1 SBI Life Insurance Company Limited Registration Number: 111 Regulated by IRDA UIN: 111N089V01 Form [Type 13 text] March 2013
2 Policy Schedule Your Policy Welcome to your SBI Life eshield policy and thank you for preferring SBI Life Insurance Company Limited to provide you with insurance solutions. The UIN allotted by IRDA for this product is 111N089V01. SBI Life eshield is also referred to as eshield in the policy document. The information you have given electronically in the web based proposal form, personal statement together with any medical reports and other documents and declarations form part of this contract of insurance with us. Your policy document, comprising this policy schedule along with the policy booklet and any endorsements, is evidence of the contract. You should read these carefully to make sure you are satisfied. Please keep these in a safe place. If you find any errors, please return your policy document for effecting corrections. SBI Life eshield provides an excellent package of insurance solution. In return for your premiums we will provide benefits as described in the following pages of the policy document. The benefits available under this policy are subject to the payment of future premiums as and when due. Your Policy is a non-participating, traditional, pure term assurance product. The benefits will be paid to the person(s) entitled as set out in the policy document, on proof to our satisfaction, of such benefits having become payable and of the title of the persons claiming the payments. Please communicate any change in your mailing address or any other communication details as soon as possible. If you require further information, please contact us. Identification 1. Policy Number << as allotted by system >> 2. Proposal Number. << from the proposal form >> 3. Proposal Date << dd/mm/yyyy >> 4. Customer ID << as allotted by system >> Page 2 of 5 Policy Number
3 Personal information 1. Name of the Life assured << Title / First Name / Surname of the Life assured >> 2. Date of Birth << dd/mm/yyyy >> 3. Age at entry 4. Gender << Male / Female >> 5. Mailing Address << Address for communication >> 6. Telephone Number with STD Code 7. Mobile Number 8. ID of the policyholder << ID of the proposer >> Nomination 1. Name of the Nominee(s) Relationship with the Life assured Age 2. Name of the Appointee(s) Relationship with Nominee Age Important dates 1. Date of commencement of policy / risk << dd/mm/yyyy >> 2. Policy anniversary date << dd/mm>> 3. Premium due dates << dd/mm >> of every year. 4. Date of expiry of term << dd/mm/yyyy >> Basic policy information 1. Plan Option 2. <<Initial >> Sum Assured (Rs.) <<Level Cover/ Level Cover with Accidental Death Benefit/ Increasing Cover/ Increasing Cover with Accidental Death Benefit>> 3. Policy Term << years>> 4. Premium Payment Term <<years>> 5. Premium frequency Yearly Page 3 of 5 Policy Number
4 Basic Policy Benefit Benefit <<Initial>> Sum Assured (Rs.) Policy Term (Years) Premium Paying Term (Years) Installment Premium (Rs.) Service Tax and Cess (Rs.) Due Date of Last Premium Date of expiry of term Base Policy << >> << >> << >> << >> << >> << >> << >> Accidental Death Benefit << >> Total Installment Premium including Service tax and Cess << >> Service tax, cess and any other taxes payable may vary as per the taxation laws then applicable. The current service tax has been 12.00% of premium, Education 2.00% of service tax and Secondary and Higher Education 1.00% of service tax. The effective rate works out to 12.36% of the installment premium. Applicable Clauses << To be printed for EMR >> << Page 4 of 5 Policy Number
5 Sum Assured Table Effective Sum Assured table for << Increasing Cover option / Increasing Cover with Accidental Death Benefit option>> Policy Years Effective Sum Assured <<Accidental Death Benefit>> <<1 to 5>> <<6 to 10 >> <<11 to 16 >> <<17 to 20 >> <<21 to 25 >> <<26 to 30 >> >> Signed for and on behalf of SBI Life Insurance Company Limited, Name Authorised Signatory Designation Date Place The stamp duty of Rs <<.>> (Rupees only) paid by pay order, vide receipt no. << >> dated <<. Government notification Revenue and Forest Department No. Mudrank << >> dated <<.>> << Digital Signature >> (Signature) Proper Officer We request you to read this policy schedule along with the policy booklet. If you find any errors, please return your policy document for effecting corrections. ***************************************** End of Policy Schedule ************************************** Page 5 of 5 Policy Number
6 Policy Booklet Table of Contents 1 Definitions Abbreviations Effective Sum Assured Level Cover Level Cover with Accidental Death Benefit Increasing Cover Increasing Cover with Accidental Death Benefit Policy Benefits Death Benefit Paid-up Benefit Survival Benefit Maturity Benefit Surrender Accidental Death Benefit Definition of Accident Exclusions Premiums Lapse and Revival Claims Death claim Survival Claim Maturity Claim Surrender claim Termination Termination of death cover Termination of your policy General Terms Free-look period Suicide exclusion... 22
7 10.3 Policy loan Nomination Assignment Non disclosure Grace period Misstatement of age Participation in profits Taxation Date formats Electronic transactions Notices Complaints Relevant Statutes Governing laws and jurisdiction Section 41 of the Insurance Act Section 45 of the Insurance Act Provision 12 (1) of Redressal of Public Grievances Rules, Index... 28
8 This is your policy booklet containing the various terms and conditions governing your policy. This policy booklet should be read in conjunction with the policy schedule and other related documents of your policy. If you find any errors, please return the policy immediately for effecting corrections. 1 Definitions These definitions apply throughout your policy document. The definitions are listed alphabetically. Items marked with alongside are provided in your policy schedule. Expressions Meanings 1. Accidental Death Benefit is the benefit which is payable on death of the policyholder due to accident. 2. Age is the age last birthday; i.e., the age in completed years. 3. Age at entry is the age last birthday on the date of commencement of your policy. 4. Appointee is the person who is so named in the proposal form or subsequently changed by endorsement, who has the right to give a valid discharge to the policy monies in case of the death of the policy holder before the end of policy term while the nominee is a minor. 5. Assignee is the person to whom the rights and benefits under this policy are transferred by virtue of assignment under section 38 of the Insurance Act, Beneficiary the person nominated by the policy owner to receive all or part of the insurance benefits under the provisions of your policy. The Beneficiary is specified in the Application Form, the policy schedule and other written agreements of your policy, if any. 7. Date of commencement of policy / risk 8. Date of expiry of term is the date from which the insurance benefits under this policy are available. is the date on which the benefits under this policy terminate on expiry of the benefit term. 9. Death Benefit is the amount payable on death of the policyholder. 10. Endorsement a change in any of the terms and conditions of your policy, agreed to and issued by us, in writing. 11. Effective Sum Assured is as defined in the policy booklet. 12. Free-look period is the period during which the policyholder has the option to return the policy and cancel the contract. 13. Grace period is the period beyond the premium due date when the policy is treated as inforce. 14. In-force is the status of the policy when all the due premiums have been paid. is the Death Benefit offered by us at the time of the inception of policy for 15. Initial Sum Assured plan options: Increasing Cover and Increasing Cover with Accidental Death Benefit. is the amount of money payable by you on each Premium Due Date in order 16. Installment premium to keep the insurance cover in force under the provisions of your policy. This does not include the service tax and other statutory levies which are payable by you in addition to the premium. 17. Lapse is the status of the policy when a premium is not paid before the end of grace period. 18. Life assured is the person whose life is insured under this policy.
9 Expressions Meanings 19. Minor is a person who has not completed 18 years of age. is the person who is named as the nominee in the proposal form or 20. Nominee subsequently changed by endorsement, as per section 39 of the Insurance Act, 1938, who has the right to give a valid discharge to the policy monies in case of the death of the life assured during the term of the policy. 21. Non-participating means that your policy does not have a share in our profits. is the same date each year during the policy term as the date of 22. Policy anniversary commencement of policy. If the date of commencement of policy is on 29th of February, the policy anniversary will be the last date of February. means the policy schedule, policy booklet, endorsements (if any), other 23. Policy document written agreements (if any) mutually agreed by you and us during the time your policy takes effect. 24. Policy Schedule is the document that sets out the details of your policy. 25. Policy Holder is the owner of the policy is the period between two consecutive policy anniversaries; by convention, 26. Policy year this period includes the beginning policy anniversary as the first day and excludes the next policy anniversary day at the end. 27. Policy Term is the period, in years, during which the insurance benefits are available is the contractual amount payable by the life assured to secure the benefits 28. Premium under the contract. This does not include service tax, cess and other statutory levies which are payable in addition to the premium. 29. Premium frequency is the period between two consecutive premium due dates for the policy; only yearly premium frequency is allowed under this policy. 30. Premium payment term is the period, in years, over which premiums are payable. 31. Revival is the process by which the benefits lost under a lapsed policy, are restored. 32. Revival period is a 2-year period from the due date of the First unpaid premium. 33. Sum assured is the Death Benefit offered by us at the time of the inception of policy for plan options: Level Cover and Level Cover with Accidental Death Benefit. 34. Surrender is the voluntary cessation of a benefit by the policyholder. Process of assessment of risk at the time of inception or at the time of revival of the policy. Based on underwriting, a decision on acceptance or 35. Underwriting rejection of cover as well as applicability of suitable revised premium and / or any other terms of the policy is taken. SBI Life Insurance Company Limited or its successors. 36. We, Us, Our We are regulated by the Insurance Regulatory and Development Authority (IRDA). The registration number allotted by the IRDA is You, Your is the person named as the policyholder.
10 2 Abbreviations Abbreviation IRDA Rs. UIN Stands for Insurance Regulatory and Development Authority Indian Rupees Unique Identification Number (allotted by IRDA for this product) These abbreviations bear the meanings assigned to them elsewhere in the policy booklet. 3 Effective Sum Assured We define Effective Sum Assured under various plan options as follows: 3.1 Level Cover Effective Sum Assured on any day is equal to the Sum Assured. 3.2 Level Cover with Accidental Death Benefit Effective Sum Assured on any day is equal to the Sum Assured. 3.3 Increasing Cover We will add 10% of the initial sum assured at the end of every 5 policy years if your policy is then in force. The effective sum assured would be the increased sum assured as applicable. 3.4 Increasing Cover with Accidental Death Benefit We will add 10% of the initial sum assured at the end of every 5 policy years if your policy is then in force. The effective sum assured would be the increased sum assured as applicable Your Accidental Death Benefit would not be increased. 4 Policy Benefits 4.1 Death Benefit If the policy is in-force on the date of death of the life assured, we will pay the benefit for the various plan options as follows: Level Cover If death of life assured occurs during the policy term, we will pay the sum assured Level Cover with Accidental Death Benefit If death of life assured occurs during the policy term, we will pay the sum assured If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit in addition to the sum assured.
11 4.1.3 Increasing Cover If death of life assured occurs during the policy term, we will pay the Effective Sum Assured on the date of death Increasing Cover with Accidental Death Benefit If death of life assured occurs during the policy term, we will pay the Effective Sum Assured as on the date of death If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit in addition to the Effective Sum Assured as on the date of death. 4.2 Paid-up Benefit Your policy does not have any paid-up benefit. 4.3 Survival Benefit Your policy does not have any survival benefit. 4.4 Maturity Benefit Your policy does not have any maturity benefit. 4.5 Surrender Your policy will not acquire any surrender value Even if you surrender the policy, we will not pay any benefit On receipt of your surrender request, your policy will terminate and we shall not have any liability under the policy. 5 Accidental Death Benefit This benefit applies only for plan options: Level Cover with Accidental Death Benefit and Increasing Cover with Accidental Death Benefit The benefit is in-built in the above mentioned plan options If death of life assured occurs due to accident during the policy term, we will pay the Accidental Death Benefit in addition to the Effective Sum Assured We will pay the Accidental Death Benefit subject to all of the following: Your policy is in-force The life assured has died as a result of an accident as defined in this document Such accidental death should be proved to our satisfaction The death of the life assured should occur within 120 days from the date of accident The death must be solely and directly due to Accident and independent of all other causes The total Accidental Death Benefit sum assured under eshield policies put together will not exceed Rs. 50,00, If you have availed Accidental Death Benefit in addition to Rs. 50,00,000 by not disclosing previous insurance details under this product, we shall not pay the Accidental Death Benefit cover in excess of Rs. 50,00,000. If we come to know of this on death of the life assured, we shall pay only the first Rs. 50,00, We would not refund the premium paid for the excess Accidental Death Benefit.
12 5.2 Definition of Accident An accident is a sudden, unforeseen and involuntary event, caused by outward, violent and visible means. 5.3 Exclusions We will not pay the Accidental Death Benefit sum assured for deaths arising as a consequence of or occurring during the following events: Infection: Death caused or contributed to, by any infection, except infection caused by an external visible wound accidentally sustained Drug abuse: Life assured under the influence of alcohol or solvent abuse or use of drugs except under the direction of a registered medical practitioner Self-inflicted injury: Intentional self-inflicted injury including the injuries arising out of attempted suicide Criminal acts: Life Assured s involvement in criminal and / or unlawful acts with unlawful or criminal intent War and civil commotion: War, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolution or taking part in a riot or civil commotion Nuclear contamination: The radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident arising from such nature Aviation: Life assured s participation in any flying activity, other than as a passenger in a commercially licensed aircraft Hazardous sports and pastimes: Taking part or practicing for any hazardous hobby, pursuit or any race not previously declared and accepted by us 6 Premiums 6.1 You may pay the premiums on the premium due date or within the grace period. 6.2 You have a choice to pay the premium 30 days before the premium due date 6.3 You have to pay the premiums even if you do not receive renewal premium notice. There is no obligation on our part to send you renewal premium notices or reminders. 6.4 You will be liable to pay all applicable taxes as levied or revised by the Government and other statutory authorities from time to time. 6.5 If we receive any amount in excess of the required premium, we will refund the excess. We will not pay any interest on this excess amount. 6.6 If we receive any amount lesser than the required premium and levies, we will not consider the same as premium till you pay the deficit. 6.7 Insufficient premiums or excess premiums remitted shall be kept in deposit and the amounts kept in deposit shall not earn any interest.
13 7 Lapse and Revival 7.1 If premiums are not paid within the grace period, your policy lapses. No benefits are then payable under your policy. 7.2 You can revive your policy within the policy term during its revival period of 2 years from the date of First Unpaid Premium. 7.3 You should write to us during the revival period requesting for revival. 7.4 You have to submit Good Health Declaration and satisfy other underwriting requirements, if any. 7.5 We may accept or reject your revival request. We will inform you about the same. 7.6 We may charge extra premium based on underwriting. 7.7 You have to pay all due premiums, not paid during the revival period, along with interest. The due premiums would include installment premium including any extra premiums intimated to you at the inception of your policy. If at the time of revival, an extra premium is charged, you shall pay that extra premium also. 7.8 Interest will be charged at a rate declared by us from time to time. 7.9 You cannot revive your policy after the revival period. 8.1 Death claim 8 Claims The nominee or the legal heir should inform the death of the life assured in writing, stating at least the policy number, cause of death and date of death We will require the following documents to process the claim: - Original policy document - Original death certificate from municipal / local authorities - Claimant s statement and claim forms in prescribed formats - Hospital records including discharge summary, etc - Any other documents including post-mortem report, first information report where applicable Claim under the policy may be filed with us within 90 days of date of claim event However, without prejudice, in case of delay in intimation or submission of claim documents beyond the stipulated period in the policy document, we, at our sole discretion, may condone such delay and examine the admissibility or otherwise of the claim, if such delay is proved to be for reasons beyond the control of the nominee / claimant We will pay the claim to the assignee, if the policy is assigned If the policy is not assigned, we will pay the claim to the nominee, if the nominee is not a minor the appointee, if the nominee is a minor provided an appointee is appointed by you or to the legal guardians if there is no appointee under the policy and the death claim arises during the minority of the nominee your legal heir, if nomination is not valid.
14 8.2 Survival Claim You cannot apply for survival claim as there is no survival benefit in your policy. 8.3 Maturity Claim You cannot apply for maturity claim as there is no maturity benefit in your policy. 8.4 Surrender claim You cannot apply for surrender claim as there is no surrender benefit in your policy. 9.1 Termination of death cover 9 Termination The death cover will terminate on the earliest of the following: End of the grace period following discontinuation of premium The date on which your policy terminates Date on which we receive your free-look cancellation request. 9.2 Termination of your policy Your policy will terminate at the earliest of the following: on settlement of death benefit on the date of expiry of policy term on payment of free-look cancellation amount at the end of revival period, if not revived on receipt of surrender request Free-look period 10 General Terms You have 30 days from the date of receipt of this policy document to review its terms and conditions. If you are not satisfied, you can return the policy stating the reasons for your objection We will then refund the premium paid after deducting the stamp duty paid, cost of medical expenses, if any, proportionate risk premium for the period of cover and the proportionate taxes You cannot revive, reinstate or restore your policy once you have returned your policy We will not pay any benefit under your policy after we receive your free-look cancellation request.
15 10.2 Suicide exclusion If the life assured, whether sane or insane, commits suicide, within one year from the date of commencement of policy or date of revival, we will not pay the death benefit In case of death due to suicide within 12 months: i. From the date of commencement of the policy, we will only pay 80% of the premium paid, provided the policy is in force. We will not consider taxes, extra premiums and Accidental Death Benefit premiums, if any, for the refund. ii. From the date of revival of the policy, we will only pay 80% of the premiums paid till the date of death. We will not consider taxes, extra premiums and Accidental Death Benefit premium, if any, for the refund Policy loan Your policy will not be eligible for any loan Nomination You have to make a nomination as per provisions of section 39 of the Insurance Act, You have to write to us if you want to change the existing nominees You have to make a fresh nomination when you get your policy re-assigned to yourself Nomination is for the entire policy and not for a part of the policy We do not express any opinion on the validity or accept any responsibility in respect of any nomination you make Assignment You have to write to us for effecting an assignment of your policy On assignment, the assignee will be the sole owner of the policy You have to make an assignment as per provisions of section 38 of the Insurance Act, Assignment is for the entire policy and not for a part of the policy You have to submit your policy document along with a valid and duly attested deed of assignment We will effect the assignment by endorsing your policy The assignment shall be binding on the Company only from the date on which your assignment is duly registered with us and not before, irrespective of the actual date of execution of the deed of assignment. If the deed of assignment is not properly executed, we may, at our sole discretion, refuse to register the assignment Assignment will automatically cancel any existing nomination Assignment will not be permitted where the policy is under the Married Women s Property Act, 1874.
16 We do not express any opinion on the validity or accept any responsibility in respect of any assignment you make Non disclosure We have issued your policy based on the statements in your proposal form, personal statement, medical reports and any other documents If we find that any of this information is inaccurate or false or you have withheld any material information, we shall declare your policy null and void but subject to section 45 of the Insurance Act, We will not pay any benefits and we will also not return the amounts you have paid Grace period You can pay your premiums within a grace period of 30 days from the due dates Your policy will be treated as in-force during the grace period If you do not pay your due premiums before the end of grace period, your policy lapses You may revive your policy during the revival period If death occurs during the grace period, we shall deduct the unpaid premium from the claim amount If death occurs during the grace period, the effective sum assured will be paid assuming that the last due premium was paid Misstatement of age If we find that the correct age of the life assured is different from that mentioned in the proposal form, we will check your eligibility for the life cover as on the date of commencement If eligible, If the correct age is found to be higher, you have to pay the difference in premiums along with interest We will terminate your policy, if you do not pay the difference in premiums and applicable interest If the correct age is found to be lower, we will refund the difference in premiums without any interest If not eligible, We will terminate your policy.
17 10.9 Participation in profits Your policy does not participate in our profits Taxation You are liable to pay service tax, cess and statutory levies as per the applicable rates, along with the premium We shall collect the taxes and statutory levies along with the premium Taxes may change subject to future changes in taxation laws Date formats Unless otherwise stated, all dates described and used in the policy schedule are in dd/mm/yyyy formats Electronic transactions We shall accept premiums and pay benefits through any approved modes including electronic transfers Notices We will communicate to you in writing and deliver the correspondence by hand, post, facsimile, or any other approved mode We will send correspondence to the mailing address you have provided in the proposal form or to the changed address that is intimated to us and recorded by us You should also communicate in writing and deliver the correspondence by hand, post, facsimile, or any other approved mode All your correspondence should be addressed to: SBI Life Insurance Company Limited, Central Processing Centre, Kapas Bhawan, Sector 10, CBD Belapur, Navi Mumbai Phone : It is important that you keep us informed of your changed address.
18 11 Complaints 11.1 Grievance Redressal procedure If you have any query, complaint or grievance, you may approach any of our offices You can also call us on our toll-free number If you are not satisfied with our decision or have not received any response within 10 working days, you may write to us at: Head Client Relationship, SBI Life Insurance Company Limited Central Processing Centre, Kapas Bhawan, Sector 10, CBD Belapur, Navi Mumbai Telephone No: Fax: Id: In case you are not satisfied with our decision, and the issue pertains to provision 12 (1) of the Redressal of Public Grievances Rules, 1998, you may approach the Insurance Ombudsman. You can lodge the complaint with the Ombudsman as per provision 13 of the said rules. The relevant provisions have been mentioned in the section Relevant Statutes The address of the Insurance Ombudsman and the Redressal of Public Grievances Rules, 1998, are, available in the website of IRDA, and in our website The address of the ombudsman at Mumbai is: Office of the Insurance Ombudsman (Maharashtra and Goa) 3 rd Floor, Jeevan Seva Annexe, S.V. Road, Santa Cruz (W), Mumbai Phone: Fax: We have also enclosed the addresses of the insurance ombudsman.
19 12 Relevant Statutes 12.1 Governing laws and jurisdiction This is subject to prevailing Indian Laws. Any dispute that may arise in connection with this shall be subject to the jurisdiction of the competent Courts of Mumbai Section 41 of the Insurance Act (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take 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 prospectuses 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 bona fide 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 Section 45 of the Insurance Act No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act 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 in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such a statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy holder knew at the time of making it that the statement was false or that it suppressed facts which it was material t o 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 the life insured was incorrectly stated in the proposal Provision 12 (1) of Redressal of Public Grievances Rules, 1998 The Ombudsman may receive and consider (a) Complaints under Rule 13 (b) Any partial or total repudiation of claims by an insurer (c) Any dispute in regard to premium paid or payable in terms of the policy (d) Any dispute on the legal construction of the policy, insofar as such disputes relate to claims (e) Delay in settlement of claims (f) Non-issue of any insurance document to customers after receipt of premium 12.5 Provision 13 of Redressal of Public Grievances Rules, 1998 (1) any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint in writing to the Ombudsman within whose jurisdiction the branch or office of the insurer complained against is located. (2) the complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer against which the complaint is made, the fact giving rise to complaint supported by documents, if any, relied on by
20 the complainant, the nature and extent of the loss caused to the complainant and the relief sought from the Ombudsman. (3) no complaint to the Ombudsman shall lie unless (a) the complainants had before making a complaint to the Ombudsman made a written representation to the insurer named in the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period of one month after the insurer concerned received his representation or the complainant is not satisfied with the reply given to him by the insurer. (b) the complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the representation of the complainant, and (c) the complaint is not on the same subject matter, for which any proceedings before any Court, or Consumer Forum or Arbitrator is pending or were so earlier *************************************End of Policy Booklet*********************************
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