Bajaj Allianz Life Insurance Company Limited. Bajaj Allianz Life Bima Dhan Suraksha Yojana. Part A FORWARDING LETTER

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1 Name of e Policyholder Bajaj Allianz Life Insurance Company Limited Part A FORWARDING LETTER Dear Sub: Issuance of e Policy under application for e life insurance policy towards Regular Premium plan dated We would like to ank you for investing your fai in us. Your policy requires <<Single/Regular>> Premiums to be paid for <XX> years. Please find enclosed herewi your Policy Document, a copy of e Proposal Form and documents mentioned herein below, based on which your Insurance Policy has been issued. This Policy is issued subject to section 45 of e Insurance Act, 1938, as amended from time to time. In case you have made any disclosures to e agent which has not been included in e Proposal Form, you are requested to intimate e same in writing to e Company wiin 15 days of e date of receipt of is policy failing which it shall be inferred at e disclosures made in e Proposal Form are full, complete and according to your instructions wherein noing has been concealed. Wiin fifteen (15) of e receipt of is Policy, you have e option to review e terms and conditions of e Policy and if you disagree to any of e terms & conditions, you have an option to return e Policy stating e reasons for your objections. You shall be entitled to a refund comprising all e Regular Premium(s) (excluding applicable taxes) paid, less e proportionate amount of risk premium for e period e Life Assured was on cover and e expenses incurred by e Company on medical examination and stamp duty. For any queries kindly write to us at e below mentioned address and we assure and strive to provide you e best of services. Auorised Signatory Head- Underwriting Document Type Proposal Form Age proof Identity Proof FOR BAJAJ ALLIANZ LIFE INSURANCE COMPANY LTD. Bajaj Allianz House, Airport Road, Yerawada, Pune Your Policy Servicing Branch : Bajaj Allianz Life Insurance Company Limited Toll Free Numbers: Please read policy document, especially following clauses on Premium Proof Non-payment of premium and forfeiture, if any Specification of Documents provided Identification No. Disclaimer: In case of dispute, English version of Policy Document shall be final and binding.

2 Preamble The Company has received a Proposal Form, declaration and e first Regular Premium / Single Premium from e Policyholder / Life Assured as named in is Schedule. The said Proposal Form and declaration along wi any statement, report or oer document leading to e issue of is Policy and referred to erein having been accepted and agreed to by e Company and e Policyholder as e basis of e contract of insurance, bo parties to e assurance contract do hereby furer accept and affirm at e Policy, in consideration of and subject to due receipt of Regular Premiums as set out in e Schedule, wi all its parts (Policy Document and Endorsements, if any) shall be subject to e terms and conditions as contained in is Policy. This Policy is issued on e basis of e information given, declaration made by e Policyholder in e Proposal Form, which is incorporated herein and forms e basis of is Policy. Name of e Policyholder Pin code SCHEDULE Gender Age at Entry Date of Bir Age Name of e Life Assured Policy No. Product Name Product Code Policy Commencement Date Unique Identification No: 116N135V02 Date of Bir Date of Commencement of Risk Age Gender Policy Term Single / Regular Premium (`)* Premium Paying Term Premium Payment Frequency Due Date of Last Premium Due Dates of Premium Age Sum Assured (`) Sum Assured on Dea Dea Benefit Extra Premium Maturity Date Maturity Benefit As Per Part B below Sum Assured on Dea * Regular Premium, Single Premium Annualised Premium will exclude any extra premium, GST. Details of e Nominee Nominee(s) Name Nominee(s) Age years Relationship to e Life Assured Appointee Name [in case e Nominee(s) is (are) a minor(s)]: Relationship to e Life Assured

3 Sales Representative Details Name Phone Number Code Id TOTAL PREMIUM PAYABLE FOR SELECTED PREMIUM PAYMENT FREQUENCY: Rs. In Words: Rupees.Only If any of e information given above is incorrect, we request you to kindly send back e whole set-of documents to e Company citing e error/mistake. To whom e Benefits are Payable: The Benefits are payable to e Claimant. The Policy shall be subject to and governed by e terms of e Policy Document along wi e Schedule contained herein and endorsements if any, made from time to time and all ese shall togeer form a single agreement All taxes, including GST, eier existing or ose at may apply in future (including enhancements of existing taxes) will be charged extra. Payment of such taxes shall be e responsibility of e Policyholder. Bajaj Allianz Life Insurance Company does not provide any warranty or assurance at e Policyholder will be, by virtue of purchasing is Policy, eligible for any income tax or oer tax rebate or relief. Signed on behalf of Bajaj Allianz Life Insurance Company Limited for Policy No. `

4 Part B DEFINITIONS & ABBREVIATIONS This Policy is issued on e basis of e information given and declaration made by e Policyholder in e Proposal Form, which is incorporated herein and forms e basis of is Policy. The following terms shall have e meaning assigned to em below. The singular includes e plural, and references to e male include e female, where e context so permits. 1) Definitions & Abbreviations: a. Age means age as at last birday. b. Annualised Premium means e total amount of Regular Premiums payable in a Policy Year. In is calculation any Extra premium or applicable taxes are excluded. c. Business Day is e common working day of e Corporate Office of e Company. d. Claimant means e Life Assure (if alive) or Policyholder (if different from e Life Assured) or e assignee or e Nominee or e legal heirs of Policyholder/Nominee(s) to whom e Policy Benefit will be payable e. Company refers to BAJAJ ALLIANZ LIFE INSURANCE COMPANY LIMITED. f. Date of Commencement of Risk means e date specified in e Schedule (unless e Policyholder is informed oerwise by e Company in writing) from which e risk cover of e Life Assured commences under e Policy. g. Dea Benefit is e benefit payable on e dea of e Life Assured. The details are as given in Section 4a) below. h. Extra Premium means additional premium charged wi your consent for acceptance of proposal on e basis of underwriting done by e Company based on its prevailing Board approved underwriting norms. i. Financial Year means e year starting from 1st April of a year and ending on 31st March of e subsequent year. j. Goods and Service Tax is charged based on type of policy communication address of Policy Holder. This may change subject to change in rate/state in address of e Policy Holder as on date of adjustment. k. Grace Period means a period of fifteen (15) days for a monly Premium Payment Frequency and irty (30) days for oer an monly Premium Payment Frequency, from e due date of e Regular Premium payment. l. GST means Goods and Service Tax. m. IRDAI means e Insurance Regulatory and Development Auority of India. n. Life Assured means e person named as e Life Assured in e Schedule whose life is assured under is Policy. o. Maturity Benefit is e benefit payable on e Maturity Date. The details are as given in Section 4b) below. p. Maturity Date means e date specified in e Schedule on which e Maturity Benefit as per Section 4b) below shall become payable to e Policyholder q. Nominee means e person specified in e Schedule who has been nominated in writing to e Company by e Policyholder or any subsequent change made by e Policyholder by submitting e request to e Company, who is entitled to receive e Dea Benefits under e Policy as mentioned in Section 4a) below. r. Paid-up Sum Assured on Maturity is 100% of total Single Premium or Regular Premiums paid under e Policy. s. Paid-up Sum Assured on Dea is e reduced value of e Sum Assured on Dea arrived at by multiplying e Sum Assured on Dea wi e proportion of e number of Regular Premiums paid to e total number of Regular Premiums payable under e Policy, subject to a minimum of 100% of total Single Premium or Regular Premiums paid under e Policy. t. Policy means e arrangements established by e Policy Document. u. Policy Anniversary means e date corresponding numerically wi e Policy Commencement Date in each subsequent year during e Policy Term. v. Policy Commencement Date means e date of commencement of e Policy as specified in e Schedule. w. Policy Document means is Policy wording e Schedule (which is attached to and forms part of is Policy and includes any Annexure or endorsement to it and, if more an one, en, e latest in time) and e Proposal Form. x. Policyholder means e adult person named in e Schedule who has concluded e Policy wi e Company. y. Policy Term means e period between e Policy Commencement Date and e Maturity Date, as specified in e Schedule. z. Policy Year means e year commencing on e Policy Commencement Date or a Policy Anniversary ereof. aa. bb. cc. dd. ee. ff. gg. Premium Paying Term means e period specified in e Schedule during which e Regular Premium is Premium Payment Frequency is a regular time interval as specified in e Schedule, at which e Regular Premium is payable during e Premium Paying Term or as altered in accordance wi Section 10 below. Proposal Form means e Policyholder s statements in e proposal for is Policy submitted by or on behalf of e Policyholder along wi any oer information or documentation provided to e Company prior to inception. Regular Premium means e amount exclusive of extra premium and applicable taxes, if any, payable by e Policyholder at regular intervals during e Premium Paying Term, in amount and at e Premium Payment Frequency, bo, as specified in e Schedule. Revival period means a period of two (2) years from e due date of first unpaid Regular Premium, during which a lapsed or paid-up Policy can be revived by e Policyholder, as mentioned in Section 7 below. Sum Assured is e amount as specified in e Schedule under e Policy. Sum Assured on Dea is e amount as specified in e Schedule under e Policy and is e higher of: For Regular Premium: The higher of (i) sum assured, ( 5 or 10 times of Annualized Premium (for PT < 10 years or for PT = 10 years respectively) or (i 105% of total Regular Premiums paid or (iv) minimum guaranteed sum assured on maturity~ or (v) any absolute amount assured to be paid on dea~ For Single Premium: The higher of (i) sum assured, ( 125% or 110% of Single Premium paid (for Age < 45 years or for Age>= 45 years respectively) or (i minimum guaranteed sum assured on maturity~ or (iv) any absolute amount assured to be paid on dea~. hh. ~The absolute amount assured to be paid on dea and e minimum guaranteed benefit to be paid on maturity (bo as per e NLIP Regulations, 2013) are e sum assured and e return of total premiums* paid respectively. Surrender Benefit means e benefit, if any, payable on e surrender of e Policy. The details are as given in Section 9 below. 2) Policy Description Part C a) This is a non-linked, non-participating, Single/Regular Premium micro term assurance product wi return of Single Premium / Regular Premiums at maturity. b) The plan provides Dea Benefit, Maturity Benefit and Surrender Benefit. c) The Policy does not in any way confer any right whatsoever on e Policyholder to oerwise share in e profits or surplus of e business of e Company. d) The total sum assured allowed on a single life assured taken under Bajaj Allianz Life Bima Dhan Suraksha Yojana cannot exceed of ` 2,00,000. 3) Premium a) Regular Premium, including applicable taxes, is payable in full on e due dates of premium specified in e Schedule or wiin e Grace Period allowed, during e Policy Term. b) The Company does not have any obligation to issue a notice at Regular Premium is due or for e amount at is due. c) The Company will not accept any amount less an e Premium along wi applicable taxes, if any, due as e Premium. d) Where e Premium along wi applicable taxes, if any, in full has not been paid even wiin e Grace Period, e Policy shall be subject to e Nonpayment of Premium and Forfeiture condition(s) as per Section 6 below. e) Single Premium under e Policy is as mentioned in e Schedule 4) Policy Benefits a) Dea Benefit i) On e dea of e Life Assured before e Maturity Date, e Company, subject to Section 10, Section 11, Section 12 and Section 23 below, provided e Policy has not been terminated as per Section 16 below, shall pay e following benefit to e Claimant. (1) If e policy is in-force as on e date of dea and, as applicable, all e due

5 Regular Premiums have been paid in full, Sum Assured on Dea shall be (2) If e Policy is a paid-up [as per Section 6b) below], Paid-up Sum Assured on Dea subject to a minimum of 100% of total premiums paid under e policy shall be (3) If e Policy is lapsed [as per Section 6a) below], no dea benefit shall be The policy will terminate immediately on intimation of e dea of e Life Assured. b) Maturity Benefit On e Maturity Date, provided e Policy has not been terminated per Section 16 below, e Company shall pay e following benefit to e Policyholder. i) If, as applicable, all e due Regular Premiums have been paid in full, 100% of Single Premium or total Regular Premiums paid under e Policy shall be i iv) If e Policy is a paid-up [as per Section 6b) below] as on e Maturity Date, 100% of Single Premium or total Regular Premiums paid under e Policy shall be If e Policy is lapsed as e Regular Premiums due during e first Policy Year are not paid as on e Maturity Date, no maturity benefit shall be payable under e Policy. The policy will terminate on e Maturity Date. 5) Free Look Period Part D Wiin fifteen (15) of e receipt of is Policy, e Policyholder has e option to review e terms and conditions of e Policy and if e Policyholder disagrees to any of e terms & conditions, he has an option to return e Policy stating e reasons for his objections. The Policyholder shall be entitled to a refund comprising all Premiums (excluding applicable taxes) paid, less e proportionate amount of risk premium for e period e Life Assured was on cover and e expenses incurred by e Company on medical examination and stamp duty. 6) Non payment of Premium and Forfeiture If a Regular Premium due under e Policy has not been paid in full before e expiry of e Grace Period, e Policy will be subject to e below mentioned conditions. a) If e Regular Premiums due during e first Policy Year are not paid, e Policy shall, immediately & automatically lapse and no benefit under e Policy will be b) If e Regular Premiums due during e first Policy Year are paid, but subsequent Regular Premiums are not paid, e Policy will immediately and automatically be converted to a paid-up on e expiry of e Grace Period. The Dea Benefits payable under e Policy will be reduced to e Paid-up Sum Assured on Dea. c) The Policyholder may revive e lapsed or paid up policy during e revival period of two (2) years from e due date of first unpaid Regular Premium, subject to e conditions per Section 7 below. 7) Revival a) If e Policy is lapsed or has become paid-up [as per Section 6 above] due to non-payment of due Regular Premium, e Policy can be revived by e Policyholder anytime during e Revival Period, subject to e conditions mentioned below: i) The application for revival is received wiin e Revival Period. i iv) The arrears of Regular Premiums togeer wi interest (as decided by e Company) along wi applicable taxes are paid. The Policyholder furnishes, at his own expense, satisfactory evidence (as decided by e Company) on heal of e Life Assured and continuity of insurability. The revival of e Policy may be on terms different from ose applicable to e Policy before it was lapsed/became paid-up, based on e prevailing Board approved underwriting norms of e Company. The Company may refuse to revive e Policy (based on e prevailing Board approved underwriting norms of e Company), and refund e amount deposited for e purposes of revival of e Policy. v) The revival of e Policy will take effect only on it being specifically communicated by e Company to e Policyholder. b) On revival, e Sum Assured on Dea under e Policy, which prevailed before e date of latest lapse/paid-up will be reinstated subject to Sub- Section a)i Sub-Section a)iv) above. 8) Foreclosure If loan has been taken under e Policy and e Policy is paid-up [as mentioned in Section 7a) above] and if at any time e loan outstanding plus interest-onloan exceeds e Surrender Benefit available en under e Policy, e Policy will be immediately and automatically foreclosed after sufficient notice [as mentioned in Section 10e) below] and no furer benefits will be available under e Policy. 9) Surrender Benefit (a) Provided e Policy has not already been terminated as per Section 16 below, e Policy will acquire Surrender Benefit and can be surrendered by e Policyholder at any time, provided. i) Regular Premium have been paid for at least first full Policy Year (b) For a Single Premium Policy, surrender is allowed anytime after e premium is paid. The Surrender Benefit payable is e higher of Special Surrender Value (SSV) or Guaranteed Surrender Value (GSV). (c) sd The GSV factor is equal to a proportion (as per e table below based on e Policy Surrender Year) of Regular Premiums / Single Premium paid. GSV factors are guaranteed roughout e Policy Term. Policy Percentage of e total Percentage of e Surrender Regular Premium paid Single Premium paid for: Year PT = PT = PT = PT = PT = PT = 5 years 7 years 10 years 5 years 7 years 10 years 1 15% 15% 15% 70% 70% 70% 2 30% 30% 30% 70% 70% 70% 3 30% 30% 30% 80% 75% 70% 4 90% 50% 50% 90% 90% 90% 5 90% 70% 50% 90% 90% 90% 6 NA 90% 50% NA 90% 90% 7 NA 90% 60% NA 90% 90% 8 NA NA 80% NA NA 90% 9 NA NA 90% NA NA 90% 10 NA NA 90% NA NA 90% (d) The SSV factor is equal to a proportion (as given in Annexure 1) of Regular Premiums / Single Premium paid. SSV factors are not guaranteed and e Company may revise e factors from time-to-time, subject to IRDAI approval. (e) The risk cover will terminate on date of surrender and e policy will terminate on e date of payment of surrender benefit. 10) Flexibilities: Alteration of Premium Payment Frequency The Premium Payment Frequency may be changed at any Policy Anniversary during e Premium Paying Term, subject to minimum Regular Premium allowed wi respect to each Premium Payment Frequency under e plan. 11) Policy Loans The Policy holder can take loan under e Policy, provided e Policy has acquired Surrender Benefit. a) The maximum amount of loan will be equal to 70% of e amount of Surrender Benefit available as on e date of loan. b) The loan rate of interest applicable on e loan amount will be decided by e Company from time to time. c) The Policyholder can repay part or full amount of loan and/or loan interest at any time during e Policy Term. d) If dea, surrender or maturity takes place during e subsistence of loan, en, any loan and/or loan-interest outstanding as at e date of dea, surrender or at e Maturity Date (as applicable) will be recovered from e Dea Benefit, Surrender Benefit or Maturity Benefit, as applicable. e) Notwistanding what has been mentioned in Sub-Section c) above, any time during e Policy Term, if e outstanding loan plus loan interest exceeds e Surrender Benefit available under e Policy as on at date, e Policyholder will be informed of e same wi a 30-days advance notice for payment of interest-due and/or full/part repayment.

6 f) Subject to Sub-Section e) above, if under a Policy at is paid-up [as per Section 6b) above], e full or part of e loan and/or loan interest is not repaid wiin e above mentioned notice period, e Policy will be foreclosed, automatically and immediately, by adjusting e amount of Surrender Benefit to e outstanding loan plus loan-interest, wiout any requirement of furer notice to e Policyholder and no benefits under e Policy will be Part E CHARGES, FUND OPTIONS, PORTFOLIO STRATEGIES, Etc Not Applicable Part F General Conditions 12) Suicide Exclusions If e Life Assured commits suicide wheer sane or insane, wiin one (1) year from e Date of Commencement of Risk or e date of e latest revival of e Policy, e Company s liability shall be limited to e extent of e amount mentioned below. If e dea due to suicide is wiin one (1) year From e Date of Commencement of Risk, e amount payable will be 80% of e Regular Premiums paid OR From e date of e latest revival, e amount payable will be e higher of 80% of e Regular Premiums paid and Surrender Benefit as on e date of dea. Any outstanding loan and loan interest will be deducted from e benefit 13) Age Proof a) The Regular Premium payable under e Policy is calculated on e basis of e Life Assured s Age and gender as declared in e Proposal Form. If e Life Assured s Age has not been admitted by e Company, e Policyholder shall furnish such proof of e Life Assured s Age as is acceptable to e Company and have e Age admitted. b) If e Age so admitted (e correct Age ) is found to be different from e Age declared in e Proposal Form, en, wiout prejudice to e Company s oer rights and remedies including ose under e Insurance Act 1938, e following actions shall be taken: i) If e correct Age is such as would have made e Life Assured uninsurable under is Policy, e plan of assurance shall stand altered to such plan of assurance as is generally granted by e Company for e Life Assured s correct Age, which will be subject to e terms and conditions as are applicable to at plan of assurance. If it is not possible to grant any oer plan of assurance, e Policy shall stand terminated wi immediate effect and e Company shall make payment of a refund comprising e all Regular Premiums (excluding applicable taxes) paid, less e proportionate amount of risk premium for e period e Life Assured was on cover and e expenses incurred by e Company on medical examination and stamp duty expense. If e Life Assured s correct Age is higher an e Age declared in e Proposal Form, e Regular Premium payable under e Policy shall be altered corresponding to e correct Age of e Life Assured and e accumulated difference between e corrected Regular Premium and e original Regular Premium from e Policy Commencement Date up to e date of such alteration shall be collected from e Policyholder. If e Policyholder disagrees to pay e same, e Policy will be terminated wi immediate effect by e Company and e Company shall make payment of a refund comprising e all Regular Premiums (excluding applicable taxes) paid, less e proportionate amount of risk premium for e period e Life Assured was on cover and e expenses incurred by e Company on medical examination i and stamp duty expense. If e Life Assured s correct Age is lower an e Age declared in e Proposal Form, e Regular Premium payable under e Policy shall be altered corresponding to e correct Age of e Life Assured from e next due date of Regular Premium. The Company shall refund of e excess premium received (which is e total of e difference between e original Regular Premium and e corrected Regular Premium from e Policy Commencement Date up to e date of such alteration). 14) Assignment Assignment should be in accordance wi provisions of section 38 of e Insurance Act 1938 as amended from time to time. [A Leaflet containing e simplified version of e provisions of section 38 is enclosed in Annexure AA for reference] 15) Nomination Nomination should be in accordance wi provisions of section 39 of e Insurance Act 1938 as amended from time to time. [A Leaflet containing e simplified version of e provisions of section 39 is enclosed in Annexure BB for reference] 16) Termination Conditions This Policy shall immediately and automatically terminate on e earliest occurrence of any of e following events: i) On e date of payment of surrender benefit; On e expiry of e revival period of 2 years from e date of first unpaid Regular Premium, if at least one (1) Policy Years Regular Premiums are not paid under e Policy. i On foreclosure, if at any time, if e Policy is paid-up, e outstanding loan plus loan interest exceeds e Surrender Benefit available under e Policy and no payment is made even on e expiry of e notice as mentioned in Section 11f) above. iv) On e dea of e Life Assured. v) On e Maturity Date. 17) Fraud Misrepresentation and forfeiture Fraud, Misrepresentation and forfeiture would be dealt wi in accordance wi provisions of section 45 of e Insurance Act 1938 as amended from time to time. [A Leaflet containing e simplified version of e provisions of section 45 is enclosed in Annexure CC for reference] 18) Notices Any notice, direction or instruction to be given under is Policy shall be in writing and delivered by hand, post, facsimile or to: a. The Policyholder/Life Assured: i) Shall be sent eier by hand, post, courier, facsimile, Short Messaging Service (SMS), Voice call, or rough any oer digital/electronic media to e Policyholder to e address or communication/ correspondence details specified by e Policyholder in e Enrollment/Proposal Form or as per subsequent most recent change of address and/or communication/ correspondence details intimation submitted by em to e Company. The Company shall not be responsible for any consequences arising out of non-intimation of change of e Policyholder s/life Assured s address and/or communication/correspondence details. In case e notice comes back to e Company undelivered to e Policyholder/Life Assured due to any reason, ere shall be no obligation upon e Company to make any attempt again towards dispatch of e notice which was returned undelivered. b. The Company, shall be submitted by hand, post, facsimile or Bajaj Allianz Life Insurance Company, Bajaj Allianz House, Airport Road, Yerawada, Pune Toll Free No Fax: customercare@bajajallianz.co.in The Policyholder must ensure at he keeps e Company informed if ere is a change of address and contact details. This will enable e Policyholder to receive regular updates, and communication from time to time and facilitate efficient and timely payouts by e Company of e benefits under e Policy. 19) Electronic Transactions Subject to Section 18 above, e Policyholder agrees to adhere to and comply wi all such terms and conditions as e Company may prescribe from time to time wi regard to all transactions and hereby agrees and confirms at all transactions (oer an ose requiring a written notice or communication under is Policy) effected by or rough facilities for conducting remote transactions including e Internet, World Wide Web, electronic data interchange, call centres, tele-service operations (wheer voice, video, data or combination ereof) or by means of electronic, computer, automated machines network or rough oer means of telecommunication, established by or on behalf of e Company, for and in respect of e Policy or its terms, or e Company s oer products and services, shall constitute legally binding and valid transactions when done in adherence to and in compliance wi e Company s terms and conditions for such facilities, as may be prescribed from time to time. 20) Currency All amounts payable eier to or by e Company shall be payable in India and in Indian Currency. 21) Waiver Failure or neglect by eier party to enforce at anytime e provisions of is Policy shall not be construed or be deemed to be a waiver of eier party s right herein nor in anyway affect e validity of e whole or any part of is Policy nor prejudice eier party s right to take subsequent action. 22) Modifications This Policy Document constitutes e complete contract of insurance. This Policy Document cannot be changed or varied except by an endorsement to e Policy, in writing and signed by an officer of e Company auorized for e purpose. 23) Payment of Claim

7 The Company shall be under no obligation to make any payment under Section 4a) above unless and until e Company has received from e Claimant any information and documentation it requests, including but not limited to: i) Written notice as soon as possible and preferably wiin 180 days of e dea of e Life Assured, and e circumstances resulting to e dea of e Life Assured. The Claimant s proof of entitlement to receive payment under e Policy. i Original Policy Document. iv) Original dea certificate of e Life Assured issued by a competent auority. v) Medical cause of dea certificate from e doctor who last attended to e Life Assured or from e hospital in which e dea occurred. vi) If e dea is due to unnatural causes; a copy of First Information Report (FIR) and Post Mortem Report (PMR). v Any oer document as asked for by e Company depending on e facts and vi circumstances of each case. Wiout Prejudice to e right of e Company to insist for any of e documents as mentioned herein above to examine e admissibility of claim for e benefits under e policy of insurance, e Company may at its sole discretion, consider claims where e claimant is unable to submit required documents. 24) Loss of Policy Document a) If e Policy Document is lost or destroyed, en subject to Sub Section c) below, at e request of e Policyholder, e Company, if satisfied at e Policy Document has been lost or destroyed, will issue a copy of e Policy Document duly endorsed to show at it is issued following e loss or destruction of e original document. The Company will charge a fee for e issuance of a copy of e Policy Document. b) Upon e issue of a copy of e Policy Document, e original Policy Document will cease to have any legal effect. c) The Company reserves e right to make such investigations into and call for such evidence of e loss or destruction of e Policy Document at e expense of e Policyholder, as it considers necessary before issuing a copy of e Policy Document. d) It is hereby understood and agreed at e Policyholder will protect e Company and hold e Company harmless from and against any claims, costs, expenses, awards or judgments arising out of or howsoever connected wi e original Policy Document or arising out of e issuance of a copy of e Policy Document. 25) Governing Law Any and all disputes arising out of and under is Policy shall be governed by and determined in accordance wi Indian law and by e Indian Courts. 26) Taxation Payment of taxes, including GST, as applicable, shall be e responsibility of e Policyholder. The Policyholder agrees to pay or allows e Company to deduct/charge from any of e benefits payable or premium received under is Policy, a sum on account of any tax or oer payment which may be imposed by any legislation, order, regulation or oerwise, upon e Company, Policyholder or any oer beneficiary, which in e opinion of e Company is necessary and appropriate. 27) Status of Insurance Agent The insurance agent is only auorized by e Company to arrange completion and submission of e Proposal Form. The insurance agent is not auorized to act as e Company s legal representative and any representation made by e insurance agent, which is against e express terms and conditions as contained in is Policy shall not be binding on e Company. Information or payment given to e insurance agent should not be considered as having been given to e Company. Any specific information given to e insurance agent at e time of solicitation of insurance business or negotiating e Policy and not incorporated in e Proposal Form on e basis of which is Policy has been issued, shall be deemed to have been concealed from e Company knowingly and deliberately by e Policyholder. In absence of any specific auorisation to an insurance agent to accept premium on behalf of e Company and issue receipt ereof, payment made to an insurance agent shall be considered from e date of receipt of e premium amount by e Company. In e event of happening of any eventuality between e date of payment of premium amount to e insurance agent and e date of receipt of e premium amount by e Company, same shall be considered in accordance wi e terms and conditions as contained herein above as if e premium was not paid as on e date of happening of e eventuality. PART G 28) Grievance Redressal In case you have any query or compliant/grievance, you may contact e Grievance Officer of any nearest Customer Care Center at Branch Office of e Company during e Company s office hours from 9 am to 6 pm. Alternatively, you may communicate wi e Company: By post at: Customer Care Desk, Bajaj Allianz Life Insurance Company Ltd., Bajaj Allianz House, Airport Road, Yerawada, Pune By Phone at: Toll Free No By Fax at: By customercare@bajajallianz.co.in In case you are not satisfied wi e resolution provided to you by e above office, or have not received any response wiin 10 days, or you have any suggestion in respect of is Policy or on e functioning of e office, you may contact e following official for resolution: Grievance Redressal Officer, Bajaj Allianz Life Insurance Company Ltd. 3rd Floor, Bajaj Finserv, Survey No: 208/1-B, Behind Weik Field IT Park, Viman Nagar, Pune Tel. No: Fax: (+91 20) ID: customercare@bajajallianz.co.in If Policyholder is not satisfied wi e response or does not receive a response from e Company wiin fifteen (15) days, he may approach e IRDAI Grievance Cell Centre (IGCC) on e following contact details: By Phone: TOLL FREE NO: By complaints@irda.gov.in By post at: Consumer Affairs Department Insurance Regulatory and Development Auority of India Survey no. 115/1, Financial District, Nanakramguda, Hyderabad By Fax at: The Policyholder can also register his complaint online at 29) Ombudsman a) In case you are not satisfied wi e decision/resolution of e Company, you may approach e Insurance Ombudsman if your grievance pertains to any of e following: i) Insurance claim at has been rejected or dispute of a claim on legal construction of e Policy Delay in settlement of claim i Dispute wi regard to premium iv) Non-receipt of your insurance document b) The address of e Insurance Ombudsman is provided as & Contact Details of Ombudsmen Centres attached herewi. For e latest list of insurance ombudsman, please refer to e IRDAI website at c) The complaint should be made in writing and duly signed by e complainant or by his legal heirs wi full details of e complaint and e contact information of complainant. d) Also please note at as per provision 13(3) of e Redressal of Public Grievances Rules 1998, e complaint to e Ombudsman can be made i) Only if e grievance has been rejected by e grievance redressal mechanism of e Company. The complaint should be filed wiin a period of one year from e date of rejection by e Company. i The complaint should not be simultaneously under any litigation. Annexure I Special Surrender Value (SSV) Factors Policy Percentage of e total Percentage of e Surrender Regular Premium paid Single Premium paid for: Year PT = PT = PT = PT = PT = PT = 5years 7 years 10 years 5years 7 years 10 years 1 15% 15% 15% 70% 70% 50% 2 70% 40% 25% 80% 70% 55% 3 80% 55% 25% 85% 75% 60% 4 90% 70% 35% 90% 80% 65% 5 95% 80% 40% 95% 85% 70% 6 NA 90% 55% NA 90% 75% 7 NA 95% 70% NA 95% 80% 8 NA NA 80% NA NA 85% 9 NA NA 90% NA NA 90% 10 NA NA 95% NA NA 95%

8 & Contact Details of Ombudsman Centres In case you have any grievance, you may approach e Company Grievance Cell. In case you are not satisfied wi e decision/resolution of e Company or if your complaint is not resolved/ not satisfied/not responded for 30 days, you may approach e Office of Insurance Ombudsman, in line wi e details provided hereinabove in e policy document, at e addresses given below: AHMEDABAD BENGALURU BHOPAL BHUBANESHWAR CHANDIGARH CHENNAI DELHI GUWAHATI HYDERABAD Office of e Insurance Ombudsman,6 Floor, Jeevan Prakash Bldg.,Tilak Marg, Relief Road, Ahmedabad Tel no s: /02/05/06, bimalokpal.ahmedabad@ecoi.co.in. Office of e Insurance Ombudsman, Jeevan Soudha Building, PID No N-19 Ground Floor, 19/19, 24 st Main Road, JP Nagar, 1 Phase, Bengaluru , Tel.: / , bimalokpal.bengaluru@ecoi.co.in. nd Office of e Insurance Ombudsman, Janak Vihar Complex, 2 Floor, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal , Tel.: / Fax: , bimalokpal.bhopal@ecoi.co.in. Office of e Insurance Ombudsman,62, Forest park, Bhubaneshwar , Tel.: / Fax: , bimalokpal.bhubaneswar@ecoi.co.in. nd Office of e Insurance Ombudsman, S.C.O.No.101,102 & 103, 2 Floor, Batra Building, Sector 17 D, Chandigarh ,Tel.: / Fax: , bimalokpal.chandigarh@ecoi.co.in. Gujarat, Dadra & Nagar Haveli, Daman and Diu Karnataka Madhya Pradesh, Chhattisgarh Orissa Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir, Chandigarh Office of e Insurance Ombudsman, Fatima Akhtar Court, 4 Floor, 453 (old 312), Anna Salai, Teynampet, Tamil Nadu, Pondicherry Town and Karaikal CHENNAI , Tel.: / Fax: , bimalokpal.chennai@ecoi.co.in. (Which are part of Pondicherry) Office of e Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi Delhi Tel.: / Fax: , bimalokpal.delhi@ecoi.co.in. Office of e Insurance Ombudsman, Jeevan Nivesh, 5 Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati Assam, Meghalaya, Manipur, Mizoram, Arunachal (ASSAM), Tel.: / Fax: , bimalokpal.guwahati@ecoi.co.in. Pradesh, Nagaland and Tripura st Office of e Insurance Ombudsman, , 1 floor, "Moin Court", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad , Tel.: / Fax: , bimalokpal.hyderabad@ecoi.co.in. JAIPUR Office of e Insurance Ombudsman, Jeevan Nidhi II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur Tel.: , bimalokpal.jaipur@ecoi.co.in. Andhra Pradesh, Telangana, Yanam and part of Territory of Pondicherry Rajasan ERNAKULAM KOLKATA MUMBAI PUNE PATNA LUCKNOW nd Office of e Insurance Ombudsman, CC 22/ Floor, Pulinat Bldg.,Opp. Cochin Shipyard, M.G.Road, Kerala, Lakshadweep, Mahe -a part of Ernakulam , Tel.: / Fax: , bimalokpal.ernakulam@ecoi.co.in. Pondicherry Office of e Insurance Ombudsman, Hindustan Bldg. Annexe, 4 Floor, 4, C.R. Avenue, KOLKATA , West Bengal, Bihar, Sikkim, Jharkhand Andaman Tel.: / , Fax : , bimalokpal.kolkata@ecoi.co.in. & Nicobar Islands rd Office of e Insurance Ombudsman, 3 Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai , Tel.: / , Fax: , bimalokpal.mumbai@ecoi.co.in. nd Office of e Insurance Ombudsman, Jeevan Darshan Bldg., 2 Floor, C.T.S. No.s. 195 to 198,N.C. Kelkar Road, Narayan Pe, Pune , Tel.: , bimalokpal.pune@ecoi.co.in. st Office of e Insurance Ombudsman, 1 Floor, Kalpana Arcade Building, Bazar Samiti, Road, Bahadurpur, PATNA , Tel No: , bimalokpal.patna@ecoi.co.in. Office of e Insurance Ombudsman, 6 Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow , Tel.: / Fax: , bimalokpal.lucknow@ecoi.co.in. Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane Maharashtra, Area of Navi Mumbai and Thane, excluding Mumbai Metropolitan Region Bihar Districts of Uttar Pradesh: Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur, Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amei, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharanagar NOIDA Office of e Insurance Ombudsman, 4 Floor, Bhagwan Sahai Palace, Main Road, Naya Bans, Sector 15, NOIDA , Tel: /51/53, bimalokpal.noida@ecoi.co.in. State of Uttaranchal and e following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Maura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Haras, Kanshiramnagar, Saharanpur Annexure Ver. 2.1 (072017)

9 Annexure AA Section 38 of Insurance Act, 1938, as amended from time to time Assignment and Transfer of Insurance Policies Assignment or transfer of a Policy should be in accordance wi section 38 of e Insurance Act, 1938, as amended by The Insurance Laws (Amendment) Act, 2015 dated The extant provisions in is regard are as follows: 1. This Policy may be transferred / assigned, wholly or in part, wi or wiout consideration. 2. An assignment may be effected in a Policy by an endorsement upon e Policy itself or by a separate instrument under notice to e Company. 3. The instrument of assignment should indicate e fact of transfer or assignment and e reasons for e assignment or transfer, antecedents of e assignee and terms on which assignment is made. 4. The assignment must be signed by e transferor or assignor or duly auorized agent and attested by at least one witness. 5. The transfer of assignment shall not be operative as against e Company until a notice in writing of e transfer or assignment and eier e said endorsement or instrument itself or copy ere of certified to be correct by bo transferor and transferee or eir duly auorized agents have been delivered to e Company. 6. Fee to be paid for assignment or transfer can be specified by e IRDAI rough Regulations. 7. On receipt of notice wi fee, e insurer should Grant a written acknowledgement of receipt of notice. Such notice shall be conclusive evidence against e Company of duly receiving e notice. 8. If e Company maintains one or more places of business, such notices shall be delivered only at e place where e Policy is being serviced. 9. The Company may accept or decline to act upon any transfer or assignment or endorsement, if it has sufficient reasons to believe at it is (a) not bona-fide or (b) not in e interest of e Policyholder / Life Assured or (c) not in public interest or (d) is for e purpose of trading of e Policy. 10. Before refusing to act upon endorsement, e Company should record e reasons in writing and communicate e same in writing to Policyholder wiin 30 days from e date of Policyholder giving a notice of transfer or assignment. 11. In case of refusal to act upon e endorsement by e Company, any person aggrieved by e refusal may prefer a claim to IRDAI wiin 30 days of receipt of e refusal letter from e Company. 12. The priority of claims of persons interested in e Policy would depend on e date on which e notices of assignment or transfer is delivered to e Company; where ere are more an one instruments of transfer or assignment, e priority will depend on dates of delivery of such notices. Any dispute in is regard as to priority should be referred to IRDAI. 13. Every assignment or transfer shall be deemed to be absolute assignment or transfer and e assignee or transferee shall be deemed to be absolute assignee or transferee, except a. where assignment or transfer is subject to terms and conditions of transfer or assignment OR b. where e transfer or assignment is made upon condition at i. e proceeds under e Policy shall become payable to Policyholder or Nominee(s) in e event of assignee or transferee dying before e Life Assured OR ii. e Life Assured surviving e Policy Term. Such conditional assignee will not be entitled to obtain a loan on Policy or surrender e Policy. This provision will prevail notwistanding any law or custom having force of law which is contrary to e above position. 14. In oer cases, e Company shall, subject to terms and conditions of assignment, recognize e transferee or assignee named in e notice as e absolute transferee or assignee and such person a. shall be subject to all liabilities and equities to which e transferor or assignor was subject to at e date of transfer or assignment and b. may institute any proceedings in relation to e Policy c. obtain loan under e Policy or surrender e Policy wiout obtaining e consent of e transferor or assignor or making him a party to e proceedings 15. Any rights and remedies of an assignee or transferee of e Policy under an assignment or transfer effected before commencement of The Insurance Laws (Amendment) Act, 2015 shall not be affected by is section. [Disclaimer: Section 38 of e Insurance Act, 1938, as amended from time to time shall be applicable. Policy Holders are advised to refer to Original text of Section 38 as amended from time to time for complete and accurate details. ] Annexure BB Section 39 of e Insurance Act, 1938, as amended from time to time Nomination by Policyholder Nomination of a life insurance Policy is as below in accordance wi Section 39 of e Insurance Act, 1938, as amended by The Insurance Laws (Amendment) Act, 2015 dated The extant provisions in is regard are as follows: 1. The Policyholder of a life insurance Policy on his own life may nominate a person or persons to whom money secured by e Policy shall be paid in e event of his dea. 2. Where e Nominee is a minor, e Policyholder may appoint any person to receive e money secured by e policy in e event of Policyholder s dea during e minority of e Nominee. The manner of appointment to be laid down by e Company. 3. Nomination can be made at any time before e maturity of e Policy. 4. Nomination may be incorporated in e text of e Policy itself or may be endorsed on e Policy communicated to e Company and can be registered by e Company in e records relating to e Policy. 5. Nomination can be cancelled or changed at any time before Policy matures, by an endorsement or a furer endorsement or a will as e case may be. 6. A notice in writing of change or cancellation of nomination must be delivered to e Company for e Company to be liable to such Nominee. Oerwise, Company will not be liable if a bona-fide payment is made to e person named in e text of e Policy or in e registered records of e Company. 7. Fee to be paid to e Company for registering change or cancellation of a nomination can be specified by e IRDAI rough Regulations. 8. On receipt of notice wi fee, e Company should grant a written acknowledgement to e Policyholder of having registered a nomination or cancellation or change ereof. 9. A transfer or assignment made in accordance wi section 38 of Insurance Act, 1938, as amended from time to time, shall automatically cancel e nomination except in case of assignment to e Company or oer transferee or assignee for purpose of loan or against security or its reassignment after repayment. In such case, e nomination will not get cancelled to e extent of Company s or transferee s or assignee s interest in e Policy. The nomination will get revived on repayment of e loan. 10. The right of any creditor to be paid out of e proceeds of any Policy of life insurance shall not be affected by e nomination. 11. In case of nomination by Policyholder whose life is insured, if e Nominees die before e Policyholder, e proceeds are payable to Policyholder or his heirs or legal representatives or holder of succession certificate. 12. In case Nominee(s) survive e person whose life is insured, e amount secured by e Policy shall be paid to such survivor(s). 13. Where e Policyholder whose life is insured nominates his/her (a) parents or (b) spouse or (c) children or (d) spouse and children or (e) any of em, e Nominees are beneficially entitled to e amount payable by e Company to e Policyholder unless it is proved at Policyholder could not have conferred such beneficial title on e Nominee having regard to e nature of his title. 14. If Nominee(s) die after e Policyholder but before his share of e amount secured under e Policy is paid, e share of e expired Nominee(s) shall be payable to e heirs or legal representative of e Nominee(s) or holder of succession certificate of such Nominee(s). 15. The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance Policies maturing for payment after e commencement of The Insurance Laws (Amendment) Act, 2015 (i.e ). 16. If Policyholder dies after maturity but e proceeds and benefit of e Policy has not been paid to him because of his dea, his Nominee(s) shall be entitled to e proceeds and benefit of e Policy. 17. The provisions of section 39 of e Insurance Act, 1938, as amended from time to time, are not applicable to any life insurance Policy to which section 6 of Married Women s Property Act, 1874, applies or has at any time applied except where before or after The Insurance Laws (Amendment) Act, 2015, a nomination is made in favour of spouse or children or spouse and children wheer or not on e face of e Policy it is mentioned at it is made under section 39 of e Insurance Act, 1938, as amended from time to time. Where nomination is intended to be made to spouse or children or spouse and children under section 6 of MWP Act, it should be specifically mentioned on e Policy. In such a case only, e provisions of section 39 of Insurance Act, 1938, as amended from time to time, will not apply. [Disclaimer: Section 39 of e Insurance Act, 1938, as amended from time to time shall be applicable. Policy Holders are advised to refer to Original text of Section 39 as amended from time to time for complete and accurate details.] Annexure CC Section 45 of e Insurance Act, 1938, as amended from time to time Policy shall not be called in question on e ground of mis-statement after ree years. Provisions regarding Policy not being called into question in terms of section 45 of e Insurance Act, 1938, as amended by The Insurance Laws (Amendment) Act, 2015 dated are as follows: 1. No Policy of life insurance shall be called in question on any ground whatsoever after expiry of ree (3) years from (a) e Policy Commencement Date or (b) e Date of Commencement of Risk or (c) e date of latest revival of e Policy or (d) e Date of Commencement of Rider; whichever is later. 2. On e ground of fraud, a Policy of life insurance may be called in question wiin ree (3) years from (a) e Policy Commencement Date or (b) e Date of Commencement of Risk or (c) e date of latest revival of e Policy or (d) e Date of Commencement of Rider; whichever is later. For is, e Company should communicate in writing to e Company or legal representative or Nominee or assignees of Policyholder, as applicable, mentioning e ground and materials on which such decision is based. 3. Fraud means any of e following acts committed by Life Assured or Policyholder or by his agent, wi e intent to deceive e Company or to induce e Company to issue e life insurance Policy: a. The suggestion, as a fact of at which is not true and which e Life Assured or Policyholder does not believe to be true; b. The active concealment of a fact by e Life Assured or Policyholder having knowledge or belief of e fact; c. Any oer act fitted to deceive; and d. Any such act or omission as e law specifically declares to be fraudulent. 4. Mere silence is not fraud unless, depending on circumstances of e case, it is e duty of e Life Assured or Policyholder or his agent keeping silence to speak or silence is in itself equivalent to speak. 5. No Insurer shall repudiate a life insurance Policy on e ground of Fraud, if e Life Assured or Policyholder / Beneficiary can prove at e misstatement was true to e best of his knowledge and ere was no deliberate intention to suppress e fact or at such mis-statement of or suppression of material fact are wiin e knowledge of e insurer. Onus of disproving is upon e Policyholder, if alive, or beneficiaries. 6. Life insurance Policy can be called in question wiin ree (3) years on e ground at any statement of or suppression of a fact material to expectancy of life of e Life Assured or Policyholder was incorrectly made in e Proposal Form or oer documents, basis which Policy was issued or revived or Rider issued. For is, e Company should communicate in writing to e Life Assured or Policyholder or legal representative or Nominee or assignees of Policyholder, as applicable, mentioning e ground and materials on which decision to repudiate e Policy of life insurance is based. 7. In case repudiation is on ground of mis-statement and not on fraud, e premium(s) collected on Policy till e date of repudiation shall be paid to e Policyholder or legal representative or Nominee or assignees of Policyholder, wiin a period of 90 days from e date of repudiation. 8. Fact shall not be considered material unless it has a direct bearing on e risk undertaken by e Company. The onus is on Company to show at if e Company had been aware of e said fact, no life insurance Policy would have been issued to e Policyholder. 9. The Company can call 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 e terms of e Policy are adjusted on subsequent proof of age of Life Assured. So, is Section will not be applicable for questioning age or adjustment based on proof of age submitted subsequently. [Disclaimer: Section 45 of e Insurance Act, 1938, as amended from time to time shall be applicable. Policy Holders are advised to refer to Original text of Section 45 as amended from time to time for complete and accurate details.] Annexure Ver. 2.1 (072017)