I

BSNI, Corporate Offrce

PAT Sectioo, 5ft floor, (qrmqr+nfl3Tfic)
Bharat Sanchar Bhawarr,
BHARAT $ANCHAR NIGAM LIMITED
H.C. Mathur Lane,New Delhi-110001

F. No. L45 / 2A19-PAT(BSNL) Dated, the 01-10-2019

To,

All Heads of Telecom. Circles &

All Heads of other Administrative Units of BSNL'

Sub: Group Term Insurance for Executives - regarding circulation of the Master policy
and Claim form.
Sir,

I am directed to endorse copies of the Master Policy No. OYRGTA-I/103006610

w.r.t. the Group Term Insurance ior Executives - Sum assured'Rs. 50 lakhs and the
Claim form as received from LIC of India for your kind information and reference.

Z. In this regard, any claims for sum assured in respect of any member of the
scheme who has died on or after 01.03.2019 i.e. the effective date of GTI
policy, may be
forwarded through proper channel to this office in the prescribed Claim form complete
in all respect ur,a"aqty checked & verified by the competent authority in the Unit where
the deceised employle had being working at the time of death. It may also be
certified
that all the appiicaLle premiums till the date of death of such executive have been
deducted from the salary of the deceased executive'

3. It is further reiterated that since the payment of premiums to LIC of India are
being made centrally by CA branch in BSNL Corporate office, the applicable GTI
pruriio* in respect'of a[ applicants/ members are to be deducted from the salary
without fail as per the schedule. The concerned DDO and the applicant himself will be
jointly ,urpo*ible in case of any lapse in deducti_on of premium as per the online
option submitted by the applicants through ERP / ESS'

Encl: (i) Master policy & (ir) Claim Form

(Sheo Prasad)
DePutY General Manager (Estt' I)
Tel. No. 23037474
Copy to:-
1. [€ to CMD, BSNL.
2. ItS to all Directors BSNL Board / CVO BSNL'
3. All PGMs/CS&CGM(1ega1)/Sr.GMs/GMs/Add1. GMs/DGMs BSNL C.O.
4. BSNL Intranet / Guard File.
@:BharatSancharBhavan,H.C.MathurLane,}anpath,NewPelhi-1.1.0001
- Identity Nunber (CIN): W899DL2000GOI107739
Website: wwlv.bsJrl.co.in, Corporate
tk"t /

Master Policy No. OYRGTA-/ 103006610 Annexure - III

W=,.=-,
Life Insurance Corporation of India
Pension ald Group Schemes Department
Divisional Office, DELHI DO.I

NETA/ O RE EG ASS
(UIN:51-2N275VAa)
Master PolicY No. 1030066L0
OYRGTA-r/.EGr
GRANTED TO BHARAT SANCHAR MGAM LIMITED

WHEREAS
"the Corporation")
(i) TI{E LIFE INSURANCE CORPORATION OF INDIA (irereinafter called
Nigam
having received a Proposal and Declaration and the fust premium from Bharat Sanchar
Limited situated at Bharat Sanchar Nigam Lirnited ' Bharat Sanchar Bhawan' H'C' l\.{athur
for providing
Lane, janpath, New Delhi - 1100m poiiryholder for this €roup insurance P,olicy
furnished
benefits oi grr" group insurance scheme (certified copy of which Schedules has been
to the Corporalonby the Company), which Rules together r,r'ith the aforesaid proposal
are

hereby declared to be the basis of this polic.v.

(ii) The Companv have also furnished to the Corporation statements as asked for by
the
benefit the
borporatior, .o*pl"t"d and signed by the Company and by the persons for whose
Assuralce hereurtder are being effected.

(iii) The Company have turther agreed to pay the premiurns as required ir accordance
with the
is material to the contract
provisions ner"oi and to furnish such statements and information as
together wiilL the
u, *u,r, be required by the Corporation which statements and information
anv other siatements
applicatiory Rules uttd * statements referred to in (i) and (ii) above and
by the Company as provided hereuacier
or information already furnished and to be furnished
Empioyees in so far as such variations have any
sving a1l the variations in the particulars of the Company have ageed'
bearing on the Assurances effected hereunder from time to time, the
WHEREAS the Corporation
shall be and are hereby declared to be the basis of this Po1iry AND
will receive an amoult as decided between both the parties- .'. , ''"ijt"-t"-
= .--'i''.;;.;.-ti
, .,r''-
(\ / ..-i\,

(Authori\flisnatory) ij
Master Poliry No. OYRGTA-103006610,
NOW THIS POLICY WTIHNESSES AND IT IS HEREBY AGREED AND DECLARED AS
FOLLOWS:
1- In this Policy where the cont ext so admits, the masculine shall include the feminine and the
following expressions shall ulless repugnant to the context have the following meaning:

(t The'Company' shall mean Bharat Sanchar Niga:n Limited having Corporate office
at Bharat Sanchar Bhawan, H.C. Mathur Lane, Janpath, New Delhi - 110001.

(i') The 'Employer' shall mean the Company and any otlrer company, fum or
corporation which may in future be managed or conkolled by or become associated
with the Company and n'hich may agree to become bould by these Rules.

(iii) The'Scheme' shall mean Bharat Sanchar Nigarrr Limited New One year Renewal
Group Term Insurance Scheme described in the Rules hereinafter defined.

(i") The 'Rules' shall mean the Rules of the Scheme for the tirne being in force and as
Amended fromtime to time.

{t) 'Eligible Employee' shall mean an Employee who is or shall become eligible to the
benefits of the Policy as rnore particularly set forth in Part I of The Schedule hereto.

(r.i) 'Member' shall mean a person who as an eligible employee becomes entitled to the
benefits of this Poliry and on whose life an Assurance has been effected according
to the provisions of The Schedule hereof and shall include any such person so long
but only so long as he continues to be entitled to the benefits hereunder.

{tii) 'Effective Date' shali mean the date fuom which this poliry takes effect. i.e,01,t
March20l9
-
(viii) 'Annual Renerval Date' shail mean in relation to the Scheme the 01't MarcM019 and
1.t March every year thereafLer

(i") 'Entry Date' shall mean (a) in relation to original Members the Effective Date and (b)
in relation to new N4embers admitted to the Scheme after the Effective Date, the
Annual Renewal Date imrnediately next follows the date on which tlrey become
eligible.

(") 'Age at E tu'y' mears calculated age as defined in the Schedule.

("i) 'Terminal Date' shall mezrn in respect of each Member the Annual Renewal Date
which is coincident with or next following the date on which the Member completes
the age a{ 6A yearc or the date {rom which he ceases to be an Eligible Employee.
F{owever premium once paid, the cover will be upto next alnual renewal date.
 ("it 'Salaty' shall mean basic'monthly salary of the Member excluding dearness
allowance, bonus, commission or any other emoluments of a contingentL variable
nature or as defined in Scheme Rules.

(xiii) 'Assurance' shall mean the particular Assurance or Assurances effected

or to be
effected hereunder on the life of ihe Member.

("iv) 'Beneficiary' shall mean the person or persons appointed by the Member
(as per
service book available with the employer) to receive the benefits hereulder in the
event of his death.

(*) The'Register' shall mean the Register of Members kept by the Corporation which
Register shall be deemed to be incorporated in and to form part of this policy.

(*i) Death i.e. death due to any reason including suicide.

(o'ii) The terms 'herein', 'hereinafter' 'hereafter','lrerea{, 'hereto', and ,hereunder' used
whenever in the Poliry refer to the poliry in its entirety.

2. The Company shaii hold the Policy and all benefits payablehereunder UPON TRUST for
the benefit of the persons to whom the said benefits are payable in accordance with the
Rules and the Schedule hereto and the Company shall have no beneficial interest hereunder.

J. On proof of the happening of the contingency stated hereiru the Corporation will pay the
benefit of the person or persons concerned under an intimation to company, the appropriate
benefits in accordance with the terms and provisions of the Schedul" urrd General
Conditions hereof subject to the payment of the appropriate premiums specified herein.

The benefits assured hereunder in respect of the Member are strictly personal and Caanot
be assigned, charged oralienated io *y way whatsoever by the Member.
5. All msnstt payableto or by the Corporationhereunder shall be paid at the Divisional Office
of the Corporation in DELHI, in Indian Rupees and the Assurances effected hereunder shall
be expressed in Indian Rupees.

6. A discharge or receipt of the Company or on their behalf of any person or persons duly
authorised in writing by the Company shall be a good, valid and sufficieni discharge to the
Corporation in respect of any payment made by the Corporation hereunder.

7 Ta4tI anp shall be as per the Tax laws arLd the rate as applicable from tirne to time. GST or
other tax shall not be included in the contuactual prernium and it wili be collected from the
policyholder separately as over ald above such premium.

8. In any case where the Corporation is liabte to account to the Revenue Authorities for
income-to9 or any other taxes or duties or any payments made under this policy, the

-_'
Corporation shall deduct such srrms from the respective payments and the Corporation
shall not be iiable to the Member or the Company for the sums so deducted.

v
9. It is hereby expressly agreed between the Company and the Corporation that this Policy is
effected in accordance with the provisions of ttre Rules of the Scheme and in the event of
the Rules being amended, such amendments, if they have any bearing on or affect i* *y
*.ay, tle terms and conditions of this policy or any of the Assurances effected hereunder,
shall become effective only if the said amendments are approved by the Corporation. Any
alternation or amendment that may become necessary in the terms and conditions of this
Policy on account of amendment or alternadorL approved by the Corporation in the
provisions of the Rules shali be given effect to by appropriate endorsements to tlre Policy
signed by the authorised Officer of the Corporation. Any alternation or amendment in the
terms and conditions of this Poliry will be done with prospective effect with the prior
approval of IRDA.

10. it is hereby further expressly agreed between tlre Company and the Corporation that all
disputes of any kind whatsoever which may arise under or in conlection with this Po1iry
shall be subrnitted to the appropriate Court or Courts having jurisdiction over the city of
DELHI.

11.'l-he provisions hereinafter contained i.e. the 'General Conditions','The Schedule' and
'Tabie of Premium rates' attached herewith and every endorsement placed on the Policy by
the Corporation shall be deemed part of this Policy as fu1l as if recited over the signature
affixed hereto.

Dated atthis 19rrr DAY OF SEPTEMBER 2019

For and the

LIFE INSURA ON OF INDIA
 GENERAL CONDITIONS
1. Every member of this scheme shall become entitled to the benefits under the Poliry as from
the Entry Date on which he first becomes an Eligible Employee.

, Evidence of age of the Member satisfactory to the Corporation will be required before anv
benefits in respect of hirn are paid under the Poiiry.

3. Subject to the provisions of these General Conditions, the Assurance shall be renewable
yearly at the option of the Company on each Annual Renelval Date.

4. If the Cornparry do not pay the premiums within the grace period, the policy shall be treated
as lapsed. Lapsed policy may be revived rvithin a period of 3 months from the date of fust
unpaid prernium or the next Annual Renewal Date whichever is earlier, on payment of
arrears of premium together with interest (compouading half-yeariy) at such rate as may
be prevailing at the time of payment The Corporation reserves *re right to accept at the
original terms, accept with modified terms or dedine the revival of lapsed policy.

5. Variations in the total benefits assured hereunder as on the Annual Renewal Dates shall be
given effect to by endorsements over the signature of a duly authorised Officer of the
Corporation.

6. The Corporatiory with mutual agreementwith the employer, reserves the right to vary from
time to time tlre rates, terms and provisions of this Poiiry including the General Conditions
and The Schedule upon giving to the Company 30 days' previous notice inwriting expiring
on tfre Annual Renewal Date following the date of the notice, of its intention to do so and
any such variations will apply only to Assurance hereunder effected or to be effected on or
after the date of exprry of such notice. Provided the premium will be revier.ved atter three
years on the basis of mortaiity experience and as per mutually agreed terms and conditions.

7. The Cornpany shalLfurnish to the Corporation all such data information and evidence as
the Corporation may reasonably require upon or with regard to any matter affecting the
Assurances effected or to be effected hereunder and the Corporation shall not be liable for
any action taken in good faith upon any data, informatiory or evidence so furnished which
shall be or shall prove to have been erroneous or inaccurate. Such of the Employer's/non
employer-empioyee group's records in original (or certified Photostat copies thereof) as in
tlre opinion of the Corporation have bearing on the benefie to be provided or the premiums
payable hereunder shall be open for inspection by the Corporation at all times.

8. The Company shail at the request of the Corporation produce the Policy whenever
necessary for the purpose of stamping, reference or inspection.

9. For clairning the amount of sum assured as laid down under Part II of the Schedule the
Company will have to subrnit to the Corporatio& copy of death certificate duiy certified by
the company along with the claim form.

b"i.g normally payable annually, il case the Cornpany choose

L0. Prernium under this Policy
to pay premiums under anv other mode viz. monthly, quarterly or half-yearly, the
 Company will not be entitled tci discontinue the payment of premium on any date other
than the ArLnuaI Rene\ /al Date for continuitv of the risk cover.

11. No loan shall be available urder this plan.

12. A grace period of 30 days from due date of prernium will be allowed for payment of
premiums. Upon non-payment of premium within the grace period the Policy shali be
treated as lapsed and nothing shall be payable in the event of death. If any death occlrrs
during the grace period, the Sum Assured shall be pa)'abie after deduction of due but
unpaid prernium.

13. If Company do not renerr. this Poiicy on anv Annual Renewal Date by paytng tlre premiums
then falling due on or before due date or within such extended time as the Corporation may
allow, the Company shall (unless the Corporation otherr,r'ise agree) be deemed to have
discontinued payment of premiums hereulder and shall not be entitled to resume payment
except with the consent of the Corporation.

14. In case the premiurns stipulated hereunder shall not be duly paid or in case any conciitions
herein mentioned or any endorsements made hereto shall be contuavened or in case it shall
here#ter appear tirat an untrue, or incorrect averment is contained in the proposal,
declaratiory lists or statements already furnished or to be furnished to the Corporation by
the Member or the Company in accordance with the provisions hereof or otherwise in
respect of the Assurance effected or to be effected hereurder or tlat any of tlre matters set
forth or referred to in such proposal, deciaratiory lists or statements have not been truly and
fairly stated or that any material information has been suppressed or withheld, then and in
every such case but subject to the provisions of Section 45 of the Insurance Act 1938,
wherever applicable, the benefits under this Polic\., in so far the same relate to the Member
or Members in respect of rn'hom such contravention of conditions or suppression or
withholding of material information takes place or such untrue or incorrect averrnent has
been made either by_th" Member himself or by the Company, shall be void and the relative
Assurances shall ceaSe and be deterrnined and all clalms to anlr benefits in respect of the
Assurances shall be nul1 and void and all the Moneys paid in respect of such Assuraaces
shali belong to the Corporation excepting always in so far as relief is provided in terms of
the provisions hereof and without prejudice to the rights of the Corporation to condone any
such contravention of condition or urLkue or incorrect averment or suppression or
withholding of material information in so far as Law permits such condonement or to
reinstate the Assurance or parts tfrereof the original values subject to fu1fi1lment of such
conditions as ihe Corporation may prescribe for such reinstaternent or to grant any other
relief to the Cornpany or to the Member or Members concerned at the sole discretion of the
Corporation.

15. This is a non-participating plan i.e. the employer doesrlt have any righi to participate in the
profit generated by the Corporation from tLis scheme.

16. Cooling Off period: The Company may review the terms arrd conditions of the Master
Poiicy and choose to return the Master Policy to *re Corporation witlr-in a period of 15 days
in case of any objection r,r'ith a writlen communication stating the reasons of their objection.
 of Master Poliry by the
The period of 15 days shali be reckoned from tlre date of receipt
shall be cancelled and the
Company. on receipt of such a comrrrunication, the Master Poliry
amounts received shall be refun.led to the Company after deduction
in respect of the
following:

a. Recovery of proportionate charges towards risk premiurn'

b. Stamp duty.

1-7. A11 conrmunication in relation

Manage\f&GS)
LIFE INSURANCE CORPORATION OF INDIA
Pension & GroupSchemes Department
25 KG MARG.NEW DEI}il-110001,

of the Insurance ombudsman is as

18. In case of any grievance under the poliry, the address
under:

O/OTHE INSURANCE OMBUDSMAN

lz apNrveRSAL INSURANCE BIILDTNG
ASAF ALI ROAD'NE'W DELHI-I.1Wz
 THE SCHEDULE
PART - I ELIGIBILITY
The employees who on the Effective Date are within the
ELIGIBILITY FOR following category/categories shail be eligible to become
MEMBERSHIP members and be entitled to the benefits of this Policy as
from the Effective Date:
All permanent employees (Executive) including posted on
deputation in other ogarrisadons who are aged not less
than 18 years and not more than 60 ye:rs.
Future employees shall become eiigible for membership
hereunder on Annual Renewal Date which next follows
the date of their entry into the above category.
The benefits under this policy shall only be available till
the date of employment or upto last Annual Renewal Date
whichever is later.
AGE AT ENTRY The minimum age at entry will be 18 years. For this
purpose, age wiil be rounded off in complete numbers of
years. i.e. years less than 6 months will be treated as age at
last birth day and othenvise age near birthday.

PART - II BENEFITS AND PREMIUMS

PLAN OF Subject to the provisions of paragraph 4 below, the Assurance is
ASSURANCE effected under LIC's New One Year Renewable Term Insuralce
Pian-I. The Assurance in respect of the Member shall commence
from the Entty Date and shall be renewable yeariy on ilre
subsequent Annual Renewal Dates
AMOTINT OF Ar1 A."*url e of Rs. SOlacs / ZaLacs shall be effected on the iife of
SUM ASSURED each Member as pef his option. The Assurance shall be held by the
Emptoyer uPoN TRUST for the benefit of the persons entided to
in Accordance with these Rules.
Term Annually Renewable
RENEWAL OF Th" As"rrtance shall be renewable annually on the subsequent
ASSURANCE IN Anrrual Renewable Dates until the Terminal Date for appropriate
RESPECT OF A sum Assured determined inthe Manner described rn-paragtaph2
MEMBER above.
pRovIDED TIIAT if the sum Assrred on +.he subsequent Annual
Renewal Date is for a sum higher that the Sum Assured under the
Assurance as on the last preceding Annual Renewal Date, such
increase in Sum Assured (the excess over the Sum assured as on
the last preceding Anrrual Renewal Date) shall be effected subject
to the isions o{ h5 below.
 5. CORPORATION'S Evidence of insurability satisfactory to the Corporation in the form
RIGHT TO and manner prescribed by the Corporation shall be furnished in
RESTRICT respect of the Member before the Assurance or increase in sum
ASSURANCE. Assured under t].e Assurance is affected. If the evidence submitted
in respect of the Member is not satisfactory, the Corporation shall
modif the terms of acceptance of the Assurance.
If sirch satisfactory evidence is not furnished or if the Member is
found uninsurable on the E t y Date or the relevant Annual
Rener,r'al Date, the Assurance or increase in Assurance shar not be
effected in respect of him.
6. PREMIUMS. The prerniums payablefor the Assurance in respect of the rvlember
on the Entry Date and subsequent Annual Renewable Dates shal1
depend upon the mortality experience of the scheme and as
mutually agreed between botl"r the parties. The prerrdum rates
applicable on the Effective Date shall be ascertained from the Tabre
of Rates glven in Part III of The Schedule. Flowever, the premium
will be reviewed on after every three years.
7 NE"I^/ ENTRANTS Not AIIou:ed
8 REFUND OF NotApplicable
PREMIUM
9 WI{EN THE The Sum Assured ulder the Assurance shall become payable only
SUM ASSURED in the event of death of the Member whilst in Sen'icelduring
BECOMES membership provided the Assurance is in force at that time.
PAYABLE.
10 TO IATHOM The Sum Assured shall be payable to the beneficiaryfor the benefit
PAYABLE of the Beneficiary of the Member with an intimation to the
company.
TL HOIAi PAYABLE The Sum Assured in respect of the deceased mernbers shall be paid
up in lump sum within 1 month of ihe receipt of claim rvith all the
relevant dccuments.
t2 TERMINATION OF The Assurance on the iife of the Member shall terminate on the
ASSURANCE discontinuance of palnnent of premium except point no. 12 of
General conditions

1.3 SURRENDER AND The assurance effected hereunder carries no Surrender or paid-up
PAID-UP VALUES values.

1.4 WAITING PERIOD Waiting period mearls that period within which no claim is
admissible from the effective date. Ffowever. this clause shall not
be applicable in this Group Insurance scheme.

15 SUICIDE CLAUSE T?ris clause shall notbe applicable in this Group Insurance scheme.
 t../
LI L :' j
!-i{J : /
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t,/
,./
f/
//

{
I /i anrrrrm^nrrnF
PART IN TABLE OF PREMIUM RATES
The Age nearer birthday of the Amount of Premrum The Age nearer Amount of
Member on the Entry required to secure Sum birthday of the premium required
ate/Annual Renewal date(Yrs Assured of Rs.1,000 for Member onthe to secure Sum
One year Entry Dat{Annual Assured of Rs.1,M
Renewal Date(Yrs) for One vear
8to14 1.60 46 L6A
15 1.60 47 1.50
16 1,.69 48 1.60
17 L.60 49 L.60
18 1..60 50 L.6A
19 1.60 51 7.74 i

2B 1.60 52 7.74

121 L.60 53 7.70 :

22 1.60 54 7.74
23 1.60 55 7.70
24 1.60 5b 7.70
57 .7.70
25 1.60
26 L.60 58 7.78
27 L.60 59 7.70
28 L.6B 60 7.70
29 1.60
30 1.60
JI L.50
32 L6A
JJ 1.68
J{t 1.60
55 1.60
36 1,.60
J/ 1.60
38 1..60
39 1.60
40 1..60
41 1.68
AN L.60
43 1,.68
44 1..60
45 1.60

The above premium rates are exclusive of GST.

Note: For sum Assured of Rs.20lacs payable (Age Group 51 to 60 year), quarterly premium w-ill
be applicable.
IL.'Jl

SECTION 45 OF INSURANCE ACT,1938

"No policy of lifb ilsurance effected before the commencement of this act shall after the explry
of two years from the date of comrnencement of this Act and no poiicy of life insurance effected
after the coming into force of this Act shall after the expiry of tn'o years from the date on which
it rt as effected, be called in question by * insurer on the ground that a statement made in the
proposal for ilsurance or in any report of a medical officer, or referee, or friend of the insured,
or in any otlter document leading to the issues of the policy, was inaccurate or false, ulless the
insurer shows that such statement \,\,'as on a material matter or suppressed facts which it was
material to disclose arrd it was fraudulentlv made by the Policyholder and that the Poliryholder
knew at the time of making it that the statement was false or that it suppressed facts which it
was material to disclose:
Provided that nothing in this section shallprevent the insurer from calling for pioof of age at
anytime if he is entitled to do so, and no poHcy shall be deemed to be called in question merely
because t} e terms of the poliry are adjusted on subsequent proof that tlre age of the life assured
was incorrectly stated in the proposal."
. A11 comrnunication in relation to this policy shall be addressed to:
LIFE INSURAI{CE CORPORATION OF INDIA
DELHIDTVISIONAL OFFTCE
PENSION & GROUP SCHEMES DEPT.
NEWDELHI ll000tAny change inthe above address shallbecommunicated to the Cornpany.
' In case you have any Complaints/Grievance, you may approach Grievance Redressal
Officer/Ombudsman, whose address is as under:

Address of Grievance Redressal officer:

DIViSIONALMANAGER
LIFE INSURANCE CORPORATION OF INDIA
DELHIDIVISIONAL OFFTCE
PENSION & GROUP SCHEMES DEPT.
Note: In case of dispute in respect of interpretation of these terms and conditions and special
provisions/conditiorts fle Enghsh version shall stand valid.
THE COMPAI{Y ARE REQUESTED TO EXAMINE THJS POLICYAND
SATISFY THEMESELVES TT{AT T}IE VARIOUS PROVISIONS CONTAINED
THEREIN CONFORM TO THEIR REQUIREMENTS. iF ANY AMENDMENT OR
MODIFICATION IS FOUND NECESSARY, THE CORPORATION MAY PLEASE
BE ADDRESSED IN T}IE MATTER IMMEDIATELY.

(At
 BSNL New One year Renewal Group Term Insurance Scheme

103006610/7/9
NOT AVAILABLE

IF NOT AVAILABLE OTHER ID

SINCE INCEPTION

Rs.50LACS
NOT TO BE FILLED
YEARLY

(Manager of SBI branch where deceased had salary account)

 Part B
Certified that the replies to the above questions are correct in every respect and have been verified
with the membership register kept for this purpose and that the deceased member was covered by
the scheme and eligible for the benefits there under as on the date of his death

Place: (Signature of Claimant)

Date:

Signature of claimant

/Copy of Cancelled Cheque

c) Death Certificate