Tata AIA Life Insurance Company Limited.

COMMON PROPOSAL FORM

Kindly Fill the form in CAPITAL and only in blue or black

(For Official Use only)

Proposal Number: C155747878 Branch Code:

Channel: WEBSALES Campaign Code:

Sub Office Code: RM CAMS Code:

Agent/Broker/Specified Person/Employee:

Code: Contact Details: License No. & Validity Details:

Customer Relationship No. (For Bancassurance Channel) PAN No.

IMPORTANT GUIDELINES: 1) IN UNIT-LINKED INSURANCE POLICIES (ULIPs), THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. 2)
Insurance is a contract of utmost good faith between the Insurer and the Insured. The Proposer and the Life to be Assured are required to disclose all facts in response to the
questions in this application form. 3) Any cancellation/alteration is to be signed by Proposer/Life to be assured as applicable. 4) KYC documents will be required for all the parties to the
contract.

I. GENERIC DETAILS

Is this policy self-proposed? Yes. If No, please answer the following details Type of Proposer: Individual Life

Relation with Life Assured: Self Type of Proposal:

II. ELECTRONIC INSURANCE ACCOUNT (eIA) DETAILS OF THE PROPOSER/POLICYOWNER

e-Insurance Account Number (eIA), if any:

I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Tata AIA Life Insurance Company Ltd. In Electronic format
(Physical copy would be sent even if proposer opts for electronic format; however, in case proposer has e-Insurance Account, only electronic copy of the Insurance Policy will be
provided)
I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Insurance Repository in the Electronic Format as and when
applicable. Please select the name of the Insurance Repository.
CAMS

III. PRODUCT DETAILS

Premium
Unit Sum Policy Premium ( ) (Inclusive of Premium Return of
Base Plan/ Rider (Benefit Option) Paying
Linked Life Insured Name Assured Term(Years applicable taxes, cesses & Paying Premium
Name Term(Years
(Yes/No) ( ) & Months) levies ) Mode option
& Months)

Tata AIA Life Insurance Mr. DEEPAK KUMAR

No 10000000 27 15 2575 Monthly Yes
Sampoorna Raksha Supreme MURMU

TATA AIA Vitality Protect

Mr. DEEPAK KUMAR
(Accidental Total and Permanent No 300000 27 15 30 Monthly Yes
MURMU
Disability)

Tata AIA Vitality Protect(CritiCare Mr. DEEPAK KUMAR

No 1000000 27 15 729 Monthly Yes
Plus) MURMU

Tata AIA Vitality Mr. DEEPAK KUMAR

No 200000 27 15 182 Monthly Yes
Health(HospiCare) MURMU

Tata AIA Vitality Protect(Term Mr. DEEPAK KUMAR

No 10000000 27 15 2575 Monthly Yes
Booster) MURMU

Life Insured Details Benefit Payout Option Details

Base Plan/ Rider (Benefit Option)
Benefit Payout Option
Name Lumpsum Income Income Income
Name DOB Gender
( ) p.a ( ) Duration(Years) Frequency

TATA AIA Vitality Protect (Accidental Mr. DEEPAK KUMAR

18/12/1990 M 300000 NA NA NA
Total and Permanent Disability) MURMU

Mr. DEEPAK KUMAR

Tata AIA Vitality Protect(CritiCare Plus) 18/12/1990 M 1000000 NA NA NA
MURMU

Mr. DEEPAK KUMAR

Tata AIA Vitality Health(HospiCare) 18/12/1990 M Lumpsum 200000 NA NA NA
MURMU

Mr. DEEPAK KUMAR

Tata AIA Vitality Protect(Term Booster) 18/12/1990 M Lumpsum 10000000 NA NA NA
MURMU
Kindly DATE BACK my Application to 1. Allowed only as per product specifications 2. Allowed within the same financial year 3. In case of juvenile (less than 1 year) back date is not
allowed. 4. Date Back of policy is allowed only up to the official launch date of the product.
FUND SELECTION DETAILS (To be filled for Unit Linked Products) a. Kindly mention the names of the fund chosen b. Incase you opt for a specific Portfolio Strategy (as available
with individual products), kindly mention the Fund Names or other details as applicable c. Kindly fill in whole numbers in percentage only. Decimals and Fractions not allowed.

Tata AIA Vitality (Wellness Program, applicable only for specific product/riders): Not Applicable

Name of Fund % Allocation

Portfolio Strategy

Funds for the chosen Portfolio Strategy (If Applicable )

OR
Debt oriented fund Equity oriented fund

Other Details(if applicable)

IV. PROPOSER / POLICYHOLDER DETAILS (Please fill in details of Life Assured if same as Proposer)

1. Title Mr.

2. Name DEEPAK KUMAR MURMU

3. Father's Name / Spouse Name MAJHIA MURMU

4. Mother's Name SALMA MURMU

5. Maiden Name(For female lives only)

6. Gender/Date of Birth Male 18-12-1990

7. Which is your Dominant Hand? (Question to be answered only if ADDL

Rider is selected )

8. Marital Status Married

9. Life Stage

Resident Indian (Nationality) INDIA

10. Nationality (If other than resident Indian, Passport as an age proof is Country of Residence : INDIA
mandatory) (If country of residence or nationality outside India then FATCA/ CRS-Self Certification Form to be
mandatorily completed)

11. Residence for Tax purposes in Jurisdiction(s) outside India No (If Yes then FATCA/ CRS-Self Certification Form to be mandatorily completed)

12. Highest Educational Qualification Post Graduate

At/ Po- Labania Via- Kusumbandh Labania Mayurbhanj

13. Correspondence Address Landmark: Ps- Bangiriposi City: Labania

State: ORISSA Country: INDIA Pin code: 757092

At/ Po- Labania Via- Kusumbandh Labania Mayurbhanj

14. Permanent Address Landmark: Ps- Bangiriposi City: Labania

State: ORISSA Country: INDIA Pin code: 757092

15. Address for Communication Current

Residence No: Mobile No: +91 9668837268

16. Telephone and Email Details
E-mail: [email protected]

17. Occupation Class Salaried

a. Name of Organisation /School / College PUNJAB NATIONAL BANK

b. Organisation Type Public Limited

c. Industry Banking / Financial / Service / Insurance

d. Nature of Work Sales & Marketing - Outdoor

e. Annual Income ( ) 1200000

18. Income Proof Latest 1 Month salary slip

19. Identity Proof (In case of Passport & Driving License please mention expiry Expiry Date :
date) xxxxxxxx1276

20. Address Proof for updated address

CEBPM2450M (kindly attach copy of Pan card)

21. Permanent Account Number ( PAN ) :
Yes I do not have PAN (kindly attach copy of Form 60 duly signed)

22. CKYC No. (If available) 10098850300757

23. Source of Funds

24. Are you a Politically Exposed Person? No. (Definition of PEP: "PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international organisation /in a
foreign country. This would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials, senior executives of state owned
corporations, important political party officials". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity) or through marriage or similar (civil) forms of partnership.
Close associates are individuals closely connected to a PEP, either socially or professionally")
V. LIFE ASSURED DETAILS (Please fill in this section only if Life Assured is different from Proposer)

1. Title

2. Name

3. Maiden Name(For female lives only)

4. Gender/Date of Birth

5. Which is your Dominant Hand? (Question to be answered only if ADDL

Rider is selected )

6. Marital Status

7. Life Stage

(Nationality)
8. Nationality (If other than resident Indian, Passport as an age proof is mandatory)
Country of Residence
9. Residence for Tax purposes in Jurisdiction(s) outside India No (If Yes then FATCA/ CRS-Self Certification Form to be mandatorily completed)

10. Highest Educational Qualification

11. Occupation Class

a. Name of Organisation/ School/College

b. Organisation Type

c. Industry

d. Nature of Work

e. Annual Income ( )

12. Income Proof

13. Identity Proof (In case of Passport & Driving License please mention expiry Expiry Date :
date) Others :

14. Address Proof for updated address

(kindly attach copy of Pan card)

15. Permanent Account Number (PAN):
Yes I do not have PAN (kindly attach copy of Form 60 duly signed)

16. Are you a Politically Exposed Person? (Definition of PEP: PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international organisation /in a foreign country.
This would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials, senior executives of state owned corporations,
important political party officials. Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity) or through marriage or similar (civil) forms of partnership. Close associates
are individuals closely connected to a PEP, either socially or professionally)

VI. HEALTH & LIFESTYLE DETAILS OF THE LIFE ASSURED

1. Nature of Age proof (Non-standard age proof submission will attract extra premium)

2. a) Height (cms or ft). 163 cms b) Weight (kg or lbs). 84 kgs

PART A: LIFESTYLE DETAILS

1. Are you employed in the Armed Forces, Paramilitary, Police Forces, Fire Brigade or any other similar occupation? No

2. Is your occupation/your hobbies associated with any specific accident/health hazard or are dangerous in any way (e.g. working with dangerous or corrosive chemicals,
explosives, radiation, working underwater/underground or at height, working in mines, non-commercial flying activities, diving, mountaineering, any form of motorbike/car racing No
etc.)?

3. Do you intend to live or travel outside India for more than 30 days for reason other than family vacation in next 6 months? No

4. Have you ever been charge sheeted or convicted of any criminal proceedings or have any criminal case or charge pending against you in any court of law in India or abroad? If
Yes, please provide complete details. No

5. Do you consume or have consumed any of the following? Please tick all relevant options and provide details No

Substance Yes/ Consumed Quantity/ Per Day for Tobacco & Per week for Alcohol No. of If stopped consumption, mention month and year in which
Consumed No As and Narcotics Years last consumed

Tobacco No

Alcohol No

Any Narcotics No

PART B: HEALTH & PERSONAL DETAILS

1. Has any of your insurance application or reinstatement application on life, accident, medical or health, critical illness, or disability ever been declined, postponed or accepted
No
at extra premium or modified terms?

2. Did you have any loss or Gain of weight of 10 kgs or more in the last six months? No

3. Do you have any physical deformity / handicap or congenital defect / abnormality? No

4. Have you ever been advised to and / or have undergone any tests, investigations or surgery or had signs or symptoms of any condition, aliment or injury and / or were advised
No
treatment for or have been hospitalized for check-up or treatment other than minor flu, cold or influenza?

5. Have you ever been diagnosed with or investigated for any of the following: Yes

a. Cardio: High or Low Blood Pressure / Raised Cholesterol / Chest Pain / Palpitation / Rheumatic Fever / Heart Murmur / Shortness of Breath / Heart Attack / Stroke / Any
Yes
other heart condition

b. Hormonal: High Blood Sugar/ Diabetes / Thyroid or endocrine disorder / Sugar in Urine / Any other hormonal disorder No

c. Respiratory: Asthma / Tuberculosis / chronic cough, chronic bronchitis, emphysema, pneumonia / Any other respiratory disorder No

d. Blood/Cellular: Cancer / Tumor or malignant growth / Leukemia / Anemia / Enlarged lymph nodes/ Any blood disorder No

e. Digestive/Regulatory: Recurrent indigestion / Gastritis / Stomach or Duodenal Ulcer / Hernia / Jaundice / Disorders of the liver / Cirrhosis and Gastrointestinal System/ Any
No
other disease
 f. Mental/Psychiatric / Neurological ailment: Symptoms or ailment relating to Brain Depression / Anxiety / Brain Disorder or disease / Mental / Psychiatric / Transient
No
ischemic attack /Parkinson's disease / Multiple Sclerosis / Nervous disorder / Paralysis or Paraplegia / Epilepsy / Any other mental or psychiatric ailment

g. Neural/Skeletal/Muscular: Musculoskeletal disorders such as Arthritis / Recurrent Back Pain / muscular dystrophies/ musculoskeletal deformities/ Slipped disc or any other
disorder of Spine, Joints, Limbs or Leprosy; / Disorders of Eye, Ear, Nose,Throat including defective sight / Disorder of speech or hearing and discharge from ears / Any other No
disorder

h. Infectious/Contagious: Were you or your spouse ever tested for Hepatitis B or C, HIV /AIDS or any other Sexually Transmitted Disease / Any other disorder No

i. Genitourinary: Hydrocele / fistula / piles / symptoms or ailment relating to Kidney / Kidney Stones/ Prostate, Urinary System or Reproductive System / Any other disorder No

6. Have you had/ are having any other illness or impairment not mentioned above? No

7. Are you presently in good health? Yes

8. Has any of your family member (Parents and Siblings) ever been diagnosed with diabetes, Hypertension, Kidney Failure, Cancer, Heart Attack or any Hereditary Disorder
No
before the age of 60?

9. Have you ever been advised to undergo any surgery or treatment or laboratory investigations (stress ECG, echocardiogram, angiography, MRI/CT scan etc.) by any doctor or
No
specialist?

10. Have you been off work due to illness for a continuous period of 7 days and above during the last 5 years? No

11. Female Life Questionnaire

a. Are you now Pregnant? If Yes, kindly state expected delivery date

b. Have you undergone any gynecological investigations for illness, internal checkups, breast checks such as mammogram or biopsy?

c. Have you ever consulted a doctor because of an irregularity at the breast, vagina, uterus, ovary, fallopian tubes, menstruation, complications during pregnancy or child
delivery or a sexually transmitted disease?

d. Have you suffered from any other disorder of the breast or reproductive organs, abnormal smear test(s) and irregular menses?

12. If answer to any of the question above is yes, kindly give full details noting the question number (attach relevant copies)
Question No.: Details:
5.a - . High Blood Pressure

13. Family Details (Mandatory if the life to insured is Juvenile/Student/Housewife)

Family Details Name Gender (M / F) Date of Birth Occupation Annual Income ( ) Insurance Details (Existing /Applied for)

Father/Husband

First Child / Sibling

Second Child / Sibling

14. Family Details to be filled for Life Assured only Father Mother Brother Sister Spouse

a. If Alive, Health Status

b. If Deceased, Cause of Death

c. Age at Death/Current Age

VII. EXISTING INSURANCE DETAILS

Do you currently hold or have applied for Life Insurance/Pension/Health (Cancer/Cardiac/Critical Illness)/Personal Accident Policies? Y / N If Yes, kindly provide details as
below:

Life Assured Proposer (If Life Assured is Juvenile/Student/Housewife)

Type of Insurance (Life/ Health (Cancer/Cardiac/Critical Company Basic Sum Type of Insurance (Life/ Health (Cancer/Cardiac/Critical Company Basic Sum
Illness)/ Unit Linked /Pension/Personal Accident) Name Assured ( ) Illness)/ Unit Linked /Pension/Personal Accident) Name Assured ( )

VIII. NOMINEE DETAILS (Required only if Proposer & Life Assured are the same) / PARTNER DETAILS (only if 'Partner Care' payout option has been opted )

Base Plan / Rider (Benefit Option) Date of Gender (Male /Female Percentage ( % ) (Do not enter % in decimals & total %
Name Relationship
Name Birth /Transgender) should be equal to 100)

Tata AIA Life Insurance Sampoorna BHANUMATI

03-05-1998 Female Spouse 100
Raksha Supreme SOREN

IX. APPOINTEE DETAILS (Required only if Nominee is less than 18 years of age)

Name Date of Birth Gender (Male /Female /Transgender) Relationship

X. PAYMENT DETAILS

Premium Payment Method: Digital/Online Payment

Name of Credit Card/Debit Card Holder: Credit Card/Debit Card Number
Cheque/DD No. Issuing Bank Branch Amount Rs. Date: DD/MM/YYYY
Premium# 5829 + Taxes, cesses & levies 262 = Total Payment 5349 for months initial deposit (To be filled for monthly mode only)
On the first policy/modal anniversary I would like to change the premium payment mode to , subject to policy contract provisions. For Annual/Monthly mode issued policies mode
change shall be accepted only on completion of first policy anniversary. # Premium is exclusive of applicable taxes, cesses & levies. All Premiums are subject to applicable taxes,
cesses & levies which will entirely be borne by the Policyholder and will always be paid by the Policyholder along with the payment of Premium. If any imposition (tax or otherwise) is
levied by any statutory or administrative body under the Policy, Tata AIA Life Insurance Company Limited reserves the right to claim the same from the Policyholder. Alternatively, Tata
AIA Life Insurance Company Limited has the right to deduct the amount from the benefits payable by Us under the Policy. Cheque/DD should be drawn in favor of Tata AIA Life
Insurance Company Ltd. (Proposal No). Do not issue blank cheque.
Renewal Payment Mode: E-Mandate NPCI

XI. Mandatory Bank Account Details:

Please provide below bank details. Bank details provided should be in the name of Proposer. All policy payouts will be made to the below mentioned bank account through electronic
transfer (NEFT). Payout would be in accordance and subject to terms and conditions of the policy.

Name of Account Holder Bank Account No. Bank Name and Branch Account Type IFSC Code

DEEPAK KUMAR MURMU 05792022000017 PUNJAB NATIONAL BANK VIJAYAWADA Saving PUNB0057910

Note: 1. Please provide a cancelled copy of your personalized cheque. If personalized cancelled cheque is not available, attach bank statement showing account holder name, address
and account number. 2. In case of Non-Credit to the given bank account with/without assigning any reason thereof or if the transaction is delayed or not effected at all for any reason of
incomplete information, Tata AIA Life Insurance Co Ltd will not be responsible. 3. Further, the Company reserves the right to use any alternative payout option inspite of opting for
Direct Credit option. 4. If Account type is NRE/NRO then FATCA/CRS-Self Certification Form to be mandatorily completed.

XII. Waiting Period (applicable only for POS products except Immediate Annuity Products):

In case of death of the life insured during the first 45 days from the date of commencement of risk, the claimant shall be entitled to the total premiums paid. Waiting period shall not be
applicable in case of death due to accident.

XIII DECLARATION & CONSENT

I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all
respects to the best of my knowledge and that I am authorised to propose on behalf of these other persons (applicable where the proposer and life insured are different).
I understand that the information provided by me 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.
I further declare that I 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.
I declare that I 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.
I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer (if any) for the sole purpose of underwriting the
proposal and/or claims settlement and with any Governmental and/or Regulatory authority.
I confirm that I have understood the contents of this Proposal Form and I am submitting this Proposal Form with all the details which are true and correct. I have not withheld any
material information or suppressed any fact which are essential for issuance of the policy. I also hereby authorize the Company to ascertain all the details from any third parties, as
may be required for assessing the risk.
I agree to undergo all medical tests as determined by the Company for obtaining the policy and I further understand that the Company reserves the right to issue the policy if all the
required criteria are met and in case of any fraud or misstatement being established, the insurer shall take action in accordance with Section 45 of the Insurance Act, 1938 as
amended time to time. I understand that the contract will be governed by the provisions of the Insurance Act, 1938 as amended time to time, the IRDA Act, 1999 and the
Regulations framed there under and that the contract will not commence until the Company's written acceptance of this Proposal Form is received. In case of the life to be insured
being a minor, I further declare and affirm that this proposal of insurance is for the benefit of the life to be insured.
Anti-Money Laundering Declaration: I hereby confirm that all premiums will be paid from bonafide sources and no premiums will be paid out of proceeds of crime related to any of
the offence listed in Prevention of Money Laundering Act, 2002. The Company has the right to peruse my financial profile and also agree that the Company has right to cancel the
insurance contract in case I have been found guilty of any of the provisions of any law, directly or indirectly, having relation to the laws governing prevention of money laundering in
the country, by any competent court of law.
I/We understand that in accordance with the IRDAI (Protection of Policyholders Interests) Regulations, 2017, the insurer is permitted to share policyholder information only with the
statutory authorities. I permit/authorize the Company to collect, store, communicate and process information relating to the Policy/Account and all transactions therein, by the
Company and any of its affiliates or service providers wherever situated including sharing, transfer and disclosure between them or with any entity or entities for the purpose of
underwriting, policyholder servicing and claims; and to the authorities in and/or outside India for compliance with any law or regulation whether domestic or foreign.
Applicable for NRI/PIO/OCI customers in case of assisted sales: I confirm that this product has been solicited to me in person in India or through email/ telephonic
communication from India. I undertake to inform the Company for any change in the above particulars including residential status. In case of any failure to do so, I shall indemnify
the Company for all losses and damages incurred by the Company due to non-fulfillment of my aforesaid obligation to the Company. I also undertake to comply with all the
regulations\ guidelines issued by Reserve Bank of India or any other regulatory authority with reference to NRIs/PIOs/ OCIs and the related insurance policies in India from time to
time.

Date:
15-04-2024
Place:
Signature/Thumb Impression of Signature/Thumb impression of Life Assured
Proposer/ Authorized [OTP 1619 received vide mobile no. +91 9668837268 has been used to authenticate your proposal form no.
Representative C155747878, benefit illustration no. 5019415346154 as well as suitability analysis on 10:55:05 on 15-Apr-2024]

I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein, immediately in
case any of the above information is found to be false or untrue or misleading or misstated, before issuance of the proposal. I, the undersigned confirm that I have verified photocopies
of the proofs submitted along with this proposal form against the originals and certify the same to be true copy.
I declare and confirm that I have carried out necessary suitability analysis while advising this product to the proposer and that the product is suitable to the proposer.

Signature of Agent/ Specified Person/ Broker/ Employee

ACKNOWLEDGEMENT
Tear away portion (To be handed over to the customer)
Proposal Number: ___________________
Dear Customer
We acknowledge receipt of your Cash/Cheque/DD for Rs.______________ by number ______________ dated ___ /___ /___ drawn on _______________ toward's Initial Deposit. We
request you to kindly verify the details filled in the proposal form before signing the same. Please do insist on Official Receipt issued by Tata AIA Life from your advisor within 2 working
days from submission of this proposal form. In case you do not hear from us or do not receive your policy within 15 days from the date of submission of your proposal, please visit us at
www.tataaia.com or call our helpline number 1860 266 9966 (local charges apply) or email us at [email protected]
This is only acknowledgement slip and not the premium receipt.

Agent code Agent name Signature of Agent Date of Acknowledgement

 IN CASE ANSWERS TO THE QUESTIONS ARE FILLED IN BY A PERSON OTHER THAN THE PROPOSER OR WHERE THE ANSWERS/SIGNATURE OF THE PROPOSER
ARE IN VERNACULAR.
Note: The below must be witnessed by someone other than advisor/employee of the company.
Declaration by Agent/Intermediary of Tata AIA Life Insurance Company Limited
I, _______________________________________ (name) have explained the contents of this proposal to the _________________________________________ (Proposer) in
____________________ (language) and ensured that the contents have been fully understood by him/her. I have accurately recorded the Proposer responses to the information
sought in the proposal form and I have read out the responses to the Proposer and he/she has confirmed that they are correct.

Date: 15-04-2024
Place:

(Signature of the person making the declaration)

Address of the person making the declaration:

Declaration by Proposer/ Life Assured:

I have understood the contents of this proposal explained to me in ______________ language and confirm that the responses provided by me are correct.

Date: 15-04-2024 Date: 15-04-2024

Place: Place:
Signature/Thumb Impression of Proposer Signature/Thumb impression of the Life Assured

(Prohibition of Rebates) Section 41 - of the Insurance Act, 1938 as amended from time to time: 1. 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. 2. Any person making default in complying with the provisions of this section shall be liable for a
penalty which may extend to ten lakh rupees."
SECTION 45 OF THE INSURANCE ACT, 1938 STATES: No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of
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. 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. 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 adjusted on subsequent proof that the age of the life insured was
incorrectly stated in the proposal. For further details, please refer to the Insurance Act, as amended from time to time.
Disclaimers: IN CASE OF A ULIP POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. Tata AIA Life Insurance Company Limited
is only the name of the Company and any contract bearing the prefix "Tata AIA Life" is only the name of the contract and does not in any way indicate the quality of the contracts, its
future prospects or returns. Premium paid in ULIP is subject to investment risks associated with capital markets & the NAV of the units may go up or down based on the performance of
the funds and factors influencing capital markets and the insured is responsible for his decision. Past performance is not indicative of future results. For more details on risk factors, terms
and conditions please read sales brochure carefully before concluding a sale.

BEWARE OF SPURIOUS PHONE CALLS AND FICTITOUS/FRAUDULENT OFFERS! - IRDAI is not involved in activities like selling insurance policies, announcing bonus or
investment of premiums. Public receiving such phone calls are requested to lodge a police complaint.

Full Form for abbreviations used:

HUF - Hindu Undivided Family | MWPA - Married Women's Property Act | OCI - Overseas Citizen of India | NRI - Non-Residential Indian | PIO - Person of Indian Origin | FATCA -
Foreign Account Tax Compliance Act | CRS - Common Reporting Standard |CKYC - Central Know Your Customer

Area census code is an identifier of the location as rural / urban as per the latest census.

L&C/Advt/2024/Jan/0176

1. Please carry valid Identity card to the medical examination center wherever applicable. 2. For cash payment, please visit our nearest Tata AIA Life branch. Please do not handover
cash to Agent. If handed over to the agent, the company will not be liable for any loss. 3. In case there is any change in the particulars given above including Life Assured/Proposer's
health and/or medical and/or financial and/or occupational status and/or being charged with and/or arrested for any criminal offence after the date of proposal but before risk
acceptance by the company; please inform the company. 4. Acceptance of premium does not constitute risk commencement. 5. Risk commencement starts after the acceptance of risk
by the company. 6. Freelook Period: If you are not satisfied with the terms & conditions/features of the policy, you have the right to cancel the Policy by providing written notice to the
Company and receive the premiums after deducting a) Proportionate risk premium for theperiod on cover & b) Stamp duty and medical examination costs including applicable taxes,
cesses & levies, which have been incurred for issuing the Policy. Such notice must be signed by you and received directly by the Company within 15 days from the date of receipt of
the policy document by you or person authorized by you. The said period of 15 days shall stand extended to 30 days, if the policy sourced through distance marketing mode which
includes solicitation through any means of communication other than in person. For Unit Linked Life Insurance products, you would receive the non allocated premiums plus charges
levied by cancellation of units plus fund value at the date of cancellation and after deducting the charges as mentioned in (a) & (b) above.

Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110 CIN: U66010MH2000PLC128403). Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park,
Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd
under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor/ Intermediary or visit Tata AIA Life's nearest branch office or
call 1- 860-266-9966 (local charges apply) or write to us at [email protected]. Visit us at: www.tataaia.com.