Jethi Tushar

Work History

Apprentice in Operation

Anchor Consumer Products Pvt Ltd

12.2023 - 12.2024

B
Relationship with the life to be assured c
Date / year of death
Please refer to annexure “Family History” Family history Your bank account type 2
Account Number IFS Code 4
Bank Name Bank Address Bank details of the life to be insured
Please refer to annexure “Female Life” Female Life (if applicable) Family Medical history
If yes, please refer to annexure “Settlement Option(Maturity) and Death Benefit Option” Settlement Options (as per plan conditions) Do you wish to avail “Option to take Maturity Benefit in Instalments Do you wish to avail “Option to take Death Benefit in Instalments
To be answered only if proposing for “LIC’s Premium Waiver Benefit Rider ” in case of insurance on Minor Life
Premium Waiver Benefit under this rider shall be equal to waiver of premiums payable under the Base Policy falling due on and after the date of death of Proposer till the expiry of rider term
However, premiums in respect of any riders, if opted for, other than this rider under the base policy shall not be waived and continue to be paid as per respective rider conditions
Further if premium paying term of the base policy exceeds the rider term all the premiums due under the base policy from the date of expiry of “LIC’s Premium Waiver Benefit Ridezr” shall be payable by the Life Assured as per the terms and conditions of the Base policy
Do you agree with the above
Note: Proposal shall be considered for LIC’s Premium Waiver Benefit Rider only , if your answer to the above question is “Yes” Premium Waiver Benefit
Yes No
Yes
Yes
No
No
NoYes
Savings Current
Yes
Yes
No
No
Yes No65
BKID0003816, Proposal Form For Aadhaar Stambh / Aadhaar Shila Plans
To be answered only if proposing under “LIC’s Aadhaar Stambh “ or “ LICs Aadhaar Shila”
A
Total existing (excluding the proposal under consideration) sum assured under LIC’s Aadhaar Shila/ LIC’s Aadhaar Stambh : b
Is your life being proposed simultaneously under the same plan?
If “Yes”, give details :
Note: The total Sum Assured under LIC’s Aadhaar Stambh or LIC’s Aadhaar Shila on an individual should not exceed Rs
5 lakhs
For New Jeevan Amar & Plans where applicable as per plan specifications
To be answered only if applicable as per Plan specifications and for New Jeevan Amar a
Under which category do you wish to apply?
Note: Non- smoker rates will be offered only on the basis of findings of Urine Cotinine Test
B
Question regarding Death Benefit:
Please select one of the options for Sum Assured on Death (by ticking (a) in the appropriate box) depending upon your specific needs:
Option I: Level Sum Assured “Level Sum Assured”, where Sum Assured on Death shall be an amount equal to Basic Sum Assured and shall remain constant throughout policy term
Option II: Increasing Sum Assured “Increasing Sum Assured", where Sum Assured on Death shall remain equal to Basic Sum Assured till completion of fifth policy year
Thereafter, it increases by 10% of Basic Sum Assured each year from the sixth policy year till fifteenth policy year till it becomes twice the Basic Sum Assured
This increase will continue under an inforce policy till the end of policy term; or till the Date of Death; or till the fifteenth policy year, whichever is earlier
From sixteenth policy year and onwards, the Sum Assured on Death remains constant i.e
Twice the Basic Sum Assured till the policy term ends
Page 5 of 9
Are you registered with LIC Portal:
If yes, give Customer ID
If not, Please visit our site www.licindia.in and register yourself with LIC Portal after completion of this proposal to avail the benefit of e services
Consent a) Have you understood fully the terms & conditions of the plan you propose to take? b) Whether the terms & conditions of the proposed plan and any other information that you needed for matching your objectives of insurance have been explained to you by the agent? For LIC's Dhan Varsha (Plan 866)
To be answered only for Dhan Varsha
The options should be chosen carefully depending on the individual’s specific needs as the premium & benefits under the plan shall vary as per the option chosen and the same shall not be altered later
Option 1: 1.25 times of Tabular Premium for the chosen Basic Sum Assured
Option 2: 10 times of Tabular Premium for the chosen Basic Sum Assured
Refer Sales Brochure for detailed benefits available under the respective option
I understand that once Option is chosen the same shall not be altered and shall become part of the Policy Document
For Jeevan Azad Plans
To be answered only if proposing under “LIC’s Jeevan Azad”
A
Total existing (excluding the proposal under consideration) sum assured under LIC’s Jeevan Azad : b
Is your life being proposed simultaneously under the same plan?
If “Yes”, give details :
Note: The total Basic Sum Assured under all policies issued to an individual under LIC’s Jeevan Azad (including Basic Sum Assured under this proposal) should not exceed Rs
5 lakhs
Any proposal even if inadvertently submitted shall be deemed null and void
Smoker Non-Smoker
Yes No
Yes No
Yes No
Yes No
Yes No, Proposal Form For Dhan Sanchay Plan
To be answered only if proposing under LIC’s Dhan Sanchay (Plan 865)
The benefits payable under the plan shall depend on the Benefit Option chosen, Policy Term, Premium Paying Term, and Payout Mode
The Benefit
Option should be chosen carefully depending upon your specific needs
Benefit Option: Please select one of the Benefit Options
Based on the Premium Payment Type opted (by ticking (
In the appropriate box):
Premium Payment Type :
Regular / Limited Premium
Single Premium
Benefit Option :
Option A: Level Income Benefit
Option B: Increasing Income Benefit
Option C: Single Premium Level Income Benefit
Option D: Single Premium enhanced cover with Level Income Benefit
Amount of Premium:
Refer Sales Brochure for detailed benefits available in the respective Benefit Option
Tick the appropriate Payout Mode for the payment of Guaranteed Income Benefit:
Yearly Half-Yearly Quarterly Monthly
I understand that once Benefit Option, Policy Term and Premium Paying Term is chosen the same shall not be altered and shall become a part of the Policy contract
For Dhan Vriddhi Plan
Page 6 of 9 For LIC’s Jeevan Kiran (Plan 870)
To be answered only if proposing under LIC’s Jeevan Kiran (Plan 870)
Under which category do you wish to apply
(Tick one of the following):
Smoker
Non-Smoker
Note: Non- smoker rates will be offered only on the basis of findings of Urine Cotinine Test
To be answered only if proposing under LIC’s Dhan Vriddhi (Plan 869)
The options should be chosen carefully depending on the individual’s specific needs as the premium & benefits under the plan shall vary as per the option chosen and the same shall not be altered later
Please select one of the Options for “Sum Assured on Death” (by ticking () in the appropriate box):
Option 1: 1.25 times of Tabular Premium for the chosen Basic Sum Assured
Option 2: 10 times of Tabular Premium for the chosen Basic Sum Assured
Refer Sales Brochure for detailed benefits available under the respective option
I understand that once Option is chosen the same shall not be altered and shall become part of the Policy Document

LIC

03.2001 - 01.2024

Plan 871)
Annexure-12(d)
Addendum to Proposal Form for Plan Specific Details
To be compulsorily filled up if proposing under LIC’s Jeevan Utsav (Plan 871)
The options should be chosen carefully depending on the individual’s specific needs as the benefits under the plan shall vary as per the option chosen:
Please select one of the following Options (by ticking in the appropriate box):
Option Tick the appropriate box
Option I: Regular Income Benefit
Option II: Flexi Income Benefit
Refer Sales Brochure for detailed benefits available under the respective option
I understand that once Option is chosen shall become part of the Policy Document
Signature/Thumb Impression of Proposer/Life to be assured
Note: The policyholder can change the option exercised by him at the inception of the policy at any time upto six months before the beginning of the policy year in which the first Regular Income
Benefit or Flexi Income Benefit becomes due.

01.2003 - 01.2019

0 000
No
No Income Proof submitted Yes CPRPT4841N Nil
N.A
N.A
N.A.0 0
Up to 35yrs 25 times 2100000
Risk Coverage with savings Regular
Conservative to Moderate 21
Conservative to Moderate Conservative to Moderate JEEVAN LABHLIC's Jeevan Labh 250000 Quarterly 3481
N.A
N.A
N.A
N.A
N.A
N.A
N.A
N.A
0 N.A
Yes
Mr
Jethi TusharLIC's Jeevan Labh 250000 Quarterly 3481, 59
Benefit Illustration
LIC's Jeevan Labh, )
A Non-Linked, Participating, Individual, Life Assurance Savings Plan (Unique Identification Number - 512N304V02)
How to read and understand this benefit illustration?
This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a
And 4% p.a
Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business
If your policy offers guaranteed benefits then these will be clearly marked 'guaranteed' in the illustration table on this page
If your policy offers variable benefits then the illustrations on this page will show two different rates of assumed future investment returns, of 8% p.a
And 4% p.a
These assumed rates of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependent on a number of factors including future investment performance
LIC's Jeevan Labh (Plan No
936)
Distribution channel Offline Agency name Agency code
Name of prospect/policyholder
Age of prospect/policyholderyears Date of illustration 01-03-2024
Name of life assured Age of life assured 18 years Benefit UID/Proposal no
ON711974478524
Policy term 21 years Premium payment term 15 years
Mode of payment of premium
Quarterly
Basic sum assured Rs
2,50,000
Sum assured on death (at inception of the policy) Rs.50,000 Instalment premium (for base plan) 3,403.00
Bonus type Simple reversionary and final additional bonus
Premium summary
Particular Base plan Riders1 Total instalment premium
Instalment premium without GST 3,403.00 3,481.00
Instalment premium with GST @ 4.50% (1st year) 3,556.00 3,638.00
Instalment premium with GST @ 2.25% (2nd year onwards) 3,479.57 3,559.32
GST rate shall be as applicable from time to time
Page 1
LIC's Jeevan Labh (Plan No
936) (Amount in rupees)
Policy year
Annualized premium2 (cumulative)
Guaranteed benefits
Non-guaranteed benefits @ 4% p.a
Non-guaranteed benefits @ 8% p.a
Total benefits (including guaranteed and non-guaranteed benefits)
Maturity benefit Death benefit3
Surrender benefit4
Surrender benefit
Death benefit
Maturity benefit
Reversionar y bonus
Surrender benefit
Reversionar y bonus
Surrender benefit
Maturity benefit, incl
Of final additional bonus (FAB), if any, @ 4% (5+6+FAB)
Maturity benefit, incl
Of final additional bonus (FAB), if any, @ 8% (5+8+FAB)
Death benefit, incl
Of final additional bonus (FAB), if any, @ 4% (4+6+FAB)
Death benefit, incl
Of final additional bonus (FAB), if any, @ 8% (4+8+FAB)
Surrender benefit @ (3+7)
Surrender benefit @ (3+9) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)13340 0 250000 0 1000 0 7500 0 0 0 251000 257500 0 026680 8004 250000 0 2000 0 15000 0 0 0 252000

01.2007 - 01.2003

- 01.2001

(1) No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the 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
(2) 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 the materials on which such decision is based
Explanation I - For the purpose of this sub section, the expression “fraud” means any of the following acts committed by the insured or by his agent, with the intent to deceive the insurer or to induce the insurer to issue a life insurance policy : (a) The suggestion, as a fact of that which is not true and which the insured does not believe to be true; (b) The active concealment of a fact by the insured having knowledge or belief of the fact ; (c) Any other act fitted to deceive ; and (d) Any such act or omission as the law specially declares to be fraudulent
Explanation II – Mere silence as to facts likely to affect the assessment of the risk by the insurer is not fraud, unless the circumstances of the case are such that regard being had to them, it is the duty of the insured or his agent, keeping silence to speak, or unless his silence is, in itself, equivalent to speak
(3) Notwithstanding anything contained in sub-section (2), no insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the mis-statement of or suppression of a material fact was true to the best of his knowledge and belief or that there was no deliberate intension to suppress the fact or that such mis

Overview

Work History

Apprentice in Operation

Education

A.O.C.P GCVT -

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Skills

Incomedetails

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Medicalhistory

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Disclaimer

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