Generated On : 21-Dec-2023 MR, DURYADHAN BEHERA, (COIS SAMBALPUR UNIVERSITY CAMPUS AVOTEVINAR BWURLA SAMBALPUR, SAMBALPUR, 768019 opistta Dear MR, DURYADHAN BEHERA, 2NY.GPIS480 ompeneat UIN’ (BI Lae -eShield Next Level Cover other than Whole [11 INIS2VOT Me RD [cceleraved Terminal Mess Benetit Rider TNIa2v0r ceidenil Death Benefit Rider T11BOISvO3 ‘CIF Code : 990139207 CIF Name ONKAR TRIPATHY Greetings from SBI Life Insurance Company ‘At the outset, we thank you forthe confidence placed in SBE Life. Your proposal forthe product mentioned above thas been received by us ‘We request you to comply with the following requirements to help us process your proposal further Apart from the Medical tes(s) conducted by a TPA (any), the requirements can be submitted on ints fepalicysbilifecoin/ Transaction story aspx or by a mail on online cell@sbiif [Link] + Plan Detaits PLAN DETAILSiKindly confirm Kindly confirm the plan details applied for Plan Option: Pian cpt Lane l COPE 1 [ike tem 30 sr¥POS® remiom AA2D iderOpionCover None: Aecléundah duets benef ™A%n AS 5050 62 _ eremiim 383° Rider/Option/Cover Name Term _ SA: Premiam RiderOption/Cover Name Term: __ SA: Prema Term: __ SA: Prema ‘Rider(OptionCover Name; Term: ‘Modal Preinium Payable (A) 1) (B;_ ‘Top-Up Premium / Additional Contribution: (if app sor tfe nsrance Company Limited ginal Underarting Unt-Dhubaneswar2nd Foor, stock Exchange Bhawan, #2 Jayadey hare RCM, "Concge chanrasetharporhubanesnar 361023 Phone: 67 42749089, website worst, coim DA Reg. No-148 CIN: .99999hRO0OPLCI2S113 Internat nega. oftce:"Natra}s it. Ve ond Western Express Mghway Junction, Andes (Eat), Mumbsl- 400 069pate @SBILife Total Instalment Premium (A+B) _remium pavable (wherever applica 1s IIE oF Service Tax. The sevice toe aplieable is sujet v0 Taree tothe above mentioned fa han, Signature or oes Date: fiz [2023 ‘Thumb impression to be attested by English Rnowing person: Plan option for the caver nd they form part of my insurance contrac. Kindly provide the plan option ofthe cover opted by you duly countersigned by you. Kindly confirm {agree to the above mentioned facts and they form part of my insurance contract. signee edhan bebe oy Date 24/13 J 42 ‘Thumb impression to be attested by English knowing person, = Term ofthe Plan Kindly specify the term of the plan opted by you duly signed by you. Kindly confirm Tan/Rider/Option Benift(Refer Respective Policy Term oduct Sales Brochure for riders/options re) accelerated Terminal liness Benefit Rider 0 = fil life - shield Next Level Cover other than’ 0 & fecidental Death Benefit Rider S 1 agree tothe above mentioned facts and they form part of my insurance contrac Signa Das, Be Pete “Thumb impression to be tested by Engliah owing pero * Consent to reduce Policy Term Kindly give us your consent for following ehanges in your life insurance contract duly signed and dated by you Consent to reduce policy term toe - consent for LPPT of 15 Yrs. smateeimboae® Behar pye al firfoor a ‘Thumb impression to be atested by English knowing person, ‘BI Lie tnsurance Company Liited Regional Underaitng Unit Shubsneswar 2nd Foor, ‘[Link] Bhubaneswar-751023. Phor ‘web site: www sbilifecon ROA Regn No.411 CIN: L99999NAH2000PLC129113 Internal Regd. Office: "Mata, bh.V- Road” Western Express Highway Junction, Andheri East), Mumbal- 400063.@ SBI Life Please note that your proposal is pending for the above requirements and risk cover is not granted on your lie. Iwill be in Your own interests to comply: swith the above requirements a the earliest. me Peace note that = The issuance of the poy willbe subj o your conFing some othe important infrmaton given in the propose form telephonically through our welcome call process, wherever applicable. " =a information rove by You psn tte above woul bs deme oe a of our roo Life Isrance * Our obligation to cover the risk begins only afer you comply with all the requirements and the contact is completed Uhrouh poly issuance after submission of the requirements, “Tae ie he ropes Haase he TE aby you is ep proporl dest an wl ter ay interes and will not cover any’ isk, Track your proposal view your proposal status oF upload tequitement dreetly through below link hups://smartcare [Link] \We value your feedback and suggestion to improve our services, so fel fice to write to us inthe address given Below \We thank you forthe confidence placed in SBI Life Insurance Company Limited ‘SBI Life Insurance Company Limited “This is computer generated document and signature fs not required, Otky then policy teem — 20 Years Poneman Rangoon dacm- 15 Years E Slaald Not Lewel Comer pt nidey — AS yours Accdael destin qejrent Aven — 1S yore Prenton naw ade vate Ren s yeaurane company ted tga! unerrting Un shone 2a lar stad ngs IGN ‘ste surance Company Le areathepurhubaneswa-7S1023. Phone; 47 4272053 . Fie ene OA Reg Woh CN: 999960 200PLC12113 Internal er. ee rn sum xpress hy incon, ae fas) Mamba 2006, Dusyadhan Behera