Transcription of PRADHAN MANTRI JEEVAN JYOTI BIMA YOJANA CONSENT …
1 PRADHANMANTRIJEEVANJYOTIBIMAYOJANACONSEN T-CUM-DECLARATIONFORM(Tobefilledinbymemb ersjoiningtheschemeduringthepermitted EnrollmentPeriod )ForOfficeUseAgent /BC sName*Agency/BCCodeNo.*BankA/cdetailsofA gent/BCSignatureofAgent/BankingCorrespon dent*I,herebygivemyconsenttobecomeamembe rof PradhanMantriJeevanJyotiBimaYojana ofLICofIndiawhichwillbeadministeredbyyou rB a n (tobepre-printed) (RupeesThreeHundredThirtyOnly) yearuntilfurtherinstructions, (Rupees threehundredthirty only)andService Taxif applicable,orany amountas decidedfromtimetotime,which maybeintimatedimmediatelyif andwhenrevised, towardsrenewal ,00,000 authorize theBank toconveymy personal details, givenbelow,asrequired, regardingmy admissioninto ,asperBank/KYCrecords.
2 NameoftheAccountholder(asperBankrecords) , ,addressandrelationship(ifany)ofnomineeN ameandaddressofGuardian(ifnomineeisminor ) , ,mymembershiptothescheme, :SignatureAddress:Signatureverified(Bran chOfficial)(RubberStampwithbankbranchnam eandcode)PRADHANMANTRIJEEVANJYOTIBIMAYOJ ANACONSENT-CUM-DECLARATIONFORM(Tobefille dinbymembersjoiningtheschemeduringtheper mitted EnrollmentPeriod )ForOfficeUseAgent /BC sName*Agency/BCCodeNo.*BankA/cdetailsofA gent/BCSignatureofAgent/BankingCorrespon dent*I,herebygivemyconsenttobecomeamembe rof PradhanMantriJeevanJyotiBimaYojana ofLICofIndiawhichwillbeadministeredbyyou rB a n (tobepre-printed) (RupeesThreeHundredThirtyOnly) yearuntilfurtherinstructions, (Rupees threehundredthirty only)andService Taxif applicable,orany amountas decidedfromtimetotime,which maybeintimatedimmediatelyif andwhenrevised, towardsrenewal ,00,000 authorize theBank toconveymy personal details, givenbelow,asrequired, regardingmy admissioninto ,asperBank/KYCrecords.
3 NameoftheAccountholder(asperBankrecords) , ,addressandrelationship(ifany)ofnomineeN ameandaddressofGuardian(ifnomineeisminor ) , ,mymembershiptothescheme, :SignatureAddress:Signatureverified(Bran chOfficial)(RubberStampwithbankbranchnam eandcode)PRADHANMANTRIJEEVANJYOTIBIMAYOJ ANACONSENT-CUM-DECLARATIONFORM(Tobefille dinbymembersjoiningtheschemeduringtheper mitted EnrollmentPeriod )ForOfficeUseAgent /BC sName*Agency/BCCodeNo.*BankA/cdetailsofA gent/BCSignatureofAgent/BankingCorrespon dent*I,herebygivemyconsenttobecomeamembe rof PradhanMantriJeevanJyotiBimaYojana ofLICofIndiawhichwillbeadministeredbyyou rB a n (tobepre-printed) (RupeesThreeHundredThirtyOnly) yearuntilfurtherinstructions, (Rupees threehundredthirty only)andService Taxif applicable,orany amountas decidedfromtimetotime,which maybeintimatedimmediatelyif andwhenrevised, towardsrenewal ,00,000 authorize theBank toconveymy personal details, givenbelow,asrequired, regardingmy admissioninto ,asperBank/KYCrecords.
4 NameoftheAccountholder(asperBankrecords) , ,addressandrelationship(ifany)ofnomineeN ameandaddressofGuardian(ifnomineeisminor ) , ,mymembershiptothescheme, :SignatureAddress:Signatureverified(Bran chOfficial)(RubberStampwithbankbranchnam eandcode)ACKNOWLEDGEMENTSLIPCUMCERTIFICA TEOFINSURANCEW eherebyacknowledgereceiptof CONSENT -cum-DeclarationForm thePradhanMantri JeevanJyotiBimaYojanawithLICofIndiaforco ver , PRADHANMANTRIJEEVANJYOTIBIMAYOJANA RULESOFTHESCHEME-SECTION IDEFINITIONSI ntheseRules,thefollowingwordsandexpressi onsshallunlessrepugnanttothecontext,have thefollowingmeanings:-i)TheMasterPolicyh oldershallbe BANK,aBodyCorporateconstitutedundertheBa nkingCompanies(A&TU)Act,1970.
5 BANK shallmean ) THECORPORATION shallmeantheLifeInsuranceCorporationofIn diaestablishedunderSection3oftheLifeInsu ranceCorporationAct, ) THESCHEME shallmean PRADHANMANTRIJEEVANJYOTIBIMAYOJANA fortheSavingsBankAccountHoldersof BANK .iv) THERULES" ) THEMEMBER ) EFFECTIVEDATE shallmean1stofJune,2015, ) ANNUALRENEWALDATE shallmean, ) ENTRYDATE shallmean01/06/2015inrespectofmembersenr olledupto31/05 ) TERMINALDATE ) THEASSURANCE shall ) THEBENEFICIARY shallmeanthepersonorpersonswhohas/havebe enappointedbytheMemberasNomineeandwhosen ameornames havebeenenteredin Bank :-Thesavingsbankaccountholderofthepartic ipatingbanksagedbetween18years(completed )and50years(agenearerbirthday)andwhohave giventheconsenttojointheschemeduringthe enrollmentperiod.
6 Satisfactoryevidenceofhealthasrequiredby theCorporationshallbefurnishedbyeveryeli giblemember,atthetimeofhisentryintotheSc heme,afterthe EnrollmentPeriod ,asincorporatedinthe CONSENT -cum-DeclarationForm :Premiumtobedeductedfrommember (ifpayable) ,00,000 :UponthedeathoftheMemberpriortoTerminalD ate,thesumassuredundertheAssuranceshallb epayabletothenominatedBeneficiary, :TheAssuranceonthelifeofaMembershallterm inateonanAnnual (agenearedbirthday) :Iftheinsurancecoverisceasedduetoanytech nicalreasonssuchasinsufficientbalancefor paymentofpremiumonduedate, :ThebenefitsassuredundertheSchemearestri ctlypersonalandcannotbeassigned, :The Bank or Corporation reservestherighttodiscontinuetheSchemeat anytimeortoamendtheRulesthereofonanyAnnu alRenewalDatesubjecttogivingonemonth Corporation and Bank.
7 ,1938asamended,theLifeInsuranceCorporati onAct,1956,theIncomeTaxAct, :The Corporationwillenterinto a Memorandumof UnderstandingwiththeBank incorporating all theAssurances affected :TheGracePeriod , :EveryMembershallnominatespouse, oneormoreofchild/children,dependants , , , ;Onreceipt ofdeathintimation,theservicingbankbranch shall sendtheClaim form(annexure7)DeathCertificate, Dischargeform(Annexure8)andCertificateof Insurance fromthenominatedBeneficiaryandshall sendtotheDesignatedBranch oftheBank ,theclaimamountwillbepaidtothebankaccoun tofthenomineewithintimationtothedesignat edbranchoftheBank(Annexure9).Incaseofreq uirementsorclaimisnotaccepted, :Therateofpremiumandconditions ofAssurance underwhich theCorporationis
