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Annexure - For Serving Defence Personnel Only
I/We understand that the Pramerica Life Insurance Limited is relying on this information for the purpose of determining the status of the applicant named above in
compliance with FATCA/CRS. The Pramerica Life Insurance Limited is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/We shall seek advice
from professional tax advisor for any tax questions.
I/We agree that as may be required by domestic regulator/tax authorities the Pramerica Life Insurance Limited may also be required to report, reportable details to CBDT or
close or suspend my account.
Annexure - For Serving Defence Personnel Only
63. Details of Related Person: (In case additional related persons, please fill Related Person details)
Addition of related Person Deletion of Related Person KYC Number of Related Person (is available)
Related Person Type Guardian of Minor Assignee Authorized Representative
Prefix First Name Middle Name Last Name
Name
(In KYC number and name are provided, below details of section 6 are optional)
Proof of Identity [Pol] of Related Person (Please see instruction (H) at the end)
A- Passport Number Passport Expiry Date
B- Voter ID Card
C- PAN Card
D- Driving Licence Driving Licence Expiry Date
E- UID (Aadhaar)
F- NREGA Job Card
Z- Others (any document notified by the central government) Identification Number
S- Simplified Measures Account - Document Type code Identification Number
64. Remarks: (If any)
65. Address in the Jurisdiction details where applicant is resident outside India for tax purposes (Applicable if section 2 of part A is ticked)
Same as Current / Permanent / Overseas Address details Same as Correspondence / Local Address details
Line 1
Line 2
Line 3 City / Town / Village
State ZIP / Post Code ISO 3166 Country Code
66. Applicant Declaration
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein,
Immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address.
Date: Place: Signture/Thumb Impression of Applicant
67. Attestation / For Office use only
Documents Received Certified Copies
KYC Verification Carried out by Institition Details
Date Name
Emp. Name Code
Emp. Code
Emp. Designation
Emp. Branch
Institition Stamp
Employee Signature
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 materials on which such decision is based. (3) 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 material fact was true to the best of his knowledge and belief or that
there was no deliberate intention 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. (4) A policy of the 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 the 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 the 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 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 material fact, and not on the ground of fraud, the premiums collected on the policy till the date of repudiation shall be paid to the insured or legal representatives or nominees
or assignees of the insured within a period of ninety days from the date of such repudiation. Mis-statement of or suppression of 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 is entitled to do so, and no policy shall be deemed to be called
in question merely because the term of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal. Please refer to our
website or contact our office for the details under the above mentioned Section 45.

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Annexure - For Serving Defence Personnel Only

64. Remarks: (If any)

66. Applicant Declaration

Date: Place: Signture/Thumb Impression of Applicant

67. Attestation / For Office use only

Documents Received Certified Copies

KYC Verification Carried out by Institition Details

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