LIFE INSURANCE CORPORATION OF INDIAPOLICY ENROLMENT FORM FOR LIC’s WEB-SITE “ www.licindia.com ”

To The Chief Manager/Sr./Branch Manager,Life Insurance Corporation of India,………………………………………………………………………………………

I have registered at Life Insurance Corporation of India’s web-site ‘www.licindia.com’ and request you to validate the following enrolled policy/ies. * Name of the Policy Holder (40 Characters)

* Login User ID (compulsory)

* Email-id Date of Birth

DD MM YYYY Phone Number Mobile Number

+91 STD Code Phone Number 91 STD Code Mobile Number Country Code STD Code Phone Number STD Code (compulsory if not a 10 digit mobile number)

Sr. * Policy Number (nine-digits)

* PremiumAmount

* Name of Life Assured

1.2.3.4.5.6.7.8.9.

10.

I have read the provisions contained in the “Terms of Service: Enrolment of Policies on LIC’s web-site: www.licindia.com” and accept them. I agree that all the transactions executed over “LIC’s web-site: www.licindia.com” under my User-id and Password will be binding on me.

Date: ……………………. Policyholder’s SignaturePlace:……………………. (Life Assured / Proposer) All fields marked with (*) are compulsory fields.

Terms of Service:Enrolment of Policies on LIC’s web-site ‘ www.licindia.com ’

General Information:

1. Login User-id and password can be obtained by registering on LIC’s web-site as new users. The existing users can continue with the same user-id and password.

2. You should submit the duly completed enrolment form at any LIC branch where your policy is being presently serviced. The Branch will verify the detail and then enrol the policies under your user-id for your access to the policy details on the web site.

3. Access to the enrolled policies will be available to you only after the enrolment form is validated by the Branch. You can enrol only those policies for which you are an authorised signatory/claimant. A confirmatory email will be sent for the enrolled policy/ies to the email-id mentioned in this enrolment form.

4. If you believe that any information relating to your account has a discrepancy, please bring it to the notice of the branch by e-mail or letter.

5. Registration/Policy enrolment cannot be claimed as a right. LIC reserves the right to reject/disqualify any registration / enrolment at its own discretion.

6. LIC reserves the right to modify the services offered or the Terms of service of LIC’s web-site. The changes will be notified to the customers through a notification on the Site.

Services offered:

1. You can view/download & print the policy status of the policies numbers you have registered.

2. You can view/download & print revival and loan quotations.3. You can submit online request for address change, without having to personally

visit the servicing branch.4. You can pay premiums of validated policies online through your net-banking

accounts. 5. If you opt, LIC will send alerts either through Email or/and SMS about the Premium

payment dates, and other information about products and services.

Policyholder’s obligations:

1. The policyholder has an obligation to maintain secrecy in regard to the user-id & password allotted by LIC. And LIC presupposes that login using the user-id and password is a valid session initiated by none other than the policyholder.

2. Transaction executed through a valid session will be construed by LIC to have emanated from the registered policyholder and will be binding on him / her.

3. The policyholder will not attempt or permit others to attempt accessing the LIC’s web-site through any unlawful means.