4.2.2.
Lapsation of Policy Date of Maturity of Policy, subject to: (i) Your written application for revival;
If the Premium is not paid within the Grace Period and if the Policy has not (ii) production of Insured’s current health certificate and other evidence of
acquired Surrender Value, the Policy will lapse from the due date of first insurability; and (iii) payment of all overdue Premiums with interest.
unpaid Premium and no benefits will be payable. The applicable interest rate for revival is determined using the SBI (State
Bank of India) [or any other public sector undertaking bank] domestic term
4.3. Reduced Paid-up: (Applicable only under Life Plus/Life
deposit rate for tenure ‘1 year to less than 2 years’, plus 2%. The interest
Income Option as chosen)
rate applicable is reviewed every 6 months and gets updated as per the
Provided the Policy has acquired Surrender Value, if subsequent Premium given formula. Any alteration in the formula will be subject to prior approval
remain unpaid at the end of Grace Period, the Policy will be converted into of IRDAI. The simple interest rate applicable as on 1st October 2020, is
a Reduced Paid-up Policy by default. 6.90% p.a. [i.e. SBI interest rate of 4.90% (which rate may be revised from
Reduced Paid-up policy is a default non-forfeiture benefit. Reduced time to time) + 2%].
Paid-Up Policy, shall continue as Reduced Paid-up Policy unless revived Upon revival, the benefits of the Policy shall be restored with effect from the
within Revival Period by payment of all due Premiums together with date of revival.
interest as mentioned in Clause 4.4 (“Revival”) of Part D. However, where a
prior claim under Payor Accelerated Benefit has been paid, 5. PART E
- Policy shall continue provided the Reduced Paid-up Benefit is higher Not Applicable for this Product
than the Payor Accelerated Benefit claim amount already paid.
6. PART F
- Policy shall lapse if the Reduced Paid-up Benefit is lesser than the
6.1. Fraud, Misstatement and Suppression
Payor Accelerated Benefit claim amount already paid.
Any fraud, mis-statement or suppression of a material fact under the Policy
In case of Reduced Paid-up Policy, the benefit shall be payable as under: shall be dealt in accordance with Section 45 of the Insurance Act, 1938 as
4.3.1. In case of no prior claim under Payor Accelerated Benefit – amended from time to time.
a. Maturity Benefit: The simplified version of the provisions of Section 45 of the Insurance Act,
- Life Plus option: The benefit shall be equal to Maturity benefit as 1938 is enclosed in Annexure 4 for reference.
per Clause 3.1.1 of Part C. 6.2. Exclusions
- Life Income option: Paid-Up Terminal Value3 (as computed below) 6.2.1. Suicide
shall be paid.
In case of death due to suicide within 12 months:
b. Death Benefit: On death of the Life Insured during the Policy Term,
- from the Date of Commencement of Risk under the Policy or from the
We shall pay Reduced Paid-up Sum Assured1.
date of revival of the Policy, as applicable, the Claimant shall be entitled
c. Payor Accelerated Benefit: Upon diagnosis of Terminal Illness of the to at least 80% of the Total Premiums Paid till the date of death or the
Life Insured as per Clause 3.1.3 of Part C, We shall pay- Surrender Value available as on the date of death (if applicable)
- Life Plus option: 50% multiplied by Reduced Paid up Factor2 whichever is higher, provided the Policy is in force; OR
multiplied by Base SA - where the Life Stage Option has been chosen, from the date of
- Life Income option: 50% multiplied by Reduced Paid-up Factor2 exercising the Life Stage Option, the Claimant shall be entitled to 80%
multiplied by Effective SA of the Premiums paid (excluding applicable taxes, Rider Premiums and
Extra Premiums) for the increased tranche(s). The Death Benefit based
d. Survival Benefit: No survival benefit is payable.
on the Base SA and any Death Benefit increased by exercising the Life
4.3.2. In case of prior claim under Payor Accelerated Benefit – Stage Option subsequently but prior to 12 months from the date of
a. Maturity Benefit: death (due to suicide) will remain payable in full.
- Life Plus option: The benefit shall be equal to Maturity benefit as 6.2.2. Waiting Period (Applicable only if the Policy is availed under
per Clause 3.1.1. of Part C. Point of Sale product norms)
- Life Income option: Paid-Up Terminal Value3 (as computed below) If death of the Life Assured occurs during the Waiting Period, We shall
shall be paid. refund Total Premiums Paid and the Policy will terminate with immediate
effect. Waiting period shall not be applicable in case of death due to
b. Death Benefit: On death of the Life Insured during the Policy Term, accident provided all due Premiums have been paid.
We shall pay
6.2.3. Payor Accelerator Benefit
Reduced Paid-up Sum Assured1 minus the Payor Accelerated Benefit
amount already paid No claim shall be payable if the diagnosis of Terminal Illness of the Life
Insured arises directly or indirectly because of attempted suicide in the first
Here, year from inception or revival of the Policy. In case a claim under Payor
• Reduced Paid-Up Sum Assured is defined as –
1
Accelerator Benefit is not payable due to the above exclusion, the Policy
Sum of Reduced Paid-Up Factor multiplied by Sum Assured, determined shall continue with the applicable death cover.
separately for the Base SA and for each tranche of Additional Sum Assured.
6.3. Misstatement of Age
• 2
Reduced Paid-Up Factor (in respect of Base SA and each tranche) shall be
equal to – Declaration of the correct Age of the Life Insured is important for Our
underwriting process and calculation of Premiums payable under the
Total period for which Premiums have already been paid divided by the Policy. If the Age declared in the Proposal Form is found to be incorrect at
maximum period for which Premiums were originally payable
any time during the Policy Term or at the time of claim, We may revise the
• 3
Paid-up Terminal Value = Reduced Paid-Up Factor multiplied by Base SA Premium with interest and/or applicable benefits payable under the Policy
multiplied by [12 multiplied by Income Rate multiplied by (Maturity Age – Income in accordance with the Premium and benefits that would have been
Start Age)], where Maturity Age = Age (last birthday) of the Life Assured at Date payable, if the correct Age would have made the Life Insured eligible to be
of Maturity.
covered under the Policy on the Date of Commencement of Policy. If at the
c. Payor Accelerated Benefit: No benefit shall be payable. correct Age the Life Insured is not insurable under this Policy pursuant to
our Underwriting Policy, the Policy shall be void ab-initio and the Company
d. Survival Benefit: No survival benefit is payable. will refund the Total Premiums Paid without interest after deducting all
e. Surrender Benefit – This benefit is same as per Clause 4.2.1 of Part D. charges incurred by the Company under the Policy.
4.4. Revival 6.4. Nomination
If there is default in Premium Payment beyond the Grace Period and Nomination allowed as per provisions of Section 39 of the Insurance Act
subject to the Policy not having been surrendered, it may be revived, in 1938 as amended from time to time. The simplified version of the
accordance with Underwriting Policy within Revival Period but before the provisions of Section 39 is enclosed in Annexure 3 for reference.
Tata AIA Life Insurance Sampoorna Raksha Supreme (UIN: 110N160V02) • IRDA of India Regn no. 110
C2021-05
6.5. Assignment Type of Claim Requirement
Assignment shall be as per Section 38 of the Insurance Act 1938 as 5. Cancelled cheque with name and account number
amended from time to time. The simplified version of the provisions of printed or cancelled cheque with copy of Bank
Section 38 is enclosed in Annexure 2 for reference.
Passbook / Bank Statement
6.6. Loss of Policy document Death
6. If no nomination - Proof of legal title to the claim
If the Policy document is lost or destroyed, then at the request of the (All causes of proceeds (e.g. legal succession paper)
death other than
Policyholder, the Company will issue a duplicate Policy document duly the Accidental Additional documents required on basis of cause of
endorsed to show that it is issued following the loss or destruction of the Death) death Medical/Natural death:
original Policy document. Upon the issuance of the duplicate Policy
document, the original Policy document immediately and automatically 1) Attending Physician's Statement
ceases to have any validity. The Company will charge a fee of R 250/- along 2) Medical Records (Admission Notes,
with the applicable tax and surcharge/cess, for the issuance of a duplicate Discharge/Death Summary, Indoor Case Papers,
Policy document. These charges are subject to revision by the Company Test Reports etc.)#
from time to time.
- Copy of the First Information Report (FIR) or
6.7. Taxes If Death due to Panchanama/Police complaint
All Premiums and interest payable under the policy are exclusive of Accident (to be
applicable taxes, duties, surcharge, cesses or levies which will be entirely submitted in - Copy of Post Mortem report (PMR)/Autopsy and
addition to the Viscera report
borne/ paid by the Policyholder, in addition to the payment of such above)
Premium or interest. Tata AIA Life shall have the right to claim, deduct, - Copy of the Final Police Investigation report
adjust and recover the amount of any applicable tax or imposition, levied (FPIR)/Charge sheet
by any statutory or administrative body, from the benefits payable under
Additional
the Policy. documents for
NRI (to be 1) FATCACRS self-certification forms Individual
6.8. Termination of Policy:
submitted in 2) FATCACRS self-certification forms Non-Individual
This Policy will terminate upon the happening of any of the following events: addition to the
above)
1. On the date of refund of Premium under Freelook request.
2. On the date of payment of the Maturity Benefit (if applicable), death
#
This is applicable if Life Assured was in hospital at the time of death or any time prior
to the date of death.
claim in accordance with the provisions of this Policy or date of
intimation of repudiation of claim by Us; Please submit copies of the following documents certified / attested by the
3. On the expiry of the Revival Period, if the Lapsed Policy has not been issuing authority. (Original Seen Verified (OSV) by Branch Personnel will
revived; also be accepted) –
4. On the date of payment of Surrender Benefit of this Policy; - All Police papers – Panchnama, Inquest, First Information Report and
Final Investigation Report.
5. On the date of payment of last income instalment under Death Benefit
(if chosen), - Medical Records (Admission Notes, Discharge/Death Summary,
Indoor Case Papers, Test Reports etc).
6. If the stipulated Death Benefit under Life Income option or Effective
Sum Assured under Credit Protect option (Clause 3.1.2 ‘Death - Postmortem report (Autopsy report) & Chemical Viscera report
Benefit’ of Part C) falls below the Payor Accelerated Benefit already (certified by Police / Magistrate / Court will also be accepted)
paid; or Copies of the other documents to be submitted by self-attestation of
7. On cancellation/ termination of this Policy by Us on grounds of fraud, the claimant
misstatement and suppression of a material fact established in terms of
Payor Accelerator Claim requirements
Section 45 of the Insurance Act, 1938 as amended from time to time.
Terminal illness should be confirmed by the treating specialist practitioner
6.9. Claims on his written statement
Notice of Claim – All cases of death must be notified, within a period of 90 along with relevant lab reports and other treatment papers which should
days, to us in writing. However, We may condone delay on merit for involve the below noting’s
delayed claims where the reason for delay is proved to be for reasons
beyond the control of the Claimant. In case of any delay on the part of the - If insured in undergoing palliative treatment or Curative care treatment
Company to process the claim within extant regulatory timeline, We shall - Status or stage of the disease
pay interest as may be prescribed by the IRDAI from time to time. - Prognosis of the illness
Please note that all death claims will be payable to the Claimant. Survival rate as per the diagnosis
Appropriate forms and supporting documents must be submitted, at the
Maturity Claim Requirements
Claimant’s expenses, within 90 days after the date the Insured event
happens, unless specified otherwise. A list of primary claim documents To ensure processing the maturity payout on or before the Maturity Date,
listing the normally required documents is attached to the Policy. We shall consider the bank account details available in Your Policy record.
Submission of the listed documents, forms or other proof, however, shall If there is any change, please submit below documents sufficiently in
not be construed as an admission of liabilities by the Company. advance, to enable us release the maturity payout on or before the
Maturity Date:
We reserve the right to require any additional proof and documents in
support of the claim. a) NEFT Form;
b) a cancelled cheque or copy of passbook with pre-printed name and
6.9.1. Claims requirements
bank account number, for payout through NEFT, and
Death claims requirements
c) a self-attested photo ID proof.
For processing the claim request under this Policy, we will require the
Note-
following documents:
• In case the claim warrants any additional requirement, We reserve the
Type of Claim Requirement right to call for the same.
1. Claimant Statement • Notification of claim & submission of the claim requirements does not
Death 2. Copy of Death Certificate issued by a local Munici- mean admission of the claim liability by the Company.
(All causes of pal Authority • No agent is authorized to admit any liabilities on behalf of the
death other than 3. Original Policy Document Company, nor to alter this list of documents or any claims
the Accidental requirements called for by the Company.
Death) 4. Copy of Claimant's Photo Identification Proof &
Current Address Proof (List of acceptable photo ID
and Address proofs)
Tata AIA Life Insurance Sampoorna Raksha Supreme (UIN: 110N160V02) • IRDA of India Regn no. 110
C2021-05
6.10. Claims Intimation Process - In case customers wishes to contact us during the course of the
Mentioned below is a list of various mediums through which Claimant can assessment, they can contact us at any of the above mentioned
touch points.
contact us.
a. Online claim intimation at - All Tata AIA Life branches have a Grievance Redressal Officer
[Link] who can be contacted for any support during the grievance
redressal process
b. WhatsApp (SMS CLAIM) to 7045669966
2) Escalation Mechanism
c. Email – claims@[Link] or Customercare@[Link]
In case customers are not satisfied with the decision of the above offices,
d. Call our helpline number 1-860-266-9966 (local charges apply) or has not received any response within the stipulated timelines, they may
e. Visit any of our branch offices contact the following officials for resolution:
f. Write directly to us on following address: • 1st level of Escalation: Head - Customer Service
Tata AIA Life Insurance Company Limited • 2nd level of Escalation: Grievance Redressal Officer (GRO)
B - Wing, 9th Floor, I-Think Techno Campus, Behind TCS, Pokhran For escalations, customers can email to
Road No.2, Close to Eastern Express Highway, Thane (West) – 400 [Link]@[Link] or write to –
607, Maharashtra. Tata AIA Life Insurance Company Limited, B-Wing, 9th Floor, I-Think
6.11. Governing Law and Jurisdiction Techno Campus, Behind TCS, Pokhran Road No.2, Close to Eastern
Express Highway, Thane (West) – 400 607, Maharashtra
The Policy will be governed by and enforced in accordance with the laws
of India. The competent courts in India will have exclusive jurisdiction in all We request our customers to follow the escalation mechanism in case of
matters and causes arising out of the Policy. non-receipt of response or unsatisfactory response from the concerned
persons mentioned above.
6.12. Material Information & Disclosures
If you are not satisfied with the response or do not receive a response from
This Policy is issued on the basis of the information provided and us within 15 days, you may approach the Grievance Cell of the Insurance
disclosures made in the Proposal Form, in respect of the Life Insureds’ Regulatory and Development Authority of India (IRDAI) on the following
health, income, occupation, education, other existing life insurance contact details:
policies, etc. (as applicable) which are material and essential for the
IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: 155255 or
issuance of the Policy. Sharing of any incorrect information/disclosures or
1800 4254 732
suppression of accurate facts by You, can result in cancellation of the
Policy and/or rejection of the claim during or after Your life time. Email ID: complaints@[Link]
You can also register your complaint online at
PART G [Link] Address for communication for complaints
by fax/paper:
CONSUMER INFORMATION
Consumer Affairs Department – Grievance Redressal Cell.,
POLICYHOLDER'S SERVICING
Insurance Regulatory and Development Authority of India,
With regards to any query or issue related to the Policy, the Policyholder
can contact the Company through the following service avenues [Link].115/1, Financial District, Nanakramguda, Gachibowli,
Hyderabad – 500 032.
• Contact your Tata AIA Life Agent/ Distributor 3) Insurance Ombudsman:
• Call our helpline number at 1-860-266-9966 (local charges apply) Where the redressal provided by the Company is not satisfactory despite
• E-mail us at customercare@[Link] the escalation above, the customer may represent the case to the
Ombudsman for Redressal of the grievance, if it pertains to the following:
• Visit the nearest the Tata AIA Life branch or CAMS Service Center - Delay in settlement of claim
• Log on to Online Customer Portal by visiting [Link] - Partial or total rejection of claim;
• Write to Us at – Tata AIA Life Insurance Company Limited B-Wing, - Dispute with regard to premium;
9th Floor, I-Think Techno Campus, Behind TCS, Pokhran Road No.2, - Misrepresentation of policy terms and conditions;
Close to Eastern Express Highway, Thane (West) – 400 607, - Legal construction of the policy in so far as dispute related to claim;
Maharashtra. - Grievance relating to policy servicing;
GRIEVANCE REDRESSAL PROCEDURE - Issuance of policy which is not in conformity with proposal form;
1) Resolution of Grievances - Non- issuance of your insurance document; and
- Any other matter resulting from the violation of provisions of the
Customers can register their grievances through multiple service avenues: Insurance Act, 1938 or the regulations, circulars, guidelines or
• Call our helpline number at 1-860-266-9966 (local charges apply) instructions issued by the IRDAI from time to time or the terms and
Email us at [Link]@[Link] conditions of the policy contract, in so far as they relate to issues
mentioned hereinabove.
• Login to online policy account on [Link] Please refer to our website [Link] for further details in this
• Visit any of the nearest Tata AIA Life branches or CAMS Service regard. The list of Ombudsman address is attached as Annexure 1
Centers The complaint should be made in writing duly signed by the complainant
or through his legal heirs, nominee or assignee, and shall state clearly the
• Contact your Tata AIA Life Agent / Distributor name and address of the complainant, the name of the branch or office of
• Log on to IGMS website [Link] the insurer against whom the complaint is made, the facts giving rise to the
complaint, supported by documents, the nature and extent of the loss
• Write to us on the following address:
caused to the complainant and the relief sought from the Insurance
Grievance Redressal Department Tata AIA Life Insurance Company Ombudsman. As per provision 14(3) of the Insurance Ombudsman Rules,
Limited, B- wing, 9th Floor, I-Think Techno Campus, Behind TCS, 2017, the complaint to the Ombudsman can be made, within a period of
Pokhran Road No.2, Close to Eastern Express Highway, Thane (West) one year provided it is not simultaneously under any litigation:
– 400 607, Maharashtra. • Only if the grievance has been rejected by the Grievance Redressal
- We shall acknowledge a customer's grievance within 3 business Machinery of the Insurer; or
days by providing the customer with the name of the Grievance • the complainant had not received any reply within a period of one
Redressal Executive who is responsible to handle the grievance. month after the Insurer received his representation; or
- We shall provide the customer with an equitable resolution within • the complainant is not satisfied with the reply given to him by the
2 weeks of receipt of the grievance. Insurer.
Tata AIA Life Insurance Sampoorna Raksha Supreme (UIN: 110N160V02) • IRDA of India Regn no. 110
C2021-05