Date of Debit of Premium

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SBI General Insurance Company Ltd.

www.sbigeneral.in
PERSONAL ACCIDENT INSURANCE POLICY –POLICY SCHEDULE This Policy Schedule is subject to the terms and conditions of the Master Policy No. 137300-0000-00 mentioned on the Certificate of Insurance (COI) issued to Insured (Account Holder) based on his/her Proposal and payment of the Premium. The Certificate of Insurance records the agreement between Insured (Account older) and SBI General Insurance Company and sets out the brief terms of insurance and the obligations of each party as below: Master Policy No: 137300-0000-00 Master Policy Effective: From 09/09/2012(00:00 hrs) To: 08/09/2014 Midnight. Certificate No: As Printed in CERTIFICATE OF INSURANCE Intermediary Name & Code: State Bank of India Insured Name: Insured Person Name: ADDRESS: Product Type: Coverage Opted: State Bank of India (Savings Bank/Individual Current Account holders) Savings Bank/Individual Current Account holders of State Bank of India Name as Stated in Certificate of Insurance As stated in CERTIFICATE OF INSURANCE Personal Accident Insurance Accidental Death (AD) only (Notwithstanding the benefits stated in the attached policy wording, the coverage under this policy is restricted to Accidental Death benefit only.) Rs. 400,000 (Rupees Four Lacs Only) As stated in CERTIFICATE OF INSURANCE As stated in CERTIFICATE OF INSURANCE 1 year from the date of transaction / date of debit of premium. As stated in CERTIFICATE OF INSURANCE Bank Branch: As stated in CERTIFICATE OF INSURANCE

SBI General Office: Registered Office: 101-201-301. Natraj, Junction of Western Express Highway & Andheri Kurla Road, Andheri (East), Mumbai 400069.

Sum Insured: Savings Bank /Individual Current A/C No: Transaction Date / Date of Debit of premium : Period of Insurance: Nominee (Name & Relationship):

Additional Conditions: Exclusion No. 1 under the General Exclusions in the Group Personal Accident Policy stands deleted.

Premium Details (Per Insured Person) Premium Particulars: Gross Premium Add Service Tax : Add: Education Cess : Add : Higher Education Cess: Final Premium: For SBI General Insurance Company Limited Authorised Signatory Important Note: Insurance is a contract of Utmost Good Faith requiring the Insured not only to disclose all information related to his health and which has a bearing on the acceptance or rejection of the Proposal by the Insurer but also not to suppress any factual information in response to the questions in the proposal form. Please examine this Policy along with Certificate of Insurance issued there under. In the event of any discrepancy, contact toll free numbers (1800 22 1111 / 1800 102 1111) of the Insurer immediately, it being noted that this Policy shall be otherwise considered as being entirely in order. All terms, conditions and exclusions as per standard Policy wordings attached with this schedule. Premium Amount

As applicable on the Date of transaction / Date of debit of premium. Rs. 100/- (Inclusive of Service Tax)

Registered Office: 101-201-301. Natraj, Junction of Western Express Highway & Andheri Kurla Road, Andheri (East), Mumbai 400069.

SBI General Insurance Company Limited

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SBI General Insurance Company Ltd.

www.sbigeneral.in

TERMS & CONDITIONS (Applicable for the Certificate of Insurance issued under Master Policy No: 137300-0000-00) • • This Policy can be bought by any permanent Indian resident having a Savings Bank/Individual Current Account with SBI and aged between 18 years to 65 years. Irrespective of the number of accounts the Insured has with any of State Bank of India / State Bank of Hyderabad / State Bank of Mysore / State Bank of Bikaner and Jaipur / State Bank of Travancore / State Bank of Patiala, insured is eligible to take only one policy from SBI General Insurance. Our liability will be restricted to maximum of Rs.400000/- for settlement of claim, if any, per life. Coverage under this Policy will be over & above any other...
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