Ngles Prop Form

Annexure-III
LIFE INSURANCE CORPORATION OF INDIA

P&GS UNIT
Proposal For LIC’s New Group Leave Encashment Cash Accumulation Plan (UIN:
512N282V01)
Unit Code/ Unit Name: Proposal No:

Agents Name: Proposal
Dated: Agency Code No: License
No:
Group Master Policy No: Date of Expiry of License:
The
1. Name of the Proposer & Address
2. (a) Name of Employer:

(b) Address : (i) Head Office – name of the company—
Web site address Phone No
(ii)
3. Nature of Business
4. (a) Is the Scheme to be administered by the YES / NO

Trustees?
(b) Is the Scheme to be approved under any YES, Under Part ‘C ’ of IV Schedule of Income Tax
of the Sections of Income-Tax Act, 1961, Act 1961 / NO
If so, which?
– name of the company—
(c) The Scheme to be described as
5. (a) Do you have any existing Gratuity

Scheme with LIC? If yes, give details.
(b) If yes, do you agree to switch the existing

Gratuity Scheme into the new scheme?
(c) Does the Proposed Scheme replace any

of the existing benefits? If so, give
details.
6. a) Was a proposal for Scheme made earlier
to any other office of the Corporation?
If so, please give details.
b) Was a proposal for Scheme made
earlier to any other insurer? If so,
please give details.
7. Date of Commencement of Scheme. --date of commencement of the scheme--
8. What is the normal Retirement age? ----------years
9. Contribution:
10. Mode of payment of Contribution: Monthly /Quarterly/Half-yearly/Yearly

11. State briefly the benefits required on death
/ Withdrawal/ Vesting of the Members. As per the Rules of Scheme (copy enclosed)
“DECLARATION”
We request the Life Insurance Corporation of India to issue a Master Policy on the basis of the
information furnished by us and such further information which the Corporation may require
us to give for purpose of the Scheme referred in Column 4(c) above and to effect the necessary
assurances there under in accordance with the provisions of the Rules of the said
Scheme, certified true copy of which is attached hereto.
We propose for assurances on the lives of the members in accordance with the Rules of
the
Scheme.
We enclose the list of members on whom the assurance is to be

effected.
It is hereby declared that we undertake and bind ourselves to furnish to the Corporation full
particulars of all statements as may be necessary, declarations by the eligible employees, reports
and certificates in respect of every person on whose life the assurances are to be effected
under the Master Policy in the form and manner required by the Corporation.
We warrant the truth of the statements and particulars herein contained and agree that
this proposal together with the particulars, statements and declarations by the eligible
members or ourselves shall form the basis of the Master Policy hereby proposed on the lives of
the Members with the Life Insurance Corporation of India. We also agree that the Assurances
proposed under the Scheme shall not be binding on the Corporation until they are accepted by
the Corporation in writing and the amounts of premium due there under and demanded by the
Corporation shall have been duly paid.
We confirm the accuracy of the above particulars and agree that the Master Policy to be issued
consequent upon this proposal shall be issued only on the basis that any statements made or to
be made to the Corporation in respect of Eligible Employees intended to be assured there under
shall be true and correct in every particular and we further agree that any misstatement or
untrue averment on the basis of which the assurances have been effected on the life of any
member shall render voidable the particular assurance or assurances in respect of which the
misstatement or untrue averment by whomsoever has been made.
We agree to call for and maintain record of nominations of the members covered under the
scheme.
SECTION 45 OF INSURANCE ACT, 1938

Policy not to be called in question on grounds of misstatement after two years -
No policy of life insurance shall, after the expiry of two years from the date on which it
was
effected, be called in question by an insurer on the ground that a statement made in
the proposal for insurance or in any report of a medical officer, or referee, or friend
of the
insured, or any other document leading to the issue of the policy, was inaccurate or
false, unless the insurer shows that such statement [was on a material matter of
suppressed facts
which it was material to disclose and that it was fraudulently made] by the
policyholder and that the policyholder knew at the time of making it that the
statement was false [or
that it suppressed facts which it was material to
disclose].
[Provided that 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 life insured was incorrectly stated in the proposal.]
Note: "Material" shall mean and include all important, essential and relevant
information in the context of underwriting the risk to be covered by the Corporation.
Insurance Act 1938 under Section 41
1) 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 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 prospectus or tables of the insurer.
Provided that acceptance by an insurance agent of commission in connection
with a policy of life insurance taken out by himself on his own life shall not be
deemed to be acceptance of a rebate of premium within the meaning of this sub-
section if at the time of such acceptance the Insurance agent satisfies the
prescribed conditions establishing that he is a bonafide Insurance Agent
employed by the insurer.
2) Any person making default in complying with the provisions of this section
shall be punishable with fine which may extend to five hundred rupees.
N.B. Rebate of premiums shall be allowed only in accordance with the details given
in the prospectus or table of premium rates or, as the case may be, the relevant
document, and that an offer or acceptance of any other rebates shall be an offence under
Section 1 of the Insurance Act, 1938.
Date: (Signature on behalf of the proposer)
Place: For Self and On behalf of the Co

– name of the company
Signature of Witness
Address:
Contact Person
Phone No.
Mobile No.

Ngles Prop Form

Uploaded by

Copyright:

Available Formats

Ngles Prop Form

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ngles Prop Form

Uploaded by

Copyright:

Available Formats

Annexure-III

LIFE INSURANCE CORPORATION OF INDIA

Unit Code/ Unit Name: Proposal No:

2. (a) Name of Employer:

4. (a) Is the Scheme to be administered by the YES / NO

5. (a) Do you have any existing Gratuity

(b) If yes, do you agree to switch the existing

(c) Does the Proposed Scheme replace any

10. Mode of payment of Contribution: Monthly /Quarterly/Half-yearly/Yearly

We enclose the list of members on whom the assurance is to be

SECTION 45 OF INSURANCE ACT, 1938

Date: (Signature on behalf of the proposer)

Place: For Self and On behalf of the Co

You might also like