Proposal Form

Plan Details

Plan Name Plan No

LIC's Nivesh Plus 749

UIN
512L317V02
Agency Code Supervisor Code Branch Code
070709863 9999999 86F

Access Id Email Id Mobile No.

2553132282 NEHA4PATEL@[Link] 9723624514
* 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
20-12-2025
AB/ADDB Req AB/ADDB Sum Assured
AB REQUIRED ₹ 1,25,000
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
Nehaben Rohitkumar Patel
Father's Name Mother's Name
SURESHBHAI PATEL VARSHABEN PATEL
Gender
Male Female Third Gender

Martial Status Date of birth

Married 22-09-1993
Age (in years) Residential Status
32 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
W/O Rohitkumar, A-802 Coral Heights, Althan Bhimrad Canal, Bhimrad, , Surat
Address Line 3 City District
City, Surat, Gujarat Bhimrad Surat
State Country Pin Code
Gujarat India 395007
Permanent Residential Address
Address Line 1 Address Line 2
W/O Rohitkumar, A-802 Coral Heights, Althan Bhimrad Canal, Bhimrad, , Surat
Address Line 3 City District
City, Surat, Gujarat Bhimrad Surat
State Country Pin Code
Gujarat India 395007

KYC Particulars

Are you an It Assessee Yes No

PAN Proof of Identity Address Proof

EROPP0012G 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
without Income
Tax
Annual income source of income Education Purpose of insurance
Qualification
₹ 2,00,000 Self Employed SSC/10th Market linked
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)
137 46
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 68 Good NA NA

 Mother Living 54 Good NA NA

Son Living 5 Good NA NA

Brother Living 35 Good NA NA

Female Life (if applicable)

Are you pregnant now? Yes No

Have you had any delivery history? Yes No

Have you had any abortion or miscarriage or Cesarean section? Yes No

Have you ever consulted a gynecologist or undergone any investigation, treatment for Yes No
any gynaec ailment?
Husband’s details
Husband Full Name Occupation Annual Income
ROHITKUMAR BUSSINESS 300000
DINESHBHAI
PATEL

Bank details of the life to be insured

Your bank account type Savings Current

Account Number IFSC Code Bank Name

5912971790 KKBK0000871 KOTAK MAHINDRA BANK LIMITED
Bank Address
SURAT

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 the Age Relationship Address

Nominee to the life of Share(%)
assured Nominee

1 ROHITKUMAR 33 Husband ,,,, 100

DINESHBHAI
PATEL
Mobile Email Bank Name Account
Number No 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 Nehaben Rohitkumar Patel 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

Nehaben W/O Rohitkumar, A-802 Coral Heights, 395007
Rohitkumar Patel Althan Bhimrad Canal, Bhimrad, , Surat
Surat Gujarat
 Suitability Analysis

Proposer Full Name Date of Birth

Nehaben Rohitkumar Patel 22-09-1993
Age Maritial Status Occupation
32 Years Married Self-employed without Income Tax
Address
W/O Rohitkumar, A-802 Coral Heights, Althan Bhimrad Canal, Bhimrad, , Surat
Bhimrad 395007

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
₹ ₹ ₹ ₹

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
No EROPP0012G
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
₹ 2,00,000

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 Nehaben Rohitkumar Patel, 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
EROPP0012G
Name Date of Birth
Nehaben Rohitkumar Patel 22-09-1993
Gender
Female
Contact Details
C/o. House/ Bldg. / Apt.

Steert/ Road/ Lane Landmark

W/O Rohitkumar, A-802 Coral Heights, Althan Bhimrad Canal, Bhimrad, , Surat

Area/ Locality/ Sector Pincode

395007
Village/ Town/ City P.O.
Bhimrad
District State
Surat Gujarat
 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)
ASHOKKUMAR
Distribution channel Offline Agency name Agency code 070709863
TULSHIBHAI PATEL
NEHABEN ROHITKUMAR
Name of prospect Age of prospect 32 years Date of illustration 20-12-2025
PATEL
NEHABEN ROHITKUMAR
Name of life assured Age of life assured 32 years Benefit UID
PATEL
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 Opted AB rider sum assured 1,25,000
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 48 5821 0 123934 121456 156250 45 5855 0 128706 126206 156250

2 0 45 1738 0 127076 125201 156250 35 1839 0 137061 135186 156250

3 0 43 1780 0 130303 129053 156250 23 1955 0 145976 144726 156250

4 0 40 1824 0 133617 132992 156250 10 2079 0 155489 154864 156250

5 0 36 1869 0 137021 137021 156250 0 2212 0 165637 165637 165637

6 0 32 1916 0 144268 144268 156250 0 2353 0 180201 180201 180201

7 0 20 2015 0 147967 147967 156250 0 2555 0 191970 191970 191970

8 0 14 2065 0 151769 151769 156250 0 2719 0 204511 204511 204511

9 0 6 2117 0 155678 155678 156250 0 2893 0 217875 217875 217875

10 0 0 2170 0 164695 164695 164695 0 3079 0 237115 237115 237115

11 0 0 2293 0 168948 168948 168948 0 3347 0 252618 252618 252618

12 0 0 2351 0 173312 173312 173312 0 3562 0 269137 269137 269137

13 0 0 2410 0 177790 177790 177790 0 3792 0 286741 286741 286741

14 0 0 2471 0 182385 182385 182385 0 4037 0 305498 305498 305498

15 0 0 2534 0 193350 193350 193350 0 4298 0 331737 331737 331737

16 0 0 2683 0 198352 198352 198352 0 4662 0 353446 353446 353446

17 0 0 2752 0 203485 203485 203485 0 4964 0 376580 376580 376580

18 0 0 2821 0 208751 208751 208751 0 5286 0 401231 401231 401231

19 0 0 2893 0 214156 214156 214156 0 5629 0 427499 427499 427499

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 2967 0 227201 227201 227201 0 5994 0 462991 462991 462991

21 0 0 3145 0 233088 233088 233088 0 6487 0 493310 493310 493310

22 0 0 3225 0 239128 239128 239128 0 6909 0 525619 525619 525619

23 0 0 3307 0 245326 245326 245326 0 7358 0 560047 560047 560047

24 0 0 3391 0 251686 251686 251686 0 7837 0 596733 596733 596733

25 0 0 3478 0 266962 266962 266962 0 8347 0 644576 644576 644576

*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 45 0 0 50 9606 130386 1680 128706 0 128706 126206 156250

2 0 0 0 35 0 0 50 10229 138850 1789 137061 0 137061 135186 156250

3 0 0 0 23 0 0 50 10894 147881 1905 145976 0 145976 144726 156250

4 0 0 0 10 0 0 50 11603 157519 2029 155489 0 155489 154864 156250

5 0 0 0 0 0 0 50 12360 167799 2162 165637 0 165637 165637 165637

6 0 0 0 0 0 0 50 13167 178754 2303 176451 3750 180201 180201 180201

7 0 0 0 0 0 0 50 14324 194475 2505 191970 0 191970 191970 191970

8 0 0 0 0 0 0 50 15260 207180 2669 204511 0 204511 204511 204511

9 0 0 0 0 0 0 50 16257 220718 2843 217875 0 217875 217875 217875

10 0 0 0 0 0 0 50 17320 235145 3029 232115 5000 237115 237115 237115

11 0 0 0 0 0 0 50 18849 255915 3297 252618 0 252618 252618 252618

12 0 0 0 0 0 0 50 20082 272650 3512 269137 0 269137 269137 269137

13 0 0 0 0 0 0 50 21395 290482 3742 286741 0 286741 286741 286741

14 0 0 0 0 0 0 50 22795 309485 3987 305498 0 305498 305498 305498

15 0 0 0 0 0 0 50 24286 329734 4248 325487 6250 331737 331737 331737

16 0 0 0 0 0 0 50 26372 358059 4612 353446 0 353446 353446 353446

17 0 0 0 0 0 0 50 28098 381494 4914 376580 0 376580 376580 376580

18 0 0 0 0 0 0 50 29937 406467 5236 401231 0 401231 401231 401231

19 0 0 0 0 0 0 50 31897 433078 5579 427499 0 427499 427499 427499

20 0 0 0 0 0 0 50 33985 461435 5944 455491 7500 462991 462991 462991

21 0 0 0 0 0 0 50 36807 499748 6437 493310 0 493310 493310 493310

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 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 50 39218 532478 6859 525619 0 525619 525619 525619

23 0 0 0 0 0 0 50 41786 567355 7308 560047 0 560047 560047 560047

24 0 0 0 0 0 0 50 44523 604520 7787 596733 0 596733 596733 596733

25 0 0 0 0 0 0 50 47440 644123 8297 635826 8750 644576 644576 644576

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 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 48 0 0 50 4803 125580 1646 123934 0 123934 121456 156250

2 0 0 0 45 0 0 50 4925 128764 1687 127076 0 127076 125201 156250

3 0 0 0 43 0 0 50 5050 132033 1730 130303 0 130303 129053 156250

4 0 0 0 40 0 0 50 5178 135391 1774 133617 0 133617 132992 156250

5 0 0 0 36 0 0 50 5310 138840 1819 137021 0 137021 137021 156250

6 0 0 0 32 0 0 50 5445 142384 1866 140518 3750 144268 144268 156250

7 0 0 0 20 0 0 50 5734 149931 1965 147967 0 147967 147967 156250

8 0 0 0 14 0 0 50 5881 153784 2015 151769 0 151769 151769 156250

9 0 0 0 6 0 0 50 6032 157744 2067 155678 0 155678 155678 156250

10 0 0 0 0 0 0 50 6188 161815 2120 159695 5000 164695 164695 164695

11 0 0 0 0 0 0 50 6546 171191 2243 168948 0 168948 168948 168948

12 0 0 0 0 0 0 50 6715 175613 2301 173312 0 173312 173312 173312

13 0 0 0 0 0 0 50 6889 180150 2360 177790 0 177790 177790 177790

14 0 0 0 0 0 0 50 7067 184807 2421 182385 0 182385 182385 182385

15 0 0 0 0 0 0 50 7249 189585 2484 187100 6250 193350 193350 193350

16 0 0 0 0 0 0 50 7685 200986 2633 198352 0 198352 198352 198352

17 0 0 0 0 0 0 50 7884 206186 2702 203485 0 203485 203485 203485

18 0 0 0 0 0 0 50 8088 211523 2771 208751 0 208751 208751 208751

19 0 0 0 0 0 0 50 8297 216999 2843 214156 0 214156 214156 214156

20 0 0 0 0 0 0 50 8512 222618 2917 219701 7500 227201 227201 227201

21 0 0 0 0 0 0 50 9031 236182 3094 233088 0 233088 233088 233088

22 0 0 0 0 0 0 50 9265 242302 3175 239128 0 239128 239128 239128

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 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 50 9505 248583 3257 245326 0 245326 245326 245326

24 0 0 0 0 0 0 50 9751 255027 3341 251686 0 251686 251686 251686

25 0 0 0 0 0 0 50 10004 261640 3428 258212 8750 266962 266962 266962

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