General Insurance Document

For Bank Use

Proposal form no: _________________________ LOS no : ___________________________

Channel Name: ________________________ Employee code: ___________________________

The name of this insurance plan is HDFC ERGO Sarv Suraksha/Motor Insurance.
I / We have Opted for Sarv Suraksha/Motor Insurance or Both
I / We have understood the Coverages & Benefits of the plan.
I / We understand that the insurance plan opted by me/us is on a voluntary basis and is NOT Mandatory
I / We are fully aware that there are alternate insurance plans available in the market
I / We hereby confirm that I/We have read and understood the important points as mentioned above of HDFC ERGO Sarv Suraksha. I /
We accordingly agree to proceed with my / our application.
Please note:
The commission has been disclosed in HDFC Bank branches & on Banks website for your reference

Signature of Customer
Mandatory

Credit Protect Document

For Bank Use

Proposal form no: _________________________ LOS no : ___________________________

Channel Name: ________________________ Employee code: ___________________________

The name of this insurance plan is HDFC Life Group Credit Protect /Credit protect Plus Plan.
Plan Objective: Loan Cover Pure Protection
This is a Single Premium Plan.
HDFC Bank is the Master Policy Holder under this plan
I / We have understood the Death Benefit payable under the plan.
I / We have understood the policy provision with respect to Surrender
I / We understand that the insurance cover under HDFC Life Group Credit Protect / Credit Protect Plus Plan is a standalone life cover
which is being provided by HDFC Standard Life Insurance Co Ltd
I / We understand that the insurance plan being opted by me/us is purely on a voluntary basis and is in no way linked to granting of the
loan / OD limit / Line of Credit by HDFC Bank.
For Group Products (single premium) including Credit Protect Plan commission payable is 2% of the premium with a ceiling on the
maximum payout as defined by Insurance Regulatory and Development Authority (IRDA) from time to time.
I/We, ________________________________________, do hereby declare that I/ we have received a loan of Rs ______________from
HDFC Bank Limited (Master Policyholder). In order to secure the said loan I/ we have taken the above referenced policy from HDFC
Standard Life Insurance Company Limited (HDFC Life). In consideration of receiving the said loan I hereby authorize HDFC Life to
make payment of Outstanding Loan Balance amount to Master Policyholder by deducting from the claim proceeds payable on
happening of the contingent event covered by the Group Life Insurance Scheme/ Policy referenced above. Request you to kindly take
note of the above mentioned request and update your records accordingly.

Signature of Customer
Mandatory