1 SURAKSHA PLUS SAVING BANK ACCOUNT Sr. Parameters Particulars No. 1 Name of the Product Suraksha Plus Saving Bank A/c 2 Product Code SBCHQ-GEN-IND- SURAKSHA-INR SBCHQ-GEN-STF-IND- SURAKSHA-INR 3 Segment Applicable to the Personal Segment including NRI Customers 4 Mode of holding Single or jointly. In case of joint accounts insurance cover will be provided to first named person only. 5 Type of Account Saving Bank Account 6 Minimum quarterly average balance ` 25,000/- 7 Penalty for non-maintenace of minimum balance ` 300/- per quarter. However, if the balance continues below the stipulated minimum balance for more than six months, insurance cover will not be available from the next renewal onwards. 8 Rate of interest As applicable to Saving Bank deposits 9 Insurance cover An accidental death insurance cover for ` 5.00 lacs will be provided to the depositor free of cost for one year. The premium will be paid by the Bank. This benefit will be subject to yearly review. 10 Debit entries allowed free of charges 100 per half year ( as against 30 per half year allowed in normal SB account) 11 Cheque leaves issued free of charges 50 leaves free in a year as against 25 leaves free only at first instance given with welcome kit for normal SB account 12 Multicity Cheques 25 leaves free in a year (as against ` 3/- per leaf for normal SB account) 13 Other conditions All the facilities available for ordinary Saving Bank deposit i.e. ATM, Internet, Mobile Banking etc. will be applicable to Saving Bank Account. Existing Saving Bank account holder can shift to Suraksha Plus Saving Bank account by giving an application. Claim if any, will be settled in favour of the nominee of the deposit only. No separate nomination to be obtained for insurance cover. Maximum claim settlement per person would be ` 5.00 lacs collectively in all schemes/account at various branches.
2 Annexure-III (Revised) CONSENT FOR GROUP PERSONAL ACCIDENT INSURANCE SCHEME AND IRREVOCABLE LETTER OF AUTHORITY The Branch Manager State Bank of Patiala Place: Date:... Dear Sir, Reg: Group Personal Accident Insurance Scheme-State Bank of Patiala I hereby give my unconditional consent to join Group Personal Accident Insurance Scheme of SBI General Insurance Co.Ltd. which has been explained to me and I have also gone through the coverage / terms / conditions of this policy. I understand that the sum insured will be minimum Rs.2.00 Lac for individual account holders having quarterly average balance above Rs /- and Rs Lac for individual account holders having quarterly average balance above Rs.25000/-.* Even in the case of multiple accounts, the maximum aggregate sum assured would be limited to Rs.5.00 Lac. In case of joint Account, Insurance cover will be available to first named person only. This insurance cover is valid from the date of acceptance to the valid period of insurance as indicated in MOU between SBI General Insurance Co. Ltd. and State Bank of Patiala and can be renewed only on mutual consent and subject to maintenance of minimum average quarterly balance as agreed above. Account No... Sum Insured: Rs...Lacs Name, relation and address of nominee; (Name of Appointee if nominee is minor Date of Birth:... Age...years (Insured should be aged between 5yrs-65yrs) Sex (Male/Female):... PAN No... (If available) as mentioned in the Saving Bank Account Opening Form) I agree that in case I close my account with your branch, I will cease to be a member of this scheme from the closure. I understand that no liability and / or risks relating to this Group Personal Accident Insurance shall get devolve on the Bank. In other words, all claim arising out of accidental death will be settled by SBI General Insurance Co.Ltd. In the event of any claim arises, my nominee /legal hair(s) will lodge along with the claim forms and other relevant documents to SBI General Insurance Co.Ltd. through your branch for settlement of claim. I authorize you to collect the claim amount on my behalf / my nominee / Legal heir(s) and credit the amount to my account/account of my nominee / legal hair(s) as the case may be. I agree to abide by the terms and conditions of the above scheme and agree to your conveying the above particulars regarding my admission into the Group Insurance Scheme to the concerned Insurance company. Signature:... Full Name:... S/o. w/o:... Address:... Witness Signature:... Full Name:... Address:...
3 Note: (1) This consent to be obtained from the account holder or from the first named person in case of Joint accounts on the opening day of the account, and the insurance will be accordingly arranged by Bank through SBI General Insurance Co.Ltd. (2) Account holder is required to submit fresh consent letter in case of increase in the sum insured at the time of annual review. (3) Existing SB Suraksha/Suraksha plus account holders need to submit fresh consent letter at the time of renewal of the policy. * Delete the clause which is not applicable.
4 Annexure-IV (Revised) STATE BANK OF PATIALA BRANCH TERMS AND CONDITIONS OF THE INSURANCE TO Shri/Smt, (Name of the depositor) Account No. OBJECTIVE: To provide Personal Accident Death Insurance cover to the deposit holder of the bank under Suraksha Saving Bank account and Suraksha plus Saving account and as per the terms and conditions hereinafter stated. COVERAGE: The deposit holders of the aforesaid deposit accounts, whether held singly or jointly with one or more persons, first name depositor only will be provided with a Personal accident death insurance cover to an extent of Rs.2 lacs & Rs.5 lacs as the case may be depending upon the scheme, for which appropriate premium has been remitted by the bank to the Insurance company. In case of joint accounts the insurance cover shall be available for the first named depositor only. The cover is provided for one year. COMMENCEMENT OF COVERAGE: Each depositor shall stand covered with the insurance policy from the date of acceptance to the valid period of insurance as indicated in MOU between State Bank of Patiala and SBI General Insurance Co. Ltd. The premium for the insurance cover will be paid by the Bank. Complete details of deposit holders will be maintained by Bank. In the event of any claim, details/documents pertaining to the depositors will be submitted to the Insurance Company by the Bank. SCOPE OF COVER: The Insurance shall cover risk of Accidental death only (as defined in the policy) arising solely and directly from accident caused by violent and visible means during the period of Insurance in force, subject to the terms, conditions & exclusions as specified in the Insurance Policy. SUM INSURED UNDER THE POLICY FOR EACH DEPOSIT HOLDER: Sum insured for Suraksha Saving account holders Rs.2 lacs * Sum insured for Suraksha plus Saving account holders- Rs.5 lacs * *subject to maximum claim settlement of Rs.5 lacs per person, regardless of the number of deposits held in various schemes / Branches. NOMINEE UNDER THE POLICY: The respective branch of the Bank shall be authorised to receive claim under the policy who in turn will remit to the depositor s nominee/legal heir.
5 PROCEDURE FOR CLAIMS: All the claims correspondence will only be with the Bank s branches where the insured person having his/ her deposit account. The information about accidental death of the insured person / depositor shall be informed to the Bank branch within 60 days from the date of accident. The following documents are required to be submitted to the branch for processing of the claim. 1) Claim form duly completed. 2) Death certificate. 3) Post-mortem Report 4) FIR/Police panchanama/inquest report 5) Any other document relevant to the claim All documents should be attested by the Branch Manager of the Bank. Manager Date Received a copy of the terms of insurance together with the details of the scheme. Depositor signature Date:
6 SBI General Insurance Company Limited GROUP PERSONAL ACCIDENT INSURANCE POLICY Claim Form (For Saving Account holders of Suraksha & Suraksha Plus of State Bank of Patiala) Call (Toll Free) Issuance of this form does not amount to admission of any liability or a waiver of any of the terms and conditions of the insurance contract. If any claim is in any manner dishonest or fraudulent, or is supported by any dishonest or fraudulent means or devices, whether by the Insured Person/Claimant or anyone acting on behalf of the Insured Person, then the benefits under this policy shall be void and all benefits payable under it shall be forfeited. Policy No. Claim No. Period of Insurance From D D M M Y Y Y Y To D D M M Y Y Y Y A. DETAILS OF INSURED/CLAIMANT 1. Name of Bank Branch 2. Name of the Insured S U R N A M E M I D D L E N A M E F I R S T N A M E 3. Date of Birth D D M M Y Y Y Y Gender Male Female 4. Profession / Occupation 5. Address Plot No/Door No. Building Name Road City State Area District Pincode 6. Contact Details Phone No. Mobile Id B. DETAILS OF ACCIDENT/INCIDENCE 1. Date of Accident/Incidence D D M M Y Y Y Y Time of Accident : A.M. / P.M. 2. Cause of Accident/Incidence 3. Details of Accident/Incidence 4. Accident/Incidence Location Address City State District Pincode 5. Were there any witness to the Accident/Incidence? Yes No If Yes, provide details, Name of Witness Address of Witness Plot No/Door No. Road City Building Name Area District State Pincode Contact Details Phone No. Mobile Id 6. Is Witness relative of Claimant? Yes No 1 Corporate & Registered Office: Natraj, 101, 201 & 301, Junction of Western Express Highway & Andheri - Kurla Road, Andheri (East), Mumbai Version 1.0, Nov 2012
7 C. DETAILS OF OTHER INSURANCE/INTEREST 1. Is the Accident/Incidence covered under any other Insurance? Yes No If 'Yes', specify details and attach a copy of the policy Name of Insurer Policy Issuance Office Location Policy No. Sum Insured (Rs.) Period of insurance From D D M M Y Y Y Y To D D M M Y Y Y Y D. FOR WHICH BENEFIT DO YOU CLAIM? [PLEASE TICK ( ) THE APPROPRIATE BOX] Benefit Accidental Death Amount claimed E. PAYEE DETAILS 1. Payable to 2. Payment Mode Cheque NEFT 3. Bank Name Bank Branch 4. Bank Account No. IFSC Code 5. MICR No. PAN No. G. ENCLOSURES CHECKLIST Accidental Death: Duly signed Claim Form to be filled in by the Legal Heir of the deceased duly attested by an official of State Bank of Patiala Branch Copy of Death Certificate attested by issuing authorities or by State Bank of Patiala Branch Manager Copy of Final Police Report attested by issuing authorities or by State Bank of Patiala Branch Manager Copy of Post Mortem Report attested by issuing authorities or by State Bank of Patiala Branch Manager Copy of FIR / MLC Copy / Spot Panchnama / Inquest Panchnama attested by issuing authorities or by State Bank of Patiala Branch Manager Statement of bank with opening balance Attested translated copies of FIR and other documents if in local language Note: The Company reserves the right to seek additional documents (including KYC documents) and information as and when necessary for processing of the Claim. H. STATE BANK OF PATIALA AUTHENTICATION This is to certify that Mr / Ms having account number in SBOP Branch, Branch Code is / was covered under Group Personal Accident Policy covering Saving Account holders of Suraksha & Suraksha Plus of State Bank of Patiala. The above information is true to best of my knowledge and we agree to provide any further information that may be required. Place: Date: D D M M Y Y Y Y Signature of Authorized Personnel: Name of Authorized Personnel: Bank Branch Seal: 2
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