Proposal Form

Plan Details

Plan Name Plan No

LIC's Nivesh Plus 749

UIN
512L317V02
Agency Code Supervisor Code Branch Code
2403394B 95781 94B

Access Id Email Id Mobile No.

2553325651 santoshkaki11@[Link] 9423331589
* Date of Proposal - Pertains to date when customer verified the proposal. Proposal number is
allotted only after receipt of the full proposal-deposit amount by LIC

Details of plan proposed

Term & PPT Sum Assured Installment Premium GST

25 - 1 ₹ 1,56,250 ₹ 1,25,000 ₹ 0
Total Amount Mode of Payment Date of
Commencement **
₹ 1,25,000 Single
31-12-2025
AB/ADDB Req
NOT required
Sum Assured Option Fund Option
1.25 times of Growth Fund
the Single
Premium
Applicable to Police Personnel if LIC’s Accident Benefit Rider / LIC’s Accidental Death And Disability
Benefit Rider is opted for :
(i). Whether you are engaged in police duty in any police organization other than Yes No
paramilitary force?
If “Yes”, (ii). Whether you wish to avail the AB/AD& DB rider while on police duty? Yes No

** Date of Commencement - This date is tentative Date of Commencement , subject to change

based on date of payment and underwriting.
 BROAD INVESTMENT PATTERN OF THE INVESTIBLE FUNDS

Fund Investment Short-term Investment Objective Risk SFIN

Type in investments in Listed Profile
Government/ such as Equity
Government money Shares
Guaranteed market
Securities/ instruments
Corporate
Debt
Bond Not less than Not more NIL To provide Low ULIF00124/12/18LICULIPBND512
Fund 60% than 40% relatively risk
safe and less
volatile
investment
option
mainly
through
accumulation
of income
through
investment
in fixed
income
securities.
Secured Not less than Not more Not less To provide Lower ULIF00224/12/18LICULIPSEC512
Fund 45% and Not than 40% than 15% & steady to
more than Not more income Medium
85% than 55% through risk
investment
in both
equities and
fixed income
securities.
Balanced Not less than Not more Not less To provide Medium ULIF00324/12/18LICULIPBAL512
Fund 30% and Not than 40% than 30% & balanced risk
more than Not more income and
70% than 70% growth
through
similar
proportion
investment
in both
equities and
fixed income
securities

Growth Not less than Not less To provide High

Not more ULIF00424/12/18LICULIPGRW512
Fund 20% and Not than 40% & long term risk
than 40%
more than Not more capital
60% than 80% growth
through
investment
primarily in
equities.

Personal details of the life to be insured

Name
Santosh Sidram Kaki
Father's Name Mother's Name
SIDRAM VIJAYALAXMI
Gender
Male Female Third Gender

Martial Status Date of birth

Married 11-07-1985
Age (in years) Residential Status
40 Years Resident Indian
Is the Tax Residency outside India? Yes No

Communication details of the life to be insured

Present Address for communication

Address Line 1 Address Line 2
plot no.52 shriram nagar behind laxminarayan cinema hall
Address Line 3 City District
solapur solapur solapur
State Country Pin Code
maharashtra india 413006
Permanent Residential Address
Address Line 1 Address Line 2
, F-11, muncipal colony ravivar peth, , solapur, infront of maruti temple,
Address Line 3 City District
Solapur North, Solapur, Maharashtra solapur Solapur
State Country Pin Code
Maharashtra India 413005

KYC Particulars

Are you an It Assessee Yes No

PAN Proof of Identity Address Proof

AVAPK3270H ekyc ekyc

Are you (Proposer) registered under the GST act ? Yes No

Occupation Details

Present Occupation Exact Nature of duties Name of the present

employer
Self-employed Business RELIABLE
without Income SOLUTION
Tax
Annual income source of income Education Purpose of insurance
Qualification
₹ 3,00,000 Self Employed Post Graduate or Market linked
Graduate Return with Risk
cover
 Other Personal Details of Life to be Assured

Is your occupation associated with any specific hazard or do you take part in hazardous Yes No
activities or have hobbies that could be dangerous in any way?
Are you Politically Exposed Person ( PEP as per RBI Guidelines PEPs are the individuals Yes No
who are or have been entrusted with prominent public functions in a foreign country. )
Have you ever been or are currently being investigated, charge sheeted, prosecuted or Yes No
convicted or having pending charges in respect of any criminal/civil offences in any court
of law in India or abroad ?

Lifestyle Details of the Life to be Insured

Do you smoke / Yes/No If YES, Quantity If STOPPED, Since

consume or have you consumed and how may months
ever smoked / Duration
consumed the
following

Alcoholic drinks Yes No

Narcotics Yes No

Any other drugs Yes No

Do you smoke/consume Yes No

or have you
smoked/consumed
tobacco in any form (
cigars, cigarettes,
beedis, pan masala etc)
in the past 60 months.
(in sticks /packets/
sachets/gms per day)

Details of previous policies held / proposals applied of the life to be

insured

a) Is the life to be assured now being proposed for another assurance or an application Yes No
for revival of a policy or any other proposal under consideration in any office of the
Corporation or to any other Insurer? If yes, give Proposal no. / Policy no. and Branch Code
b) Whether proposed simultaneously on the life of spouse/ children/ parents ? If yes, give Yes No
Proposal no. and Branch Code
Has a proposal ( or an application for revival of a policy) on your life made to any office of the
Corporation or to any other Insurer ever been Accepted with extra or modified terms, Withdrawn,
Deferred, Dropped or Declined?, if yes give proposal number& branch / policy number / Name of
Insurer Yes No

Have you / Life to be assured during the past one year returned any policy of the Corporation as
the same was not acceptable ?, if yes give give policy number. Yes No

I hereby declare that I do not have any existing policies in-force or lapsed policies with LIC.

I hereby declare that I do not have any existing policies in force or lapsed policies with other Insurers.
 Medical details of the life to be insured

Are you suffering from or have you ever suffered or undergone investigation in the past or have
you been advised to undergo investigation or treatment for the following ailments
1. Lungs/ Respiratory Disease / Persistent cough, asthma, bronchitis, pneumonia, Yes No
Tuberculosis/, pleurisy / spitting of blood/Covid 19etc
2. Peptic ulcer/colitis, jaundice,Hepatitis, anaemia, piles, dysentery, or any other disease Yes No
of the stomach, liver, spleen, gall bladder or pancreas/ digestive disorder
[Link], Hypotension, rheumatic fever, pain in chest, breathlessness, palpitation, Yes No
any disease of the heart or arteries?
4. Endocrine disorders such as Diabetes, Goitre, Thyroid etc or have you ever passed Yes No
sugar, albumin, pus or blood in urine
5. Any disease of kidney /prostate or urinary system? Yes No

6. Bone / Joint/ Spine Disease/ Arthritis / varicose veins /any bodily defect or deformity Yes No

7. Any disease of ear, nose, throat or eyes, including defective sight or hearing and Yes No
discharge from the ears
8. Cancer/leukemia/lymphoma/ tumour / cyst/ Any other growth / lumps/ blood disorder Yes No
/enlarged glands
[Link]/epilepsy/ insanity/ tremors, numbness, double vision, dizzy or fainting spells/ Yes No
head Injury / insomnia/ nervous breakdown / Mental Disorder (Depression/ Anxiety, etc.).
/ any other disease of the brain or the nervous system
10. Chronic infections- Skin Disease/ skin eruption/ Leprosy / ,filariasis, gonorrhoea, Yes No
syphilis or any other venereal disease or AIDS&HIV related condition
11. Hernia/hydrocele, varicocele, fistula Yes No

12. Any other disease ? Yes No

Medical History of the life to be insured

Please state exact height and weight ( without shoes)

Height (in cms) Weight (in Kgs)
167 74
During the last five years did you consult a Medical Practitioner for any Yes No
ailment requiring treatment for more than a week ?
Have you ever been admitted to any hospital or nursing home for general Yes No
check up, observation, treatment or operation?
Have you remained absent from place of work on grounds of health during the Yes No
last 5 years ?

Family History

(Please mention specifically if suffering from or died of heart disease, stroke, high blood pressure,
diabetes mellitus, cancer, kidney disease or any hereditary disorders, Insanity, or any contagious
diseases such as tuberculosis ,hepatitis, AIDS / HIV etc)

Relationship Living/Dead Present age State of Age of Death Cause of

Health Death

Father Living 67 Good NA NA

 Mother Living 62 Good NA NA

Spouse Living 35 Good NA NA

Daughter Living 14 Good NA NA

Son Living 8 Good NA NA

Brother Living 42 Good NA NA

Sister Living 45 Good NA NA

Bank details of the life to be insured

Your bank account type Savings Current

Account Number IFSC Code Bank Name

070510110002481 BKID0000709 BANK OF INDIA

Bank Address
SOLAPUR RETAIL HUB

Settlement Option of Life to be Insured

Do you Wish to avail Option for Death Benefit in installments Yes No

Nomination Details

Particulars of Nomination

SI No. name of Age Relationship Address of Nominee

the to the life Share(%)
Nominee assured
1 ARCHANA 35 Wife , F-11, muncipal colony 100
ravivar peth, ,,solapur,
infront of maruti
temple,,solapur,solapur,
413005

Mobile Email Bank Name Account No

Number IFSC
Code
 Summary of Section 45 of Insurance Laws (Amendment) Act 2015

(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.
(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
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​statement of or suppression of a material fact are within the knowledge of the insurer: Provided that in case
of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive.
Explanation:
A person who solicits and negotiates a contract of insurance shall be deemed for the purpose of the formation
of the contract, to be agent of the insurer.
(4) 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 sommencement 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 that any statement of or suppression of a fact material to the
expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of
which the policy was issued or revived or rider issued:
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 materials on which such decision to repudiate the policy
of life insurance is based:
Provided further that in case of repudiation of the policy on the ground of misstatement or suppression of a
material fact, and not on ground of fraud, the premiums collected on the policy till the date of repudiation shall
be paid to the insured or the legal representatives or nominees or assignees of the insured within a period of
ninety days from the date of such repudiation.
Explanation:
For the purposes of this sub-section, the mis-statement of or suppression of fact shall not be considered
material unless it has a direct bearing on the risk undertaken by the insurer, the onus is on the insurer to show
that had the insurer been aware of the said fact no life insurance policy would have been issued to the insured.
(5) Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to
do so, and no policy shall be deemed to be called in question merely because the terms of the policy are
adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.

Summary of Section 41 of Insurance Laws (Amendment) Act 2015

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out
or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate
of the whole or part of the commission payable or any other rebate of the premium shown on the policy, nor
shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be
allowed in accordance with the published prospectuses or tables of the insurer.
Signature of the life to be
Assured

Declaration of the life to be insured

I Santosh Sidram Kaki the person whose life is herein being proposed to be assured, do hereby declare that
the foregoing statements and answers have been given by me after fully understanding the questions and the
same are true and complete in every particular and that I have not withheld any information and I do hereby
agree and declare that these statements and this declaration shall be the basis of the contract of assurance
between me and the Life Insurance Corporation of India . And I further agree that if after the date of submission
of the proposal but before the issue of First Premium Receipt (i) any change in my occupation or any adverse
circumstances connected with my financial position or the general health of myself or that of any members of
my family occurs or (ii) if a proposal for assurance or an application for revival of a policy on my life made to
any office of the Corporation is withdrawn or dropped, deferred or accepted at an increased premium or subject
to a lien or on terms other than as proposed, I shall forthwith intimate the same to the Corporation in writing to
reconsider the terms of acceptance of assurance. Any omission on my part to do so shall render this contract to
be dealt with as per provisions of Section 45 of the Insurance Act, 1938, and that if any untrue averment be
contained therein the said contract shall be dealt with as per provisions of Section 45 of the Insurance Act,1938
as amended from time to time. Not-withstanding the provision of any law, usage, custom or convention for the
time being in force prohibiting any doctor, hospital, diagnostic center and/or employer, reinsurer/ credit bureau
from divulging any knowledge or information about me concerning my health or employment , occupation,
insurance , financials [Link] the grounds of privacy, I , my heirs, executors, administrators and assignees or any
other person or persons, having interest of any kind whatsoever in the policy contract issued to me, hereby
agree that such authority , having such knowledge or information, shall at any time be at liberty to divulge any
such knowledge or information to the Corporation and the Corporation to divulge the same to any Authorised
Organisation / Institution / Agency / and Governmental / Regulatory Authority for the sole purpose of
underwriting / investigation / risk mitigation / fraud control and/or claim settlement. I am aware that if the
information on my Tax Residency is found to be false or untrue or misleading or misrepresenting, I may be held
liable for it. I also undertake to inform the Corporation of any change in my Tax Residency status. I undertake to
inform the Corporation immediately of any changes in KYC documents such as residence. I also give my
consent to obtain and share my data from / with Central KYC Registry respectively and to receive phone calls ,
SMS/ E mail from Central KYC registry in this regard. I understand that the Corporation reserves the right to
accept /Postpone/ drop/ decline or offer alternate terms on this proposal for life insurance . I hereby give my
consent to receive phone calls, SMS/whatsapp messages, E mail on the below mentioned registered number(s)/
E mail address from / on behalf of the Corporation with respect to my life insurance policy/regarding servicing of
insurance policies/ notifying about the status of Claim I understand that if I have deposited “application money”
as a token consideration under this proposal for insurance, the closing NAV of the date of completion only will
be applied for allotment of units. I also understand that the premiums, charges and benefits under the policy
are subject to taxes / duties/ charges in accordance with the laws as applicable from time to time.
Signature of the Life
to be insured

Name Address Pin Code

Santosh Sidram plot no.52 shriram nagar behind 413006
Kaki laxminarayan cinema hall solapur
maharashtra

Suitability Analysis
Proposer Full Name Date of Birth
Santosh Sidram Kaki 11-07-1985

Age Maritial Status Occupation

40 Years Married Self-employed without Income Tax
Address
plot no.52 shriram nagar behind laxminarayan cinema hall solapur 413006
2. What is proposer'yearly income from: (if life assured is different from the proposer)
Employment Businees / Profession Other Sources H.U.F. if any
₹ 3,00,000 ₹ ₹ ₹
Income of life to be
assured
₹
3. Whether income proof submitted? (if Yes, give details below)

Nature of document Is he/she Income tax Is yes, please provide Income Tax Bracket
for income verification Assessee PAN 0%
Yes AVAPK3270H

s 4. Previous Policy Details (as per proposal form)

5. Family History (as per proposal form)
Spouse Details
Name Occupation Annual Income
NA NA NA

6. Need Analysis
Total Annual Income
₹ 3,00,000

Outstanding Liablities
Secured Loans Non-Secured Loans
₹ ₹

based on his age and income, the maximum insurance that can be granted is:
Age Group Multiple of Avg. Maximum allowable
Annual Income Insurance

7.
Object of Insurance How would you like to pay your premiums
Market linked Return with Risk cover Single
Risk Profile Time frame for this invesement
Aggressive
8. Categorization of plans in relation to object of Insurance
Category Risk Profile Plan Name
Aggressive Aggressive LIC's Nivesh Plus

9. Product Chosen
Plan No Plan Name Term Sum Assured
749 LIC's Nivesh Plus 25 ₹ 1,56,250

Mode Premium
Single ₹ 1,25,000
a) if ULIP is proposed:
1st Year 2nd Year 3rd Year onwards Life cover
charges

Policy Administration Fund Management

Charges Charges

b) if Annuity / Pension is proposed:

Target Annuity per annum Type of Annuity Annuity Amount per Defement
annum Period

Is the total insurance added to the present proposal is reasonable in relation to income
The questions above pertain to your personal condition at the time of appliction to your understanding of the
features of the product for which you are applying. This information will not be used for any other purpose and
will remain confidential.
I Santosh Sidram Kaki, having received the informationwith respect to the above, have understood the
selection of product befor into this contract. My plan details are as following:
Plan No Plan Name Term Sum Assured
749 LIC's Nivesh Plus 25 ₹ 1,56,250

Mode Premium
Single ₹ 1,25,000

KYC Details of Life to be Insured as per E-KYC

Personal Details
Pan No
AVAPK3270H
Name Date of Birth
Santosh Sidram Kaki 11-07-1985
Gender
Male
Contact Details
C/o. House/ Bldg. / Apt.

Steert/ Road/ Lane Landmark

, F-11, muncipal colony ravivar peth, , solapur, infront of maruti temple,

Area/ Locality/ Sector Pincode

413005
Village/ Town/ City P.O.
solapur
District State
Solapur Maharashtra
 LIC's Nivesh Plus (Plan No. 749)

Benefit Illustration

LIC's Nivesh Plus (Plan No. 749)

A Non-Par, Linked, Life, Individual Savings Plan
(Unique Identification Number - 512L317V02)
RAMESH PAPAYYA
Distribution channel Offline Agency name Agency code 2403394B
MHANTA
Name of prospect Santosh Sidram Kaki Age of prospect 40 years Date of illustration 31-12-2025
Name of life assured Santosh Sidram Kaki Age of life assured 40 years Benefit UID
Mode of payment of
Policy term 25 years Premium paying term 1 years Single
premium
Sum assured 1,56,250 Single premium 1,25,000.00 GST rate Nil
Investment strategy
Fund opted Growth fund Risk level High risk Self managed
opted for
LIC's Linked ADB rider Not opted AB rider sum assured 0
Death benefit option 1 Sum assured multiple 1.25
Note: GST rate shall be as applicable from time to time. Currently, it is exempted.

How to read and understand this benefit illustration?

This benefit illustration is intended to show what charges are deducted from your premiums and how the unit fund, net of charges and taxes, may grow over the years of the
policy term if the fund earns a gross return of 8% p.a. or 4% p.a. These rates, i.e., 8% p.a. and 4% p.a. are assumed only for the purpose of illustrating the flow of benefits if
the returns are at this level. It should not be interpreted that the returns under the plan are going to be either 8% p.a. or 4% p.a.

Net yield mentioned corresponds to the gross investment return of 8% p.a., net of all charges but does not consider mortality, morbidity charges, underwriting extra, if any,
guarantee charges and cost of riders, if deducted by cancellation of units. It demonstrates the impact of charges exclusive of taxes on the net yield. Please note that the
mortality charges per thousand sum assured in general, increases with age.

The actual returns can vary depending on the performance of the chosen fund, charges towards mortality, morbidity, underwriting extra, cost of riders, etc. The investment risk
in this policy is borne by the policyholder, hence, for more details on terms and conditions please read sales literature carefully.

Part A of this statement presents a summary view of year-by-year charges deducted under the policy, fund value, surrender value and the death benefit, at two assumed rate
of return. Part B of this statement presents a detailed break-up of the charges, and other values.

Page 1
 LIC's Nivesh Plus (Plan No. 749)

Part A:

(Amount in rupees)

At 4% p.a. gross investment return At 8% p.a. gross investment return

Other Other
charges charges
(including (including
GST GST
Single FMC and FMC and
Policy year (excluding (excluding
premium GST on GST on
Mortality GST on Fund at end Surrender Death Mortality GST on Fund at end Surrender Death
FMC but FMC but
charges FMC and of year value benefit charges FMC and of year value benefit
excluding discontinua excluding discontinua
discontinua nce charge) discontinua nce charge)
nce charge nce charge
and its and its
GST)* GST)*
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

1 125000 77 5771 0 123955 121476 156250 72 5805 0 128729 126229 156250

2 0 76 1688 0 127118 125243 156250 58 1789 0 137113 135238 156250

3 0 74 1731 0 130365 129115 156250 40 1906 0 146066 144816 156250

4 0 70 1775 0 133700 133075 156250 17 2031 0 155630 155005 156250

5 0 67 1821 0 137127 137127 156250 0 2164 0 165839 165839 165839

6 0 61 1867 0 144398 144398 156250 0 2306 0 180468 180468 180468

7 0 39 1967 0 148132 148132 156250 0 2509 0 192306 192306 192306

8 0 27 2018 0 151975 151975 156250 0 2674 0 204921 204921 204921

9 0 12 2070 0 155934 155934 156250 0 2849 0 218364 218364 218364

10 0 0 2124 0 165009 165009 165009 0 3036 0 237688 237688 237688

11 0 0 2248 0 169321 169321 169321 0 3305 0 253280 253280 253280

12 0 0 2306 0 173746 173746 173746 0 3522 0 269895 269895 269895

13 0 0 2367 0 178286 178286 178286 0 3753 0 287599 287599 287599

14 0 0 2429 0 182945 182945 182945 0 3999 0 306465 306465 306465

15 0 0 2492 0 193975 193975 193975 0 4261 0 332819 332819 332819

16 0 0 2642 0 199044 199044 199044 0 4628 0 354651 354651 354651

17 0 0 2711 0 204246 204246 204246 0 4931 0 377916 377916 377916

18 0 0 2782 0 209583 209583 209583 0 5255 0 402706 402706 402706

19 0 0 2855 0 215060 215060 215060 0 5600 0 429123 429123 429123

Page 2
 LIC's Nivesh Plus (Plan No. 749)

(Amount in rupees)

At 4% p.a. gross investment return At 8% p.a. gross investment return

Other Other
charges charges
(including (including
GST GST
Single FMC and FMC and
Policy year (excluding (excluding
premium GST on GST on
Mortality GST on Fund at end Surrender Death Mortality GST on Fund at end Surrender Death
FMC but FMC but
charges FMC and of year value benefit charges FMC and of year value benefit
excluding discontinua excluding discontinua
discontinua nce charge) discontinua nce charge)
nce charge nce charge
and its and its
GST)* GST)*
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

20 0 0 2929 0 228180 228180 228180 0 5967 0 464773 464773 464773

21 0 0 3108 0 234142 234142 234142 0 6463 0 495261 495261 495261

22 0 0 3189 0 240261 240261 240261 0 6887 0 527749 527749 527749

23 0 0 3273 0 246539 246539 246539 0 7338 0 562369 562369 562369

24 0 0 3358 0 252982 252982 252982 0 7820 0 599259 599259 599259

25 0 0 3446 0 268343 268343 268343 0 8333 0 647320 647320 647320

*See 'Part B' for details

Force Majeure Conditions:

a. The Corporation shall value the funds (SFIN) on each day for which financial markets are open. However, the Corporation may value the SFIN less frequently in extreme
circumstances external to the Corporation, i.e. in force majeure events, where the value of the assets is too uncertain. In such circumstances, the Corporation may defer
the valuation of the assets for up to 30 days until the Corporation is certain that the valuation of SFIN can be resumed.
b. The Corporation will inform IRDAI of such deferment of the valuation of assets. During the continuance of the force majeure events, all requests for servicing the policy,
including policy related payment, shall be kept in abeyance.
c. The Corporation will continue to invest as per the investment pattern of the fund type opted by the policyholder. However, the Corporation reserves the right to change the
exposure of all or any part of the fund to money market instruments (as defined under Regulations 1(8) Schedule III of IRDAI(Actuarial, Finance and Investment functions of
Insurers) Regulations, 2024) in circumstances mentioned under points (a) and (b) above. The exposure of the chosen fund shall be reinstated within reasonable timelines
once the force majeure situation ends.
d. Few examples of such circumstances as mentioned in point (a) & (b) above are:
i. When one or more stock exchanges which provide a basis for valuation of the assets of the fund are closed otherwise than for ordinary holidays.
ii. When, as a result of political, economic, monetary or any circumstances which are not in the control of the Corporation, the disposal of the assets of the fund would be
detrimental to the interests of the continuing policyholders.
iii. In the event of natural calamities, strikes, war, civil unrest, riots and bandhs.
iv. In the event of any force majeure or disaster that affects the normal functioning of the Corporation.
e. In such an event, an intimation of such force majeure event shall be uploaded on the Corporation's website for information.

Page 3
 LIC's Nivesh Plus (Plan No. 749)

IN THIS POLICY, THE INVESTMENT RISK IS BORNE BY THE POLICYHOLDER AND THE ABOVE INTEREST RATES ARE ONLY FOR ILLUSTRATIVE PURPOSE.

I, ________________________________________ (name), have explained I, ________________________________________ (name), having received

the premiums, charges and benefits under the product fully to the the information with respect to the above, have understood the above statement
prospect/policyholder. before entering into the contract.
Place : Place :
Date : Signature of agent/intermediary/official of the insurer Date : Signature of prospect/policyholder

Page 4
 LIC's Nivesh Plus (Plan No. 749)

Part B:

(Amount in rupees)

Gross yield (p.a.) 8.00% Net yield (p.a.) 6.80%

GST
Single (excluding
Premium premium Accident FMC
GST on Policy
Single allocation less Mortality benefit Addition to Fund (including Fund after Guarantee Fund at Surrender Death
Policy year FMC and admin
premium charge premium charge rider the fund before FMC tax charge FMC d addition end of year value benefit
discontinu charge
(PAC) allocation charge on FMC)
ance
charge charge)
(12)=(10)-
(1) (2) (3) (4)=(2)-(3) (5) (6) (7) (8) (9) (10) (11) (13) (14) (15) (16)
(11)
1 125000 4125 120875 72 0 0 0 9607 130410 1680 128729 0 128729 126229 156250

2 0 0 0 58 0 0 0 10232 138903 1789 137113 0 137113 135238 156250

3 0 0 0 40 0 0 0 10899 147972 1906 146066 0 146066 144816 156250

4 0 0 0 17 0 0 0 11612 157661 2031 155630 0 155630 155005 156250

5 0 0 0 0 0 0 0 12373 168003 2164 165839 0 165839 165839 165839

6 0 0 0 0 0 0 0 13185 179024 2306 176718 3750 180468 180468 180468

7 0 0 0 0 0 0 0 14348 194816 2509 192306 0 192306 192306 192306

8 0 0 0 0 0 0 0 15289 207595 2674 204921 0 204921 204921 204921

9 0 0 0 0 0 0 0 16292 221213 2849 218364 0 218364 218364 218364

10 0 0 0 0 0 0 0 17361 235724 3036 232688 5000 237688 237688 237688

11 0 0 0 0 0 0 0 18897 256585 3305 253280 0 253280 253280 253280

12 0 0 0 0 0 0 0 20137 273416 3522 269895 0 269895 269895 269895

13 0 0 0 0 0 0 0 21457 291352 3753 287599 0 287599 287599 287599

14 0 0 0 0 0 0 0 22865 310464 3999 306465 0 306465 306465 306465

15 0 0 0 0 0 0 0 24365 330830 4261 326569 6250 332819 332819 332819

16 0 0 0 0 0 0 0 26460 359279 4628 354651 0 354651 354651 354651

17 0 0 0 0 0 0 0 28196 382847 4931 377916 0 377916 377916 377916

18 0 0 0 0 0 0 0 30045 407961 5255 402706 0 402706 402706 402706

19 0 0 0 0 0 0 0 32016 434723 5600 429123 0 429123 429123 429123

20 0 0 0 0 0 0 0 34117 463240 5967 457273 7500 464773 464773 464773

21 0 0 0 0 0 0 0 36951 501724 6463 495261 0 495261 495261 495261

Page 5
 LIC's Nivesh Plus (Plan No. 749)

(Amount in rupees)

Gross yield (p.a.) 8.00% Net yield (p.a.) 6.80%

GST
Single (excluding
Premium premium Accident FMC
GST on Policy
Single allocation less Mortality benefit Addition to Fund (including Fund after Guarantee Fund at Surrender Death
Policy year FMC and admin
premium charge premium charge rider the fund before FMC tax charge FMC d addition end of year value benefit
discontinu charge
(PAC) allocation charge on FMC)
ance
charge charge)
(12)=(10)-
(1) (2) (3) (4)=(2)-(3) (5) (6) (7) (8) (9) (10) (11) (13) (14) (15) (16)
(11)
22 0 0 0 0 0 0 0 39375 534636 6887 527749 0 527749 527749 527749

23 0 0 0 0 0 0 0 41958 569707 7338 562369 0 562369 562369 562369

24 0 0 0 0 0 0 0 44710 607079 7820 599259 0 599259 599259 599259

25 0 0 0 0 0 0 0 47643 646902 8333 638570 8750 647320 647320 647320

Page 6
 LIC's Nivesh Plus (Plan No. 749)

(Amount in rupees)

Gross yield (p.a.) 4.00%

GST
Single (excluding
Premium premium Accident FMC
GST on Policy
Single allocation less Mortality benefit Addition to Fund (including Fund after Guarantee Fund at Surrender Death
Policy year FMC and admin
premium charge premium charge rider the fund before FMC tax charge FMC d addition end of year value benefit
discontinu charge
(PAC) allocation charge on FMC)
ance
charge charge)
(12)=(10)-
(1) (2) (3) (4)=(2)-(3) (5) (6) (7) (8) (9) (10) (11) (13) (14) (15) (16)
(11)
1 125000 4125 120875 77 0 0 0 4803 125601 1646 123955 0 123955 121476 156250

2 0 0 0 76 0 0 0 4926 128806 1688 127118 0 127118 125243 156250

3 0 0 0 74 0 0 0 5052 132096 1731 130365 0 130365 129115 156250

4 0 0 0 70 0 0 0 5181 135476 1775 133700 0 133700 133075 156250

5 0 0 0 67 0 0 0 5314 138947 1821 137127 0 137127 137127 156250

6 0 0 0 61 0 0 0 5450 142516 1867 140648 3750 144398 144398 156250

7 0 0 0 39 0 0 0 5739 150098 1967 148132 0 148132 148132 156250

8 0 0 0 27 0 0 0 5888 153993 2018 151975 0 151975 151975 156250

9 0 0 0 12 0 0 0 6041 158004 2070 155934 0 155934 155934 156250

10 0 0 0 0 0 0 0 6199 162133 2124 160009 5000 165009 165009 165009

11 0 0 0 0 0 0 0 6560 171569 2248 169321 0 169321 169321 169321

12 0 0 0 0 0 0 0 6731 176052 2306 173746 0 173746 173746 173746

13 0 0 0 0 0 0 0 6907 180653 2367 178286 0 178286 178286 178286

14 0 0 0 0 0 0 0 7087 185373 2429 182945 0 182945 182945 182945

15 0 0 0 0 0 0 0 7273 190217 2492 187725 6250 193975 193975 193975

16 0 0 0 0 0 0 0 7711 201687 2642 199044 0 199044 199044 199044

17 0 0 0 0 0 0 0 7913 206957 2711 204246 0 204246 204246 204246

18 0 0 0 0 0 0 0 8119 212365 2782 209583 0 209583 209583 209583

19 0 0 0 0 0 0 0 8332 217915 2855 215060 0 215060 215060 215060

20 0 0 0 0 0 0 0 8549 223609 2929 220680 7500 228180 228180 228180

21 0 0 0 0 0 0 0 9071 237251 3108 234142 0 234142 234142 234142

22 0 0 0 0 0 0 0 9308 243450 3189 240261 0 240261 240261 240261

Page 7
 LIC's Nivesh Plus (Plan No. 749)

(Amount in rupees)

Gross yield (p.a.) 4.00%

GST
Single (excluding
Premium premium Accident FMC
GST on Policy
Single allocation less Mortality benefit Addition to Fund (including Fund after Guarantee Fund at Surrender Death
Policy year FMC and admin
premium charge premium charge rider the fund before FMC tax charge FMC d addition end of year value benefit
discontinu charge
(PAC) allocation charge on FMC)
ance
charge charge)
(12)=(10)-
(1) (2) (3) (4)=(2)-(3) (5) (6) (7) (8) (9) (10) (11) (13) (14) (15) (16)
(11)
23 0 0 0 0 0 0 0 9551 249812 3273 246539 0 246539 246539 246539

24 0 0 0 0 0 0 0 9801 256340 3358 252982 0 252982 252982 252982

25 0 0 0 0 0 0 0 10057 263039 3446 259593 8750 268343 268343 268343

Notes:

1. Refer the sales literature for explanation of terms used in this illustration.
2. Fund management charge is based on the specific fund option(s) chosen.
3. In case rider charges are collected explicitly through collection of rider premium, and not by way of cancellation of units, then such charges are not considered in this
illustration. In other cases, rider charges are included in other charges.
4. In case LIC's Accidental Death Benefit rider is opted for, rider charges are included in other charges under Part A. However, under Part B, accident benefit rider charge is
shown separately.
5. The above illustrations are for indicative purpose. The annual charges shown above are sum total of charges deducted throughout the policy year as per the
frequency/conditions detailed in sales brochure/policy document.
6. This illustration is prepared by considering standard life (from medical, life style and occupation point of view) and assuming LIC's Linked Accidental Death Benefit rider is
not opted for.
7. Fund at the start shall be the amount available for investment in the first year and previous year's end fund for rest of the years.
8. Above calculations have been performed considering deductions of mortality charge and tax charge on mortality charge at the start of each policy month and deduction of
FMC and Tax charge on FMC the end of each policy month.
9. Tax charge is subject to change from time to time.
10. Total death benefit is the amount payable immediately on death of the life assured, which is higher of (basic sum assured reduced by partial withdrawal made during the
two years period immediately preceding the date of death) or unit fund value, where basic sum assured is (1.25 * single premium) for Option 1 and (10 * single premium)
for Option 2.
11. The death benefit has been calculated assuming that death occurs on completion of the policy year and the option of partial withdrawal has not been exercised.
12. In addition to death benefit, accident benefit sum assured is payable as per terms and conditions of the policy if LIC's Accidental Death Benefit rider is opted for and death
occurs due to accident.
13. The above illustration assumes the policy is surrendered on completion of the policy year after addition of guaranteed addition in unit fund. In case the policy is
surrendered on or before 5 years' lock-in-period, surrender value shown above equals unit fund value at the end of policy year minus discontinuance charge minus tax
charge on discontinuance charge. This amount shall be transferred to the discontinued policy fund and the proceeds of the discontinued policy fund shall be payable on
completion of 5 years' lock-in-period. In case the policy is surrendered after expiry of 5 years' lock-in-period, the surrender value shall be payable immediately.

Page 8
 LIC's Nivesh Plus (Plan No. 749)

14. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
I, ________________________________________ (name), have explained I, ________________________________________ (name), having received
the premiums, charges and benefits under the product fully to the the information with respect to the above, have understood the above statement
prospect/policyholder. before entering into the contract.
Place : Place :
Date : Signature of agent/intermediary/official of the insurer Date : Signature of prospect/policyholder

Page 9
 नामांकन क्रम/ Enrolment No.: 0854/13046/04790
To
संतोष सिद्राम काकी
Santosh Sidram Kaki
F-11, muncipal colony ravivar peth,
infront of maruti temple,
solapur,
VTC: Solapur North,
PO: Daji Peth,
Sub District: Solapur North,
District: Solapur,
State: Maharashtra,
PIN Code: 413005,
Mobile: 9423331589

Signature Not Verified

Digitally signed by DS Unique
Identification Authority of India
05
Date: 2025.12.31 19:37:03
IST

8282 3650 0410

VID : 9149 4162 5372 0586
Aadhaar no. issued: 25/03/2014

संतोष सिद्राम काकी पता:

एफ-11, मुनसिपल कॉलनी रविवार पेठ, मारुती मंदिर समोर,
Details as on: 31/12/2025

Santosh Sidram Kaki सोलापुर, सोलापूर नॉर्थ, दाजी पेठ, सोलापूर,

महाराष्ट्र - 413005
जन्म तिथि/DOB: 11/07/1985
पुरुष/ MALE Address:
F-11, muncipal colony ravivar peth, infront of maruti
temple, solapur, Solapur North, PO: Daji Peth, DIST:
Solapur,
Maharashtra - 413005

8282 3650 0410

8282 3650 0410 VID : 9149 4162 5372 0586