% 50% 50% 50%
6 90% 90% 75% 50% 50% 50% 50% 50%
7 90% 90% 75% 50% 50% 50% 50%
8 90% 90% 75% 75% 75% 75%
9 90% 90% 75% 75% 75%
10 90% 90% 90% 90%
11 90% 90% 90%
12 90% 90%
13 100%
Appendix 2: Death Benefit Multiple

Sum Assured will be determined based on your entry age and the Annualized Premium you commit to pay in a policy year.
Age* Death Benefit Age* Death Benefit Age* Death Benefit Age* Death Benefit
Multiple Multiple Multiple Multiple
5 15.00 19 13.60 33 12.20 47 10.80
6 14.90 20 13.50 34 12.10 48 10.70
7 14.80 21 13.40 35 12.00 49 10.60
8 14.70 22 13.30 36 11.90 50 10.50
9 14.60 23 13.20 37 11.80 51 10.45
10 14.50 24 13.10 38 11.70 52 10.40
11 14.40 25 13.00 39 11.60 53 10.35
12 14.30 26 12.90 40 11.50 54 10.30
13 14.20 27 12.80 41 11.40 55 10.25
14 14.10 28 12.70 42 11.30 56 10.20
15 14.00 29 12.60 43 11.20 57 10.15
16 13.90 30 12.50 44 11.10 58 10.10
17 13.80 31 12.40 45 11.00 59 10.05
18 13.70 32 12.30 46 10.90 60 10.00
*Age on the Date of Risk Commencement.
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Appendix 3: Guaranteed Income Payable
Entry Ages: 5 to 60 years
Guaranteed Income payable each year during the Payout Period

Premium
Policy Term
Payment Term
25 years 30 years
5 years 5 years 35.25% of Annualized Premium 35.00% of Annualized Premium
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Annexure I c. obtain loan under the policy or surrender the policy
without obtaining the consent of the transferor or
Section 38 - Assignment or Transfer of Insurance Policies assignor or making him a party to the proceedings
(15) Any rights and remedies of an assignee or transferee of a life
insurance policy under an assignment or transfer effected before
Assignment or transfer of a policy should be in accordance with Section commencement of the Insurance Laws (Amendment) Act, 2015
38 of the Insurance Act, 1938 as amended by Insurance Laws shall not be affected by this section.
(Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this [Disclaimer: This is not a comprehensive list of amendments of
regard are as follows: Insurance Laws (Amendment) Act, 2015 and only a simplified
version prepared for general information. Policy Holders are
(1) This policy may be transferred/assigned, wholly or in part, with advised to refer to Insurance Laws (Amendment) Act, 2015dated
or without consideration. 23.03.2015 for complete and accurate details. ]
(2) 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. Annexure II
(3) The instrument of assignment should indicate the fact of transfer
or assignment and the reasons for the assignment or transfer, Section 39 - Nomination by policyholder
antecedents of the assignee and terms on which assignment is
made.
(4) The assignment must be signed by the transferor or assignor or Nomination of a life insurance Policy is as below in accordance with
duly authorized agent and attested by at least one witness. Section 39 of the Insurance Act, 1938 as amended by Insurance Laws
(5) The transfer or assignment shall not be operative as against an (Amendment) Act, 2015 dated 23.03.2015. The extant provisions in this
insurer until a notice in writing of the transfer or assignment and regard are as follows:
either the said endorsement or instrument itself or copy there of
certified to be correct by both transferor and transferee or their
1) The policyholder of a life insurance on his own life may nominate a
duly authorised agents have been delivered to the insurer.
(6) Fee to be paid for assignment or transfer can be specified by the person or persons to whom money secured by the policy shall be
Authority through Regulations. paid in the event of his death.
(7) On receipt of notice with fee, the insurer should Grant a written 2) Where the nominee is a minor, the policyholder may appoint any
acknowledgement of receipt of notice. Such notice shall be person to receive the money secured by the policy in the event of
conclusive evidence against the insurer of duly receiving the policyholder’s death during the minority of the nominee. The
notice. manner of appointment to be laid down by the insurer.
(8) If the insurer maintains one or more places of business, such
3) Nomination can be made at any time before the maturity of the
notices shall be delivered only at the place where the policy is
being serviced. policy.
(9) The insurer may accept or decline to act upon any transfer or 4) Nomination may be incorporated in the text of the policy itself or
assignment or endorsement, if it has sufficient reasons to believe may be endorsed on the policy communicated to the insurer and can
that it is (a) not bonafide or (b) not in the interest of the be registered by the insurer in the records relating to the policy.
policyholder or (c) not in public interest or (d) is for the purpose 5) Nomination can be cancelled or changed at any time before policy
of trading of the insurance policy. matures, by an endorsement or a further endorsement or a will as
(10) Before refusing to act upon endorsement, the Insurer should
the case may be.
record the reasons in writing and communicate the same in
writing to Policyholder within 30 days from the date of 6) A notice in writing of Change or Cancellation of nomination must
policyholder giving a notice of transfer or assignment. be delivered to the insurer for the insurer to be liable to such
(11) In case of refusal to act upon the endorsement by the Insurer, nominee. Otherwise, insurer will not be liable if a bonafide
any person aggrieved by the refusal may prefer a claim to payment is made to the person named in the text of the policy or in
IRDAI within 30 days of receipt of the refusal letter from the the registered records of the insurer.
Insurer.
7) Fee to be paid to the insurer for registering change or cancellation
(12) The priority of claims of persons interested in an insurance
policy would depend on the date on which the notices of of a nomination can be specified by the Authority through
assignment or transfer is delivered to the insurer; where there Regulations.
are more than one instruments of transfer or assignment, the 8) On receipt of notice with fee, the insurer should grant a written
priority will depend on dates of delivery of such notices. Any acknowledgement to the policyholder of having registered a
dispute in this regard as to priority should be referred to nomination or cancellation or change thereof.
Authority. 9) A transfer or assignment made in accordance with Section 38 shall
(13) Every assignment or transfer shall be deemed to be absolute
automatically cancel the nomination except in case of assignment to
assignment or transfer and the assignee or transferee shall be
deemed to be absolute assignee or transferee, except the insurer or other transferee or assignee for purpose of loan or
a. where assignment or transfer is subject to terms and against security or its reassignment after repayment. In such case,
conditions of transfer or assignment OR the nomination will not get cancelled to the extent of insurer’s or
b. where the transfer or assignment is made upon condition that transferee’s or assignee’s interest in the policy. The nomination will
i. the proceeds under the policy shall become payable to get revived on repayment of the loan.
policyholder or nominee(s) in the event of assignee or 10) The right of any creditor to be paid out of the proceeds of any
transferee dying before the insured OR
policy of life insurance shall not be affected by the nomination.
ii. the insured surviving the term of the policy
Such conditional assignee will not be entitled to obtain a loan 11) In case of nomination by policyholder whose life is insured, if the
on policy or surrender the policy. This provision will prevail nominees die before the policyholder, the proceeds are payable to
notwithstanding any law or custom having force of law policyholder or his heirs or legal representatives or holder of
which is contrary to the above position. succession certificate.
(14) In other cases, the insurer shall, subject to terms and conditions 12) In case nominee(s) survive the person whose life is insured, the
of assignment, recognize the transferee or assignee named in the
amount secured by the policy shall be paid to such survivor(s).
notice as the absolute transferee or assignee and such person
a. shall be subject to all liabilities and equities to which the 13) Where the policyholder whose life is insured nominates his (a)
transferor or assignor was subject to at the date of parents or (b) spouse or (c) children or (d) spouse and children (e)
transfer or assignment and or any of them; the nominees are beneficially entitled to the amount
b. may institute any proceedings in relation to the policy payable by the insurer to the policyholder unless it is proved that
policyholder could not have conferred such beneficial title on the
nominee having regard to the nature of his title.
13 of 29
14) If nominee(s) die after the policyholder but before his share of the 5) No Insurer shall repudiate a life insurance Policy on the ground of
amount secured under the policy is paid, the share of the expired Fraud, if the Insured / beneficiary can prove that the misstatement
nominee(s) shall be payable to the heirs or legal representative of was true to the best of his knowledge and there was no deliberate
the nominee or holder of succession certificate of such nominee(s).
intention to suppress the fact or that such mis-statement of or
15) The provisions of sub-section 7 and 8 (13 and 14 above) shall apply suppression of material fact are within the knowledge of the
to all life insurance policies maturing for payment after the
insurer. Onus of disproving is upon the policyholder, if alive, or
commencement of Insurance Laws (Amendment) Act, 2015 (i.e.
23.03.2015). beneficiaries.
6) Life insurance Policy can be called in question within 3 years on
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 the ground that any statement of or suppression of a fact material to
nominee(s) shall be entitled to the proceeds and benefit of the expectancy of life of the insured was incorrectly made in the
policy. proposal or other document basis which policy was issued or
17) The provisions of Section 39 are not applicable to any life revived or rider issued. For this, the insurer should communicate in
insurance policy to which Section 6 of Married Women’s Property writing to the insured or legal representative or nominee or
Act, 1874 applies or has at any time applied except where before or assignees of insured, as applicable, mentioning the ground and
after Insurance Laws (Amendment) Act, 2015, a nomination is materials on which decision to repudiate the policy of life insurance
made in favour of spouse or children or spouse and children is based.
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 7) In case repudiation is on ground of mis-statement and not on fraud,
to spouse or children or spouse and children under Section 6 of the premium collected on policy till the date of repudiation shall be
MWP Act, it should be specifically mentioned on the policy. In paid to the insured or legal representative or nominee or assignees
such a case only, the provisions of Section 39 will not apply. of insured, within a period of 90 days from the date of repudiation.
[Disclaimer: This is not a comprehensive list of amendments of 8) Fact shall not be considered material unless it has a direct bearing
Insurance Laws (Amendment) Act, 2015and only a simplified version on the risk undertaken by the insurer. The onus is on insurer to
prepared for general information. Policy Holders are advised to refer to show that if the insurer had been aware of the said fact, no life
Insurance Laws (Amendment) Act, 2015dated 23.03.2015 for complete insurance policy would have been issued to the insured.
and accurate details. 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
Annexure III questioning age or adjustment based on proof of age submitted
subsequently.
Section 45 – Policy shall not be called in question on the ground of
mis-statement after three years
[Disclaimer: This is not a comprehensive list of amendments of
Provisions regarding policy not being called into question in terms of Insurance Laws (Amendment) Act, 2015and only a simplified version
Section 45 of the Insurance Act, 1938, as amended Insurance Laws prepared for general information. Policy Holders are advised to refer to
(Amendment) Act, 2015 dated 23.03.2015are as follows: Insurance Laws (Amendment) Act, 2015dated 23.03.2015 for complete
and accurate details. ]
1) No Policy of Life Insurance shall be called in question on any
ground whatsoever after expiry of 3 yrs 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.
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.
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SPACE FOR ENDORSEMENTS
15 of 29
Office Copy
FIRST PREMIUM RECEIPT
Date: 26/12/2022
We certify that the premium amount mentioned below, which was received from you as
initial deposit has, consequent to the issue of a Life Insurance policy, been accounted by
us towards First Premium payable.
Policy No. 25593025 Client Id : QU364851
Plan HDFC Life Sanchay Plus
Policy Holder Ms. JAYANTI SINGH
Premium Amount
(Including Taxes and ` 50,056.00
Levies as applicable)
Premium Adjusted
22nd December 2022
with effect from :
*Notes :
(A) - This receipt is valid subject to realisation of payment by all modes.
(B) - The premiums paid are allowed as deduction from the Gross Total Income under Section 80 C
of the Income Tax Act,1961, subject to limits specified there in.
Yours sincerely,
For HDFC Life Insurance Company Limited.
HDFC LIFE INSURANCE COMPANY LIMITED

Branch Address:HDFC Life Dhanbad-Shastri Naga, 2nd floor Commerce House II, Shastri Nagar Bank Mode, Dhanbad,
826001
Corporate Office: 12th & 13th Floor, Lodha Excelus, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai - 400
011.
Registered Office: Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400 011.
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YOUR POLICY AT A GLANCE
This is a document that will help you to understand the key features of this product and is not the policy document. In case of any discrepancy between
this document and your policy document, the policy document will prevail over this document.
Plan Name , Plan HDFC Life Sanchay Plus - Long Term Income Option UIN: 101N134V15
Option & UIN
Aim of the plan This is a non participating limited paying savings insurance plan wherein you get maturity benefits as a guaranteed income for
fixed term of 25 or 30 years starting from (Policy Term+ 1)th year, in arrears and return of premium at the end of payout period.
This plan emphasizes on guaranteed benefits along with flexibility to choose your premium payment term and Policy Term .
Type of the Plan A non-participating, non-linked savings insurance plan which provides insurance coverage throughout the term of the policy
along with guaranteed maturity benefits over 25 or 30 years.
Premium Payment
Term (PPT),/ PPT 5 years – Policy Term 5 to 10 years
Policy Term (PT) PPT 6 years – Policy Term 6 to 11 years
PPT 7 years – Policy Term 7 to 10 years
PPT 11 years – Policy Term 11 & 12 years
PPT 12 years – Policy Term 12 & 13 years
Premiums Frequency Annual Half Yearly Quarterly Monthly

Minimum installment premium (exclusive of taxes Rs 30,000 Rs 15,000 Rs 7,500 Rs 2,500
and levies as applicable)
There is no limit on the maximum premium amount. However, the acceptance of any case is subject to Board approved
underwriting policy.
Under POS variant, there is no limit on maximum premium subject to maximum Sum Assured on Death of 25 Lacs. The
acceptance of any case is subject to Board approved underwriting policy.
Sum Assured Sum Assured is determined based on the life assured’s entry age and the Annualized Premium committed to paid in a policy
year. Please refer the policy document for the applicable Sum Assured.
Guaranteed Sum On Maturity Date, policyholder shall have an option to receive the future regular income as a lump sum, which shall be the
Assured on present value of future payouts, discounted at a rate of 9% p.a. Please refer the policy document for the applicable Guaranteed
Maturity Sum Assured on Maturity.
Maturity Benefit On your survival, at end of the policy term, the Maturity Benefit payable shall be Guaranteed Income on Maturity as mentioned
in the policy schedule , payable at the end of each Income Payout Frequency as applicable, during the Payout Period.
At the end of the Payout Period, the policy terminates by returning Total Premiums paid.
On death during the payout period, the nominee will continue to receive the remaining benefit payouts as per the benefit option
chosen, including the return of total premiums, till the end of Payout Period.
At any point of time during the payout period, policyholder/ nominee shall have an option to receive the future income as a lump
sum, which shall be the present value of future payouts, discounted at a rate which is computed using the prevailing interest
rates. For more details, please refer to the policy document.
In cases where Life Assured is minor, the policy will automatically vest on him or her on attaining age 18 years.
Death Benefit On death during the policy term, provided all due premiums have been paid, we will pay Sum Assured on Death to the nominee.
Where the Sum Assured on Death is highest of the following:
1. 10 times the Annualized Premium^
2. 105% of Total Premiums* paid
3. Premiums paid accumulated at an interest of 5% p.a. compounded annually
4. Guaranteed Sum Assured on Maturity as applicable under this option
5. An absolute amount assured to be paid on death, which is equal to the Sum Assured
Sum Assured shall be equal to the applicable Death Benefit Multiple times the Annualized Premium.
^ 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.
* Total Premiums Paid means total of all the premiums received, excluding any extra premium, any rider premium and taxes.
On payment of the Death Benefit, the policy will terminate and no further benefits will be payable.
Recipient of Death Benefit shall be payable to the nominee(s), if the Policyholder and the Life Assured are the same; or to the Policyholder
Benefits if the Life Assured is other than the Policyholder.
All other benefits shall be payable to the Policyholder.
If the policy has been assigned, all benefits shall be payable to the Assignee.
Policy Loans Once the policy has acquired a Surrender Value, you can take a policy loan up to 80% of the surrender value of your policy,
subject to the applicable terms and Conditions
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Exclusion In case of death 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 nominee or beneficiary of the policyholder shall be entitled to at least 80% of the total
premiums paid till the date of death or the surrender value available as on the date of death whichever is higher, provided the
policy is in force.
Free Look in 15 days from the date of receipt of the original policy document.
period If you have purchased your Policy through Distance Marketing this period will be 30 days.
Grace Period 15 days from the premium due date for monthly mode. 30 days from the premium due date for other modes.
Premium If You don’t pay the due premiums before the expiry of the grace period, your Policy will:
discontinuance & 1. Lapse if it has not acquired a Guaranteed Surrender Value (GSV). Once your Policy lapses, all the benefits
Paid-up including the risk cover will cease.
2. Become a reduced paid-up policy if it has acquired a GSV with reduced benefits. Your Sum Assured on
Death/Maturity will reduce to Paid-up Sum Assured on Death/Maturity
For details on maturity and death benefit of paid-up policy please refer to your policy document.
Revival A lapsed or paid up policy can be revived within 5 years subject to the conditions mentioned in the policy document.
Surrender The minimum Guaranteed Surrender Value shall be the sum of:
Applicable GSV factors on the total premiums paid at the time of surrender multiplied to the total premiums paid to date.
For details on GSV factors please refer your policy document.
The Company may pay a surrender value higher than the GSV in the form of a Special Surrender Value (SSV).
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Part G
(Grievance Redress Mechanism)
Grievance Redressal Process
(i) The customer can contact us on the below mentioned address or at any of our branches in case of any complaint/ grievance:
Grievance Redressal Officer
HDFC Life Insurance Company Limited
11th Floor, Lodha Excelus, Apollo Mills Compound,
N. M. Joshi Marg, Mahalaxmi, Mumbai, Maharashtra - 400011
Helpline number: 18602679999 (Local charges apply)
E-mail: service@hdfclife.com
(ii) All grievances (Service and sales) received by the Company will be responded to within the prescribed regulatory Turn Around Time (TAT) of 15 days.
(iii) Written request or email from the registered email id is mandatory.
(iv) If required, we will investigate the complaints by taking inputs from the customer over the telephone or through personal meetings.
(v) We will issue an acknowledgement letter to the customer within 3 working days of the receipt of complaint.
(vi) The acknowledgement that is sent to the customer has the details of the complaint number, the Policy number and the Grievance Redressal Officer’s name who
will be handling the complaint of the customer.
(vii) If the customer’s complaint is addressed within 3 days, the resolution communication will also act as the acknowledgment of the complaint.
(viii) The final letter of resolution will offer redressal or rejection of the complaint along with the appropriate reason for the same.
(ix) In case the customer is not satisfied with the decision sent to him or her, he or she may contact our Grievance Redressal Officer within 8 weeks of the receipt of
the communication at any of the touch points mentioned in the document, failing which, we will consider the complaint to be satisfactorily resolved.
(x) The following is the escalation matrix in case there is no response within the prescribed timelines or if you are not satisfied with the response. The number of
days specified in the below- mentioned escalation matrix will be applicable from the date of escalation.
Level Designation Response Time Email ID Address
Sr. Manager OR Associate 11th Floor, Lodha Excelus,

1st Level 10 working days escalation1@hdfclife.in
Vice President – Customer Relations Apollo Mills Compound,
N M Joshi Marg,
2nd Level (for response Vice President OR Sr. Mahalakshmi,
7 working days escalation2@hdfclife.in Mumbai 400011
not received from Level 1) Vice President – Customer Relations
You are requested to follow the aforementioned matrix to receive satisfactory response from us.
(xi) If you are not satisfied with the response or do not receive a response from us within 15 days, you may approach the Grievance Cell of IRDAI on the following
contact details:
• IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: 155255/ 18004254732
• Email ID: complaints@irdai.gov.in
• Online- You can register your complaint online at http://www.igms.irdai.gov.in/
• Address for communication for complaints by fax/paper:
General Manager
Consumer Affairs Department – Grievance Redressal Cell
Insurance Regulatory and Development Authority of India
Sy No. 115/1, Financial District,
Nanakramguda, Gachibowli,
Hyderabad – 500 032
2. Ombudsman are provided below. You are requested to refer to the IRDAI website at “www.irdai.gov.in” for the updated details.
a. Details and addresses of Insurance Ombudsman
Office of the Ombudsman Contact Details Areas of Jurisdiction
AHMEDABAD - Shri Kuldip Singh

Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor, Gujarat,
AHMEDABAD Tilak Marg, Relief Road, Dadra & Nagar Haveli,
Ahmedabad – 380 001. Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
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BHOPAL - Shri R M Singh

Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Madhya Pradesh
BHOPAL Near New Market,
Chattisgarh.
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in

62, Forest park,
Bhubneshwar – 751 009.
BHUBANESHWAR Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in

Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
BENGALURU JP Nagar, Ist Phase, Karnataka.
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
Office of the Insurance Ombudsman, Punjab,

S.C.O. No. 101, 102 & 103, 2nd Floor, Haryana(excluding Gurugram,
Batra Building, Sector 17 – D, Faridabad, Sonepat and Bahadurgarh)
CHANDIGARH Chandigarh – 160 017. Himachal Pradesh, Union Territories of
Tel.: 0172 - 2706196 / 2706468 Jammu & Kashmir,
Fax: 0172 - 2708274 Ladakh& Chandigarh.
Email: bimalokpal.chandigarh@cioins.co.in

Fatima Akhtar Court, 4th Floor, 453, Tamil Nadu,
Anna Salai, Teynampet, Tamil Nadu
CHENNAI CHENNAI – 600 018. PuducherryTown and
Tel.: 044 - 24333668 / 24335284 Karaikal (which are part of
Fax: 044 - 24333664 Puducherry).
Email: bimalokpal.chennai@cioins.co.in

2/2 A, Universal Insurance Building, Delhi &
Asaf Ali Road, Following Districts of Haryana -
DELHI Gurugram, Faridabad,
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504 Sonepat&Bahadurgarh.
Email: bimalokpal.delhi@cioins.co.in
Office of the Insurance Ombudsman, Assam,

Jeevan Nivesh, 5th Floor, Meghalaya,
Nr. Panbazar over bridge, S.S. Road, Manipur,
GUWAHATI
Guwahati – 781001(ASSAM). Mizoram,
Tel.: 0361 - 2632204 / 2602205 Arunachal Pradesh,
Email: bimalokpal.guwahati@cioins.co.in Nagaland and Tripura.

6-2-46, 1st floor, "Moin Court",
Andhra Pradesh,
Lane Opp. Saleem Function Palace,
Telangana,
A. C. Guards, Lakdi-Ka-Pool,
HYDERABAD Yanam and
Hyderabad - 500 004.
part of Union Territory of
Tel.: 040 - 23312122
Puducherry.
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in
20 of 29

Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
JAIPUR Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in

2nd Floor, Pulinat Bldg., Kerala,
Opp. Cochin Shipyard, M. G. Road, Lakshadweep,
ERNAKULAM Ernakulam - 682 015. Mahe-a part of Union Territory
Tel.: 0484 - 2358759 / 2359338 of Puducherry.
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue, West Bengal,
KOLKATA KOLKATA - 700 072. Sikkim,
Tel.: 033 - 22124339 / 22124340 Andaman & Nicobar Islands.
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in
Districts of Uttar Pradesh :

Lalitpur, Jhansi, Mahoba, Hamirpur,
Banda, Chitrakoot, Allahabad, Mirzapur,
Office of the Insurance Ombudsman, Sonbhabdra, Fatehpur, Pratapgarh,
6th Floor, Jeevan Bhawan, Phase-II, Jaunpur,Varanasi, Gazipur, Jalaun,
Nawal Kishore Road, Hazratganj, Kanpur, Lucknow, Unnao, Sitapur,
LUCKNOW Lucknow - 226 001. Lakhimpur, Bahraich, Barabanki,
Tel.: 0522 - 2231330 / 2231331 Raebareli, Sravasti, Gonda, Faizabad,
Fax: 0522 - 2231310 Amethi, Kaushambi, Balrampur, Basti,
Email: bimalokpal.lucknow@cioins.co.in Ambedkarnagar, Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur,
Chandauli, Ballia, Sidharathnagar.

3rd Floor, Jeevan Seva Annexe, Goa,
S. V. Road, Santacruz (W), Mumbai Metropolitan Region
MUMBAI Mumbai - 400 054. excluding Navi Mumbai &
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31 Thane.
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in
State of Uttaranchal and the following

Districts of Uttar Pradesh:
Office of the Insurance Ombudsman, Agra, Aligarh, Bagpat, Bareilly, Bijnor,
Bhagwan Sahai Palace Budaun, Bulandshehar, Etah, Kanooj,
4th Floor, Main Road, Mainpuri, Mathura, Meerut, Moradabad,
Naya Bans, Sector 15, Muzaffarnagar, Oraiyya, Pilibhit,
NOIDA
Distt: Gautam Buddh Nagar, Etawah, Farrukhabad, Firozbad,
U.P-201301. Gautambodhanagar, Ghaziabad, Hardoi,
Tel.: 0120-2514252 / 2514253 Shahjahanpur, Hapur, Shamli, Rampur,
Email: bimalokpal.noida@cioins.co.in Kashganj, Sambhal, Amroha, Hathras,
Kanshiramnagar, Saharanpur.

2nd Floor, Lalit Bhawan,
Bailey Road, Bihar,
PATNA
Patna 800 001. Jharkhand.
Tel.: 0612-2547068
Email: bimalokpal.patna@cioins.co.in

Jeevan Darshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198, Maharashtra,
PUNE N.C. Kelkar Road, Narayan Peth, Area of Navi Mumbai and Thane
Pune – 411 030. excluding Mumbai Metropolitan Region.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in
21 of 29
b. Insurance Ombudsman-
1) The Ombudsman shall receive and consider complaints alleging deficiency in performance required of an insurer (including its agents and intermediaries) or an
insurance broker, on any of the following grounds—
(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 in so far 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 arising from non-observance of or non-adherence to the provisions of any Regulations made by the Authority with regard to protection of
Policyholders’ interests or otherwise, or of any circular, guideline or instruction issued by the Authority, or of the terms and conditions of the Policy contract, insofar
as such matter relates to issues referred to in clauses (a) to (h).
c. Manner in which complaint is to be made -
1) Any person who has a grievance against an insurer or insurance broker, may himself or through his legal heirs, Nominee or Assignee, make a complaint in writing
to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer or the insurance broker, as the case may be, complained against
or the residential address or place of residence of the complainant is located.
2) The complaint shall be in writing, duly signed or made by way of electronic mail or online through the website of the Council for Insurance Ombudsmen, by the
complainant or through his legal heirs, Nominee or Assignee and shall state clearly the name and address of the complainant, the name of the branch or office of the
insurer against whom the complaint is made, the facts giving rise to the complaint, supported by documents, the nature and extent of the loss caused to the
complainant and the relief sought from the Insurance Ombudsman.
3) No complaint to the Insurance Ombudsman shall lie unless—
(a) the complainant has made a representation in writing or through electronic mail or online through website of the insurer or insurance broker concerned to the
insurer or insurance broker, as the case may be, named in the complaint and—
i. either the insurer or insurance broker, as the case may be, had rejected the complaint; or
ii. the complainant had not received any reply within a period of one month after the insurer or insurance broker, as the case may be, received his representation; or
iii. the complainant is not satisfied with the reply given to him by the insurer or insurance broker, as the case may be;
(b) The complaint is made within one year—
i. after the order of the insurer or insurance broker, as the case may be, rejecting the representation is received; or
ii. after receipt of decision of the insurer or insurance broker, as the case may be, which is not to the satisfaction of the complainant;
iii. after expiry of a period of one month from the date of sending the written representation to the insurer or insurance broker, as the case may be, if the insurer named
fails to furnish reply to the complainant.
4) The Ombudsman shall be empowered to condone the delay in such cases as he may consider necessary, after calling for objections of the insurer or insurance
broker, as the case may be, against the proposed condonation and after recording reasons for condoning the delay and in case the delay is condoned, the date of
condonation of delay shall be deemed to be the date of filing of the complaint, for further proceedings under these rules.
5) No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before or disposed of by any
court or consumer forum or arbitrator.
6) The Council for Insurance Ombudsmen shall develop a complaints management system, which shall include an online platform developed for the purpose of
online submission and tracking of the status of complaints made under rule 14 of Insurance Ombudsman Rules, 2017.
22 of 29
PROPOSAL FORM FOR SINGLE LIFE/JOINT LIFE
Linked and Non Linked Individual Life Limited Underwriting & Pension Plans
For Office use only

Consultant Name & Code: MANISH KUMAR 01196840
License No: License Expiry Dt: Bancassurance Code:
Company Lead: Lead Reference No: 1-200749919957 Channel Partner Cust Id:
IA / CAO Emp No: IA / CAO Name: Branch Code: 1125
Channel Code: FOS Code: Telecode:
ALL UNIT LINKED POLICIES ARE DIFFERENT FROM TRADITIONAL INSURANCE POLICIES AND ARE SUBJECT TO DIFFERENT RISK FACTORS.
IN UNIT LINKED POLICY THE INVESTMENT RISK IN YOUR CHOSEN INVESTMENT PORTFOLIO IS BORNE BY YOU Photograph of life to be assured*
to be signed across by the life to
be assured
* Not mandatory if life to be
assured is different from the
1) The entire form is to be filled in black ink only by the policyholder. Use CAPITAL letters for information required in boxes with a space between Proposer except if Life to be
assured is minor
words. 2) Any cancellation / alteration is to be signed by the proposed policyholder or life to be assured as appropriate. 3) All information provided here
shall be relied on and should be accurate, complete and true in all respects for processing the proposal quickly. In case you have any doubt whether the
particular information is material or not, please disclose the information. 4) Please attach an extra sheet, wherever additional information is to be given.
Proposer (Primary Life to be Assured)/ Policy Owner Details (Proposer in case of Click 2 Wealth for Premium Waiver Option)
1. Full Name:(Leave a blank Ms. JAYANTI SINGH
space between First, Middle &
Last Name)
2. Maiden Name:(for married woman SHANTI DEVI
only)
3. Date of Birth (DD/MM/YYYY): 24/12/1976

4. Gender(M/F/Tg): Female
5. Marital Status: Married
6. Nationality: Indian
7. Education: BA
8. Resident status: Resident Indian
If you are NRI/PIO/OCI, Please attach
appropriate Questionnaire.
Country of Residence:
If NRI/PIO/OCI
Country of Workplace:
If NRI/PIO/OCI
Permanent Country:
9. Do you have an existing HDFC If Yes, please provide Policy NO: Annualised Premium:
Life policy:
10. Does your spouse have an If Yes, please provide Product
existing HDFC Life policy: Name:
11. Are You an employee of HDFC If Yes, please provide Employee Relationship with HDFC Group
Group or Spouse/child of HDFC ID: Employee(if applicable)
Group employee:
12. Correspondence W/O SATENDRA SINGH NEAR NEHRU, CHOWK DIST DHANBAD DUMRA, DUMRA
Address: Bokaro, Jharkhand-828306 India
13. Permanent Address (If W/O SATENDRA SINGH NEAR NEHRU, CHOWK DIST DHANBAD DUMRA, DUMRA
different from Bokaro, Jharkhand-828306 India
correspondence address)/
Overseas residential
address for NRI / PIO / OCI :
14. Mobile: 919431314830
Telephone No(R):
Telephone No(O):
E - mail ID: JAYANTISINGH00000@GMAIL.COM
Email ID if provided, will be
considered as preferred mode of
communication
15. Preferred language of English

communication:
16. Present Occupation: Self employed/ Business
Gross Yearly Income 3,50,000
(INR):
Workplace Name and Owner, Baghmara, Baghmara,
Address:
^ if Retired, please provide name of
last organisation
Industry Type (cement, Cosmetics

baking, etc.):
Exact Nature of work
(clerical, mechanical,
supervisory job, etc.):
Nature of Occupation Owner & Proprietor
(architect, etc.):
17. Income Proof (proposer): Identity Proof (Proposer):
Address Proof Age Proof (Life Assured):
(Proposer):
PAN* (Proposer):
18. PAN Photocopy
enclosed :(*Submit Form 60 if PAN
is not available)
19. Do you want policy in No E insurance account number:

Demat form?If a policy is requested
in demat form, it will not be given in
physical form and vise versa.
23 of 29
20. Is the Policy holder same Yes
as Life Assured
Relationship with Life to Self
be Assured
21. Are you taking the policy No
to primarily protect the
disabled person?
22. Are you a "Politically No
Exposed Person"?
Definition of a Politically Exposed Person: Politically exposed persons are individuals who are or have been entrusted with prominent public functions in a foreign country, their family members
and close relatives; for e.g. Heads of States or of Governments, Senior politicians, Senior government / judicial / military officers,Senior executives of state-owned corporations, Important
politicals party officials, etc.
23. Do you have any history of conviction / acquittal under any criminal proceedings in India or abroad? No
24. Sources of Funds: If Premium & Single Premium Top-ups, if any is equal to or more than INR 1 lakh, please enclose proof of income e.g. ITR
Salaries Business House Property Capital Gains Investments Agriculture Others Total
100% 100%
Details of Secondary Life to be Assured (Life Assured in case of Click 2 Wealth for Premium Waiver Option)
1. Full Name: (Leave a blank space Ms. JAYANTI SINGH
between First, Middle & Last Name)
2. Maiden Name:(for married woman only) SHANTI DEVI
3. Father/Husband Name:
4. Mother's Maiden Name:
5. Relationship with Primary Life Assured:
6. Date of Birth (DD/MM/YYYY) : 24/12/1976
7. Gender(M/F/Tg): Female
8. Marital Status: Married
9. Nationality: Indian
10. Education: BA
11. Resident status: Resident Indian
If you are NRI/PIO/OCI, Please attach appropriate
Questionnaire.
Country of Residence:
If you are NRI/PIO/OCI
Country of Workplace:
If you are NRI/PIO/OCI
Permanent Country:
12. Present Occupation: Self employed/ Business
13. Gross Yearly Income (INR): 3,50,000
14. Workplace Name and Address: Owner, Baghmara, Baghmara,
^ please provide name of last organisation
15. Industry Type (cement, baking, etc.): Cosmetics

16. Exact Nature of work (clerical,
mechanical, supervisory job, etc.):
17. Nature of Occupation (architect, etc.): Owner & Proprietor
18. Do you have any history of conviction / acquittal under any criminal proceedings in India or abroad? No
19. If Life to Assured is a student/housewife, please provide insurance details regarding parents/husband/siblings.
(Please attach a separate sheet for multiple policies if required.)
Total Sum Assured of all inforce life Policy No. and Name of Company Husband's / Parent's Occupation /
insurance policies Income
Personal Details of Life to be Assured (Primary) (Proposer in case of Click 2 Wealth for Premium Waiver Option)
1 Have you suffered from or received treatment for any symptoms or medical condition(s) such as HIV, AIDS or HIV AIDS NO
related or sexually transmitted diseases?
2 Have you suffered from or received treatment for any symptoms or medical condition(s) for any of the following? NO
• Chest pain or heart attack or any other heart disease or problem or hypertension
• Stroke or paralysis
• Cancer, tumour, growth or cyst of any kind
• Diabetes or high blood sugar or sugar in urine
• Kidney problems (excluding Kidney stones) or disease of the reproductive organs
• Liver problem (excluding jaundice) or hepatitis B or C
• Muscular - skeletal disorder
• Gastro - intestinal disorders
• Nervous, psychiatric or mental disorders
• Respiratory diseases (excluding Asthma and Bronchitis)
3 Have you suffered from or received treatment for any symptoms or medical condition(s) for any of the following in last two NO
years?
• Kidney stone
• Jaundice
• Asthma
4 Apart from minor ailments, such as colds and flu, have you received any treatment from any doctor or specialist or been NO
hospitalised or undergone hospital treatment, in the last 5 years.
5 Has any proposal for assurance on your life ever been Declined, Postponed, Accepted at extra premium, Accepted on special NO
terms, and Accepted with reduced cover or withdrawn by yourself.
6 Do you have any physical disability which is affecting your day to day activities? NO
7 Please provide details, if any, regarding your occupation or business, which may render you susceptible to injury or illness. None of these
(e.g. exposure to chemical substances/hazardous materials/harmful dust or gases/ explosives/ working at heights/ handling
heavy machinery etc.)
Important Information: 1. Any false declaration in the above short medical questionnaire may be liable for rejection of the proposal form and the contract of insurance shall be treated
null & void. It may also lead to rejection of the claim on death of the life assured.
Date: Place: Signature of Primary Life to be Assured
Nominee Details (To be filled only if Proposer and Life to be assured are same)
Nominee Full Name Date of Birth(DD/ Gender(M/F/Tg) Relationship Contact No % Share
MM/YYYY) with Life to be
Assured
1 Mr. SATYENDRA SINGH 20/04/1974 Male Husband 100
Details of Products Applied For
1. Objective of Savings 24 of 29
Insurance:
2. Mode :(for regular / limited Annual
premium paying plan)
3. Premium Payment
Option:
4. Top-up Option: No ________Top up % (available only under Click 2
Protect 3D Plus )
5a. Product Details:

Product Name Cover type Plan Option Policy Term Premium Sum Modal
(Self/PPH/HUF/ (in years) Payment Assured(in Premium (in
MWPA/Business) INR) INR)
Term(in years)
HDFC Life Sanchay Plus Long Term Income 7 6 5,26,900 47,900

6a. For YoungStar
Udaan, Classic Waiver
Plan Option:
6b. For YoungStar
Super Premium, also
choose Benefit Option:
6c. For Sampoorn
Nivesh, also choose
Benefit Option :
6d. For Classic One,
choose Coverage
Variant :
6e. For Click 2 Wealth,
choose plan option :
6f. For Sanchay Annual
Plus,choose Income
Payout Mode :
6g. For Sanchay Par
Advantage, choose
survival benefit payout
option :
6h. For Sanchay Par
Advantage, also choose
frequency :
6i. For Sanchay Par
Advantage, also choose
date :
6j. For Click 2 Protect Return of Premium: WoP CI: Accidental Death
Life, choose add on Benefit:
option :
6k. For Smart Protect
Plan, choose plan
option:
6l. For Smart Protect Level Cover Period
Plan, Decreasing Cover
and Decreasing with
Capital Guarantee Plan
option choose:
7. Rider Details: Product Rider Name Coverage Rider Option Rider Policy Rider Premium Pay Term(in Rider Sum Modal
(with additional premium) Name Type Term(in years) years) Assured(in Premium (in
INR) INR)
8. Top-up Premium NIL Top-up Sum Assured NIL Total Premium (INR): 50,056
(INR): (INR):
9. Commencement Backdation Charges
date^: (INR) (if any):
(^only for non linked plan - Has to be within
the same financial year)
10.I wish to opt for Systematic Transfer Plan (STP) No

Source Fund Target Fund Amount Transfer Date
In case the Transfer Date is not selected, it will be consider

as 1st of the Month.
In order to activate/continue STP, Policyholder has to ensure
that sufficient premiums are allocated in Source Fund.
11. For unit linked plans, kindly indicate % of allocation in below mentioned funds as applicable (please check the fund for the product applied)
Income Balanced Blue chip Opportuni Equity Diversified Bond Conservat Liquid Discovery Equity Bond Plus Secure Sustaina Total
Fund Fund Fund ties Fund Plus Fund Equity Fund ive Fund Fund Fund Advantage Fund Advantage ble Equity
Fund Fund Fund Fund
% % % % % % % % % % % % % % 100%
Immediate Annuity Plan Details

8 a) Single Premium (Purchase Price) Rs.
8 b) Annuity Amount to be paid Rs.
8 c) Annuity Options (Please tick one option only in appropriate box)
Lifetime Annuity Lifetime Annuity with Return of 100% of the Purchase Price Lifetime Annuity with Guarantee
Lifetime Annuity with Return of Balance of Purchase Price 5 yrs 10 yrs 15 yrs 20 yrs
Lifetime Annuity increasing at a simple rate of 5% p.a. Lifetime Annuity with Return of Purchase Price in Parts
Lifetime Annuity with Return of 100% of the Purchase Price on Diagnosis of Critical Illness or Death
Joint Life, Last Survivor with return of 100% of the purchase price 50% 100%
Joint Life, Last Survivor 50% 100%
Frequency of Annuity Payments
Details of Spouse (applicable for joint life annuity options only)

25 of 29
Full Name: (Leave a blank space between
First, Middle & Last Name)
Date of Birth: Gender M F Tg
Details of First Premium Deposit.

Payor Details: Self
Payment Details: Amount in (INR): 50,056
Drawn on (Bank name & branch): ______________________
Cheque / DD No. ______________________ Date: ______________________ Bank A/c No. ______________________
Payout Mode(Choose any one)

Selected mode would be used by the company to make payout(s) to the Proposer. Payout would be in accordance and subject to the terms and conditions of the policy.
1 Account Type: Savings 2 Bank Name: BANDHAN BANK

3 Account 50220037399543 4 Bank Branch: BANDHAN BANK Katresgarh
Number:
5 IFSC Code: BDBL0001695
Declaration: 1. In case of non credit to my bank account with/without assigning any reasons there of or if the transaction is delayed or not effected at all for reasons of incomplete / incorrect information, I would not hold HDFC Life Insurance Co. Ltd
responsible. 2. In case of NRI/NRE account, cheque will be issued.
Note: Please provide a cancelled copy of your cheque.
Signature of Proposer
Declaration of the Life(s) to be Assured and Proposer / Policy Owner
I/We declare that:

i.I/We have replied to the questions, and have made the statements in respect of the matters sought for, in the proposal Form/Electronic proposal form ("Proposal Form") and I
understand and agree that the replies given and statements/declarations made in the Proposal Form together with any documents submitted by me/us for processing my/our
application for insurance shall be the basis of the contract between me/us and HDFC Life Insurance Company Limited ("the Company"). All documents submitted by me/us along with
this Proposal Form are authentic, valid, and where relevant true copies of originals for the purpose of this Proposal Form have been submitted and I/ we have not withheld any material
fact within my/ our knowledge. ii. I/We understand and agree that in case of misstatement or suppression of material facts the policy contract shall be treated in accordance with the
Sec 45 of Insurance Act,1938 as amended from time to time. iii.I/We shall be bound to notify the Company forthwith, in writing, of any change in my/our health, occupation or income
between the date of this Proposal Form and the date of acceptance of my/our proposal for insurance, as communicated in writing to me/us by the Company. iv. I/We have deposited
the first premium along with this Proposal Form, and the premiums payable under the Policy that may be issued in pursuance of this proposal for insurance, will be paid, strictly in
accordance with the law of the land. Amounts paid, otherwise than from my account shall be paid only if i/we can establish an insurable interest. v. All/any amounts paid/payable
towards the policy will be out of legally declared and assessed sources. Further,all the premiums will be paid in accordance with Prevention of Money Laundering Act 2002 (as
amended from time to time) or any other applicable laws.vi. I/we will provide information as required by the Company, on its own or under any lawful instruction/ order, regarding
sources of funds/utilization/ withdrawals.
I/We agree and understand:

i.That the Company will be on risk in pursuance of this proposal for insurance only after the risk under the Proposal Form is accepted by the Company and such acceptance is
communicated to me/us in writing by the Company. ii.That the Company has the right either to accept or reject my/ our proposal and I undertake that there shall be no costs, claims,
charges being raised by me/ us against the Company thereof. iii. That the Company shall be entitled to retain the premium paid along with the Proposal Form as an interest free initial
deposit to be adjusted against premium payable upon issuance of the Policy. In the event the proposal for insurance is not accepted by the Company the aforesaid deposit shall be
refunded without any interest subject to deductions for medical costs, if any. iv. That the premium payable as well as the sum assured (main as well as additional benefits) may vary
upon assessment of risk by the Company. v.That the Company may seek information from any of my/ our past or present employers/ business associates or from a doctor/medical
examiner / hospital / laboratory / clinic who at any time have attended to me/ us concerning anything which affects my/ our physical or mental health or may seek information from any
insurance office to which an application has been made for insurance on my/ our life. I/ We hereby authorize such parties to furnish information as required by the Company and also
to furnish any documents regarding my/ our employment/business, my/ our health and habits or health and habits of the Life to be Assured (without taking the prior consent of my/ our
family or of any member thereof) as it may require either for the purpose of processing my/ our proposal for insurance or at any time thereafter for any other purpose in relation to the
Policy that may be issued in pursuance of this proposal for insurance vi.In the event of I/we being medically examined, the answers given by me/ us to the medical examiner acting on
behalf of the Company shall be deemed to be incorporated in this proposal for insurance.vii. That the Company may, without any reference to me/us or my family or any member
thereof, furnish any details/ information furnished in this Proposal Form to any judicial or statutory or other authority or to any insurer or reinsurer in connection with the processing of
this proposal for insurance or servicing of this policy. viii. That the Company may contact/ communicate with me/us through postal or courier service, email, telephone, mobile, sms or
VoIP including Whats App. ix. I hereby declare and agree that the above disclosures along with the Statements and the declarations made under the proposal made by me as
Proposer and on behalf of the other/secondary life assured in case of joint life proposals will be the basis of the contract of assurance between us and HDFC Life. If any statement is
found to be untrue or inaccurate or if any fact that might influence the terms of acceptance of this proposal is not disclosed by me in my capacity as Proposer and on behalf of the other/
secondary life assured in case of joint life proposals, the contract shall be treated in accordance with the Sec 45 of Insurance Act,1938 as amended from time to time.x. That I/We have
voluntarily given my/our consent to collect, process, receive, possess, store, deal or handle my/our sensitive personal data or information [as defined in the Information Technology
(Reasonable security practices and procedures and sensitive personal data or information) Rules 2011 as amended from time to time], with third parties/ vendors associated with the
Company for various purposes and outsourced activities related to issuance/servicing/settlement of claim as required under the Policy.
Additional Declaration (Applicable for Health Rider / Product):

i. I/We hereby declare, on my/our behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me/us are true and
complete in all respects to the best of my/ our knowledge and that I/ We am/are authorised to propose on behalf of these other persons. ii. I/We understand that the information
provided by me / us will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurer and that the policy will come into force only after full
payment of the premium chargeable.iii. I/We further declare that I / We will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer
after the proposal has been submitted but before communication of the risk acceptance by the company. iv. I/We declare that I/We consent to the company seeking medical
information from any doctor or hospital who/which at any time has attended on the person to be insured/proposer or from any past or present employer concerning anything which
affects the physical or mental health of the person to be insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured /
proposer has been made for the purpose of underwriting the proposal and/or claim settlement. v. I/We authorize the company to share information pertaining to my/our proposal
including the medical records of the insured/proposer for the sole purpose of underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory
authority.
Signature/Thumb impression of (Primary) life to be assured. Signature should match with signature on ECS/SI mandate
Date: Place:
Mobile:
PLEASE DO NOT SIGN ON THE BLANK PROPOSAL FORM
Declaration of good health for spouse
Name: DOB: Amount of Insurance:

Within the past 5 years from the date of signing this proposal form, I have neither been hospitalized for, required medication or treatment for, nor consulted a 26 of 29
physician (to include a follow-up visit) due to, or as a result of, any of the following: alcohol or drug abuse, heart or circulatory disorder, stroke, cancer or
leukemia, diabetes, high blood pressure, chronic kidney or liver disease, mental, nervous or neurological disorders, lung disorders, AIDS (acquired immune
deficiency syndrome), ARC (AIDS related complex), or had tests indicating exposure to the AIDS virus.
Yes No Date:____________________ Signature of the spouse
Declaration (If signed in Vernacular language / Thumb impression has been affixed above)
Declaration to be made by a 3rd person where: The life to be assured/proposed policyholder has affixed his/her thumb impression; OR the life to be assured/proposed
policyholder has signed in vernacular; OR the life to be assured/proposed policyholder has not filled the application OR/AND The spouse of the life to be assured/
proposed policyholder has affixed his/her thumb impression or signed in vernacular the Declaration of Good Health applicable under Elite Option of Smart Woman Plan.
I hereby declare that I have explained the contents of this application form to the life to be assured / proposed policyholder in ________________________language and have
truthfully recorded the answers provided to me. I further declare that the life to be assured/proposed policyholder has signed/affixed his/ her thumb impression in my presence.
____________________________________________________________________________________________________ ___________________________________
Name and address of Declarant Signature
Declaration made by life to be assured/proposed policyholder
I/We certify that the contents of the form have been fully explained to me by Mr. / Mrs.:______________________________
_____________________________________________________________________ ______________________________________
Signature/Thumb impression of life to be assured/proposed policyholder Signature/Thumb impression of Witness
Sections of the Insurance Act 1938 as amended from time to time
Section 41 - Prohibition of rebates: No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance
in respect of any kind of risk relating to lives 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 such rebate as may be allowed in accordance with the published prospectuses or tables of the
insurer.
Section 45 - 1.No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy, i.e., from the date of
issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later. 2. A policy of life insurance may be
called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to
the policy, whichever is later, on the ground of fraud: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or
assignees of the insured the grounds and materials on which such decision is based. 3.Notwithstanding anything contained in sub-section (2), no insurer shall repudiate a life
insurance policy on the ground of fraud if the insured can prove that the misstatement of or suppression of a 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 mis-statement of or suppression of a material fact are within the knowledge of the insurer: Provided that in case of fraud,
the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive. 4.A policy of life insurance may be called in question at any time within three years from the date
of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground that any
statement of or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which the policy was
issued or revived or rider issued: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the
grounds and materials on which such decision to repudiate the policy of life insurance is based: Provided further that in case of repudiation of the policy on the ground of misstatement
or suppression of a material fact, and not on the ground of fraud, the premiums collected on the policy till the date of repudiation shall be paid to the insured or the legal representatives
or nominees or assignees of the insured within a period of ninety days from the date of such repudiation. 5. Nothing in this section 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.
27 of 29
22-12-2022
Quote No : qbgul9zyi34ds,Application No : 1100079200199
Benefit Illustration for HDFC Life Sanchay Plus

This Illustration has been produced by HDFC Life Insurance Company Limited to help you understand the benefits of your
HDFC Life Sanchay Plus
DETAILS
Name of the Prospect/Policyholder: JAYANTI SINGH Proposal No: NA
Age: 45 Name of Product: HDFC Life Sanchay Plus
A non-participating non-linked savings
Name of Life Assured: JAYANTI SINGH Tag Line:
insurance plan
Age: 45 Unique Identification No: 101N134V15
Policy Term: 7 Years GST Rate: 4.5%* for first year
2.25%* second year
Premium Paying Term: 6 Years
onwards
Amount of Instalment Premium
Rs.47900
(Without GST):
Mode: Annual
*0% if qualifies as zero-rated supply under GST law
This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.
"Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. If your policy offers
guaranteed benefits then these will be clearly marked "guaranteed" in the illustration table on this page. If your policy offers variable benefits then the illustrations on this page will
show two different rates of assumed future investment returns, of 8% p.a. and 4% p.a. These assumed rates of return are not guaranteed and they are not the upper or lower limits
of what you might get back, as the value of your policy is dependent on a number of factors including future investment performance."
Policy Details
Policy Option Long Term Income Sum Assured Rs. 526900
Guaranteed Payout Sum Assured on Death (at

Annual 526900
Freqency inception of the policy) Rs.
Guaranteed Payout Payout Term

24070 25
Amount (years)
Premium Summary
PP PP Total
Base Plan CI Rider IB Rider PP Rider (PAC) Rider Rider Instalment
(ADC) (CC) Premium
Instalment Premium without GST 47,900 0 0 0 0 0 47,900

Instalment Premium with First Year GST 50,056 0 0 0 0 0 50,056
Instalment Premium with GST 2nd Year Onwards 48,978 0 0 0 0 0 48,978
28 of 29
(Amount in Rupees)
Policy Year Single/ Guaranteed Non Guaranteed
Annualized
Survival Benefits / Other benefits Maturity Benefit Death Benefit Min Special Surrender Value
Premium
Loyalty Additions (if any) Guaranteed
Surrender
Value
1 47,900 0 0 0 5,26,900 0 0
2 47,900 0 0 0 5,26,900 28,740 28,740
3 47,900 0 0 0 5,26,900 50,295 50,295

4 47,900 0 0 0 5,26,900 95,800 95,800
5 47,900 0 0 0 5,26,900 1,19,750 1,71,878
6 47,900 0 0 0 5,26,900 2,58,660 2,25,331

7 0 0 0 0 5,26,900 2,58,660 2,46,174
8 0 0 0 24,070 0 0 0
9 0 0 0 24,070 0 0 0
10 0 0 0 24,070 0 0 0
11 0 0 0 24,070 0 0 0
12 0 0 0 24,070 0 0 0
13 0 0 0 24,070 0 0 0
14 0 0 0 24,070 0 0 0
15 0 0 0 24,070 0 0 0
16 0 0 0 24,070 0 0 0
17 0 0 0 24,070 0 0 0
18 0 0 0 24,070 0 0 0
19 0 0 0 24,070 0 0 0
20 0 0 0 24,070 0 0 0
21 0 0 0 24,070 0 0 0
22 0 0 0 24,070 0 0 0
23 0 0 0 24,070 0 0 0
24 0 0 0 24,070 0 0 0
25 0 0 0 24,070 0 0 0
26 0 0 0 24,070 0 0 0
27 0 0 0 24,070 0 0 0
28 0 0 0 24,070 0 0 0
29 0 0 0 24,070 0 0 0
30 0 0 0 24,070 0 0 0
31 0 0 0 24,070 0 0 0
32 0 0 0 3,11,470 0 0 0
Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods & Service Tax.
I MANISH KUMAR, have explained the premiums charges and benefits under the I JAYANTI SINGH,having received the information with respect to the above, have
product fully to the prospect / policy holder. understood the above statement before entering into the contract.
Place:
Date: Signature of Agent /Intermediary / Official Date: Signature of Prospect / Policyholder
Note: Kindly note that name of the company has changed from "HDFC Standard Life Insurance Company Limited" to "HDFC Life Insurance Company Limited".
29 of 29

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Part A

Ref no.: 25593025 PSCDEAD-D2C_MumPost-2297789-2380289

Ms. JAYANTI SINGH

Cancellation in the Free-Look Period:

Name Ms. JAYANTI SINGH

W/O SATENDRA SINGH NEAR NEHRU

Life Assured Details

Name Ms. JAYANTI SINGH

W/O SATENDRA SINGH NEAR NEHRU

Plan Option Long Term Income

Premium Due Date(s) 22nd December

Sum Assured ` 526,900.00

Sum Assured on Death ` 526,900.00

Premium Paying Term 6 years

Frequency of Premium Payment Annual

Underwriting Extra Premium per ` 0.00

Total Premium per Frequency of ` 47,900.00

Annualized Premium ` 47,900.00

Guaranteed Income on Maturity ` 24,070.00

Payout Period 25 years starting from year 08

Income Payout Frequency Annually

Grace Period 30 days

Final Premium Due Date 22/12/2027

Maturity Date 22/12/2029

HDFC Life Insurance Company Limited

Stamp Duty of ` 105.40/- is paid as provided under Article 47D(iii) of Indian

Nominee’s Name Mr. SATYENDRA SINGH

Nominee’s Relationship with the Life Husband

Date of Birth of Nominee 20th April 1974

W/O SATENDRA SINGH NEAR NEHRU

Nominee’s Relationship with the Life

Date of Birth of Nominee

Date of Birth of Appointee

Signed at Mumbai on 27th December 2022

Sum Assured shall be equal to the applicable Death Benefit

Upon the payment of the Death Benefit in case of death of

Guaranteed Surrender Value Factors as percentage of Total Premiums Paid

Policy Policy Term

2 30% 30% 30% 30% 30% 30% 30% 30% 30%

3 35% 35% 35% 35% 35% 35% 35% 35% 35%

4 90% 50% 50% 50% 50% 50% 50% 50% 50%

5 90% 90% 50% 50% 50% 50% 50% 50% 50%

6 90% 90% 75% 50% 50% 50% 50% 50%

7 90% 90% 75% 50% 50% 50% 50%

8 90% 90% 75% 75% 75% 75%

9 90% 90% 75% 75% 75%

10 90% 90% 90% 90%

11 90% 90% 90%

Appendix 2: Death Benefit Multiple

Entry Ages: 5 to 60 years

Guaranteed Income payable each year during the Payout Period

5 years 5 years 35.25% of Annualized Premium 35.00% of Annualized Premium

5 years 6 years 38.25% of Annualized Premium 37.75% of Annualized Premium

5 years 7 years 41.25% of Annualized Premium 40.75% of Annualized Premium

5 years 8 years 45.25% of Annualized Premium 44.50% of Annualized Premium

5 years 9 years 48.25% of Annualized Premium 47.75% of Annualized Premium

5 years 10 years 54.25% of Annualized Premium 53.75% of Annualized Premium

6 years 6 years 45.75% of Annualized Premium 45.00% of Annualized Premium