Soumyadip Das

#RakshakaranKiReet 1/38
 IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER.

, ,

KO01 U156217569 SP 1049/1490 BROK Non Term_NonEIA

SOUMYADIP DAS
S/O SHYMAL DAS July 28, 2022
GORKHARA BADAMTALA MONDALPARA RAJPUR
SONARPUR
M
KOLKATA, 700150
WEST BENGAL INDIA
M- 8910785486

Dear Policyholder,
Congratulations on becoming your family’s Param Rakshakarta !!
Today, protection is the need of the hour and we are privileged that you have chosen us as your Rakshakaran partner. We are
delighted that you have opted for one of our comprehensive solutions that will provide Life Cover as well as market-linked returns
and protection for your health – helping you secure your loved ones’ financial future.
The comprehensive solutions will provide following benefits:

Comprises of Tata AIA Life Insurance Smart Sampoorna Comprises of Tata AIA Life Insurance Smart Sampoorna
Raksha, Tata AIA Life Insurance Comprehensive Protection Raksha and Tata AIA Life Insurance Comprehensive
Rider and Tata AIA Life Insurance Comprehensive Health Rider Protection Rider

Life Insurance Cover Life Insurance Cover

Accidental Death Benefit Accidental Death Benefit

Accidental Total & Permanent Disability Benefit Accidental Total & Permanent Disability Benefit

Criticare Plus Benefit

Hospicare Benefit

All in all, these solutions will cater to your protection, wealth and health protection needs.
At Tata AIA Life Insurance, we are committed to help you with solutions that will provide Param Rakshakaran to your family so
that you can enjoy life without any worries.
Best Wishes
Tata AIA Life Insurance Company Limited

Disclaimers: Param Rakshak solution comprises of Tata AIA Life Insurance Smart Sampoorna Raksha, A Unit-linked, Non-participating, Individual Life Insurance Plan for Savings and
Protection (UIN:110L156V02) and Tata AIA Life Insurance Linked Comprehensive Protection Rider, A Non-linked, Non-participating, Individual Health Rider (UIN: 110A032V02) and
Param Rakshak Plus solution comprises of Tata AIA Life Insurance Smart Sampoorna Raksha, A Unit-linked, Non-participating, Individual Life Insurance Plan for Savings and Protection
(UIN:110L156V02), Tata AIA Life Insurance Linked Comprehensive Protection Rider, A Non-linked, Non-participating, Individual Health Rider (UIN: 110A032V02) and Tata AIA Life
Insurance Linked Comprehensive Health Rider, A Non-linked, Non-participating, Individual Health Rider (UIN: 110A031V02). For more details please refer to the customized benefit
illustration and terms & conditions of the product. In case of any inconsistency between this letter and policy document, the policy document shall always prevail.
2/38
 , ,

KO01 U156217569 SP 1049/1490 BROK Non Term_NonEIA

SOUMYADIP DAS
S/O SHYMAL DAS July 28, 2022
GORKHARA BADAMTALA MONDALPARA RAJPUR
SONARPUR
M
KOLKATA, 700150
WEST BENGAL INDIA
M- 8910785486
1. Part A

Dear SOUMYADIP DAS,

Thank you for choosing us for your insurance needs. Tata AIA Life is committed to give you world-class products and professional
service.

We take great pleasure in presenting your Policy Document. Please check your personal details and the policy provisions carefully.
Should you have any queries, please contact your agent or contact us at the address mentioned below. You can also reach us via
email at customercare@tataaia.com or call our helpline number at 1860-266-9966 (Local charges apply).

Intermediary/Agent Name:BLUECHIP INSURANCE BROKING PRIVATE LTD |

Intermediary/Agent Code:(004000629) | Intermediary/Agent Contact details: 25787046 /
srinivasan@bluechipindia.co.in
In order to provide You better services, We request you to intimate us in the event of any change in the address of the Policyholder
or the nominee.

Free Look Provisions

If the Policyholder is not satisfied with the terms & conditions /features of the Policy, he/she can cancel the Policy by giving
written notice to the Company and receive the non-allocated Premium plus charges levied by cancellation of Units plus Fund Value
at the date of cancellation less (a) proportionate risk Premium for the period of cover (b) medical examination costs, if any and (c)
stamp duty, along with taxes on above which has been incurred for issuing the Policy. Such notice must be signed by the
Policyholder and received directly by the Company within 15 days after receipt of the Policy.

At Tata AIA Life, we believe that life inspires us to think ahead. Our insurance solutions are therefore designed to be a stepahead,
thus giving you an advantage to adapt to tomorrow’s changes, starting today.

We look forward to a long and cherished relationship with you.

Best wishes,

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Naveen Tahilyani
CEO & Managing Director /†e7‚ž‚“ˆ.”CL£Aj0fn©jK8{}QY0|y“.K ›j
Authorised Signatory
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Scan the QR to download e-policy document

CLICK HERE TO READ THE TERMS AND CONDITIONS

Policy Servicing Branch : HORIZON 1ST FLR, 57 JAWAHARLAL, NEHRU RD, KOLKATA - 700071
Tata AIA Life Insurance Company Ltd (IRDA of India Regn.No.110) (CIN - U66010MH2000PLC128403)
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.

#RakshakaranKiReet Go to Table of Contents 3/38

 "Stamp duty of Rs. 3200 is paid as provided under Article 47(C)/(D) 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 his order No. LOA/CSD/261/2022/521 / Date 01/02/2022 / Validity period Dt.
08/02/2022 to Dt. 01/02/2023"

(Signature)
Proper Officer

Tata AIA Life Insurance Smart Sampoorna Raksha (UIN: 110L156V02)

Unit-linked, Non-participating, Individual Life Insurance Plan for Savings and Protection

In this policy, the Investment risk in Investment portfolio is borne by the Policyholder

LIFE INSURED SOUMYADIP DAS

POLICY NUMBER U156217569

PREAMBLE

Tata AIA Life Insurance Company Limited (“the Company”), having received a Proposal form and other related documents with
Declaration thereto and initial premium from the Policyholder hereby issues Tata AIA Life Insurance Smart Sampoorna
Raksha, a Unit-linked, Non-participating, Individual Life Insurance Plan for Savings and Protection plan. The Company under
this Policy; does agree in consideration and subject to Policy conditions to pay the benefits under the Policy on the happening of
an Insured event, while the Policy is in force. The basic insurance plan provided under this Policy, with its amount of coverage
and Premium is specified on the Policy Schedule. Entitlement to benefits, conditions for payment and other policy details are
also set out inside. This Policy is subject to terms and conditions motioned herein below and endorsements if any.

Signature valid
Signed by: Naveen Tahilyani
Date:
Location:

This is a system generated document requiring no physical signature.

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 , ,

KO01 U156217569 SP 1049/1490 BROK Non Term_NonEIA

SOUMYADIP DAS
S/O SHYMAL DAS July 28, 2022
GORKHARA BADAMTALA MONDALPARA RAJPUR
SONARPUR
M
KOLKATA, 700150
WEST BENGAL INDIA
M- 8910785486

Tata AIA Life Insurance Linked Comprehensive Protection Rider (UIN: 110A032V02)
Non-linked, Non-participating Individual Health Rider

1. Part A
Dear SOUMYADIP DAS,

Thank you for choosing us for your insurance needs. Tata AIA Life is committed to give you world-class products and professional
service.

We take great pleasure in presenting your Rider Pack for our Tata AIA Life Insurance Linked Comprehensive Protection Rider, a
Non-linked, Non-participating Individual Health Rider. Please check your personal details and the rider provisions carefully. Should
you have any queries, please contact your agent or contact us at the address mentioned below. You can also reach us via email at
customercare@tataaia.com or call our helpline number 1860-266-9966 (Local charges apply).

Intermediary/Agent Name:BLUECHIP INSURANCE BROKING PRIVATE LTD |

Intermediary/Agent Code:(004000629) | Intermediary/Agent Contact details: 25787046 /
srinivasan@bluechipindia.co.in
In order to provide better service, We request you to intimate us in the event of any change in the address of the Policyholder or
the nominee.

You have a free look period of 15 days from the date of receipt of the Rider document, to review the terms and conditions of the
Rider. If You disagree to any of those terms or conditions, You have the option to return the Rider document for cancellation of
the benefit option, stating the reasons for objection and be entitled to a refund of the premiums paid, for the benefit option,
without interest after deduction of proportionate risk premium, stamp duty and medical examination cost along with applicable
taxes and cesses or levies, if any.

On examination of the Rider, if you notice any mistake, please return the Rider document to the Company immediately for
correction.

At Tata AIA Life we believe that life inspires us to think ahead. Our insurance solutions are therefore designed to be a step ahead,
thus giving you an advantage to adapt to tomorrow’s changes, starting today.

We look forward to a long and cherished relationship with you.

Best wishes,
Tata AIA Life Insurance Company Limited

Naveen Tahilyani
CEO & Managing Director
Authorised Signatory
Policy Servicing Branch : HORIZON 1ST FLR, 57 JAWAHARLAL, NEHRU RD, KOLKATA - 700071
Tata AIA Life Insurance Company Ltd (IRDA of India Regn.No.110) (CIN - U66010MH2000PLC128403)
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.

#RakshakaranKiReet Go to Table of Contents 5/38

 "Stamp duty of Rs. 3200 is paid as provided under Article 47(C)/(D) 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 his order No. LOA/CSD/261/2022/521 / Date 01/02/2022 / Validity period Dt.
08/02/2022 to Dt. 01/02/2023"

(Signature)
Proper Officer

Tata AIA Life Insurance Linked Comprehensive Protection Rider (UIN: 110A032V02)
Non-linked, Non-participating Individual Health Rider

Tata AIA Life Insurance Company Limited

INSURED SOUMYADIP DAS

RIDER NUMBER U156217569

PREAMBLE

Tata AIA Life Insurance Company Limited has entered into this contract of insurance on the basis of the information given in the
Proposal Form together with the premium deposit, statements, reports or other documents and declarations received from or on
behalf of the proposer for effecting a life insurance contract on the life of the person named in the Schedule below.

We agree to pay the benefits under the Rider on the happening of the insured event, while the Policy and Rider are in force
subject to the terms and conditions stated herein.

Signature valid
Signed by: Naveen Tahilyani
Date:
Location:

Tata AIA Life Insurance Company Limited

This is a system generated document requiring no physical signature.

CLICK HERE TO READ TERMS AND CONDITIONS

OF COMPREHENSIVE PROTECTION RIDER

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 TABLE OF CONTENTS
Section Description Page No.

Policy schedule Detailed overview of your registered policy 8

List of the beneficial features that comprise

Key feature document 11
your plan

Range of customer-centric services offered by

Service options 16
Tata AIA Life Insurance

A pre-investment, agreed-upon form that

Proposal Form 20
proposes the details of your policy

An illustrative way of presenting year-wise

Benefit illustration premiums payable and benefits under the 20
policy

Record of all transactions that occur with the

Unit Statement 35
funds in your ULIP investment

Acknowledgement of the first premium

First premium receipt 37
payment

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 POLICY SCHEDULE
Tata AIA Life Insurance Smart Sampoorna Raksha (UIN: 110L156V02)
Unit-linked, Non-participating, Individual Life Insurance Plan for Savings and Protection
THIS SCHEDULE MUST BE READ WITH THE POLICY DOCUMENT AND IS PART OF
THE LIFE INSURANCE CONTRACT
Policy Number: U156217569
Policyholder Details Policyholder Life Assured
Name SOUMYADIP DAS SOUMYADIP DAS
S/O SHYMAL DAS S/O SHYMAL DAS
GORKHARA BADAMTALA MONDALPARA RAJPUR GORKHARA BADAMTALA
SONARPUR MONDALPARA RAJPUR SONARPUR
M M
Address
KOLKATA, KOLKATA
700150 KOLKATA
WEST BENGAL INDIA 700150
WEST BENGAL INDIA
Client ID 295880017 295880017
Date of Birth 01/11/1994 01/11/1994
Age at entry 27 years 27 years
Age Admitted Yes Yes
Gender Male Male
Date of Date of Annualised
Basic Sum Date of Maturity Policy Term
Base Plan/Rider Name commencement of commencement Premium (Excl.
Assured (Rs.) of Policy (Years)
policy of Risk taxes) (Rs.)
Tata AIA Life Insurance Smart
Sampoorna Raksha
(UIN: 110L156V02), Unit-linked,
80,00,000.00 27/07/2022 27/07/2022 27/07/2062 65,574.00 40
Non-participating, Individual Life
Insurance Plan for Savings and
Protection
Please refer to Schedule Page 2 for additional rider details

Modal Total Modal

Mode of Premium Due Date of Premium Applicable
Premium Premium Premium
Base Plan/Rider Name Premium Paying Last Premium (Excl. taxes) taxes, cesses &
Due Date (s) (Incl. taxes) (Incl. taxes)
Payment Term(Years) Payment (Rs.) levies (Rs.)
(Rs.) (Rs.)
Tata AIA Life Insurance Smart
Sampoorna Raksha
(UIN: 110L156V02), Unit-linked,
Monthly 5 27/08/2022 27/06/2027 5,462.00 .00 5,462 8,012.00
Non-participating, Individual Life
Insurance Plan for Savings and
Protection
Please refer Schedule Page 2 for additional rider details

Benefits payable
Maturity Benefit As per Clause 1 of Part C of policy document
Death Benefit As per Clause 2 of Part C of policy document

Applicable Target Gross Reduction-in-Yield (TGRIY)

Policy Year TGRIY Policy Year TGRIY Policy Year TGRIY Policy Year TGRIY Policy Year TGRIY
1 13.54 9 11.54 17 9.54 25 7.54 33 5.54
2 13.29 10 11.29 18 9.29 26 7.29 34 5.29
3 13.04 11 11.04 19 9.04 27 7.04 35 5.04
4 12.79 12 10.79 20 8.79 28 6.79 36 4.79
5 12.54 13 10.54 21 8.54 29 6.54 37 4.54
6 12.29 14 10.29 22 8.29 30 6.29 38 4.29
7 12.04 15 10.04 23 8.04 31 6.04 39 4.04
8 11.79 16 9.79 24 7.79 32 5.79 40 3.79

Nominee details (under section 39 of the Insurance Act 1938)

Name of the Nominee (s) Relationship with Life Assured Gender Age Nomination %
SOMA DAS Parents Female 52 100.00

Appointee details (Applicable in case the Nominee is a minor)

Name of the Appointee (s) Relationship with Nominee Gender Age (years)
On examination of the Policy, if you notice any mistake, please return the Policy to the Company immediately for correction.

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 POLICY SCHEDULE
Tata AIA Life Insurance Smart Sampoorna Raksha (UIN: 110L156V02)
Unit-linked, Non-participating, Individual Life Insurance Plan for Savings and Protection
THIS SCHEDULE MUST BE READ WITH THE POLICY DOCUMENT AND IS PART OF
THE LIFE INSURANCE CONTRACT
NA NA NA NA

On examination of the Policy, if you notice any mistake, please return the Policy to the Company immediately for correction.

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 SCHEDULE
Tata AIA Life Insurance Linked Comprehensive Protection Rider (UIN: 110A032V02)
Non-linked, Non-participating Individual Health Rider

Accidental Total and

Benefit Option Permanent Disability Accidental Death Benefit
Benefit
UIN 110A032V02 110A032V02
Life Insured Name SOUMYADIP DAS SOUMYADIP DAS
Address as per proposal form as per proposal form
Client ID 295880017 295880017
DOB 01/11/1994 01/11/1994
Age at entry (Years) 27 27
Age Admitted Y Y
Gender Male Male
Sum Assured under
80,00,000.00 80,00,000.00
Benefit Option (Rs.)
Benefit Payout Option Lumpsum Lumpsum
Lumpsum (Rs.) 80,00,000.00 80,00,000.00
Income p.a. (Rs.) NA NA
Income Duration NA NA
Return of Balance
No No
premium option
Coverage Term (Years) 40 40
Premium Payment Term
5 5
(Years)
Date of Commencement
27/07/2022 27/07/2022
of Risk
Due Date of Last
27/06/2027 27/06/2027
Premium Payment
Maturity/Expiry Date 27/07/2062 27/07/2062
Annualised Premium
9,200.00 15,280.00
(Excl taxes) (Rs.)
Modal Premium
812.00 1,349.00
(Excl taxes) (Rs.)
Tax, Surcharge and
146.00 243.00
Cess (Rs.)
Total Modal Premium
958.00 1,592.00
(Incl taxes) (Rs.)

Details of Nominee (not applicable if Benefit Payout Option is Partner Care)

As per Base Plan

Details of Partner (applicable only if Benefit Payout Option is Partner Care)

Benefit Relationship with Rider Life
Name of Rider Life Insured Name of Partner DOB of Partner Gender Percentage
Option Insured

Note: This schedule must be read with the accompanying policy document and is part of the life insurance contract.

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 OTHER ENDORSEMENT

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 KEY FEATURE DOCUMENT
This is a Unit-Linked, Non-participating, Individual Life Insurance Savings Plan for
Smart Sampoorna Raksha Savings and Protection.
Unit-linked, Non-participating, Individual Life
Insurance Plan for Savings and Protection.

Benefits you've opted for under the plan

Market-Linked Returns Choice of Fund Options
See your investment grow with potential Choice of 11 fund options to enhance
market linked returns and loyalty additions. investment opportunities

Life Cover
Enjoy life cover throughout the policy term

You will receive Total fund value which is the sum of Regular/Single Premium Fund
Maturity Benefit Value and Top-up Premium Fund Value at applicable NAV as on date of Maturity.

Death Benefit
In case of death of the life insured during the policy term and while the policy is in force, the claimant heir will get, highest of
(i) the Basic Sum Assured net of all “Deductible Partial Withdrawals”, if any, from the Regular/Single Premium Fund Value, or
(ii) the Regular / Single Premium Fund Value of this Policy or
(iii) 105 percent of the total Regular/Single Premiums paid up to the date of death.
In addition to this: Highest of
(i) the approved Top-up Sum Assured(s) or
(ii) Top-up Premium Fund Value of this Policy or
(iii) 105 percent of the total Top-up Premiums paid up to the date of death

Loyalty Additions
Refund of 2X Mortality Charges Refund of 2X Premium Cover Continuance Booster -
Allocation Charges -
Starting from the 11th Policy Year, two times At the end of 10th, 11th, 12th and 13th Non-negative amounts shall be added in form of
the monthly mortality charge (excluding Policy Years, two (2) times the total addition of units at the end of Policy Month if Fund
underwriting extra and taxes) deducted during Premium Allocation Charges (excluding Value falls below 10% of the Modal Premium
the period of 120 preceding Policy Month shall taxes), deducted over the Policy Years 1, 2, during First 15th Policy Years and at the end of
be added to the Fund Value at the end of each 3 and 4 respectively, shall be added to the each Policy Month if Fund Value falls below Fund
Policy Month in the form of addition of units. Fund Value in the form of addition of units. Value implied by the Target Net Yield from 16th
Policy Year till the end of Policy Term

Grace Period Waiting Period

Monthly Mode: 15 days | Other Modes: 30 days Not Applicable

Exclusion
In case of death due to suicide within 12 months from the date of commencement of the policy or from the date of revival of the
policy, the nominee or beneficiary of the policyholder shall be entitled to fund value/policy account value, as available on the date
of intimation of death. Any charges other than Fund Management charges recovered subsequent to the date of death shall be
paid-back to the nominee or beneficiary along with death benefit

Riders The detailed provisions of the rider if availed, are available in the terms and conditions.

The detailed provisions of the rider if availed, are available in the terms and conditions.

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 CUSTOMER INFORMATION SHEET
Description is illustrative and not exhaustive

POLICY
SR. TITLE DESCRIPTION CLAUSE
NO. NUMBER

1 Product Name Tata AIA Life Insurance Linked Comprehensive Protection Rider
(UIN: 110A032V02) (A Non-Linked, Non- Participating Individual Health Rider)

2 What am I Benefit Option: Accidental Total and Permanent Disability Benefit: 100% of the Insured Amount under this Part C
covered for: Benefit Option will be payable in the event of the Total and Permanent Disability of the Life Insured due to an Clause 1
accident within the Benefit Option Term, provided the disability occurs within 180 days from that accident as (III)
per Part C Clause 1 (III) of the Policy Document.

3 What are the Accidental Disability Benefit shall be not payable for any losses caused directly or indirectly, wholly or
major exclusions partly, by any one of the following occurrences:
in the policy: • Disablement as a result of any disease or infection.
• Disablement arising due to any condition other than disablement solely and directly as a result of an accident.
• Any pre-existing condition or disability arising out of a pre-existing diseases or any complication arising
therefrom. Wherever the proximate cause is accident which has occurred after the rider inception date, this
exclusion shall not apply
• If the Disability has not persisted for at least 180 days and is not in the opinion of a medical practitioner,
deemed to be permanent.
• Attempted suicide, attempted self-destruction or self-inflicted injury, irrespective of mental condition.
• Disablement arising from or caused due to use, abuse or a consequence or influence of an abuse of any
substance, intoxicant, drug, alcohol or hallucinogen
• Disablement arising out of or attributable to foreign invasion, act of foreign enemies, hostilities, warlike
operations (whether war be declared or not or while performing duties in the armed forces of any country
during war or at peace time), participation in any naval, military or air-force operation, civil war, public
Annexure 1
defense, rebellion, revolution, insurrection, military or usurped power ‘Exclusions’
• Disablement caused by Participation by the insured person in any flying activity, except as a bonafide, Section
fare-paying passenger of a recognized airline on regular routes and on a scheduled timetable.
• Insured Person whilst engaging in a speed contest or racing of any kind (other than on foot), bungee jumping,
parasailing, ballooning, parachuting, skydiving, paragliding, hand gliding, mountain or rock climbing
necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and
breathing apparatus, polo, snow and ice sports in so far as they involve the training for or participation in
competitions or professional sports, or involving a naval, military or air force operation and is specifically
specified in the Policy Schedule
• Working in underground mines, tunnelling or explosives, or involving electrical installation with high tension
supply, or as jockeys or circus personnel, or engaged in Hazardous Activities
• Disablement arising or resulting from the Insured Person committing any breach of law or participating in an
actual or attempted felony, riot, crime, misdemeanor, or civil commotion with criminal intent.
• Disablement arising from or caused by ionizing radiation or contamination by radioactivity from any nuclear
fuel (explosive or hazardous form) or resulting from or from any other cause or event contributing
concurrently or in any other sequence to the loss, claim or expense from any nuclear waste from the
combustion of nuclear fuel, nuclear, chemical or biological attack.

4 Waiting period Not Applicable -

5 Payment Basis Benefit as described in Part C Clause 1 (III) of the Policy Document will be paid on the occurrence of a
Part C
covered event. You can choose to receive the benefits as a Clause 5
1. Combination of Lump sum and income for a fixed income period chosen
2. Income till survival of chosen dependent partner(s) (Partner Care)
3. Waiver of future premiums
For more details please refer Part C, Clause 5 of Policy Document

6 Loss Sharing Not Applicable -

7 Renewal -
Not Applicable
Conditions

8 Renewal
Not Applicable -
Benefits

9 Cancellation This policy will be cancelled, and no claim or refund would be due to you if;
a) You have not correctly disclosed details about current and past health status OR
b) Have otherwise encouraged or participated in any fraudulent claim under the policy OR
c) In case of misrepresentation of material information
Also, this Benefit Option shall automatically terminate on the occurrence of any of the events described in Part
D Clause 8

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 POLICY
SR. TITLE DESCRIPTION CLAUSE
NO. NUMBER

10 Claims For processing the claim request under this rider, please share documents as listed under Part F Clause 2 of Part F
the Policy Document. Clause 2
The evidence of travel in public land transportation, airline or visit to theatre, cinema, public auditorium, hotel
will be required for Double Benefit claim to be considered.

11 Policy For details on policy servicing/grievances/complaints, please refer the terms and conditions Part D
Servicing/ of the base plan and
Grievance/ Part G
Complaints

12 Insured’s Right Free look & Revival: For the purpose of this Supplementary Contract, the provisions of the base plan in respect Part D
of Free look cancellation and revival, shall apply.
Turn Around Time (TAT) for Claim Processing: For Health Claims: The claim will be decided within 30 days of
receiving all documents and clarification. If the claim is investigated, the investigation will be completed within 30
days and the claim decided in another 15 days, therefore not exceeding 45 days in total.
13 Insured’s Please disclose all pre-existing disease/s or condition/s before buying a Policy. Non-disclosure may Part F
Obligations result in claim not being paid. Clause 4
Disclosure of Material Information and any changes therein during the Policy period should be
communicated to us by:
- Sending an email to customercare@tataaia.com from your email id registered with us
- Submission of the Request for Change form* (filled and signed) at any Tata AIA Life Insurance
Branch or Service Centre
*Request for Change form is available on our website – www.tataaia.com

1) Kindly note that this document does not substitute the Policy Contract.
2) In case the age is found to be higher/lower than the actual age, the rights and remedies would get affected

(LEGAL DISCLAIMER) NOTE: The information must be read in conjunction with the Product Brochure and Policy Document. In case of any conflict
between the Customer Information Sheet and the Policy Document, the terms and conditions mentioned in the Policy Document shall prevail.

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 customercare@tataaia.com. Visit us at: www.tataaia.com.
L&C/Advt/2020/Nov/1352.

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 CUSTOMER INFORMATION SHEET
Description is illustrative and not exhaustive

POLICY
SR. TITLE DESCRIPTION CLAUSE
NO. NUMBER

1 Product Name Tata AIA Life Insurance Linked Comprehensive Protection Rider
(A Non-Linked, Non- Participating Individual Health Rider) (UIN: 110A032V02)

2 What am I Benefit Option: Accidental Death Benefit (ADB): The Insured Amount under this Benefit Option will be Part C
covered for: payable in the event of the death of the Life Insured due to an accident within the Benefit Option Term, Clause 1
provided the death occurs within 180 days from the accident as per Part C Clause 1 (II) of the Policy Document (III)

3 What are the Accidental Death Benefit shall not be payable for any losses caused directly or indirectly, wholly or partly,
major exclusions by any one of the following occurrences:
in the policy: • Death as a result of any disease or infection
• Death arising due to any condition other than death solely and directly as a result of an accident
• Any pre-existing condition of disability arising out of a Pre-existing diseases or any complication arising
therefrom. Wherever the proximate cause is accident which has occurred after the rider inception date, this
exclusion shall not apply
• Suicide, attempted suicide, attempted self-destruction or self-inflicted injury, irrespective of mental condition.
• Death arising from or caused due to use, abuse or a consequence or influence of any abuse of any
substance, intoxicant, drug, alcohol or hallucinogen
• Death arising out of or attributable to foreign invasion, act of foreign enemies, hostilities, war like operations
(whether war is declared or not or while performing duties in the armed forces of any country during war or at
peace time), participation in any naval, military or air force operation, civil war, public defense, rebellion,
revolution, insurrection, military or usurped power.
• Death caused by Participation by the insured person in any flying activity, except as a bonafide, fare-paying
passenger of a recognized airline on regular routes and on a scheduled timetable.
• Insured Person whilst engaging in a speed contest or racing of any kind (other than on foot), bungee jumping, Annexure 1
parasailing, ballooning, parachuting, skydiving, paragliding, hand gliding, mountain or rock climbing ‘Exclusions’
necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and Section
breathing apparatus, polo, snow and ice sports in so far as they involve the training for or participation in
competitions or professional sports, or involving a naval, military or air force operation and is specifically
specified in the Policy Schedule.
• Working in underground mines, tunnelling or explosives, or involving electrical installation with high tension
supply, or as jockeys or circus personnel, or engaged in Hazardous Activities.
• Death arising or resulting from the Insured Person committing any breach of law or participating in an actual
or attempted felony, riot, crime, misdemeanor, or civil commotion with criminal intent.
• Death arising from or caused by ionizing radiation or contamination by radioactivity from any nuclear fuel
(explosive or hazardous form) or resulting from or from any other cause or event contributing concurrently or
in any other sequence to the loss, claim or expense from any nuclear waste from the combustion of nuclear
fuel, nuclear, chemical or biological attack.
No benefits will be payable for any condition(s) which is a direct or indirect result of any pre-existing
conditions unless Life Insured has disclosed the same at the time of proposal or date of revival whichever
is later and the Company has accepted the same.

4 Waiting period Not Applicable -

5 Payment Basis Fixed amount as described in Part C Clause 1 (II) of the Policy Document will be paid on the occurrence Part C
of a covered event. You can choose to receive the benefits as a Clause 5
1. Combination of Lump sum and income for a fixed income period chosen
2. Income till survival of chosen dependant partner(s) (Partner Care)
For more details please refer Part C, Clause 5 of Policy Document.

6 Loss Sharing Not Applicable -

7 Renewal -
Not Applicable
Conditions

8 Renewal
Not Applicable -
Benefits

9 Cancellation This policy will be cancelled, and no claim or refund would be due to you if;
a) You have not correctly disclosed details about current and past health status OR
b) Have otherwise encouraged or participated in any fraudulent claim under the policy OR
c) In case of misrepresentation of material information
Also, this Benefit Option shall automatically terminate on the occurrence of any of the events described in Part
D Clause 8 of the Policy Document

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 POLICY
SR. TITLE DESCRIPTION CLAUSE
NO. NUMBER

10 Claims For processing the claim request under this Rider, please share documents as listed under Part F Clause 2 of Part F
the Policy Document. Clause 2
The evidence of travel in public land transportation, airline or visit to theatre, cinema, public auditorium, hotel will
be required for Double Benefit claim to be considered.

11 Policy For details on policy servicing/grievance/complaints, please refer the terms and conditions of Part D
Servicing/ the base plan and
Grievance/ Part G
Complaints

12 Insured’s Right Free look & Revival: For the purpose of this Supplementary Contract, the provisions of the base plan in respect Part D
of Free look cancellation and revival, shall apply
Turn Around Time (TAT) for Claim Processing: For Health Claims: The claim will be decided within 30 days of
receiving all documents and clarification. If the claim is investigated, the investigation will be completed within 30
days and the claim decided in another 15 days, therefore not exceeding 45 days in total.

13 Insured’s Please disclose all pre-existing disease/s or condition/s before buying a Policy. Non-disclosure may Part F
Obligations result in claim not being paid. Clause 4
Disclosure of Material Information and any changes therein during the Policy period should be
communicated to us by:
- Sending an email to customercare@tataaia.com from your email id registered with us
- Submission of the Request for Change form* (filled and signed) at any Tata AIA Life Insurance
Branch or Service Centre
*Request for Change form is available on our website – www.tataaia.com

1) Kindly note that this document does not substitute the Policy Contract.
2) In case the age is found to be higher/lower than the actual age, the rights and remedies would get affected

(LEGAL DISCLAIMER) NOTE: The information must be read in conjunction with the Product Brochure and Policy Document. In case of any conflict
between the Customer Information Sheet and the Policy Document, the terms and conditions mentioned in the Policy Document shall prevail.

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 customercare@tataaia.com. Visit us at: www.tataaia.com.
L&C/Advt/2020/Nov/1350.

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 SERVICE OPTIONS

)LDFKQLLKBPQLMPELMCLOVLROPBOSF@FKDKBBAP

My
DigiAccount

%LTQLILDFK
Visit https://myinsurance.tataaia.com

Authenticate your policy details and date of birth

Verify your registration via OTP

Your registration is now complete

#B>QROBP

Simplified OTP-based login Buy products online

Single dashboard with Easy servicing options

key policy information

Pay premium, download

Read interesting
receipts & statements
blogs & articles

Set notification on
policy milestones

-OBJFRJM>VJBKQLMQFLKP
4EBOBQLM>VMOBJFRJ
Pay on Website
Bank Website
https://apps.tataaia.com/PG/#!/policyPayment

Apps (PayZapp, Paytm, Google Pay,

My DigiAccount
Phone Pe, Jio Money, Airtel Money,
https://myinsurance.tataaia.com
Itz Cash, MobiKwik, Amazon Pay)

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%LTQLM>VMOBJFRJ

Credit card/debit card

Netbanking

Mobile wallets

Bharat Bill Payment System (BBPS)

UPI

Watch our video on premium payment options

https://youtu.be/Dg1CYdlBa8w

%>PPIB COBB0Q>KAFKD&KPQOR@QFLKP
Ensure Non-Stop Rakshakaran by registering for Standing Instructions where premium amount
will automatically get debited on due date.

/ACEOPANKJ https://apps.tataaia.com/PG/#!/RegAutoDebt uOEJCCredit Card or Bank Account

4>VPQL>@@BPPAFDFQ>IMLIF@VAL@RJBKQ

SMS Email WhatsApp My DigiAccount DigiLocker e-Insurance

Account

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https://www.tataaia.com/customer-service/claim-registration.html

https://www.tataaia.com/contact-us.html?contactUs-2

https://youtu.be/BaIjmQ5X6k0

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 www.tataaia.com

https://www.tataaia.com/contact-us.html?contactUs-2

https://myinsurance.tataaia.com

customercare@tataaia.com

https://myinsurance.tataaia.com

https://myinsurance.tataaia.com

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Go to Table of Contents 35/38
 UNIT STATEMENT
IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT
PORTPOLIO IS BORNE BY THE POLICYHOLDER
Product Name Tata AIA Life Insurance Smart Sampoorna Raksha (UIN - 110L156V02)
Policy No U156217569
Policy Date 27/07/ 2022
Next Due date 27/08/ 2022
Basic Policy Premium(`) 5462.00
Rider Premium(`) 2161.00
Service Tax on Rider Premium(`) 388.98
Policy Term 40
Premium Paying Term 5
Mode Monthly
Insured Name SOUMYADIP DAS
Owner Name SOUMYADIP DAS

Section 1: FUND VALUE AS AT 27 /07/2022

Regular/Single Top-Up Regular/Single Premium
Net Asset Top-Up Premium Account Surrender
Premium Premium Account
Fund Portfolio Value(`) Units Fund Value(`) Units Fund Value(`) Value(`)
Account Account
Allocation Allocation (A) (B) C=(A*B) (D) E=(A*D) (F)
Whole Life Mid Cap Equity Fund
100.00% 0.00% 80.8823 50.296666 4068.11 0.000000 0.00 3780.08
(ULIF 009 04/01/07 WLE 110)
TOTAL 100.00% 0.00% 4068.11 0.00 3780.08

Section 2: PREMIUM INFORMATION IN THE CURRENT POLICY YEAR (2022-2022)

Regular/Single Premium Top-Up Premium
Premium Details
Current Policy Year (`) Since Inception(`) Current Policy Year(`) Since Inception(`)
Total Premium(s) Paid 5462.00 5462.00 0.00 0.00
Total Premium(s) Invested 0.00 4688.58 0.00 0.00

BREAKUP OF TOTAL CHARGES DEDUCTED IN THE CURRENT POLICY YEAR

Charge Details Regular/Single Premium (`) Top-Up Premium (`)
Total Mortality Charges on Sum Assured (525.82) 0.00
Service Tax on Mortality Charges on Sum Assured (94.65) 0.00

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 Section 3: COVERAGE INFORMATION DETAILS
Benefit Type Sum Assured (`) Effective Date Expiry Date
Basic Sum Assured 8000000.00 Jul 27, 2022 Jul 27, 2062
Total Top-up Sum Assured 0.00

Current Death Benefit (Regular / Single Premium Account) as at 27 /07/2022 (`) 8000000.00
Current Death Benefit (Top-up Premium Account) as at 27 /07/2022 (`) .00
Total Death Benefit as at 27 /07/2022 * (`) 8000000.00

* Please refer to the Policy Contract on Death Benefit. It does not include any Supplementary Benefit with Death Coverage.

Unit Pricing methodology under Unit Linked Life insurance products has undergone changes pursuant to IRDA of India Circular ref:
IRDA/F&I/ CIR/INV/173/08/2011 dated 29th July, 2011. Policyholders are informed that effective from 16th August, 2011 we have
started calculating unit prices as per the procedure prescribed in the above Circular as amended/modified by IRDA of India from time
to time. There is no change in the number of units to the credit of any policyholder on account of this change.

**In case of Complete Withdrawal within the first five years of the policy, the proceeds of the Discontinued Policy shown in the Unit
Statement shall be paid to the policyholder post completion of the lock-in period of five years from the inception of the policy or on
death of the insured, if earlier.

“Proceeds of the Discontinued Policy” means the fund value as on the date of discontinuance plus entire income earned after
deduction of the fund management charges, subject to a minimum guarantee of interest @ 4% p.a. or as prescribed by IRDA of India
from time to time.

Contact Us:
Contact Us:
SMS 'HELP' to 5676799 for list of services offered via SMS'SERVICE' to 58888 to receive call back from our Customer Service Executives

Website www.tataaia.com Log on to the Customer Portal

Email customercare@tataaia.com

Call Center Helpline No.-1800-267-9966 (Toll Free)1860-266-9966 (Local ChargesApply) Callers Outside India 080-67603700 (Charges apply)

Write us to Tata AIA Life Insurance Company Ltd.

14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013

Kindly Note:
l Investment Risk in the investment portfolio shall be solely borne by the policyholder. The premium paid in Unit Linked Life
Insurance policies are subject to investment risks associated with capital markets and the NAVs of the units may go up or down
based on the performance of the fund and factors infiuencing the capital market and the insured shall be responsible for his or her
decision.
l The underlying Fund’s Unit Price will be affected by interest rates and the performance of the underlying stocks. The Fund’s
Unit Price may goup or down refiecting the market value of the underlying assets.
l Please know the associated risks and the applicable charges, from your insurance agent or the Intermediary or policy
document issued by theinsurance company.
l Whilst every care has been taken in the preparation of this statement, it is subject to correction and this statement should be
read along with the policy document and does not individually confer any legal rights. For policy terms and conditions, please refer to
the policy document.
l This statement shall form a part of the policy document.
l As this is a computer generated statement, no signature is required.
l Service tax is applicable as per governing laws and the same shall be borne by the policyholder. Tata AIA Life Insurance
Company Limitedreserves the right to recover from the Policyholder, any levies and duties (including service tax), as imposed by the
goverment from time to time.
l Insurance cover is available under this product.
l For policy terms and conditions, please refer to the policy document. (Unique Reference No: L&C/Advt/2014/Mar/159)

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 FIRST PREMIUM RECEIPT
PERSONAL DETAILS
Tata AIA Life Insurance Smart
Policy Number: U156217569 Plan Name:
Sampoorna Raksha (110L156V02)
Policy Owner Name: SOUMYADIP DAS Life Assured Name: SOUMYADIP DAS
BLUECHIP INSURANCE BROKING
Email ID: RIVUDAS1@GMAIL.COM Distributor/Agent Name:
PRIVATE LTD
Contact No. : 8910785486 Distributor/Agent Contact Number: 25787046
PAN Details BWNPD4805N

PREMIUM DETAILS
Premium Amount Due (In Rs.) 7623.00 Payment Mode Monthly
Goods & Service Tax (GST) 389.00 Next Premium Due on 27/08/2022
Total Amount (In Rs.) (a) 8012.00 Excess Amount (In Rs.) (b-a) 8,012.00
Amount Received (In Rs.) (b) 16,024.00

TAX BENEFIT DETAILS

Sec 80 C Sec 80 CCC Sec 80 D
7200.00 .00 812.00

PAYMENT DETAILS
Receipt Number Receipt Date Amount (In Rs.) Payment Method
ID3282497 25/07/2022 16,024.00 Cash/Cheque/DD

Please Note:
l This document can be used as a proof for claiming deduction while filling your tax returns and tax benefits would be applicable as per
the prevailing tax laws.
l Payments made through modes other than cash are subject to clearance including through electronic mode payments.
l Any excess premium will be adjusted towards premium due in the current financial year or due in the next three months, whichever is later. Else
premium will be auto refunded post 15 days.
l Applicable govt taxes, surcharge, cess including GST would be charged in accordance with applicable Laws and Company will have the right to
recover the same from the policyholder.
l Please refer to the policy document for detailed terms and conditions and our website for FAQ on applicable tax benefits.
l In case of Unit Linked Policy (ULIP), if premium is received by us after 3:00 pm on a business day, NAV of the next business day shall apply.
GST DETAILS
Base Premium Taxable Value CGST .00% SGST/UTGST .00% IGST 18.00% Reverse Charge
` 7623.00 ` 2161.00 ` .00 ` .00 ` 389.00
Tata AIA Life Insurance Tata AIA Life Insurance GST
MAHARASHTRA 27AABCT3784C1ZD SAC Description Life Insurance
State IN
Policy Owner's GST State WEST BENGAL Policy Owner's GSTIN Not Registered SAC Code 997132

Consolidated Revenue stamp duty paid: Notification No. Mudrank – CSD/179/2019/4939, dated 16th October, 2019 vide receipt number
MH006751891201920M dated on 26th September, 2019.
PAN: AABCT3784C.

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