Kotak Complete Cover Group Plan - Certificate Of Insurance

A non-linked non- participating Group Credit Life Insurance Plan

(Product UIN: 107N018V06)
SCHEDULE
Certificate No: CD000247_SPLN65989238_2082 Member ID: 208260016
Member Joint Life Assured
Policy No: CD000247

Name of the Member & Joint Life Assured (if applicable): SIVAJI KOTIPALLI NA
Address: hno 30 642 5 1F 2, Plan Option: Life Cover NA
NR. gateno2, DAVpublic Interest Rate: 21% NA
school, chandragiri, colony,
Sum Assured : 1300000 NA
old Telangana 500056
Benefit Multiplier : 100 NA
Moratorium Period: NA NA

Premium Amount Rs: 14849.12 NA

Premium Payment Options: Single NA
Premium Payment Term: 1 NA
Cover Term: 60 Months NA
Last Premium Due On: Single Premium NA
Date of Inception of Risk/Cover: 23-FEB-22 NA
Date of Maturity of Cover: Not Applicable Not Applicable
Age of the Member as on Date of Commencement
33 NA
of Risk/Cover:
Name of Nominee: K. Priyanka NA

Age of Nominee: 30 NA

Relationship with Member & Joint Life Assured (if NA

applicable) : WIFE

Name of the Appointee where Nominee is minor: NA NA

Premium payment Mode: Single Premium NA

Branch: HYDERABAD Region: HYDER

Goods and Services tax and Cess, surcharges and other levies if applicable shall be at the current applicable rates and may vary from time to time.
Our Valued Member,
Kotak Mahindra Life Insurance Company Ltd. (hereinafter referred to as "the Insurer") takes great pride in extending life insurance cover to you under Kotak
Complete Cover Group Plan (hereinafter referred to as “the Policy/ the Policy Contract”). (Policy No. CD000247) is a group insurance cover designed for the
Members of KOTAK MAHINDRA BANK LIMITED (hereinafter referred to as “the Policyholder”). This Certificate o f Insurance constitutes of this Schedule and the
benefits sections, along with the standard terms and conditions mentioned in Annexure 1 , enclosed hereunder (“COI”). The COI is issued o n the basis o f the facts,
information and declaration provided in the Member Data/Membership Form Cum Declaration o f Good Health, if applicable, and such other documents duly
provided/signed and executed by you.

In case the Member is not agreeable to any of the provisions stated in the Policy, then there is an option o f returning the COI, stating the reasons thereof within
15 days from the date of the receipt of the Policy. The cancellation request should be submitted to nearest Branch o f the Insurer or sent directly to the Insurer’s
Head Office. On receipt of letter along with the original COI, the Insurer shall refund the Premium paid after deducting the proportionate risk premium, medical
charges (if any) and stamp duty. COI once returned shall not be revived, reinstated or restored at any point o f time and a new proposal will have to be submitted
for a new policy.

The Benefits payable will be calculated on the basis of the Plan option as mentioned in the table above.

Following are the benefits under the Policy:

1. Benefit Terms & Conditions:
Benefits under the Policy shall be payable to the Beneficiary/Policyholder (as mentioned under point F of this section) and depending upon the Plan option
chosen and shall be determined basis the date of incident. Except for the Life Cover Option, all other options include accelerated benefit as more specifically
mentioned in the relevant sections. An accelerated benefit is not an additional benefit and it only facilitates earlier payment of the Insured Benefit under the
option upon occurrence of the covered events. No maturity benefit is available under the Policy.

A. Benefits available under Life Cover Option:

i. Upon death of the Member during the Cover Term while the cover for the concerned Member is in force, Insured Benefit shall be payable. This benefit
shall be payable in lump sum and the cover shall cease.
ii. In case of occurrence of the covered event, during the Grace Period, the unpaid due Premium shall be deducted from the Insured Benefit payable.
 B. Payment of Insured Benefit to Policyholder:
If the Policyholder is a regulated entity as follows: 1) Reserve Bank o f India (RBI) regulated Scheduled Banks (including Cooperative Banks) 2 ) NBFCs having
Certificate o f Registration from RBI or 3) National Housing Bank (NHB) Regulated Housing Finance Company, 4 ) National Minority Development Finance
Corporation (NMDFC) and its State Channelizing Agencies 5) Small Finance Banks (SFB) regulated by RBI 6 ) Mutually Aided Cooperative Societies formed and
registered under the applicable State Act concerning such Societies 7 ) Microfinance companies registered under section 8 o f the Companies Act, 2013 8 )
any other category as approved by IRDAI the payment of Insured Benefit may be made to the Policyholder, to the extent o f loan outstanding as o n the date
o f contingent event, on obtaining a specific authorization from the Member, the payment o f Insured Benefit may be made to the Policyholder, to the extent
of loan outstanding as on the date of contingent event, and subject to the conditions laid down by IRDAI under the Circular
IRDA/LIFE/CIR/172/09//2019, dated 26.9.2019, and various other applicable Regulations/ Guidelines/ Circulars or instructions issued from time-to-time and
specific authorization obtained from the member concerned. In other cases of non-regulated entities, the Insured Benefit shall be payable to the Beneficiary.

C. Rider Benefits: No riders are available under the Policy.

2. Surrender:
Master Policyholder surrender:
In case the Policyholder surrenders the Policy, the Members shall be given the option to continue their cover till the end o f their respective Cover Term
Members who do not opt to continue with their cover, the Surrender value as defined below shall be payable to them as lump sum.

• Single Premium paying policies will acquire Surrender Value immediately after the payment of Single Premium. Surrender value for Single Premium policies is
equal to –
60% * Total Premiums Paid to date * (Outstanding Cover Term / Cover Term)* ((Cover term-PPT)/Cover term) * (Outstanding loan amount^ / Initial loan
amount^) ^ The initial and outstanding loan amount mentioned above will be as per the loan cover schedule issued to the member at inception of the cover.

Member surrender:
The Cover shall continue till the end of the contracted term, unless expressly surrendered by the Member. Surrender value as defined above shall be payable.

3. Suicide Exclusion:
In case of death due to suicide within 12 months from the date of commencement of risk under the policy or from the date of revival of the policy, as
applicable, the nominee or beneficiary of the policyholder shall be entitled to 80% of the total premiums paid till the date of death or the surrender value
available as on the date of death whichever is higher, provided the policy is in force.
However if the policy is revived within the 6 months from the date of first unpaid premium, the suicide exclusion shall not be applicable provided the death is
after 1 year from date of commencement of cover

*Total Premiums Paid is total of all the premiums paid, excluding any extra premium, any rider premium and taxes

4. Beneficiary:
Means, the Member; or the nominee; or the legal heir of the Member or the nominee, as the case may be. The Policyholder shall be responsible to identify the
nominee or the eligible legal heirs of the Member in case of death of nominee.
5. Lapse:
Single Premium Cover shall not lapse

This COI is issued for the purpose of information only and mere possession o f this COI shall not entitle any person to the cover unless he/she satisfies all the
relevant terms and conditions (including but not limited to the eligibility criteria for Membership and payment o f premiums) as specified in the Policy
Contract. This COI is the summary of the key terms of the Policy Contract. In the event o f any difference, discrepancy or conflict between the terms o f this COI
and the Policy arises; the terms of the Policy Contract shall prevail. In all events, the Policy Contract shall be the final and superseding document governing
your cover benefit under the Policy Contract.

The standard terms and conditions as mentioned in Annexure 1 are also available on the following URL: www.insurance.kotak.com→→ Download Centre→→
Policy Document Specimen →→ Group Plans →→ Kotak Complete Cover Group Plan

Sincerely,
for Kotak Mahindra Life Insurance Company Ltd.

Authorised Signatory
 Annexure 1
Terms used
Member is a person who is entitled to be a member as defined in the Policy Contract and has been added to the list o f `Members' in accordance with the terms
of the Policy Contract
“Grace Period”: Means the time granted by the Insurer i.e. 30 days from the due date for the payment o f Premium for annual, half-yearly and quarterly mode
and 15 days for monthly mode without levy of any interest or penalty during which time the Policy is considered to be in-force with the risk cover without any
interruption as per the terms of the Policy. Grace Period is not applicable to Single Premium cover. For policies having One Year Renewable Term with annual
mode, Grace Period will not be applicable.
Loan Cover Schedule - is a schedule incorporated in Annexure 2 of this COI giving the details of the cover.
“Accident”: Means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
“Act”: means Insurance Act, 1938, as amended from time to time.
“Benefit Multiplier”: Means the option available with the Member to choose the Insured benefit equal to 100%, 110% or 120% of the Outstanding Loan
Amount for all the Plan Options. This must be chosen at inception by the Member . Benefit Multiplier does not provide any separate cover, it only determines
the amount payable under this Policy with reference to the outstanding loan amount.
“Cover” or “Insured Benefit”: Means the cover available to the Member as per the terms o f this Policy Document and shall be calculated as follows: Insured
Benefit = Outstanding Loan Amount x Benefit Multiplier

“Date of Inception of Risk/Cover”: means the date from which the risk on the life of Member is assumed by the Insurer.
“Lapse”: Means a suspension of insurance cover for a Member for non-payment o f Premiums where Premium is not paid within Grace Period. Such
suspension shall be deemed effective from the date of the first unpaid Premium.
“Moratorium Period”:Means the option available to the Member at inception to choose from a period o f i. 1 to 7 years; or ii. 1 0 years; or iii. 1 2 years, wherein
the Sum Assured shall not reduce and remain level during such period. After the expiry o f Moratorium Period, the benefit will reduce as per the benefit
schedule based on interest rate and frequency chosen at the inception.
“Outstanding Loan Amount”:Means the loan outstanding calculated from the Loan Cover schedule, determined basis the interest rate, loan repayment
frequency, term of the Cover, and Moratorium period chosen at inception and as mentioned in the schedule above.
“ Revival”: Means reinstatement of the lapsed benefits of the Cover in accordance with the provisions of the COI.
“Sum Assured”: Means the outstanding loan amount at the inception of the cover.
1. Difference in Age: The Insurer may vary or decline benefit(s) if it comes to the notice o f the Insurer that the actual age o f the member differs from the age
declared to the Insurer at the time of commencement of cover. In such cases, , without prejudice to the Insurer's other rights and remedies including those
under the Insurance Act, 1938, and any other laws then prevailing, the Insurer will have the right to recover balance premium without interest for the
concerned Member/Life Insured before settling his/her claim. In case o f excess Premium, the Insurer shall refund the same without interest, after deducting
expenses (if any).
2. Loans: No loans are available under this Policy.

3. Discontinuation of Policy: This Policy Contract may be discontinued by the Policyholder or the Insurer for new entrants by giving the other party at least one
month's prior notice in writing.
However in case of single premium payment mode the cover for the existing members will continue even after the discontinuance of the policy. In case of
regular premium payment mode the cover for the existing members will continue only for the period for which the premiums have been paid. Thereafter, the
cover will continue subject to the payment of future premiums as per the premium rate table, for the balance remaining term subject to all the policy terms and
conditions.
4. Cessation of Cover: A member cover ceases on the earliest of the date o n which any one o f the type o f benefits are paid; the date o n which the Member
discontinues payment of regular due premiums; the date on which the premium for that Member ceases; the Member attaining the Maximum Age at maturity
as mentioned in the synopsis provided by the Insurer .
5. Forfeiture: The cover will be forfeited if, (i) lapsed cover is not revived as mentioned in `Revival' clause above; or (ii) any condition herein contained or
endorsed hereon is contravened.
6. Fraud/Misstatement: In case of fraud or misstatement by the Member, the provisions of section 45 of the Insurance Act, 1938 as amended from time to time
will be applicable.

7. Free Look Period: In case the Member is not agreeable to any of the provisions stated in the Policy, then there is an option of returning the COI, stating the
reasons thereof within 15 days from the date of the receipt of the Policy. The cancellation request should be submitted to nearest Branch of the Insurer or
sent directly to the Insurer’s Head Office. On receipt of letter along with the original COI, the Insurer shall refund the Premium paid after deducting the
proportionate risk premium, medical charges (if any) and stamp duty. COI once returned shall not be revived, reinstated or restored at any point of time and a
new proposal will have to be made for a new Policy.
8. Claims: All claims must be notified to the Insurer by the Policyholder/Nominee in writing preferably within 3 months of the date of the death along with the
death certificate and the documents as specified in the Policy Document. The Insurer may condone the delay on merit for delayed claims, where the delay is
genuine and proved to be for reasons beyond the control of the life insured/claimant.
The Insurer is liable for any claim if the premiums in respect of the concerned member is received by the Insurer/Policyholder, subject to the Member proving
that he has paid the Premium and has secured a proper receipt that he was duly insured. The benefits/claim payment will be facilitated through the
Policyholder for onward transfer to the nominee/legal heir or to such other person(s) as directed by a Court of competent jurisdiction in India.
All amounts due under this policy are payable in Indian Currency at the office of the Insurer situated at Mumbai, but the Insurer at its absolute discretion may
fix an alternative place of payment for the claim at any time before or after the claim arises.
The primary documents normally required for processing a death claim are:
1) Death Claim Intimation Form 2) Proof of age of life insured. 3) Original death certificate and related documents based on death, 4) Last attending doctors
certificate and hospital papers (where cause of death is suspicious) 5) Original Certificate of Insurance or other proof of membership 6) Proof of identity of
beneficiaries if claim is payable to beneficiaries, 7) Particulars of Beneficiary(ies), if any, in writing in the Insurer's format signed by the authorised
representative of the Policyholder, 8)If death is due to accident or any other unnatural cause - Certified copy of the FIR filed with the police authorities, A
certified copy of the post mortem/autopsy report, A certified copy of the driving license if death occurred while driving
Additional requirements may be called for by the Insurer depending on the circumstances of the death of the Member on a case-to-case evaluation. The
claimant can lodge claim at following address of the Policyholder
KOTAK MAHINDRA BANK LIMITED 4th floor Building No 21 Infinity Park Off Western Express Highway General A.V.K Maharashtra Executive Vice President
400097
 or at the following address of the Insurer and comply with further documentation requirements as mentioned in the Policy Contract.
The Claims Manager - Group Claims, Kotak Mahindra Life Insurance Company Ltd., (IRDAI Regn. No: 107)7th Floor, Building No.21, Infinity Park, Off Western
Express Highway, General A.K. Vaidya Marg, Malad (E), Mumbai - 400097

8. Query/ Complaint Resolution: For any clarifications on policy terms, conditions & exclusions or claims, the member may contact either the Policyholder at the
address mentioned above or the Insurer at the address mentioned below. The Complaints, if any, should be addressed to the Insurer at the address mentioned
below.
“Group Operations, Kotak Mahindra Life Insurance Company Ltd.,7th Floor Zone IV, Building No.21, Infinity Park, Off Western Express Highway, General A.K.
Vaidya Marg, Malad (E), Mumbai - 400097”. Telephone:1800-120-7856 (Monday-Friday (excluding public holidays) between 10.00 a.m. to 6.00 p.m). Email:
kli.groupoperations@kotak.com.
If you are not satisfied with the decision of the above office, or have not received any response within 10 days, you may contact the Chief Grievance Officer, at
the aforesaid address or on the Toll Free No.: 1800 209 8800; or Email ID: kli.grievance@kotak.com
If you are not satisfied with the response or do not receive a response from the aforementioned official, within 15 days, you may approach the Grievance Cell
of the Insurance Regulatory and Development Authority (IRDA) on the following contact details:
IRDA Grievance Call Centre (IGCC) TOLL FREE NO:1800 4254 732
Email ID: complaints@irda.gov.in
You can also register your complaint online at http://www.igms.irda.gov.in/ Address for complaints to Consumer Affairs Department, of IRDAI: Sy.No.115/1,
Financial District, Nanakramguda, Gachibowli, Hyderabad-500032.

If you have a grievance, approach the grievance cell of Insurance Company first.
If complaint is not resolved/ not satisfied/not responded for 30 days then you can approach The Office of the Insurance Ombudsman(Bimalokpal) as per
Insurance Ombudsman Rules, 2017, notification no. GSR 413(E) [F.NO.14019/22/2010-INS.II], dated 25-4-2017. The details are available at www.ecoi.co.in
www.gbic.co.in

Note: The Policy is subject to prevailing Indian Laws.

In the event of any difference or discrepancy between this COI and the details provided in the “list of proposed lives to be insured” by the Policyholder to the
Insurer, the details provided in the “list of proposed lives to be insured” by the policyholder shall prevail for payment of benefits under this COI, subject to the
terms and conditions of the policy contract.
Please note that this arrangement can be modified, suspended or withdrawn at any time by Kotak Mahindra Life Insurance Company Ltd and /or the
Policyholder without prior intimation.
The COI is the simplified version of important terms and conditions applicable to the Policy contract, which are compiled for the information and benefit of
the member. Member shall be liable for the compliance of additional terms and conditions in the master policy contract, if any.
For details on all terms and conditions of the said policy contract the Member should contact the Policyholder for reference to the Policy contract. The Policy
is subject to the tax laws and other legislation prevailing in India, including the amendments thereto from time to time.
Registered Office: Kotak Mahindra Life Insurance Company Ltd, CIN: U66030MH2000PLC128503, Regd. Office: 2nd Floor, Plot #C-12, G- Block, BKC, Bandra
(E), Mumbai- 400 051, Website: http://insurance.kotak.com
http://insurance.kotak.com , Email: clientservicedesk@kotak.com
clientservicedesk@kotak.com , Toll Free No.: 18002098800, Email:
clientservicedesk@kotak.com
clientservicedesk@kotak.com, Website: http://insurance.kotak.com

Annexure 2

Outstanding Loan Amount shall be calculated as per the following Loan Cover schedule
 Life Cover Schedule

Certificate No: CD000247_SPLN65989238_208260016 Member Joint Life Assured

Policy No.:CD000247

Name : SIVAJI KOTIPALLI NA

Age: 33 Yrs NA

Cover Schedule @: 21% NA

Sum Assured: 1300000 NA

Premium Amount Rs: 12584 NA

DOC: 23-FEB-22 NA

Flat Term: NA NA

Repayment Tenure 60 (Months) NA

S. No. From date To Date Cover (in Rupees) S. No. From date To Date Cover (in Rupees)
1 23-FEB-22 22-MAR-22 1300000 61 23-FEB-27 22-MAR-27 0
2 23-MAR-22 22-APR-22 1286939
3 23-APR-22 22-MAY-22 1273669
4 23-MAY-22 22-JUN-22 1260187
5 23-JUN-22 22-JUL-22 1246489
6 23-JUL-22 22-AUG-22 1232571
7 23-AUG-22 22-SEP-22 1218431
8 23-SEP-22 22-OCT-22 1204064
9 23-OCT-22 22-NOV-22 1189467
10 23-NOV-22 22-DEC-22 1174637
11 23-DEC-22 22-JAN-23 1159569
12 23-JAN-23 22-FEB-23 1144259
13 23-FEB-23 22-MAR-23 1128705
14 23-MAR-23 22-APR-23 1112902
15 23-APR-23 22-MAY-23 1096845
16 23-MAY-23 22-JUN-23 1080531
17 23-JUN-23 22-JUL-23 1063957
18 23-JUL-23 22-AUG-23 1047116
19 23-AUG-23 22-SEP-23 1030007
20 23-SEP-23 22-OCT-23 1012623
21 23-OCT-23 22-NOV-23 994961
22 23-NOV-23 22-DEC-23 977016
23 23-DEC-23 22-JAN-24 958783
24 23-JAN-24 22-FEB-24 940259
25 23-FEB-24 22-MAR-24 921438
26 23-MAR-24 22-APR-24 902316
27 23-APR-24 22-MAY-24 882888
28 23-MAY-24 22-JUN-24 863148
29 23-JUN-24 22-JUL-24 843093
30 23-JUL-24 22-AUG-24 822716
31 23-AUG-24 22-SEP-24 802013
32 23-SEP-24 22-OCT-24 780979
33 23-OCT-24 22-NOV-24 759607
34 23-NOV-24 22-DEC-24 737894
35 23-DEC-24 22-JAN-25 715833
36 23-JAN-25 22-FEB-25 693419
37 23-FEB-25 22-MAR-25 670645
38 23-MAR-25 22-APR-25 647507
39 23-APR-25 22-MAY-25 623999
40 23-MAY-25 22-JUN-25 600114
41 23-JUN-25 22-JUL-25 575847
42 23-JUL-25 22-AUG-25 551191
43 23-AUG-25 22-SEP-25 526141
44 23-SEP-25 22-OCT-25 500689
45 23-OCT-25 22-NOV-25 474830
46 23-NOV-25 22-DEC-25 448557
47 23-DEC-25 22-JAN-26 421863
48 23-JAN-26 22-FEB-26 394742
49 23-FEB-26 22-MAR-26 367186
50 23-MAR-26 22-APR-26 339189
51 23-APR-26 22-MAY-26 310744
52 23-MAY-26 22-JUN-26 281843
53 23-JUN-26 22-JUL-26 252480
54 23-JUL-26 22-AUG-26 222647
55 23-AUG-26 22-SEP-26 192335
56 23-SEP-26 22-OCT-26 161539
57 23-OCT-26 22-NOV-26 130249
58 23-NOV-26 22-DEC-26 98459
59 23-DEC-26 22-JAN-27 66159
60 23-JAN-27 22-FEB-27 33342