Policy Certificate

BATHEM VENKATA RAMA NARSAIAH

HNO 1-24/3
NAYAKANGUDEM VIL
KUSUMANCHI MANDAL,KHAMMAM DIST

Intermediary 92789 Intermediary Name: STATE BANK OF INDIA Certificate No. 413190321

Date: 16/07/2023 This is to certify that

BATHEM VENKATA

is insured for an amount of INR 2000000 /- , under Personal Accident Policy subject to exclusions,
provisions and other terms as specified in Master Policy for a period of 1 year from 16/07/2023

Nominee : LAVANYA BATHEM Relationship Spouse

:
Name with Nominee

Proposal Ref.
SBI Account No.: 30457474310

Premium received: 1000

INR 1000/- (inclusive of taxes as applicable)
Authorised Signatory
Note: Please consider above as acknowledgement for receipt of premium. Policy schedule along with detailed list of
coverages and policy wordings will be sent on your Registered Address and/or Email address/Mobile no. available with us.

SBI General Insurance Company Limited, 9th Floor, A & B Wing, Fulcrum Building, Sahar Road, Andheri (East), Mumbai 400099. | IRDAI Reg. No. 144 dated
15/12/2009 | CIN: U66000MH2009PLC 190546 | SBI Logo displayed belongs to State Bank of India and used by SBI General Insurance Co. Ltd. under
license.
Dear Customer,
Thank you for selecting SBI General's Group Personal Accident Insurance Policy. We are pleased to provide you with your ‘Certificate of Insurance’. At SBI
General we are constantly seeking to provide our customers with excellent support for all our policies. Therefore, should you have any Queries, please do
not hesitate to contact our team at the Customer Care at 1800 22 1111 / 1800 1021111 (Toll Free 8:00 am to 8:00 pm - Monday to Saturday).

MOST IMPORTANT TERMS & CONDITIONS OF THE MASTER POLICY

This Cerificate of Insurance is subject to the terms and conditions of the Master Policy Number overleaf issued to State Bank of India and Regional Rural
Banks* of SBI and is based on Proposal and payment of the Premium. This Certificate records the agreement between Insured and SBI General Insurance
Company and sets out the brief terms of insurance and the obligations of each party as below:

TERMS & CONDITIONS

• This Policy can be bought by any permanent Indian resident having a Saving Bank / Individual Current Account with SBI/RRBs* of SBI and aged
between 18 years to 65 years.

• Coverage is limited to death on account of

1. Loss of life due to accident
2. Permanent Total Disability
3. Child Education- covers up to max. of 1% of accidental death's sum insured or 20000/- whichever is lower for First & second child of insured
member(In case of death or PTD admissible claim)
4. Repatriation & Funeral expenses -1% Accidental Death's Sum insured subject to maximum of 10000/-
5. Adaptation allowance (Home & Vehicle) - 1% Accidental death's Sum insured subject to max of 20,000 in case of PTD admissible claim.
6. Ambulance cover - 1% Accidental Death's Sum insured up to maximum of 1500/- per incident/accident towards admissible claim of death or
Permanent Total Disability(PTD)
7. Free Look Period

The Free Look Period will be applicable on new policy and not renewals.
The insured person shall be allowed free look period of fifteen days from date of receipt of the policy document to review the terms and conditions of
the policy, and to return the same if not acceptable.
If the insured has not made any claim during the Free Look Period, the insured shall be entitled to
I. A refund of the premium paid less any expenses incurred by the Company on medical examination of the insured person and the stamp duty
charges or
II. Where the risk has already commenced and the option of return of the policy is exercised by the insured person, a deduction towards the
proportionate risk premium for period of cover or
III. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during
such period
• Irrespective of the number of accounts the Insured has with State Bank Of India , insured is eligible to take only one policy from SBI General Insurance.
Our liability will be restricted to maximum of the Sum Insured stated on this Certificate of Insurance for settlement of claim, if any, per life.

• Coverage under this Policy will be over and above any other Personal Accident Policies Insured has with SBI General or with any other Indian General
Insurance Companies.
• If no claim has been made under the Policy, then we will refund premium in accordance with the table below:

Length of time Policy in force Refund of premium Length of time Policy in force Refund of premium
Up to 1 month 75% Up to 6 months 25%
Up to 3 months 50% exceeding 6 months 0%

• We may terminate this Policy upon 15 days notice by sending a written notice of cancellation to your address and we shall refund a rateable proportion
of the premium actually paid in respect of any Insured Person. Termination of this Policy shall not affect any claim filed prior to the date on which
termination becomes effective as specified in the notice of termination.

• Such Termination may be on grounds of mis-representation, fraud, non-disclosure of material facts or non-cooperation of the insured.

• The premium at the time of the renewal of the policy would be the applicable premium at the date of renewal and as approved by IRDA. However,
renewal will be subject to the Account of the Insured with SBI & its Associate Banks being still live and operational.
• The policy shall become voidable at the option of Insurer, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-
disclosure in any material particular in the proposal form/personal statement, declaration and connected documents or any material information having
been withheld by the Insured or anyone acting on Insured’s behalf. Any person who, knowingly and with intent to defraud the Company or any other
person, files a proposal for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact
material thereto, commits a fraudulent insurance act, which will render the policy voidable at the sole discretion of the Company.

EXCLUSIONS
The Company shall not be liable for any claim or claims under this Policy arising from

• Any pre-existing disability, condition or any complication arising from it; or

• Suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted injury or illness, or sexually transmitted conditions, mental or nervous
disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV) infection; or

• In case of Defence Service Personnel, death classified as battle casualties by their respective service headquarters, the insurance company shall not be
liable for any claims. Apart from this, death while performing their duties and /or related to their occupation, like patrolling duty, rescue operations,
training activities, exercised and other routine duties in difficult environment shall be excluded; or

• Being under the influence or abuse of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a physician and token as
prescribed; or
• Participation in an actual or attempted felony, riot, crime, misdemeanour, or civil commotion; or
• Operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft apart from a Scheduled Airline; or whilst
engaged in aviation or ballooning, or whilst mounting into dismounting from or travelling in any balloon or aircraft other than as a passenger (fore posing
or otherwise) In any duly licensed standard type of aircraft anywhere in the world; or

• Any loss arising out of war, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether war be declared or not), rebellion,
mutiny, use of military power or usurpation of government or military power; or

• Payment of compensation in case of death of the Insured person from nuclear damage caused by, contributed to, by or arising from ionising radiation or
contamination by radioactivity from:
- any nuclear fuel or from any nuclear waste;or -from the combustion of nuclear fuel(including any self-sustaining process of nuclear fission);
- nuclear weapons material; -nuclear equipment or any part of the equipment;or

• The dispersal or application of pathogenic or poisonous biological or chemical materials; the release of pathogenic or poisonous biological or chemical
materials, or congenital anomalies or any complications or conditions arising there from; or
• Participation in winter sports, skydiving/parachuting, hand gliding, bungee jumping, scuba diving. ballooning, mountain climbing (where ropes or guides
are customarily used), riding or driving in races or raIIies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin
diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or booting outside coastal waters (2 nautical miles).
Participation in any professional sports, any bodily contact sport or/and any other hazardous or potentially dangerous sport for which Insured is
untrained; or

• Death resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy; or

• For any loss to which a contributing cause was insured person's actual or attempted commission, or wilful participation in, an illegal act or any violation
or attempted violation of the law or resistance to arrest or insured person committing any breach of law with criminal intent;
• Loss caused directly or indirectly, wholly or partly by infections (except pyogenic infections which shall occur through an accidental cut or wound) or any
other kind of disease

For complete details of Coverage and Policy Wording, kindly visit our website - www.sbigeneral.in

In the unfortunate event of a claim our Customer Care may be informed on the toll free numbers or email may be sent to customer.
care@sbigeneral.in quoting the Saving Bank / Individual Current A/c No. of the insured which appears on the Certificate of Insurance
overleaf.

Grievance Redressal procedure: We value your relationship and are committed to offer you best in class service. However, if you are
dissatisfied with the services rendered by us during any of your interactions with us or on resolution provided by us on your service request
or complaint, we request you to register your concern with our Customer Care by following the steps mentioned below. We will
acknowledge receipt of your concerns within next 72 working hours and wil respond to you as soon as possible, upon completion of the
investigation.

Step 1: Call us at 1800-102-1111/1800-22-1111 (Toll-free 8:00 am to 8:00 pm - Monday to Saturday) or write to us at customer.
care@sbigeneral.in. If you don't hear from us within 48 hrs please follow Step 2

Step 2: If you are not happy with the resolution provided, please write to Head — Customer Care at our Registered Office address printed
overleaf. If after having followed Step 1 and Step 2 your issue remains unresolved for more than 30 days from the date of filing your first
complaint, you may approach the Insurance Ombudsman for redressal of your grievance.