ALLAHABAD BANK

PRIORITY SECTOR CREDIT DEPARTMENT

HEAD OFFICE: 2, NETAJI SUBHAS ROAD, KOLKATA-700001

Instruction Circular No. 14066/PSC/2015-16/ 39 Date : 21.12.2015

All Offices and Branches

PERSONAL ACCIDENT INSURANCE SCHEME

FOR KISAN CREDIT CARD HOLDERS ( PAIS)

Branches/ Offices are aware that all Kisan Credit Card holders are provided with
Personal Accident Insurance coverage upto Rs.50,000.00.

The Board of Directors of the Bank had approved “Janata Personal Accident
Insurance” scheme of M/S Universal Sompo General Insurance Co. Ltd. for providing
Personal Accident Insurance coverage to Kisan Credit Card holders details of which was
advised in Head Office Instruction Circular No. 11049/PSC/2010-11/13 dated 06.07.2010.

In order to provide Personal Accident Insurance coverage to Bank’s KCC

borrowers, MOU has been signed with M/S Universal Sompo General Insurance Co. Ltd.
on 11.12.2015. The scheme will be implemented with immediate effect. The salient feature
of the scheme is as under:

1.1 Scope of Cover

The insurance scheme will cover all Kisan Credit Card borrowers of the Bank and
those to be issued Allahabad Bank Kisan Credit Card facility by the Bank against death or
permanent/partial disability resulting from accident.

1.2 Persons Covered

KCC borrowers up to age of 70 years.

1.3 Risk Coverage (Total Sum Insured)

a. Death due to accident : Rs. 50, 000.00
b. Permanent total disability : Rs. 50, 000.00
c. Loss of two limbs/eyes or
one limb and one eye : Rs. 50, 000.00
d. Loss of one limb/eye : Rs. 25, 000.00

1.4 Period of Insurance

On the basis of amount of premium paid, the insurance will be in force for a period
of one year/ two years/ three years from date of receipt of premium.

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1.5 Premium
Rs.18/- per KCC holder for three years
Rs.12/ per KCC holder for two years
Rs.6.36 per KCC holder for one year

Premium will be shared between Bank and KCC borrower in the ratio of 2:1. (e.g. in
case of premium for three year Rs.12/ will be paid by Bank and Rs.6/ will be paid by the
borrower).

1.6 The insurance will commence from the date of realisation of premium amount
from borrowers account in favour of Insurance Company.

2. CLAIM PROCEDURE

2.1 Death Claim

2.1.1 Claim under PAIS (Janata Personal Accident Insurance Scheme) will be processed
at corporate office of M/S Universal Sompo General Insurance Co.Ltd., Mumbai.

2.1.2 An intimation of claim (Format provided in Annexure – III) can be received at

Bank Branch through various modes like fax, e-mail or letter. The following information
is required for lodgement of claim

• Name, age, gender and designation of beneficiary

• A brief note on how the loss has taken place

The claim intimation received at Branch will be forwarded to corporate office of

Universal Sompo General Insurance Co. Ltd under copy to Zonal Office and designated
office of USGICL (as per Annexure – II). Zonal Office will maintain data regarding receipt of
such claims and coordinate with the Corporate Office of USGICL through their respective
designated branch for timely disposal/settlement of claim.

2.1.3 The claimant will submit the following documents to the Bank Branch:

2.1.3.1. In case of Death

Following documents are required to be submitted by the claimant:

a. Duly filled in Claim form

b. Death certificate
c. Post Mortem report
d. FIR attested copy or original
e. Legal Heir certificate / nominee
f. Report from claim enquiry cum verification committee

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2.1.3.2. Verification and Certification of Claim Documents by Verification
Committee

A verification committee consisting of

a. The Branch Manager of the concerned Branch of our Bank (Head of the
Committee)
b. The Branch Manager of the designated branch of USGICL of the concerned Zone
will verify and attest the documents and will also verify the coverage of the individual
under the Kisan Credit Card holder policy. The entire set of documents duly verified
by the verification committee (Format of Verification Report provided in Annexure
– IV) will be forwarded to The Manager (Claims), Corporate Office (Accident &
Health) claim team of USGICL.

• On receipt of claim USGICL will process the same to check admissibility of claim
based on the terms and conditions of the policy.
• Investigators shall be appointed for death claims, however, for other claims, it is the
discretion of USGICL to ascertain whether an investigation is necessary or not.
Investigator shall submit their report within 15 days from receipt of claim intimation.

2.1.3.3. In case of Permanent Total Disability

Following documents are required to be submitted by the claimant:

• Duly completed claim form
• Disability certificate from attending doctor ( Registered Medical Practitioner) Hospital
• Report from Claims Enquiry cum Verification committee.
• Photo of injured person highlighting the disability
• Policy copy
• Claim intimation
• FIR attested copy or original
• Confirmation of coverage letter

.2.2. Disbursement of Claim

a. After receipt of required documents, USGICL will issue claim cheque along with
loss voucher to the concerned Branch in the favour of nominee / insured.
b. All correspondence will be routed through respective bank Branch.

3. Restrictive Clause

3.1. The nominee of the insured should give notice to the concerned Branch within 45
days of incidence. The accidental injury resulting into death/disablement within a
period of 12 months only becomes admissible under the policy.

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 3.2. Claim of insured person presumed to be dead due to drowning and whose body has
not been traced, the claim shall be settled after 2 years of submission of following
documents:
• Police Report and Final Investigation Report
• Report of findings by Customs/Port Authorities
• Nominee’s affidavit duly notarized.

4. OPERATIONAL GUIDELINES:

4.1 The designated office of the USGICL will issue a policy covering the KCC holders
separately for all Zonal Offices.
4.2 All new KCC account holders shall be covered under the policy.
4.3. All old KCC account holders will be covered under the policy after expiry of the
existing coverage
4.4 It is to be ensured that KCC holders provide nomination and the same should be
communicated to Insurance Company.
4.5 Branch will realise the premium amount as mentioned in Sl.No. -1.5 and remit the
same along with details mentioned in annexure-A to their Zonal Office.
4.6. Branch and Zonal Office will maintain record of KCC holders insured under the
scheme along with their nominee.
4.7 Zonal Office will submit the premium collected from Branches under its operation
along with list of KCC holders and details of their nominees to the designated
office of USGICL on Monthly basis within 7th of the succeeding month. A list of
such designated offices of USGICL corresponding to Bank’s respective Zonal
Offices is enclosed in Annexure – II.
4.8 As the insurance will commence from the date of realization of premium amount
from borrowers account in favour of Insurance Company, Branch/ Zonal Office
must ensure timely submission of premium along with details to USGIC to avoid
any inconvenience.
4.9 Branch and Zonal Office must ensure that no KCC borrowers are left uncovered.

Branches/ Offices are advised to note the contents of this circular and ensure
meticulous compliance.

Hindi version of this circular follows.

(L.V.Prabhakar)
General Manager
(PSC, FI, SME & Retail Lending)

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 ANNEXURE-I

Name of Bank :
Name of Branch :
District :
State :

Details of Kisan Credit card Holders to be covered under

Personal Accident Insurance Scheme

Sl.No. Name of Father’s Address Age KCC A/c Existing Name of

KCC Name No Disability Nominee &
holder Relationship

(To be submitted in triplicate to Zonal Office along with premium immediately after sanction/
disbursement of KCC loan)

Signature :
Designation:
Date :

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 ANNEXURE – II

SL Bank’s USGICL USGICL BRANCH ADDRESS

NO Zonal Office BRANCH
1 AGRA AGRA 1ST FLOOR, SAKET MALL, 75/76 GANDHI NAGAR, BYE PASS ROAD AGRA-
282004

2 AHMEDABAD AHMEDABAD UNIT NO 405, 4TH FLOOR, 3RD EYE ONE, OPP HAVMOR RESTAURANT,
PANCHVATI, C G ROAD AHMEDABAD – 380006
3 ALLAHABAD ALLAHABAD 19-A NYAY MARG (HASTING ROAD), ASHOK NAGAR ALLAHABAD 211001, U.P.

4 AMRITSAR JALANDHAR SCO - 4, 2ND FLOOR,PUDA COMPLEX,LADOWALI ROAD,JALANDHAR 144001.

5 ASANSOL ASANSOL 1st FLOOR, HOUSE -2, STREET NO -1 HINDUSTAN PARK, ASANSOL 713304
ST
6 BAHARAICH VARANASI 1 FLOOR, PLOT AT VILL: CHUPPEPUR WARD : SIKROL, PARGANA SHIVPUR,
VARANASI 221002

7 BANGALORE BANGALORE 3RD FLOOR, K V V SAMRAT, 217/A, 3RD MAIN OUTER RING ROAD, KASTURI
NAGAR, BANGALORE - 560043

8 BARASAT KOLKATA - II FE-362, SALT LAKE, SECTOR-III, KOLKATA-700106

9 BEHALA KOLKATA 7TH FLOOR, EXPRESS TOWERS, 42A, SHAKESPEARE SARANI, KOLKATA - 700017

10 BERHAMPORE RAGHUNATHGANJ GROUND FLOOR, HOTEL INDIGO,NEAR BUS STAND, P.O RAGHUNATHGANJ,
DISTT – MURSHIDABAD - 742225

11 BHAGALPUR BARARI FIRST FLOOR,SMT ROAD,OPP-VETERINARY HOSPITAL,BARARI,TIKAMANJI

BHAGALPUR-812001,BIHAR
ST
12 BHOPAL BHOPAL 1 FLOOR, BLOCK No. 4
PRYAWAS BHAVAN ARERA HILLS, JAIL ROAD, NEAR SECRETARIAT

13 BHUBANESWAR BHUBANESHWAR 1ST FLOOR, 98, KHARVEL NAGAR, KESHARI TALKIES COMPLEX,
BHUBANESWAR - 751001

14 CHANDIGARH CHANDIGARH SCO NO 72, 1ST FLOOR, SWASTIK VIHAR, SECTOR 5, MANSA DEVI COMPLEX,
PANCHKULA -134109

15 CHENNAI CHENNAI VAJIRAM TOWERS, 1ST FLOOR, FLAT NO.103, NEW NO. 44, OLD NO. 39,
HALLS ROAD, EGMORE, CHENNAI 600008

16 CHINSURAH KOLKATA - II FE-362, SALT LAKE, SECTOR-III, KOLKATA-700106

17 DEHRADUN DEHRADUN 2ND FLOOR, 58, RAJPUR ROAD, DEHRADUN-248001

18 DELHI-NCR DELHI UNIT NO 903 & 904, 9TH FLOOR, GDITL TOWER, NETAJI SUBHASH PLACE,
PITAMPURA, NEW DELHI - 110034

19 DEOGHAR PATNA UNIT NO 402, GRAND PLAZA, FRASER ROAD, PATNA – 1, BIHAR- 800001

20 DIBRUGARH GUWAHATI UNIT NO – 1 COM B, 1ST FLOOR, ADAMS PLAZA, G S ROAD, CHRISTIAN BASTI,
GUWAHATI - 781005

Contd.

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 ANNEXURE – II (contd.)

SL Bank’s USGICL USGICL BRANCH ADDRESS

NO Zonal Office BRANCH
21 GONDA GONDA GROUND FLOOR, NEAR M/S V K PANDEY & SONS PETROL PUMP,LUCKNOW
ROAD,HARIPUR,GONDA- 271001,UP
22 GORAKHPUR GORAKHPUR OFFICE NO 202, 2ND FLOOR, SUNANDA TOWERS PVT LTD, BANK ROAD,
GORAKHPUR 273001
23 GUWAHATI GUWAHATI UNIT NO – 1 COM B, 1ST FLOOR, ADAMS PLAZA, G S ROAD, CHRISTIAN BASTI,
GUWAHATI - 781005
24 HAMIRPUR LUCKNOW OFFICE NO 401, SHALIMAR LOGIX, 4 RANA PRATAP MARG, LUCKNOW - 226001

25 HYDERABAD HYDERABAD 302, VASUDEVA PLAZAD.NO. 8-3-977/4, OPP SRINAGAR COLONY

RECREATION CLUB, SRINAGAR COLONY, HYDERABAD - 500073

26 JABALPUR JABALPUR 1ST FLR. 651/5 M.R-4, VJAY NAGAR, JABALPUR 482002, MADHYA PRADESH

27 JAIPUR ALWAR 4-5, FIRST FLOOR, KUSH MARG, STATION ROAD, ALWAR 301001

28 KANPUR JHANSI 2ND FLOOR, PLAT NO 64, GREEN PARK COLONY, BEHIND SBI MAIN BRANCH ,
CIVIL LINE , JHANSI 284001

29 KOLKATA METRO KOLKATA 7TH FLOOR, EXPRESS TOWERS, 42A, SHAKESPEARE SARANI, KOLKATA - 700017

30 KOLKATA URBAN KOLKATA 7TH FLOOR, EXPRESS TOWERS, 42A, SHAKESPEARE SARANI, KOLKATA - 700017

31 LAKHIMPUR KHERI LUCKNOW OFFICE NO 401, SHALIMAR LOGIX, 4 RANA PRATAP MARG, LUCKNOW - 226001

32 LUCKNOW LUCKNOW OFFICE NO 401, SHALIMAR LOGIX, 4 RANA PRATAP MARG, LUCKNOW - 226001
33 LUDHIANA LUDHIANA 5TH FLOOR, SCO 10-11 FEROZE GANDHI MARKET CITY : LUDHIANA 141001
34 MEERUT MEERUT FIRST FLOOR, M 82, SUKH SHANT COMPLEX, MANGAL PANDEY NAGAR,
MEERUT. UTTAR PRADESH *
35 MIDNAPORE KOLKATA 7TH FLOOR, EXPRESS TOWERS, 42A, SHAKESPEARE SARANI, KOLKATA - 700017

36 MIRZAPUR VARANASI FIRST FLOOR, PLOT AT VILL: CHUPPEPUR WARD : SIKROL, PARGANA SHIVPUR,
VARANASI CITY : VARANASI 221002
37 MORADABAD BAREILY SECOND FLOOR, AASHIRWAD KUNJ,HARTMAN BYE PASS ROAD,OPPOSITE
CHANDRA GAS GODOWN, BAREILLY-243001. U.P.
38 MUMBAI DADAR (MUMBAI) 101, SAPNA COOPERATIVE HOUSING SOCIETY LTD, DR S K BOLE ROAD, AGAR
BAZAR, DADAR (W), MUMBAI - 400028
39 MUZAFFARPUR MUZAFFARPUR NEAR SUVIDHA SERVICES SHOP, VRIDNDAWAN MARKET, BELA ROAD,
MITHANPURA MUZAFFARPUR 842002, BIHAR
40 NAGPUR AURANGABAD SHOP NO 14, UPPER GROUND FLOOR, KUBER AVENUE, RANA NAGAR, NEAR
SEVEN HILLS, AURANGABAD
41 NEW DELHI DELHI UNIT NO 903 & 904, 9TH FLOOR, GDITL TOWER, NETAJI SUBHASH PLACE,
PITAMPURA, NEW DELHI - 110034
42 PATNA PATNA UNIT NO 402, GRAND PLAZA, FRASER ROAD, PATNA – 1, BIHAR- 800001
OFFICE NO - 403, 4TH FLOOR, WINNERS COURT,
43 PUNE PUNE
PLOT NO 23, CTS NO 599A+598+593/41A, MUNJERI, SAHANEY SUJAN PARK,
LULLA NAGAR, PUNE - 411040
44 RAIPUR RAIPUR 1ST FLOOR, B – 7, SHREE RAM NAGAR, TV TOWER ROAD, RAIPUR 492001
2ND FLOOR “JHA NIVAS” OPP HOTEL YUVRAJ PALACE, DIVERSION ROAD,
45 RANCHI RANCHI
DORANDA, RANCHI – 834002. JHARKHAND
46 SATNA SATNA FIRST FLOOR ABOVE ALLAHABAD BANK,SOHAWAL BRANCH,PANNA
ROAD,SATNA (M.P) - 485001
4, UDHAM SINGH SARANI ( SEVOKE ROAD), 2ND FLOOR, ASHRAMPARA ,
47 SILIGURI SILIGURI
OPPOSITE TO SOUBHAGYA PALACE , SILIGURI - 734001
48 SITAPUR LUCKNOW OFFICE NO 401, SHALIMAR LOGIX, 4 RANA PRATAP MARG, LUCKNOW - 226001
49 VARANASI VARANASI FIRST FLOOR, PLOT AT VILL: CHUPPEPUR WARD : SIKROL, PARGANA SHIVPUR, 7
VARANASI 221002
 ANNEXURE – III

APPLICATION FORM FOR INTIMATION OF CLAIM

I. To be filled in case of death only

I/We ……………………………………………………………………… son of / daughter of / widow

of /husband of Shri/Smt ………………………………………………………………. Residing at
……………………………………………………………………………………. hereby apply as legal
representatives (s) for the grant of compensation on account of death of
Shri/Smt/Kumari…………………………………………………………..son of / daughter of /
widow of Shri/Smt ……………………………………………………………who died in an
accident on ……………………………. At ……………………………………………………………………

Particulars of the accident and the other information are enclosed.

Date:
Place: Signature of Claimant (s)

II. To be filled in case of Disability

I/We ……………………………………………………………………… son of / daughter of / widow

of /husband of Shri/Smt ………………………………………………………………. Residing at
……………………………………………………………………………………. hereby apply as legal
representatives (s) for the grant of compensation on account of DISABLEMENT
sustained by me in an accident on …….……………………………. At
……………………………………………………………………

Particulars of the accident and the other information are enclosed.

Date:
Place: Signature of the insured

Contd.

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 ANNEXURE – III (Contd.)

Particulars in respect of accident and other information are given below:

1. Name and Father’s Name of KCC Holder Died / Disabled:IIIIIIIIIIIII..
(Husband’s name in case of a Married woman or Widow)
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

2. Address of the KCC holder Died / Disabled:IIIIIIIIIIIIIIIIIII

3. Age and Date of Birth:IIIIIIIIIIIIIIIIIIIIIIIIIIII.

4. Sex (of KCC holder Died / Disabled:IIIIIIIIIIIIIIIIIIIIII..

5. Kisan Credit Card Particulars including Date of Issue:IIIIIIIIIIIIIII

6. Place, Date and Time of Accident:IIIIIIIIIIIIIIIIIIIIIIII

7. Nature of accident (Give full Details):IIIIIIIIIIIIIIIIIIIIII

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII..

8. Name and address of Police Station in whose jurisdiction the accident took place Or
was registered:IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII.

9. Name and Address of the Medical Practotioner attended:IIIIIIIIIIII.

10. Name and Address of the Claimant / Claimants (Death only) & Relationship

With the deceased:IIIIIIIIIIIIIIIIIIIIIIIIIIII.

11. Any other information that may be considered necessary or helpful

in the disposal of the claim:
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII.

……………………………………………………………….. ……..………………………………………………………
Signature of the Branch Manager Signature of the Claimant / Insured

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 ANNEXURE - IV

REPORT OF THE CLAIMS VERIFICATION COMMITTEE

On the basis of the verification and enquiry conducted by us on the genuiness of the

claim, we hereby recommend sanction of RsIIIIIIIIIIII.

IIIIIIIII.’//

‘;-p[

(RupeesIIIIIIIIIIIIIIIIIIIIIIIonly) as compensation in respect

of death / disablement of Mr. / Mrs. IIIIIIIIIIIIIIIIIIIIIIIII.

( Name of the KCC holder) S/o / W/o IIIIIIIIIIIIIIIIIIIIIIIII

A resident of IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII..

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

(Full residential Address) resulting from IIIIIIIIIIIIIIIIIIIIII..

(Nature of accident) which took place at IIIIIIIIIIIIIII.(Name of the place)

onIIIIIIIIII.(Date)

Date:

Place:

……………………………………………………………….. ……..………………………………………………………
Signature of the Branch Manager Signature of the Branch Manager
Designated BranchIIIIIIIII Allahabad BankIIIII..Branch
Universal Sompo General Insurance Co. Ltd Under Z.OIIIIIII..

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