The document discusses the key objectives and process of underwriting in the insurance industry. It provides definitions of underwriting as examining and classifying risks to determine appropriate premiums. The objectives are outlined as providing equitable, profitable and deliverable insurance policies. Key aspects covered include risk factors considered, principles of utmost good faith and moral hazard, types of underwriters and their roles, and importance of sound underwriting. Rules for application forms and documentation requirements are also summarized.

1. Underwriting

2. Objectives
1 Underwriting, Principles and types
2 Application Form and Documentation
3 Rules and Regulations
4 Underwriting Process Flow

3. What is underwriting?
• Underwriting is the process of
– Examining, accepting or rejecting insurance risks, and
– Classifying those selected, in order to charge the appropriate
premium for each.
• The purpose of underwriting is to spread the risk among a pool of
insured in a manner that is equitable for the insureds and
profitable for the insurer.
Risk
The possibility of any adverse deviation from a
desired outcome that is expected or hoped from
any occurrence

4. Broad Classification of underwriters
Underwriters
Field cum primary Technical
Underwriter Underwriters
• Agents & the Agency • The person actually
development managers. concluding the contract of
• They come in personal insurance there by
contact with the client and committing the contractual
have an excellent liability and obligations.
opportunity to assess the • He is required to be vigilant
risk. while scrutinizing each and
• It is essential that the they every document submitted
should help to screen out and ensure that the basic
bad risk. underwriting requirements
are abided by.

5. What does an Underwriter do?
• The underwriter is an employee of the
insurer who-
Accepts Applications
B
Evaluates Declines
risk A Underwriter C Applications The decision to
provide insurance
coverage or not is
commonly referred to
D as an underwriting
decision
Determines appropriate premium
These decisions greatly affect the success or failure of
an insurance company

6. Why is sound underwriting important?
• Sound underwriting is beneficial to the insurance company, the
insured and the insurance sales persons:
– Helps insurance companies remain competitive and financially strong.
– An insurer‟s profit primarily determined by controlling expenses, accurately
pricing products and exercising sound judgment in underwriting
– An insurer must charge premium amounts that correspond to the risk that
each proposed insured represents.
– Sound underwriting benefits sales agent because they can use an insurer‟s
sound underwriting practices as a selling point to demonstrate the
company‟s focus on fairness to policy owners and its commitment to
financial strength.
Sound
Underwriting Underwriting is considered to be sound if each risk is
evaluated accurately, classified properly, approved for an
appropriate premium amount, or denied accurately

7. What are the objectives of Underwriting?
• Effective underwriting enables insurers to issue policies that are:
Basic concept underlying life insurance pricing is to
ensure that the premium amounts charged for a cover is Equitable to
based only on factors affecting the policy’s costs. As the policy-owners,
underwriter receives each application for insurance, he
evaluates the degree of risk presented by the proposed
insured and charges a fair premium to insure the risk.
When the agent delivers the policy, the customer may
choose not to accept it, if the premium or the coverage
is different from what was expected.
To be acceptable to the buyer, a policy must satisfy Deliverable by
three basic requirements.
agents
1. The policy must provide benefits that meet the
buyer’s needs.
2. The coverage provided by the policy must be
affordable to the buyer.
3. The premium charged for the coverage must be
competitive in the marketplace.

8. What are the objectives of Underwriting?
Just like insured should be charged premium
amounts that are appropriate for the level of risk
they present, insurance companies should also be
compensated for the level of risk they accept on
each policy.
Profitable to the
All insurance companies, require sound insurance
underwriting to help assure favorable financial company.
results.
Although underwriters are only indirectly involved in
establishing a company’s premium structure,
underwriters’ decisions are crucial in producing
actual mortality results that correspond to the
actuaries’ mortality projections, and, thus, produce
profitable business.

9. Insurance Products
[Sum Assured: Rs. 100]
Risk Premium Risk Premium
[Rs. 25] [Rs. 5] [Rs. 5]
[Rs. 20]
Savings Premium
Typical Endowment Plan Typical Term Plan
[5 Year]

10. “Utmost Good Faith”
(Uberimma fides )
• “ A Duty voluntarily to disclose, accurately and fully all material
facts pertaining to risk proposed, whether requested or not. ”

11. Anti Selection
• Any action by the applicant which obstructs the underwriter from
selecting and classifying risk fairly
• How does one Antiselect ???
– Non-disclosure
– Misleading information
– Avoiding medical tests
– Legally the insurer can repudiate claim and even confiscate premium.

12. Moral hazard
• Moral hazard is the prospect that a party insulated from risk may
behave differently than it would if it were fully exposed to the
risk.
• Moral hazard arises because an individual or institution does not
bear the full consequences of its actions or may want to bring
about an unnatural outcome to an other wise normal life.

13. Risk Factors in Life Insurance
• The various risk factors to be assessed prior to underwriting
decision are:
1. Medical
2. Financial
3. Personal
Life Insurance Risk Factors
1 2 3
1. Build 1. Insurable 1. Occupation
Interest
2. Habits 2. Avocation
2. Income
3. Personal Medical 3. Hobbies
Protection
History 4. Residence
3. Persistency
4. Family Medical 5. Moral Hazard
History 4. Net Worth

14. Some Product rules
• Product not offered to NRI/PIOs/Foreign Nationals (residing in India)
• Term products, Term riders and Hospitalization products are not offered
to NRI /PIOs/Foreign Nationals
• Product not offered to Illiterate
• Term plans, Term Riders Accident & Health products are not offered to
Illiterates.
• Product not offered to Class 5
• Riders and Accident & Health products are not offered to Individuals
belonging to occupation class 5.
• Products where back date is not allowed
• Unit Linked covers, Accident & Health products and Term plans and
product with term rider are products where back date is not allowed.
• Product not available to Housewife
• Term plans, Term riders are not available to Housewife.
• Products not available to Juveniles less than age 18
• Any riders, term plans, ShubhLife, Health products, Nirvana plus, Assure
Security and growth plans.

15. Some Product rules
• ADB and ADDL cannot be offered simultaneously
• Whenever CI rider has been opted, the premium cannot be paid
through CC authorization or SI instruction.
• No riders can be attached to term plans
• Regulatory Rule: - Total rider premium should not exceed 30% of
basic premium: - Such cases have to be pended for reduction in
sum assured of riders.
• For HP, the ADB benefit cannot be more than 2 times the Term
benefit. The total FADD benefit cannot be more than the Term
benefit.
• NRIs as well PIOs can be offered HP subject to AHC rider minimum
i.e. Rs.100/-as well as Term benefit minimum.

16. Filling in the application form

17. Rules relating to application form filling
• The application form is the basis of each and every contract and
as such is, in the majority of cases, the most important source of
information available to the underwriter. Each question contained
within the form has its relevance in assessing the risk being
presented while a cover is being applied for. Hence it is very
essential that all the details are captured correctly and to the
fullest
• All details in the application form as well other documents
submitted should be completed in all respects (no blanks
acceptable).
• Any overwriting, correction or cancellation in the Application form
and other documents including Amendment form has to
countersigned by the Insured/Applicant (same signature as on the
last page of the application form).

18. Rules relating to application form filling
• Questions, in the application form and other documents, should
not be answered as NA or Not Applicable. If the answer is in
negative, should be answered as NIL (Exception: Female life
Questions where Insured is male.)
• Combined Life application form, HP and FIH forms, only the first
part of Health Declaration is to be filled up to the specified
simplified limits of corresponding plans, but both parts of the
Health declaration has to be filled beyond the limits.
• However if there is any adverse health declaration, than both
parts of Health declaration has to be filled even within the
simplified limits.

19. Application Form
Important information in an application
form

20. Application form
• Name: This not only gives the identity of the applicant but also
can reveal their ethnic origin, indicate if they are famous or even
infamous, and would suggest Insured‟s lifestyle, travel, pastimes,
etc.
• Points to be noted
– Specify the full name of the proposed insured corresponding to the age proof
submitted by the client.
– Insured/Applicant's name must be written in block letters using blue / black
ink as Surname-------------First Name---------------Middle Name
– In case of married female, if the name has been changed after marriage,
Maiden Name Declaration (full name of the Insured prior to Marriage) has to
be completed in the application form.
– Name Mismatch: In case name of the Insured has been changed or there is a
mismatch in the name, as given in the application form vis-à-vis age proof
submitted, a gazette copy has to be provided as proof of the name change.

21. Application form
• Address: Apart from its role in communicating with the applicant,
the address can give some idea of the financial status of the
applicant, especially if he or she lives in an area, which is well
known. In conjunction with other features such as occupation and
marital status, it can lead to further enquiries regarding lifestyle.
• Points to be noted
– Ensure that both the Residential & Business addresses are mentioned in full.
– For NRI or PIO residing abroad, the foreign address can be mentioned as
residential address.
– Address Proof required of the Temporary or Permanent from AML perspective
– Both the permanent & current address proofs required if both are
different as per application form.

22. Application form
• Marital Status: A useful indicator for the need for cover & of the
level of acceptable sum assured.
• Points to be noted
– For the Male Insured, based on marital status, BPE test will be called
at the age 35 and above.
– For age between 35 – 40 year above 100,000 Sum assured RBT is
required and for age 40 years RBT will be called in all sum assured

23. Application form
• Date of birth: This information is essential for premium rate
calculation. It is also important in determining if the sum
proposed exceeds routine non-medical limits & is important in
assessing the significance of certain medical impairments e.g.
Asthma.
• Points to be noted
– Date of Birth mentioned in the application form should match with that on the
standard/Non standard Age proof submitted.
– DOB Mismatch:
• If there is mismatch of the Age as per the DOB mentioned in Application form vis-a
vis non standard age proof submitted, and if the Age as per DOB mentioned in the
Application form is lower, alternate Standard age proof will be required or higher
age premium and higher age SIS can to be submitted with reconfirmation of the DOB
in a GAF.
• However, if the Age as per DOB mentioned in the Application form is higher, the
same can be accepted, if the corresponding premium and SIS has been submitted.

24. Application form
• Nationality Check nationality and residential status:
– Nationality should be specified correctly since based on nationality and
residential status (Nationality of the Proposed Insured other than Indian or
residing for more than 180 days out of India), Specific NRI/PIO rules will be
applied for the case.
 For PIOs /Juveniles & housewife having foreign resident Parent or Husband,
respectively, the residential status should be clearly mentioned in a separate
GAF.

25. Application form
• Occupation
– The obvious advantage of knowing the applicant's occupation is being able to
assess any associated accident and/or health risk and, for disability coverage
to classify the occupation for rating purposes.
– Occupation are classified in to five different categories as per the risk they
bring along with them (described in occupation section).
– The information can also be useful to assess whether the sum proposed and
premiums payable are reasonable, given the applicant's likely financial status
and income.
– If the occupation is „Driver‟, a special mention should be made regarding the
type of vehicle and the nature of the goods being transported (Hazardous/Non
Hazardous) and in other occupations appropriate Occupation Questionnaire
should be provided.

26. Application form
• Applicant and Nominee details
If applicant is different as compared to Insured, all the details as mentioned
earlier needs to captured.
For HUF and Keyman cover, the same has to be specified in the Applicant
name details and the date of Incorporation of the HUF or company has to be
provided.
As per Section 39 of Insurance Act, 1938 the holder of a policy on his own
life, may either at the time of taking out the policy or any time during the
term of the policy before maturity, nominate the person or persons to whom
the money secured by the policy shall be paid in the event of death of the Life
Assured, for the disbursement to the Legal heirs (beneficiaries).
As per the company rules, direct relatives e.g.
Father, Mother, Wife, Children, brother, sister, grandparents can be
designated as Nominee for the cover

27. Application form
• Following can be nominated, subject to a satisfactory declaration from
the client.
– Aunt
– Uncle
– Cousin
– Nephew
– Niece
• Any other Nomination would not be allowed.
• Name, age and relationship of the Nominees should be specified.
• Nomination is not allowed in all cases where Applicant & Insured are
not the same (e.g. Juvenile cases, Housewives, Students above 18
years)
• Although nomination is not compulsory, it is preferable to declare
nominee for the ease of payout at the claim stage.
• Although multiple nominees can be allowed, assigning percentage for
the various nominees is not allowed.
• A minor (less than 18 years of age) can be a Nominee but not an
Appointee.

28. Application form
• Appointee and Contingent policyholder:
– When a nominee is a minor (below age 18 yrs), the applicant (Payor) of the
policy should appoint an appointee.
– In juvenile policies, contingent policy holder name with age and relationship
should be provided, The CPH should an adult. If the CPH is not among the
relatives as mentioned above, an explanation has to be provided.
– CPH signature has to be mandatory be provided.
– Applicant cannot be the contingent policyholder.

29. Application form
• Hazardous risk questions:
– Details of any hazardous pursuits, frequent flying or working in armed force
should be answered „Yes‟ or „No‟, N.A is not accepted.
– If any previous cover has been rated up or declined or postponed, the same
should be specified and details have to provided.
– If answer to Hazardous risk Questions like working in Arm force or working
as Pilot is „Yes‟, the corresponding questionnaire should be enclosed
• Aviation/ Armed Forces question:
– Many hazardous sports and pastimes require a high level of physical fitness,
whilst others such as sub-aqua diving or private aviation can require
participants to undergo periodical medical in order to meet licensing
requirements.
– The special questionnaires have to be provided, as it is essential in the
assessment of risk to obtain considerably more information than would
normally be available from a standard application form.

30. Application form
• Insurance Covers with other companies:
– Should clearly state the Insured‟s or Applicant‟s insurance cover giving
relevant policy details.
– In case policy with TATA-AIG the policy number should be provided.
– If the Proposed Insured does not have any insurance, other than the current
policy for which he/she is applying then “NIL” has to be written in the
column provided.
– Previous cover detail is used determine to eligibility of the maximum cover
to carry out Financial underwriting
– If any previous policy with any other Insurance has been declined,
Postponed or rated up, details of the same must be provided.

31. Application form
• Questions for smoking, alcohol and build
– The proposed insured or the applicant should clearly specify the type and no.of
cigarettes smoked or type and quantity of tobacco consumed along with details of how
many years, since consumed.
– If there is alcohol consumption, the amount and type of Alcohol consumed, and how
frequently & since how many years need to be specified.
– Build need to be specified correctly.
• Points to be noted:
– Ht should be specified in cms and Wt in Kg.
– If there is large discrepant Build, Medical examination may be called based on the
same.
– If there is significant change in Build with in last 12 months, the same should be
mentioned along with the reason for the same.
– In Juveniles, the Height and Weight of the child should be captured correctly and
accurately. Even small discrepancy, in Build of child, may lead to rejection of case.
– If the Ht and Wt of the child has been measured in presence of Doctor, the same should
be captured in a GAF, duly attested and signed by the physician (Reg. No. of Doctor
should be provided) and the same can be submitted at the time of application itself.

32. Application form
• Health Questions
– Health declaration Questions are mandatory including the family
history Questions and if there any positive health declaration, the
details of the same should be provided.
• Points to be noted
– In case the client discloses any personal Impairment – further
Questionnaires, Medical examination or medical test, personal reports
or APS may be called.

33. Application form
• Date Back option questions:
– Dating back or Back Dating is an option that allows the assured to get the
benefits of lower age by commencing the policy from a date earlier than the
date on which the proposal form was signed. Application date and date back
can‟t be the same.
– Birth date and date back date cannot be the same.
– In case of juvenile (less than 1 year) back date is not allowed.
– In case of term riders, term plans, 20TROP, UL & Health first back date is not
allowed.
– For ShubhLife, date back allowed for a maximum of 6 months within the same
financial year.
– Date backing is allowed up to 12 months for Nirvana Plus-WSM cases.
– The back date should not be more than 6 months from the application date.
– Premium to be collected from Date back date.

34. Application form
• Signature:
– Signature of the Proposed Insured and/or applicant and signature of the agent
has to be provided.
– For Juvenile cases, applicant only has to sign the application form. In cases
where Insured is Adult (> age 18) and applicant is different (Parent or
Husband), signature of both the applicant and Insured would be required.
– Vernacular declaration is required to be counter-signed by the agent or the
person explaining the contents of the application form along with his identity
details.
– If agent is the proposed insured/applicant, application form is to be duly
attested by the RDM/ADM.
– Corrections done in the agent related information should be countersigned by
the RDM/ADM.

35. Application form
• Signature (Continued):
– In HUF and Keyman cover, the signature of the Karta with the Karta stamp,
and Signature of Authorized signatory along with stamp would be required in
addition to Signature of proposed insured.
– For Illiterate Right thumb in Females and Left thumb in Males.
– The place of signing the application form has to be within India.
– When the agent has filled the application form on behalf of the Applicant, a
declaration has to be provided to the effect by the agent as well as Applicant.
– Also a declaration has to be provided by the agent, regarding the submission
of the KYC and AML documents in non Health or Term plans

36. Customer Signature
Please note:
Effective 1st June 2008, it is MANDATORY for all supplementary
proofs submitted to be signed by the customer.
• Following are the list of proofs that require self attestation :
– Age Proof
– Address/Residential Proof
– MOA/AOA
– Attended Physician's statement
– Personal Medical reports/Prescription papers / Hospital Discharge card
– Income documents like ITR ; Salary Slip or certificate ; Bank Statements ; CA
Certificate ; Asset & Liability statement ; PnL ; Balance Sheet etc. If income
documents are multiple pages or compilation of several documents then
attestation or signature should be on relevant pages only i.e. certification
page , stake holder's detail page ,Balance Sheet /P&L details page.

37. Some common errors relating to application forms
Height and weight details not provided. Other
details correctly filled in.

38. Age Proof

39. Age Proof Guidelines
• Classification based on the Sum Assured* and Products
Sum 0 – 8,00,000 / 8,00,001 – 30,00,000 > 30,00,000 /
Assured* Health First Health First more
(Rs) up to 4 Units than 4 Units
Type of All products All products All products.
Product
Type of List A List B List C
acceptable
Age proofs
For SA band 8.0 Lacs to 30.0 Lacs for all products we will require List B only.
We shall not call for List C for Term/ Health products and covers more then 8
lacs and having Term/Critical illness riders
*Sum Assured will include Basic plan along with Term and Critical illness riders and Total
Permanent Disability with TALIC and will include all the policies on the Life of that individual
with TATA AIG Life.

40. Acceptable Age Proofs- List “A”
• Driving License – a document that is issued by the Issuing Authority (It should
have completed more than 2 years since it has been issued and for an Expired
Driving License it should be not more than 2 years since expiry)
• Pan Card – a document issued by the Income Tax authorities
• Ration Card (Date of issue of the Ration card is required.) – Issued by the
municipal authority for every family.
• Voter ID card – issued by Government
• The Certificate issued by the Village Panchayat, providing details of the name
and date of birth and duly stamped.
• LIC policies where the age is shown as admitted, will be accepted
• TALIC Agents License / ID card.
• Health Scheme (CGHS) certificate with details of Age/DOB on it, will be
accepted for all Central Government employees.
• ESIS card
• PF statement from employers, which states the name and date of birth.
• Only discharge card from the Nursing home/Hospital specifying the DOB for age
upto 5 yr. will be acceptable. However, it is mandatory to submit name of the
child or an amendment form in which applicant (Payor) gives declaration that
the age proof belongs to the proposed insured for age 0-5 year.

41. Acceptable Age Proofs- List “A”
• Baptism certificate, Municipal Birth Certificate with DOB & Name of the
proposed Insured will be acceptable. However in case where the name of the
child is missing in the age proof, it is mandatory to submit an amendment form
in which applicant gives declaration that the age proof belongs to the proposed
insured and clearly stating the name and DOB (acceptable only upto age 5
years).
• S.L.C. or Higher Secondary Mark list, School / College certificate/Certified
extract from school or college/Progress Cards will be acceptable. The
certified extracts have to be provided on the letter head of the institution duly
signed, stamped by the Principal.
• Certified extract from Service register in case of Govt. Employee &
Employee of Quasi Government & Institutions belonging to Public Ltd. Cos.
provided, conclusively evidence of age was produced at the time of recruitment
of employees. Certified extract to be obtained on the Cos. letter pad and Cos.
seal and countersigned by insured.
• ID cards of only TATA Employees, Government/Semi government employees
clearly stating the DOB will be accepted as standard age proof
• Passport
• Marriage Certificate of a Christian issued by a Roman Catholic Church
• ID card issued by Defense Dept.
• Domicile Certificate
• Copy of Family extract page 2 of the Gram Panchayat, which gives details of
Name, Age, Date of Birth and relationship to the head of the Family *
• Bonafide school certificate stating the date of birth**.

42. Acceptable Age Proofs- List “B”
• Driving License – a document that is issued by the Issuing Authority (It should
have completed more than 2 years since it has been issued and for an Expired
Driving License it should be not more than 2 years since expiry. (Learner‟s
license will not be accepted as Age proof)
• Pan Card – a document issued by the Income Tax authorities.
• Only discharge card from the Nursing home/Hospital specifying the DOB for age
upto 5 yr. will be acceptable. However, it is mandatory to submit name of the
child or an amendment form in which applicant (Payor) gives declaration that
the age proof belongs to the proposed insured for age 0-5 year.
• Baptism certificate, Municipal Birth Certificate with DOB & Name of the
proposed Insured will be acceptable. However in case where the name of the
child is missing in the age proof, it is mandatory to submit an amendment form
in which applicant gives declaration that the age proof belongs to the proposed
insured and clearly stating the name and DOB (acceptable only upto age 5
years).
• S.L.C. or Higher Secondary Mark list, School / College certificate/Certified
extract from school or college/Progress Cards will be acceptable. The
certified extracts have to be provided on the letter head of the institution duly
signed, stamped by the Principal.
• Certified extract from Service register in case of Govt. Employee &
Employee of Quasi Government & Institutions belonging to Public Ltd. Cos.
provided, conclusively evidence of age was produced at the time of recruitment
of employees. Certified extract to be obtained on the Cos. letter pad and Cos.
seal and countersigned by insured.
• ID cards of only TATA Employees, Government/Semi government employees
clearly stating the DOB will be accepted as standard age proof

43. Acceptable Age Proofs- List “B”
• Passport
• Marriage Certificate of a Christian issued by a Roman Catholic Church
• ID card issued by Defense Dept.
• Domicile Certificate
• Copy of Family extract page 2 of the Gram Panchayat, which gives details of
Name, Age, Date of Birth and relationship to the head of the Family.
• LIC Policy –
• The LIC policies and the premium receipts, which indicates the age, admitted
based on the following codes only will be accepted as Standard age proof.
The codes are
• P: Passport
• S: School Certificate
• C: College Certificate
• M: Municipal Birth Certificate
• B: Baptism Certificate
• I: Defense ID card
• J: Domicile Certificate
• E.g. LIC Policy which indicates Age, admitted: Yes (P), will be accepted as
standard age proof.
• Policies with the above abbreviations only, will be accepted as Standard age
Proof.
• Bonafide school certificate stating the date of birth.

44. Acceptable Age Proofs- List “C”
• Only discharge card from the Nursing home/Hospital specifying the DOB for age
upto 5 yr. will be acceptable. However, it is mandatory to submit name of the
child or an amendment form in which applicant (Payor) gives declaration that
the age proof belongs to the proposed insured for age 0-5 year.
• Baptism certificate, Municipal Birth Certificate with DOB & Name of the
proposed Insured will be acceptable. However in case where the name of the
child is missing in the age proof, it is mandatory to submit an amendment form
in which applicant gives declaration that the age proof belongs to the proposed
insured and clearly stating the name and DOB (acceptable only upto age 5
years).
• S.L.C. or Higher Secondary Mark list, School / College certificate/Certified
extract from school or college/Progress Cards will be acceptable. The
certified extracts have to be provided on the letter head of the institution duly
signed, stamped by the Principal.
• Certified extract from Service register in case of Govt. Employee &
Employee of Quasi Government & Institutions belonging to Public Ltd. Cos.
provided, conclusively evidence of age was produced at the time of recruitment
of employees. Certified extract to be obtained on the Cos. letter pad and Cos.
seal and countersigned by insured.
• ID cards of only TATA Employees, Government/Semi government employees
clearly stating the DOB will be accepted as standard age proof
• Passport
• Marriage Certificate of a Christian issued by a Roman Catholic Church

45. Acceptable Age Proofs- List “C”
• ID card issued by Defense Dept.
• Domicile Certificate
• Copy of Family extract page 2 of the Gram Panchayat, which gives
details of Name, Age, Date of Birth and relationship to the head of the
Family. (Attached is the copy family extract)
– LIC Policy –
• The LIC policies and the premium receipts, which indicates the age, admitted
based on the following codes only will be accepted as Standard age proof.
The codes are
• P: Passport
• S: School Certificate
• C: College Certificate
• M: Municipal Birth Certificate
• B: Baptism Certificate
• I: Defense ID card
• J: Domicile Certificate
• E.g. LIC Policy which indicates Age, admitted: Yes (P), will be accepted as
standard age proof.
• Policies with the above abbreviations only, will be accepted as Standard age
Proof.
– Bonafide school certificate stating the date of birth.

46. Acceptable Age Proofs
• NOTE:
• All I.D must clearly show date of birth. (I.D. showing age only will not be
acceptable).
• Age proofs in Vernacular (regional) language should be translated and
attested by the Br. Manager.

47. Format for School Certificate
S ch o o l C e rtificate
T h is is ce rtify th at S hri / K u m a ri : --------------S o n / D a u g hte r of shri/M r-------------------------
V illa g e ----------------- P .O ------------ D ist/T a hsil.------- S ta te----------------- w a s a b o n afid e
stu d e n t
O f o u r in stitutio n ----------------------- d urin g th e se ssio n --------------------------------- --------------.
H is/H e r d a te of b irth a s pe r th e sch o o l a d m issio n re g ister n um b er (if a va ila b le ). -------------
-------
D a te : S ig n a ture of th e h e a dm aste r
S ig n a ture of th e in sure d / a p p lica n t
______________________________________________________________________
_________
I u n d ersig n e d h e reb y co nfirm th at th e a b o ve in stitu t io n /sch o o l is e xistin g in th e g ive n
lo ca tio n a n d is cu rre n tly fu n ctio n a l
B ra n ch O p e ratio n M a n a g er/ G a ze tte d office r
D a te :
______________________________________________________________________
__

48. Points to be noted
• The copy of age proof submitted has to be signed by the Life
Assured.
• Pan card and Driving License are acceptable for Sum Assured 8 -
30 lacs .i.e. as soon as Sum assured (Basic plan along with Term
and Critical illness riders and Total Permanent Disability) 8 lacs
through single or multiple policies, list B will be applicable
except when customer has opted for Term plan or Health
Products or where plans has Term or critical illness riders in any
of the plan opted with TALIC.
• Driving License provided, should have been issued more than 2
years ago, at the point of application.
• An expired passport can be used as Age proof document
(however not as photo ID proof)
• The Affidavit cannot be submitted as an age proof

49. Points to be noted
• When two substandard documents have been submitted as Age
proof and Photo ID proof and there is mismatch in the age as
mentioned in the two documents and customer has opted for
lower age as mentioned in the Application form, the Applicant
can
– provide a a alternative std age proof document or
– can take higher age as per higher age giving document submitted,
confirming the same by a GAF and
– pay higher age premium and provide SIS for the higher Age in
conventional plan or just provide higher age SIS for ULIP plans.

50. Points to be noted
• However, if the Age as per DOB mentioned in the Application
form is higher, the same can be accepted, if the corresponding
premium and SIS has been submitted.
• Age proofs in Vernacular (regional) language should be
translated and attested by the Br. Manager.
• DOB declared by school/college should be on the letterhead of
the institution, bearing its stamp & signed by the
Principal/Headmaster (exception of letterhead in rural cases).

51. Sales Presenter and Goal Finder/DnA

52. Sales Illustration - SIS
• SIS has to be submitted in all cases.
• The SIS has to be of the same version and same set and all the
pages have to be submitted.
• SIS should be signed by applicant/Insured in pages where
signature column is provided.
• It may or may not have signature of the Applicant on all the
pages; however it needs to have signature of the Applicant (and
Insured, if different from applicant and age > 18 yrs).
• The following areas are important:
1. Name, 6. Rider details
In addition to these,
2. Age 7. Term for Unit Linked
3. Gender (if CI rider 8. Sum Assured Insurance Plans, the
has been opted) premium multiple and
9. Premium fund allocation is also
4. Payment opted important.
5. Plan opted

53. Sales Illustration- Format
Customer Specific Details
Policy Specific Details

54. DnA Sales Tool
• DnA Sales Tool is mandatory in all Unit linked cases, however they
are not required Bancassuarnce and Broker channel & DM Channel
.
• The following information should be captured:
– Clients Personal Information
– Family Members/ Dependents
– Policy Owners Signature
– Agents Signature
– Clients Chosen Plan
– Client's Risk/Return Attitude. (At least one option should be ticked)

55. D n A- Format

56. Forms and Questionnaires

57. General Amendment Form
• This form is used to make any changes/clarification called for in
the application form prior to the issue of the policy.
• All the details should be mentioned clearly in the general
amendment form and the form has to be signed by the applicant
and the agent, duly dated.

58. Financial Questionnaire
• Financial Questionnaire is an important declaration provided by
the Applicant, giving details of the financial status of the
insured.
• Part II of the Financial Questionnaire is mandatory for Business
class and self employed, where all the Business details for the
Applicant have to be filled up.
• For non earning individuals like juveniles or housewives,
financials details of the applicant or the Payor have to be
provided and incase the Insured is adult, signature of both
insured and Payor is required, otherwise it has to be duly signed
by the applicant.

59. Financial Questionnaire
• Modified abbreviated form of financial questionnaire can be
utilized for covers for individuals who are premier or power
vantage customers of premier banks only.
• Part II of the modified financial questionnaire has to be filled by
the Relationship manager of the bank providing the relationship
details.
• Annual Income section of the Financial Questionnaire should
reflect the actual earned income of the applicant or the payor.

60. Important parts of the financial questionnaire
• Intent of taking cover
• Previous cover details including Individual on which the covers is taken,
kind of cover, Insurance company, sum assured and premium.
• Pan No.
• Nature of occupation, salaried or Business.
• Last 3 years annual income.
• Income from other source, details.
• Various assets including properties and investments and liability.
• Lifestyle questions
• Juvenile Questions giving details on life cover on the sibling of the
insured.
• Business ownership details.
• Account details of the Business.
• Part III of the Financial Questionnaire has to be filled by the agent.

61. Asset Liability Statement
• All parts of asset liability statement should be duly filled up.
• Important areas these statements are:
1. Name of the bank should be specified.
2. Last 3 years annual income details
3. Various categories of Asset and liabilities
4. Name of the bank with whom the investments are made should be specified.
5. Net worth of the Individual.
6. Statement should be duly dated & signed by the Applicant/Payor.
7. In case of bancassurance channel, it has to be duly signed by the Relationship
manager and Bank manager, along with the applicant. (HSBC certified asset liability
is not acceptable)
8. In case of Non bancassurance channel case, it has to be duly dated and signed by
the Chartered accountant (CA), duly stamped. Also name of the CA firm with name of
the main partner or proprietor and CA registration no. has to be provided, along with
applicant signature.

62. Juvenile Questionnaire
• Juvenile Questionnaire is to be mandatorily filled in all juvenile cases.
Important areas of Juvenile Questionnaire are:
• Current and previous cover details
• Annual income and existing or applied cover details of both the parents.
• Details if Insured has any siblings less than age 18 and details of the
cover on their life.
• Based on these details, decision of the maximum cover that can be
granted on the life of the juvenile is decided.
• Part II of Juvenile Questionnaire has to be signed by the
applicant, when the total TALIC cover on the child exceeds the limit of:
Age bands Total Sum assured
0 to 12 years Rs 1,000,000
13 to 17 years Rs 2,000,000

63. Housewife Questionnaire
• Housewife questionnaire has to be submitted in housewife cases.
It provides details about the
 Profile of the Housewife
 Annual income of Husband of the Insured.
 Existing or applied cover on the life of Husband.
• If the cover of the Housewife is more than 10 lacs, proof of
Husband‟s income and proof of cover on his life has to be
provided.

64. Payment
• Through Credit card or ECS :
1. Incase of payment to be made through credit card, we require the
front side of credit card copy along with the Credit card
authorization form
2. Incase of Auto premium payment through ECS we require the original
forms to submit to the POS dept and not the Xerox.
3. Incase of Debit card instruction, only debit card copy is sufficient.

65. Payment
• Through Standing Instruction (SI) :
1. Should contain the S.V (Signature verified) stamp OR HSBC Stamp.
2. Should contain signature of authorized HSBC employee with HSBC
stamp in the allotted space below "For bank use only".
3. Should contain the HSBC employee's signing number.
4. If there is any alteration in the account number, policy number,
policy name or amount, should be countersigned.

66. Payment
• Towards a bounced instrument
1. Payment towards bounced instrument should be in cash/demand
draft.
2. If the payment is for SI or CC bounce cases, then the cashier would
only accept that modal premium in cash/cheque.
3. For any payment against bounced cheque, maximum amount
accepted in cash would be 49,999 and the balance should be
presented by Demand Draft.
A general amendment form is required from the applicant when he
wants to change the mode of payment from SI or CC to cash or cheque,
confirming the same.

67. Payment
• Transfer of funds request:
– Transfer of funds can be requested via letter/GAF duly signed and
mentioning the policy no. from the customer.
– The Customer can request for transfer of funds in his capacity of an
Insured or Payor.
– It can be transfer of funds from one policy to another or for a
particular policy if a refund cheque has been send back by the
applicant.
• Transfer of Funds can be done only in the following two
scenarios:
From an existing policy of the
From an existing policy of the Customer,
Customer, his children or wife (which
his children or spouse (which is closed,
is closed, postponed, declined) with
declined, postponed or withdrawn) with
our company to another of his earlier
our company to a new application being
inforce policy for adjustment against
submitted by the customer.
his due premium.

68. Medical Underwriting

69. Medical Underwriting
• Medical Limit- Total Sum Assured for Medical Underwriting
This includes the amount of Basic Life (Permanent or Term) + Term Rider +
Critical illness rider + ½Sum Assured of Payor Benefit Rider of all TALIC policies
(provided there are no fully underwritten Health products) + Top up Sum Assured.
• Medical Limit- Total Sum Assured for Medical Underwriting
– Where along with conventional life covers, A&H product is also
applied for, the medical limit would be defined as for
• If the HP applied for is simplified, than medical limit would be Total permanent
disability benefit+ CI or cancer benefit+ CI benefits of Health first plan for all TALIC
plans
• Fully underwritten life and A&H -Basic Life (Permanent or Term) + Term Rider +
Critical illness rider + Top up Sum assured + ½Sum Assured of Payor Benefit Rider +
Term Benefit (>4 Lac) +Total permanent disability benefit+ CI or Cancer benefit +
Health First CI benefit (for all TALIC policies)

70. Factors affecting Medical Underwriting
Gender
F1
Build
Age
F7 F2
7
Factors F3
Lifestyle
F6 Habits
F5 F4
Family Medical Personal Medical
History History

71. Factors affecting Medical Underwriting
• Individually each of these items can have a significant effect on
mortality and where an adverse response is given, may lead to
further medical evidence being requested.
• However, in combination with other items such as occupation,
they can help to build up a picture of the proposed insured which
may give the underwriter a better insight into the risk presented.
• For example a proposed insured with a stressful occupation may
be prone to drink or smoke to excess.
• Similarly, an under average family history in combination with
overweight and or smoking may lead to further investigations that
individually those items may not be warranted.

72. Tools for medical underwriting
• Medical Reports (Insurance/personal)
– Based on the findings on the Medical reports, a decision can be
taken about the health status of the Proposed Insured.
• Attending Physician‟s Statement
– Often some of the Past health details of the Insured would be
available with Attending Physician of the proposed insured only and
hence APS would become very important certain such cases.
• Medical Check-up Questionnaire
– Whenever, the proposed Insured has undergone medical test or
check up, the Medical check up Questionnaire will have to be
provided along with copy of reports.
• Specific Disease Questionnaires
• Discharge Report

73. Medical Limits for India
Revision in Non Medical Limits
Revision in Non Medical Limits
Please find revised Medical requirement table effective 4th January 2008.
Please find revised Medical requirement table effective 4th January 2008.
Revision in Non M edical Lim its
th
P le a se fin d re vise d M e d ica l req u irem e n t ta b le effe ctive 4 Ja n u a ry 2 0 0 8 .
SA Band Unto 13 Yrs 14- 17 Yrs 18-35 Yrs 36-45 Yrs 46 Yrs & Above
SA Band Unto 13 Yrs 14- 17 Yrs 18-35 Yrs 36-45 Yrs 46 Yrs & Above
0- 10,00,000 NM NM NM NM NM
0- 10,00,000 NM NM NM NM NM
ME, BPB,A b o v e
S A B and U n to 1 3 Y rs 1 4 - 1 7 Y rs 1 8 -3 5 Y rs 3 6 -4 5 Y rs 4 6 Y rs &
10,00,001 - 15,00,000 NM NM NM NM HBA1c, ECG-R
ME, BPB,
10,00,001 - 15,00,000
0 - 1 0 ,0 0 ,0 0 0
NM
NM
NM
NM
NM
NM
NM
ME, BPB,
NM
HBA1c, ECG-R
ME, BPB,
NM
15,00,001 - 20,00,000 NM NM NM HBA1c, ECG-R
ME, BPB, HBA1c, ECG-R
ME, BPB,
M E, BPB,
15,00,001 - 20,00,000
1 0 ,0 0 ,0 0 1 - 1 5 ,0 0 ,0 0 0
NM
NM
NM
NM
NM
NM
HBA1c, ECG-R
ME, BPB,
NM
HBA1c, ECG-R
ME, BPC,C G -R
H BA 1c, E
20,00,001 – 25,00,000 NM NM NM HBA1c, ECG-R
ME, BPB, HBA1c, ECG-Exe
ME, BPC,
M E, BPB, M E, BPB,
20,00,001 – 25,00,000
1 5 ,0 0 ,0 0 1 - 2 0 ,0 0 ,0 0 0
NM
NM
NM
NM
NM
NM
HBA1c, ECG-R
ME, BPB,C G -R
H BA 1c, E
HBA1c, ECG-Exe
ME, BPC,C G -R
H BA 1c, E
25,00,001 - 30,00,000 NM NM ME, BPB HBA1c, ECG-R
ME, BPB, HBA1c, ECG-Exe
ME, BPC,
M E, BPB, M E, BPC,
25,00,001 - 30,00,000
2 0 ,0 0 ,0 0 1 – 2 5 ,0 0 ,0 0 0
NM
NM
NM
NM
ME, BPB
NM
HBA1c, ECG-R
ME, BPC,C G -R
H BA 1c, E
HBA1c, ECG-Exe
ME, BPC,C G -E x e
H BA 1c, E
30,00,001 - 50,00,000 JMR ME, BPB ME, BPB HBA1c, ECG-Exe
ME, BPC, HBA1c, ECG-Exe
ME, BPC,
M E, BPB, M E, BPC,
30,00,001 - 50,00,000
2 5 ,0 0 ,0 0 1 - 3 0 ,0 0 ,0 0 0
JMR
NM
ME, BPB
NM
ME, B P B
BPB
M E , BPB,
HBA1c, ECG-Exe
ME, BPC,C G -R
H BA 1c, E
HBA1c, ECG-Exe
ME, BPC,C G -E x e
H BA 1c, E
50,00,001 - 100,00,000 JMR ME, BPB HBA1c, ECG-R
ME, BPB, HBA1c, ECG-Exe
ME, BPC, HBA1c, ECG-Exe
ME, BPC,
M E, BPC, M E, BPC,
50,00,001 - 100,00,000
3 0 ,0 0 ,0 0 1 - 5 0 ,0 0 ,0 0 0
JMR
JM R
ME, BPB
M E, BPB
HBA1c, ECG-R
ME, BPB,
M E, BPB
HBA1c, ECG-Exe
ME, BPC,C G -E x e
H BA 1c, E
HBA1c, ECG-Exe
ME, BPC,C G -E x e
H BA 1c, E
> 100,00,000 JMR ME, BPB HBA1c, ECG-R
ME, BPB, HBA1c, ECG-Exe
ME, BPC, HBA1c, ECG-Exe
ME, BPC,
M E, BPB, M E, BPC, M E, BPC,
> 100,00,000
5 0 ,0 0 ,0 0 1 - 1 0 0 ,0 0 ,0 0 0
JMR
JM R
ME, BPB
M E, BPB
HBA1c, ECG-R
H B A 1 c , E C G -R
HBA1c, ECG-Exe
H B A 1 c , E C G -E x e
HBA1c, ECG-Exe
H B A 1 c , E C G -E x e
M E, BPB, M E, BPC, M E, BPC,
NM Non Medical
> 1 0 0 ,0 0 ,0 0 0 JM R M E, BPB H B A 1 c , E C G -R H B A 1 c , E C G -E x e H B A 1 c , E C G -E x e
NM Non Medical
JMR Juvenile Medical Report
JMR Juvenile Medical Report
NM N o n M e d ic a l
ME Medical Examiners Report
ME
JM R
Medical ExaminerseReport
FBS n ile M e d ic aCholesterol, Triglycerides, S.Creatinine, Urea,
J u ve (Glucose), l R p o rt
S Bilirubin, SGPT, SGOT, GGT, Alk. Phosphatase, Albumin,
FBS (Glucose), Cholesterol, Triglycerides, S.Creatinine, Urea,
BPB ( 13 Tests)
ME HIV, ic a l E x a m in e rsSGOT, GGT, Alk. Phosphatase, Albumin,
S e d HbsAgSGPT, R e p o rt
M Bilirubin,
BPB ( 13 Tests) HIV, HbsAg
F B S (G lu c o s e ), C h o le s te ro l, T rig lyc e rid e s , S .C re a tin in e , U re a ,
BPC ( 15 Tests) BPB +Complete T , S G O T , G G+ ,HDL. P h o s p h a ta s e , A lb u m in ,
S B iliru b in , S G P Blood Count T A lk
B P B ( 1 3 T e s ts )
BPC ( 15 Tests) BPB H b s A g
H IV , +Complete Blood Count + HDL
Random Blood test will be called based on Products (Term plans & HP with term benefit more
B P Cthan 4 e s ts ) Occupation bele te B lo obased n t +of D L insured. plans & HP with term benefit more
Random BloodBtest + C o mand MaritalC o u on Products (Term
( 1 5 T lacs), P B will p called d status H the

74. Medical Limits for India

75. Medical Limits for India
• Points to be noted
• Please note that Random Medical examination may be called for certain
Non Medical cases randomly based on certain percentages.
• RBT (not called randomly but based on certain criteria) is mandatory for
certain specified occupation, Single male aged 40 & above OR aged 35 &
above if S.A. > Rs.1 lac and all term plans and Health protector plan with
Term benefit more than 4 lakhs.
• Please note that that during Medical test, the Insured (and in Juvenile
cases, Applicant) has to sign the Medical test form and has to submit
Xerox copy of their Photo identity proof (Signature, during ME, has to be
in same format as used in the Application form).
• Based on Disclosed History, certain additional requirements can be called
for
• (For any past history of significant Illness, Hospitalization or operation or
medical test carried out, it would be advisable to submit beforehand all
the relevant papers like Discharge summary or copy of reports, for faster
processing of cases).

76. Medical Table- Health First
• The Non medical limit is 2 units subject to a maximum age of 55
years. Age 56 and beyond are subject to Medical requirements.
• The Medical requirements table for the FIH product is:
Medical Limits for India -FIH.
Age
Units 18 - 35 36 - 45 46 - 50 51 - 55 56 +
0-1 0 0 0 0 2
2 0 0 2 2 2
3-4 0 2 2 2 2
5-7 3 3 3 3 3
8-16 3 3 3 4 4
17-20 4 4 4 4 9
Medical Examination [ME] to be performed by AIA Panel Doctors.
HIV Testing Limit Rs 800,000. All Term cover to have HIV testing
0. Non Medical
1. Blood or Saliva test (HIV)
2. ME, BPA
3. ME, BPB
4. ME, BPC, ECG-R
5. ME (AIA), BPC, ECG-R, APS or Med Records, PFT or CXR
6. ME (AIA), BPC, ECG-R, APS or Med Records (if available), PFT or CXR, Abdominal
Ultrasound
7. ME
8. ME (AIA), Blood (BPC + PSA), ECG-R, APS or Med Records (if available), PFT or
CXR, Abdominal Ultrasound, ECG-EX
9. ME, BPC, ECG-R, APS OR MEDICAL RECORDS, PFT OR CXR, ECG-EX

77. Medical Table- Health First
Blood Profile A Cholesterol, Triglycerides, Glucose, Creatinine,
[BPA] Urea, HbsAg, SGOT, SGPT, Alk Phos, Gamma GT,
Albumin.
Blood Profile B HIV, Cholesterol, Triglycerides, Glucose, Creatinine,
[BPB] Urea, HbsAg, SGOT, SGPT, Alk Phos, Gamma GT,
Albumin.
Blood Profile C CBP, HIV, Cholesterol, Triglycerides, HDL Chol,
[BPC] Glucose, Creatinine, Urea, HbsAg, SGOT, SGPT,
Gamma GT, Alk Phos, Albumin, AFP.
Term benefit and Total permanent Disability benefit of Health protector
would trigger medicals based on general life Medical table, whereas
Critical Illness or cancer benefit would trigger medicals based on Health
first Medical table (where different medical are required based the two
tables, higher medicals will be called).

78. Medical requirements for specific diseases
• High Blood pressure or Hypertension: Specific Medicals +
Hypertension Questionnaire.
• Diabetes Mellitus type II: Specific Medicals + Diabetes
Questionnaire.
• Asthma: Asthma Questionnaire with or without medicals
• Thyroid problem: Medical + Latest Personal thyroid Function
reports + Attending Physician statement for thyroid problem
• History of jaundice in last 5 years: Hepatitis Questionnaire with
or without medicals
• History of Mental Illness: Mental disorder Questionnaire.

79. Medical requirements for specific diseases
• History of Respiratory problem: Specific medicals with Attending
Physician attending Respiratory disorder Questionnaire.
• History of Back or neck problem: Past reports + back Neck
disorder Questionnaire.
• History of Growth, swelling, cyst or cancer: Medicals + Past
reports including Histopath reports+ Attending Physician
statement + Tumor Questionnaire.
• History of Heart problem: Medicals + Personal reports +
Attending physician statement + Congenital Heart Disorder Qn.(
if since birth) or Ischemic Heart disease Questionnaire. (if low
blood supply to Heart problem)
• History of Injury: Injury Questionnaire.

80. Financial Underwriting

81. Objective of financial underwriting
• The main purpose of Insurance cover is to facilitate and allow only
the replacement of the financial loss due to any untoward
incident.
• In general, while offering a cover to a individual one has to
remember that the gain due to death or Illness or disability should
not be more than the continued normal survival of the Insured.
• So, financial Underwriting is done to ensure that that the level of
cover proposed, corresponds with and is appropriate to the
personal or business circumstances of the customer

82. Objective of financial underwriting
• Traditionally, the following reasons are given for financial
underwriting:
– Ensure a valid Insurable Interest.
– Ensure that there is no intention or temptation on the part of the
insured or the other party to bring about the claim earlier than
anticipated by the insurer.
– Ensure the sum assured and contract proposed is consistent with the
customer‟s needs, lifestyle and ability to pay the premiums throught
the contract term.
– Overall to ensure that no moral hazard is generated by offering the
cover to the individual Insured.

83. Steps of financial underwriting
Insurable interest for A
the cover
First step of establishing financial eligibility is to ensure that there is Insurable interest
in offering the cover
A person has an "insurable interest" in something when loss or damage to it would
cause that person to suffer a financial loss or certain other kinds of losses.
A basic requirement for all types of insurance is the person who buys a policy must
have an insurable interest in the subject of the insurance.
Life Income Multiple B
calculation.
Subsequent step would be establishing Financial eligibility
Premium Paying C
Capacity.
The final step is establishing Premium paying capacity.
Financial eligibility and Paying Capacity can be assessed by the
current annual income of the proposed.

84. Maximum cover based on HLV Multiple
• Life Insurance Need/Maximum cover that can be offered =
Substantiated Annual income X Human Life value multiple based on age
(as given below)
• This Maximum cover, mentioned above,
gives the Total cover that can be availed
on the life of insured (Cover with TALIC
and Non TALIC covers).
• Human Life value indicates today's value
of Insured‟s future earning.
• This formula helps to determine Insured‟s economic value for his
loved ones.
• Normally any Individual is never offered a cover more than
Maximum cover, mentioned above.

85. Premium Paying Capacity
• Premium paying capacity is the percentage of Insured‟s annual
Income that can be contributed for all the covers paid by him. (It
includes TALIC and Non TALIC covers as well as premium paid by
Insured for the covers on life his Family members).
• In general, we can allow 30 to 50 % of premium paying capacity,
depending on the plan opted by the insured.
• Spouse or father of the Insured can support his/her premium
paying capacity.
• Premium paying capacity calculation is not carried out for single
premium cases.

86. Maximum Cover based on Net Worth of the
Insured
• In some cases where there is significant assets belonging to Insured
with out much liabilities, a cover can be offered based on Net
worth of the Insured.
Net Worth = Total assets – Total liabilities
• (However even for consideration of such kind, the Premium
paying capacity has to be still established, in terms of liquid cash
available with the Insured)
• Net worth of the Insured can be established by a CA certified
Asset-Liability statement duly stamped with registration number.

87. Financial Assessment of Riders
Accident rider
Critical illness
multiple & Disability benefit &
benefit &
Age Maximum Maximum Disability
Maximum Critical
Accident benefit
illness cover
cover
15X Annual
16-45 yrs 5X Annual Income 5X Annual Income
Income
10X Annual
46 yrs and above 5X Annual Income 5X Annual Income
Income
Maximum issue limit 10,000,000 1,000,000 10,000,000

88. Financial Limits
• Total Sum Assured for Financial Underwriting:
This includes the amount of Basic SA of all policies with TALIC (including pure
term plans) + Term rider of all policies with TALIC + CI rider of all the policies with
TALIC +1/2 of Payor benefit rider+ Top up sum assured + Non simplified Health
Protector {Term benefit (if more than 4 lacs) + CI benefit + TPD Benefit + Accident
Benefit} + Basic cover of all policies with other companies
• Financial Requirement grid:
Financial Limit Requirement
Up to Rs. 2,500,000/- Application Form
Rs. 2,500,001/- to Financial Questionnaire
5,000,000/-
Rs. 5,000,001/- to o Financial Questionnaire
10,000,000/- o Asset and Liability Statement [Refer annexure]
& Surrogates/Std Financials
Rs 10,000,001 and above o Financial Questionnaire
o Std Financials along with surrogates & Asset –
Liability statement

89. Documents for verification of financial status of
applicant
• Latest financial document has to be provided.
• If there is discrepancy in the profile of the customer vis-à-vis the
cover opted for, financial document will have to be provided, to
justify the cover and premium paying capacity.
• Salary certificate provided has to company letter head duly signed
by the authorized signatory of the company.
• Asset- Liability statement, balance sheet, P/L account and CA
certificate certifying the annual income of the applicant, has to
be signed by the CA, duly stamped along with registration
number.
• When the annual turnover of the company is more than Rs 40 lac,
audited accounts have to be provided.
• For non proprietorship firm/company, stake of the
Insured/applicant in the company/firm has to be provided.

90. List of standard income proofs
• Income Tax Returns /Form 16 of past three years
• Evidence of Salary earned (e.g. salary slips) of past 6 months
• P&L Account and Balance sheets duly certified by the CA of past
three years. (If audited company financial statements are not yet available, then
obtaining most recent management accounts (profit and loss statements and balance sheets)
or provisional statements - signed by life assured and stamped and signed by company
accountant or auditor - can be utilized.)

91. List of documents in lieu of income proofs
• List of surrogate assets is given below that can be accepted in
lieu of standard income proofs, to verify financial capacity
– Asset & liability statement duly signed by the applicant and certified
by his CA/Bank manager. (copy attached)
• It is important to know what the life assureds net worth is (assets –
liabilities).
• Life assured could have Rs10, 000,000 in fixed deposit, but liabilities of Rs
20,000,000.
– Bank Statements for the past 6 months
(The only problem with normal current account statements is that
balances normally fluctuate due to regular (almost daily) deposits and
withdrawals. Hence more value is given to saving account as compared to
current account. Statement should include ongoing balance to check if
balance is relatively consistent, or even increasing.)

92. List of documents in lieu of income proofs
– Investment Proofs/Deposits in Government Bonds/Long Term Bank Deposits/
Portfolio Report
• Proofs of the same will be required.
– Copy of the Rent Agreement
– Letter from the local revenue department specifying the agricultural income
/Copy of Sat Barah Utara/Copy of Patwari Report.
– Form J giving details of the earning through agriculture.
– Mortgages held with reputable providers such as Personal/Home Loan
statements for the past 6 months
– Last six months payment statement from the concerned financing institution
can be used to give an indication of income.
– Details of Property /Car Ownership (non Hypothecated cars) document
• Relevant papers should be provided if the asset is purchased in the name of the
applicant.

93. Financial assessment- premier status of the bank
customers
• Applicable for Banking Relationship Customers only
• Applicable to the defined Privileged Customers of Approved banks
only.
• Rules will be applicable to customer who have relationship
strength exclusive of premium paid for the policy applied for
• Completed Revised Financial Questionnaire & Bank endorsement
of the Privilege status on Bank Letterhead by the Bank Manager
• Anti-Money Laundering Documents (as per current AML policy) has
to be provided in addition to the above requirement.
• It is applicable to Investment Products only
• Occupation class I to V
• Not applicable to Housewife / Retired individuals

94. Financial assessment- premier status of the bank
customers
• Covers to Children of such Privileged customers may be offered
based on case to case consideration
• Limits are based on total Cover on life (cover with Tata-AIG and
with other companies)
• Riders will be offered based on normal underwriting rules
• Amount of cover needs to be justified financially. It means that
although there is relaxation in terms of documentation, there will
still be Financial underwriting be carried out in all such cases.
With the satisfaction of the above mentioned criteria and up to the
below mentioned limits for different categories of customers, we
can offer such high covers with simplified Documentation of
Revised Financial Questionnaire and Anti Money Laundering
Documents

95. Regulations for premier banks
Bank HSBC bank Premier Customer
Premier Salaried Businessman
customer
Relationship Investments/Loans Investments/Loans
type
No. Of Years > 2 years 6 months – 0 - 6 months > 2 years 6 months – 0 - 6 months
2 years 2 years
Maximum Up to 2 crore Up to 1.5 Up to 75 lacs Up to 1.5 Up to 1.25 Up to 50 lacs
Sum assured crore crore crore
allowed
Requirement 1.Financial Questionnaire (revised) 1.Financial Questionnaire (revised)
2. Bank Endorsement 2. Bank Endorsement
3.Relationship proof (bank statements/investment 3.Relationship proof (bank statements/investment
proof as AML requirement) proof as AML requirement)

96. Regulations for premier banks
Sector HSBC Power Vantage Customers
Premier Salaried Businessman
customer
Relationship Investments/Loans Investments/Loans
type
No. Of Years 6 months – 0 - 6 months 6 months – 0 - 6 months
2 years 2 years
Maximum Sum Up to 50 Lacs Up to 35 lacs Up to 40 Lacs Up to 30 lacs
assured
allowed
Requirement 1.Financial Questionnaire (revised) 1.Financial Questionnaire (revised)
2. Bank Endorsement 2. Bank Endorsement
3.Relationship proof (bank statements/investment 3.Relationship proof (bank
proof as AML requirement) statements/investment proof as AML
requirement)

97. Regulations for premier banks
Bank Other Multinational Bank
Premier Salaried Businessman
customer
Relationship Investments/Loans Investments/Loans
type
No. Of Years > 2 years 6 months – 0 - 6 months > 2 years 6 months – 0 - 6 months
2 years 2 years
Maximum Sum Up to 1 Up to 75 Lacs Up to 37.5 Up to 75 Lacs Up to 62.5 Up to 25 lacs
assured allowed crore lacs Lacs
Requirement 1.Financial Questionnaire (revised) 1.Financial Questionnaire (revised)
2. Bank Endorsement 2. Bank Endorsement
3.Relationship proof (bank 3.Relationship proof (bank statements/investment
statements/investment proof as AML proof as AML requirement)
requirement)

98. Rules relating to proof of source of income
• Based on AML guidelines, depending on the premium paid for all
the TALIC policies as Insured, Applicant or just Payor, further
proof of Source of income will be called for as per below
mentioned norms.
Total Aggregate Premium Proof required
with TALIC (excluding the
Service tax)
Equal to more than Rs Std Financial document. Other documents e.g.
2,500,000 documents substantiating proceeds from an
existing insurance policy but not forming part
of standard income proof may be used as
additional source of income proof
Less than Rs 2,500,000 Std or Non Std Financial document (which may
be supported by actual source of the money
paid for the premium) or Non Std or Surrogate
Financial document
Less than Rs 100,000 No Proof of Source of Income required

99. Standard Financial Evidence- Proof of source of
income
Proof of Source of Income (Document) Guidelines
Latest ITR (Latest)
Latest last one month Salary slip
Allow 50 % of Net Annual income as maximum Total premium
Latest Appointment / Contract Letter (latest) paying capacity
Latest Form No 16 (latest)
CA certified Asset Liability Statement as of 50% of Total Liquid Assets*** would be considered as maximum
date in the format specified by TALIC premium paying capacity (Liquid assets as per below specified
list).
Latest CA certified Profit & Loss account 50% of Net Profit would be considered as maximum premium
paying capacity for individual.
50% of the individuals share in Net Profit of the Company /
Partnership firm would be considered as maximum premium
paying capacity
Agricultural Income: Saat Bara Utara / 50% of the total Annual Income would be considered as maximum
Tehsildar /revenue officer certificate premium paying capacity for individual.
Salary credits in Bank statements 50% of the Annualized salary credits would be considered as
maximum premium paying capacity.

100. Surrogate Financial Evidence- Proof of source of
income
Proof of Source of Income Guidelines
(Document)
Bank Statements of last 3 months 50% of Average of last 03 months bank balance would be considered as
maximum premium paying capacity where Saving / Current (proprietorship)
Account is provided as a proof of source of income *
If the statement shows salary credits, the same will be extrapolated to derive his
annual income, 50% of which will be allowed as his maximum premium
paying capacity
Mutual Portfolio Statement & 50% of current market value of mutual fund portfolio / Bank Deposits/
Bank Deposits Investments would be considered as maximum premium paying capacity.
Bank Certification Bank can certify the Liquid static Assets (Mutual funds, Fixed Deposits etc),
only with them or invested through them. The Certification has to include
actual breakup of the investments. Certification of the average balance of
Saving Account/ current account has to be backed with actual bank
statements.
Guidelines for Single Premium Products:
Single Premium Guidelines
Products
50% of Total Liquid assets would be considered as maximum
premium paying capacity.
If Large flows of Income from genuine source (like proceeds sale of shares, properties, Mutual
funds or receiving of Bonus / retirement funds) are known than, basis the customer declaration
and proof of the same, larger Single Premiums can be given**

101. • * For bank account statement containing only one transaction, the
transaction has to be at least 3 months old i.e. the closing balance has to
be static for the preceding 3 months. For account transactions, which are
mostly cash in nature, & large cash transaction or cheque deposits with
no narration, further proof of source of Income would be required.
• ** If bank statements have narration like Mutual funds
redemption, dividends, Bonus, salary credits, then further proof will not
be required for AML. If source of Funds is another bank / institute then
proof of that funds will have to be provided.
• *** Liquid Assets: Cash in Hand & Bank, Stocks, Certificate of Deposits &
investments (as per def of liquid)
• **** For salary income net salary (after deduction of tax) will be
considered
• Basis any discrepancies in the documents provided further proof of
source of income can be called for as per underwriter’s discretion on
case-to-case basis.

102. Special Underwriting for Selected products
• Health First:
– Up to 4 units of Health First, Financial underwriting is simplified i.e.
no Financial underwriting is carried out.
– From 5 units onwards, Coverage units calculation is carried out based
on following formula
– No. of Units = Annual income/ 50,000
– I.e. if a individual is earning Rs 300,000, he can avail of 6 Units.
– Housewife is offered maximum cover of 4 units.
– Students are offered maximum cover of 2 units.
• Invest Assure Gold financial underwriting:
– For IA Gold minimum multiple stands revised .
– For all cases of IA Gold one can opt for 5 times premium multiple
irrespective of the age

103. Simplified Underwriting

104. Simplified Products
• Nirvana Plus - up to sum assured Rs.4, 00,000/-
• Nirbhay Life - up to sum assured Rs. 4, 00,000/- for Banc
assurance and Rs.2, 00,000/- for all other channels.
• Star Kid - up to sum assured Rs.10,00,000/- through different
policies (Through a given policy only maximum of 4 lacs can be
applied for)
• Invest Assure extra and care up to limits of 20 lacs and 10 lacs
respectively.
The above mentioned all 3 products are completely simplified,
sourced through one page simplified application form

105. Simplified Process
• Mahalife Gold
• 21Year Money Saver Plan
• Life Plus
• Health Protector
• Health First
– For Mahalife gold, 21 Year money saver plan and for Life plus the
Simplified process limits are
– For age 0 – 35 years = SA 10, 00, 000/-
– For age 36 – 45 years = SA 4, 00,000/-
– For age 46 and above = fully underwritten.

106. Important points to be considered
• Products Mahalife Gold, 21 years Money Saver plan and Life plus
has to be sourced through common life application form only.
• For age 46 and above complete application form has to be filled
i.e. step 10 of the application form has to be filled.

107. Riders
• The following riders can be attached with the said plans and will
be treated as Simplified.
– ABD
– ADDL
– ADDS
– WP
– PB
• Note: - Cases with CI and Term rider will be treated as fully
underwritten (i.e. step 10 mandatory in common life application
form), irrespective of the Sum assured and age.

108. Simplified limits for Health First and Health
Protector
• Health First
– 18-45 years - 4 units
– 46-55 years- 2 units
– 56-60 years- 1 unit.
• Health Protector
– ADB rider - Rs. 8,00 ,000/-
– TPD rider Rs. 8, 00,000/-
– CI/ Cancer rider -Rs. 8,00,000/-
– Term rider - Rs. 4,00,000/-
– FADD rider - Rs. 4,00,000/-
– AHC rider - Rs. 10,000/-
• Any rider if exceeds its simplified limits, becomes fully underwritten and
completely filled application (step 7 and 8 for FIH and HP application form) form
is required.
• Any adverse Health declaration in the Application form even within simplified
process limits will mandate filling up of the entire application, as per the fully
underwritten process and will be subjected to full underwriting.

109. Rural Business
• Micro Insurance – All 3 products up to sum assured Rs.50, 000/-
(including previous policies with TALIC)
• 5TN1 product - Age 18 to 55, sum assured Rs.50, 000/-(including
previous policies with TALIC)

110. Business Insurance- Partnership
• Each partner owns a share of capital or goodwill in the partnership
and is similarly responsible for a share of the liabilities.
• An individual partnership agreement may specify otherwise, but
usually local legislation states that:
– Profits, assets and liabilities are shared equally, and
– A partnership is dissolved upon death
Partnership ‘The relationship, which exists between persons carrying on
business in common, with a view to profit other than as a
member of a corporate body'.

111. Business Insurance- Partnership
• In the event of a death the partnership is at risk in that the
interests of the deceased might pass into the hands of a third
party that may either not understand or contribute to the
profitable running of the partnership.
• They may therefore sell the interest to a competitor.
• A written agreement often called a buy and sell or partnership
agreement is essential so that the interests of a deceased may be
acquired by the surviving associate(s).
• This is an undertaking entered into which legally obliges the
estate of a deceased partner to offer for sale his/her interest to
the surviving partner(s).

112. Business Insurance- Partnership
• Underwriting requirements
– Partnership agreement
– To determine level of cover we require, three years accounts or
valuation report of the partnership by an accountant or lawyer.
– All Partners should be insured.
– Only term Plans
For Calculation purposes:
Two & half or three times the average net profits for the previous
three years, over all lives involved.

113. Business Insurance- Key Person
• Why is Key Person Insurance necessary?
– The knowledge and abilities of a key person are unique and extremely
valuable. Loss of this person could cause financial loss to the
company.
– Should the unfortunate happen, the business will require time and
finance to find and then adequately train a replacement.
– Business may have been secured because of the key-person's
reputation or personal relationships would otherwise not have been
extended to the company.

114. Business Insurance- Key Person
• Why is Key Person Insurance necessary?
– Future business development could be significantly affected by the
loss of that valued person.
– Suppliers may also not extend credit when the key-person dies
– Relationship with the work force may be affected.
It is therefore the value of his contribution and the financial
consequences to the business on death that is being insured.

115. Business Insurance- Key Person
• Rules Relating to Key Person Insurance:
– The key-person must be a full time employee of the company and
actively involved in the day to day running of the company.
– The sum assured for employees is limited to 10 - 15 times salary for
ages 25 - 40 and 12 times for 41 or over.
– For owners of the business, the total cover (all sources) available to
all the Key Persons is limited to 3 times average gross profit or 6
times average net profit.
– A maximum of 5 Key Persons per company may be insured

116. Business Insurance- Key Person
• Underwriting Requirements for a Key Person Insurance Cover:
– Application Form signed by Insured & the authorized person on behalf
of the company
– Age proof of the Insured
– Medical Reports as required for the Cover proposed
– Board Resolution of the Company allowing for the purchase of a Key-
man contract on the Key-man's life and the name of the person
authorized to sign on behalf of the company
– Justification for the Face Amount proposed
– Justification as to why the Key-man is a Key-man
– Questionnaire regarding the Key-man

117. Business Insurance- Key Person
• Underwriting Requirements for a Key Person Insurance Cover:
– Keyman Endorsement
– Profit & Loss Account and Balance sheet of the Company for the last 3
years
– Income Tax Returns of the Company for the last 3 years
– Personal Income Tax returns of the proposed Key-man
– Memorandum/Articles of Association of the Company
For Calculation purposes:
The replacement cost basis The loss of profits basis
• Age 25-40 yrs., use 15X • Multiple of profits, we use
multiple of salary three times average gross
• Age 41yrs & over, use 12X profit or six times average
multiple of salary net profit.
These two methods include the amount of cover for all the key persons in total, under that company.

118. Business Insurance- Key Person
• The premium notice is sent to the Company, since the company is
the owner rather than the life insured.
• Details of the company are captured in the applicant part of the
Application form, including the Date of Incorporation in the Birth
date part of the Applicant details.
• Nominee part in the application is to be left blank.
• There must be two signatures in the application form:
– Signature of life proposed, and
– Signature of the official representative of the company

119. Business Insurance- Key Person
• Whenever a Key Man insurance application is to be received an
endorsement has to be also submitted along with the app. form
duly signed by Official Representative of the Company.
• No Riders are allowed to a Keyman.
• Only Term Insurance policy will be offered for Key man Insurance
cover.
• As per IRDA guidelines, no alteration( increase) in the sum
assured is allowed after the policy is issued of Key Man
/Partnership cases.

120. Employer- Employee Insurance
• A benefit provided to the employees of a company or an
organization as a perk benefit.
• Employee and/or the Employer needs to complete the form.
• The employer must issue first premium cheque.
• However, renewal payment for premiums can be made through
cheque issued by employee or employer.
• Cashier will be verifying that the employer has issued the cheque
received for the first premium.
• The letter of undertaking will be required on the company‟s
(Employer) letterhead as per the prescribed format and should
bear the company‟s seal and signatures of the authorized
signatory.

121. Employer- Employee Insurance
• The policy under the employer-employee scheme can be
purchased only on the life of the employee and the benefits
should be passed on to the nominees/ rightful heirs of the
employee either directly or through the company.
• The company does not have rights on the benefits of the plan.
• The existing underwriting rules and guidelines will be applicable
to the policies submitted under Employer-Employee scheme.
• This benefit should be available to the employees of the company
(as per its HR policy).
Cover cannot be offered under this scheme by a company, to a
individual who has more than 5% stake in the same company.

122. Scheme 1
• Employer is the applicant and policyholder.
Employer: Employee:
Pays the premiums Is the insured
Is the applicant and policy holder
and passes the benefits to the
relative of the employee
Please note: This Scheme has been scrapped with immediate effect
due to regulatory reasons.

123. Scheme 2
• Employee is the applicant and policyholder.
Employer: Employee:
Pays the premiums Is the insured and policy holder.
His nominee will get the death
benefits of the policy.

124. Specific requirements for Scheme-2
• The Insured (Employee) only has to sign the application form.
• All correspondence during the processing of the policy will be
addressed to the insured (employee) and the address would be of
the Applicant (Employer).
• The PIP document will be dispatched to the address of the
Applicant (Employer).
• The Renewal Premium has to be paid by the applicant (Employer)
and a reconciliation statement is required with such payment
showing the details of the policy number, Premium Amount and
Name of the Employee.
• Any plan can be offered under this scheme.

125. Draft letter of undertaking for Scheme-1

126. Draft letter of undertaking for Scheme-2

127. Hindu Undivided Family (HUF)
• An HUF consists of:
– All persons lineally descendent from a common ancestor and have not separated, their
Wives & unmarried daughters.
Co- Female
Karta parcenars Members
All male descendents of a common male
The head/senior most ancestor. Male children of the co-parcenars
male member of the acquire interest in the family by birth and This includes wife of the
family. He is responsible are admitted to the benefits of the family but Karta, wives and
for all the affairs of the are not liable to the commitment of the HUF unmarried daughters of
family. He represents the during their minority. co-parcenars.
HUF as the Manager. Every co-parcenars has joint possession
and joint interest in the HUF property.
A Hindu Undivided Family (HUF), which is also known
HUF as Joint Hindu Family is governed by the Hindu Law.
HUF is presumed to be joint in food, worship and
estate.

128. Hindu Undivided Family (HUF)
• Neither the Karta of the HUF nor any member thereon can take
out policies on their own lives for their own benefits or for the
benefits of their dependants and finance them to the detriment of
HUF funds.
• Therefore if policy is financed through HUF funds, the policy
would always belong to the HUF entirely and as such the policy
money would be payable only to the Karta who represents the
HUF as the Manager.
• Hence financial eligibility for a cover under HUF is based on the
Income under HUF only.

129. Hindu Undivided Family (HUF)
• Policy is for the benefit of the HUF and it forms a part of the HUF fund.
• Premium must be paid out of the HUF fund.
• Policy proceeds form a part of the HUF fund.
• Applicant for the life insurance policy must always be the Karta of the HUF.
• The application form must be signed by the Karta along with the stamp of the
HUF.
• HUF deed or HUF ITR may have to be submitted to establish the status of HUF.
• Addendum to HUF must be submitted along with the application form.
• Neither the Karta of the HUF nor any member can take out policies on his/her own
life for own benefits or for the benefits of his/her dependents and pay premium
from the HUF fund.
• Policy exclusively belongs to the HUF. Therefore, Nomination is not allowed.
• Assignment may be allowed. Only the Karta can effect the assignment either for
valuable consideration or for natural love & affection by way of gift, among
members of the family.
• No Loans or Surrender can be availed except for legal necessity or benefit of the
HUF. In this event, a consent letter signed by the members of the HUF must be
obtained.
• In case of dissolution of the HUF, the policy must be surrendered.

130. Married Women‟s Property Act
• It is a cover taken for the benefit of wife and children.
• The insurance proposal should be accompanied by an ADDENDUM
to Married Women‟s Property Act.
• The beneficiaries must be identified - his wife and children, (or)
wife or children (or) children - by mentioning their names
specifically
• A special trustee may be appointed at the point of application.
• The special trustee may be the wife (who may be the beneficiary)
or any other person or an entity such as a bank.
• The consent of the special trustee would be required.
• All signatures must be witnessed.
• There are no restrictions on the type of insurance plan
(endowment, term, whole life or money back; traditional or U L
insurance plan).

131. Married Women‟s Property Act
• Policy should be issued under the MWP Act. So, the proponent
should clearly mention this requirement under the Nomination
column of the Proposal.
• Existing policies cannot be brought under MWP Act later.
• Married Man includes a Widower.
• The man whose life is insured is liable to pay the premiums, but
loses all his rights on the policy like, pledging the policy,
surrendering the policy, revoking the Trust or enjoying the
survival / maturity benefits.
• As far as this policy is concerned only the trustee can act on
behalf of the beneficiaries (according to the conditions expressed
in the Trust Deed, if any).

132. Occupational Ratings Guide

133. Occupations
• There are 5 different classes of occupations depending on the
varying degrees of risk associated with that particular occupation:
Occupation Class
Class 1 Class Class 3 Class 4 Class 5
2
Mostly ‘White Some ‘White Collar’
Collar’ workers workers whose Skilled or semi- Industrial workers
The risk is higher
working inside an occupations are skilled industrial whose occupations
than Class 4 and
office and are not subject to some workers involving require the use of
therefore has to be
subject to other hazardous factors either manual heavy machinery or
individually
factors, which and whose duties labour or the use of other unskilled
considered
would increase their are outdoor or light machinery labourer.
risk traveling.

134. Occupation Code
• Selection of occupation code is as per the occupation of the
Individual and is also dependent on the Industry in which the
Proposed Insured is working, exact nature of activities, the
percentage of manual activities. (Annual Income and residential
location can also be indicator of the occupation code and class).
• Occupation details may also be important from the financial
underwriting perspective as the occupation & industry may give
some may give some idea of the annual income of the individual.
• Hence it is very important all this information should be captured
correctly.

135. Occupation Code
• With higher occupation class, with some specific occupation
types, there may be extra premium charged fore life cover due to
those hazardous natures of occupations.
• With higher occupation class, there will be definitely extra
premium charged for accident and Disability benefits.
• And if correct occupation code and occupation class has not been
selected correctly while generating the SIS and paying the
premium, Counter offer will be sent for occupation loading.

136. Occupation Questionnaires
• To gather further information about a occupation, Occupational
Questionnaire will be called for.
– Mariner- Marine avocation Questionnaire
– Driver- Driving Questionnaire
– Pilot- Aviation Questionnaire
– Oil rig worker- Oil Rig Questionnaire
– Army personnel- Armed force Questionnaire**
– Diver – Diving Questionnaire
– Driver – Driving Questionnaire
• Occupation related HIV test: Based on certain occupations,
Random Blood test (HIV test) will be called for.

137. NRI Rules
• Medical: Medicals on the Insured will be called for all NRI cases,
as per sum assured and age (no mandatory medicals)
• The applicant must have an account with an Indian Bank.
• No repatriation of funds is allowed outside India.
• The applicant has to be in India on the date of signing the
application form
• Copy of passport showing entry to India is required.
• If the Insured is a Juvenile, then the copy of passport showing
entry in India is required for both Insured and applicant.
NRI These are Indians working abroad holding Indian
Passport and nationality.

138. NRI Rules
• Financial underwriting rules are as follows:
– Maximum SA (LIFE): Based on Income Multiples and
– Normal Financial U/W rules.
– All riders allowed except for the Term rider.
– Term Plan, Term Rider and Health First products are not allowed.
– Health Protector can be offered to NRIs but the Accident Hospital
Care and term benefit has to be minimum.
– Simplified products can be sold to NRI wherein there is no residential
extra and occupation has to be Class I & II and sourced through
Bancassurance.
– No life policies would be sold to US residents.

139. NRI Rules
• Following evidences are required for underwriting US Citizen cases that
have relocated to India:
– Declaration with address proof that he/she has relocated back to India
– Income Tax return filed in India
– Declaration that he/she is no longer assessable under the US Tax laws.
 We can underwrite cases from Nepal on individual merits and subject to
fulfilling the requirements outlined below:
For Residents of Nepal (NRI, People of Indian origin in Nepal):
– If Insured is of Indian origin, and salaried, proof of employment submitted,
then there is scope of cover
– If self employed, any cover should have some income proof
– Proof of residence, business interests in India etc required
– Limited cover can be offered
– For citizens of Nepal (Not of Indian origin) and residing in Nepal: We will not
provide the cover, as there is little justification of cover.

140. NRI Rules
• As per Internal guidelines, policies sourced from following
countries will not be processed.
1. Cuba;
2. Iran;
3. Sudan;
4. Burma (Myanmar);
5. Iraq
6. Libya
7. The Balkans, Belarus, Cuba, the Democratic Republic of Congo,
Iran, Iraq, Ivory Coast, Liberia., North Korea, Myanmar (Burma),
Sudan, Syria and Zimbabwe
• The Residential Rating will be applied for cases sourced from
any non- standard countries and this are subject to change
from time to time.

141. PIO
PIO
" PIO means a foreign citizen (not being a citizen of Pakistan,
Bangladesh and other countries as may be specified by the Central
Government from time to time) if,
1. He/she at any time held an Indian passport or
2. He/she or either of his/her parents or grand parents or great
grand parents was born in and permanently resident in India
as defined in the Government of India Act, 1935 and other
territories that became part of India, thereafter provided
neither was at any time a citizen of any of the aforesaid
countries or
3. He/she is a spouse of a citizen of India or a person of Indian
origin covered under (1) or (2) above.
4. They neither hold Indian Passport nor Indian nationality. These
customers tend to visit India as they have their relatives here
or may have relocated back to India.

142. PIO
• Following are the guidelines that we shall use to decide the cover for a PIO:
– Application only from acceptable countries to be taken. (Africa, Iraq e.t.c. would be an
outright reject).
– The applicant must have an account with an Indian Bank.
– No repatriation of funds allowed outside India.
– The applicant has to be in India on the date of signing the application form Copy of
passport showing entry to India is required. If the Insured is a Juvenile, then the copy of
passport showing entry in India is required for both Insured and applicant.
– The Intent for taking insurance in India has to be provided. PIOs who have citizenship of
one country but are residing in another country, actual proof of relationship of the
individual with India has to be provided.
– The Total Maximum cover to be provided will be based on eligibility of the financial cover
and premium paying capacity.
– Medicals will be called based on Sum assured and age.
– Riders except term are allowed to PIO.
– Health Protector can be offered to NRIs but the Accident Hospital Care and term benefits
has to be minimum.

143. Foreign Nationals
• Following are the guidelines that we shall use to decide the cover for a Foreign
National:
– Application only from acceptable countries to be taken. (Africa, Iraq would be an
outright reject)
– There has to be a cap on the Sum Assured. Students should not be offered more than
1,000,000. Working class to be capped at a maximum of 5,000,000.
– The applicant must have an account with an Indian Bank.
– No repatriation of funds allowed outside India.
– No Riders allowed to Foreign Nationals.
A Foreign National is an individual who is not of Indian origin as well as
Foreign not having Indian Nationality. If a foreign national has been either
Nationals working in India or settled in India for a period of at least 3 years and
shows intent of indefinitely residing in India or at least for the tenure of
the policy, than we can consider offering cover to him.

144. Foreign Nationals
• Following are the guidelines that we shall use to decide the cover for a
Foreign National:
– Medicals will be called as per sum assured and age.
– The applicant has to be in India on the date of signing the application form
The reason for taking insurance and the reason and proof for residing in India
(Work permit/Studies) has to be provided.
– Medical and financial underwriting would be as per age and sum assured.

145. Female Life Underwriting
• Two categories:
Category 1: Category 2:
Gainfully employed women with earned income / Non-working woman, dependent on husband.
unearned income, pays income tax, single or
married, good educational and social This group is referred as 'Housewife'.
background.
This category is again classified in to 2
Assessment of this category of female is per categories depending on the Husband’s
normal any earning individual. insurance status.
 Maximum Sum Assured (Life) available to each category:
Category 2
Category 1
Husband has Life insurance Husband has no Life insurance
Subject to normal Lesser of 10x husband’s annual Lesser of 5x husband’s annual income or
underwriting income or Rs. 1,000,000 Rs. 1,000,000

146. Female Life Underwriting
• Product Type available to each category:
Category 2
Category
Product type Husband has similar Husband does not have similar type
1
type of insurance of insurance
Basic permanent
Allowed Allowed Allowed
plan
Term plan or rider * Allowed Not allowed Not allowed
CI rider # Maximum is # Maximum is Rs.1, 000,000/- per
Allowed
(accelerated) Rs.1,000,000/- per Life Life
CI rider # Maximum is # Maximum is Rs.1, 000,000/- per
Allowed
(lump sum) Rs.1,000,000/-per Life Life
Disability rider # Offered at 1.5x
Allowed Not allowed
(WP and PB) standard premium rate
# Offered at Class 2;
Accident rider Allowed Maximum 1x basic Not allowed
permanent plan
# = Allowed and subject to individual product rule.
= The only term product that will be available to housewife will be the ROP Term
product. Cover limit rules will be as per basic cover for housewife.
Riders are available at a nominal extra cost

147. Female Life Underwriting
Sum Assured Requirement Note
Up to Rs. 1,000,000/- Application Form
Above Rs. 1,000,000/- o Housewife o Sum Assured not to exceed Husband’s cover
(Up to a maximum of Rs. Questionnaire o Sum Assured to be within 10 times Husband Income
5,000,000/-) o Housewife Questionnaire to be completed by
Proposed Insured
o Proof of Husbands Income to be provided
o Proof of Husbands Insurance to be provided
• Note:
– Maiden name declaration will be required to be submitted, if the name of the
Housewife as mentioned in the application form ( name after the marriage)
differs from that mentioned in the Age proof document (name of the Insured
prior to marriage).
• Special Amendment Form
– The Special Amendment Form (with pre-set content & without the health
declaration) is required if the proposed insured is a housewife (upto age 35)
and the applicant/policyholder/nominee is her husband. It has to be signed
together with the Application Form.

148. Juvenile Underwriting
• Basic Rules to apply to all Juvenile cover:
– Term (basic or rider), disability, Critical Illness and accident cover
are not allowed to juvenile lives.
– Juvenile Questionnaire to be submitted with all Juvenile Cases
– All TATA AIG policies and policies held at other companies are to be
added to assess the total sum assured.
– Total Sum Assured will be limited to the amounts outlined in the
Juvenile Cover Issue Limits (Table 1).
– Non-working student ages 18 or above will be subject to Juvenile
Rules.

149. Juvenile Underwriting
• Students, above age 18 Yrs, are taken as occupation code O21,
which is classified as occupation class 3: -
– 18 Yr + Students are now classified as Occupation Class 3, which means Occupation
Code - O21 will be Class 3.
– We allow certain products/riders to Students which are being offered to Occupation
Class 3
• Product-Wise clarification as follows for Students more than Age
18 years:
Basic products: Riders and A&H products:
Shubh Life - Allowed Accident riders – Allowed
20TROP - Allowed Accident riders will be offered 5 times
Nirvana - Allowed the parent’s income or 50 Lakhs
Health First - Allowed upto 2 units. whichever is lower.
Pure Term/Raksha - Not Allowed Critical Illness - Allowed
Waiver of Premium - Allowed
Term Rider - Not Allowed
Health protector offered to a
maximum of simplified limits.
• All siblings under age 18 ideally to be insured. If one or more of the children are not
insured, a reasonable explanation is required.
• For the siblings, the lowest sum assured must be at least 50% of highest sum assured.

150. Juvenile Underwriting
Table 1: For Money Saver plan
Ages < 1 Ages 1 -12 Age 13 +
Not all All
siblings Not all siblings Not all
All siblings are All siblings siblings are are siblings
Condition are insured insured are insured insured insured are insured
One or
both
Parents Lesser of 5 x parents income or
Rs Rs Rs Rs 2,000, Rs
Insured Rs 1,000,000 200,000 1,000,000 500,000 000 1,000,000
Lesser of 3 x parents income or
Parents Rs
not Rs 1,000,00 Rs
insured Rs 200, 000 100,000 Rs 500,000 Rs 300,000 0 500,000

151. Juvenile Underwriting
Table 2: The below table is applicable to Mahalife, Mahalife Gold, Assure
Educare, Assure Career Builder and Unit link.
Age 18 +
Ages < 1 Ages 1 – 12 Age 13 - 17 Student
All siblings are Not all All siblings Not all All siblings are Not all Sibling(s)
Conditio insured siblings are are insured siblings are insured siblings are insured or
n insured insured insured not
Lesser of 5x Lesser of Lesser of 5x Lesser of 5x Lesser of 5x Lesser of 5x Lesser of
parents income 5x parents parents parents parents income or parents 5x parents
or Rs 1,000,000 income or income or income or Rs Rs 2,000,000 income or Rs income or
Rs 200,000 Rs 500,000 1,000,000 the cover
1,000,000 as per
financial
OR OR OR eligibility
subject to
Lesser of 5x Lesser of 5x Lesser of 5x
Special
parents income parents parents income or
Lien ##
or the cover as income or the cover as per
per financial the cover as financial eligibility
eligibility subject per financial subject to Special
to Special Lien eligibility Lien ##
One or
## subject to
both
Special Lien
Parents
##
insured
Lesser of 3x Lesser of Lesser of 3x Lesser of 3x Lesser of 3x Lesser of 3x
parents income 3x parents parents parents parents income or parents
Parents or Rs 200,000 income or income or income or Rs Rs 1,000,000 income or Rs
not Rs 100,000 Rs 500,000 300,000 500,000
insured

152. Juvenile Lien
• In all cases of Juveniles wherein the basic plan is either Maha
Life, Maha Life Gold, Educare 18/21, Assure Career Builder, Unit
Link Plans (and for other Juvenile plans where there is Lumpsum
Benefit) and the Applicant desires to apply for a policy on a
Juvenile Life so that total TALIC cover on the life is in excess of
the maximum allowed Juvenile Sum Assured limits, the Applicant
has to complete the entire modified Juvenile Questionnaire with
declaration of modified death benefit through built in Lien (If the
Total cover on the Juvenile Life is within specified Maximum
Limit, than only Page 1 of The Juvenile has to be completed).

153. Lien Clause
• The amount of death benefit under the above basic insurance plan and any supplementary
contract attached to it providing any death benefit shall be the lesser of the “Fixed amount” or
the amount determined using the “Percentage of death benefit” as specified in the following
schedule, but in all cases shall be no less than the total premiums paid for the basic insurance
plan or its Cash Value (for all non Unit linked products) or Account value (for all Unit linked
products), if greater, after deducting all payments made by the Company under the basic
Fixed amount Percentage of death
Insured’s attained age at death (in Rs.) benefit*
Less than 1 year 80,000 20
1 year to Less than 2 years 160,000 40
2 years to Less than 3 years 240,000 60
3 years to Less than 4 years 320,000 80
4 years to Less than 13 years 1,000,000 100
13 years to Less than 18 years 2,000,000 100
*For the purpose of this schedule the death benefit shall include the Face Amount, and if
applicable Sum Assured of the Relevant Supplementary Contract of the policy which are
payable in the event of the death of the insured.
# Please note that the total death benefit, with TALIC will be limited to the table specified
above.
Note: After age 18 Yrs, Full Sum assured will be available as the Death benefit

154. Juvenile Questionnaire

155. Unemployed or Retired Life
• The unemployed individuals are theoretically declined risk
because there is no insurability
• For retired individual or Unemployed individuals, we use the
following guideline:
 Life: Maximum TSA (Life) of Rs 2,00,000/-
 Riders: Term: Decline
 Disability: Decline
 Critical Illness: Individual consideration, maximum </= 1x basic SA
or Decline

156. Effective date- Risk commencement date
• As per new process, we have moved over to ‘Policy date = Issue Date =
Risk Commencement Date.’
• This will address the following critical issues: The reduced policy term
arising out of the current practice (of having separate Policy Dates and
Issue Dates) conflicts with Policy Contract (Policy Term).
• In the proposed scenario, since age will be calculated basis the risk
commencement (underwriting approval date), there is a possibility of a
change in premium and other requirements if the customer‟s birthday
falls between the application date and the underwriting approval date.
• The customer can choose a date prior to his birthday so that premium is
charged as per the old age (with the consent of the insured). Giving the
customer an option to choose his policy date ensures that he is not
adversely affected due to underwriting delays.

157. Effective date- Risk commencement date
• For Term Rider, Term Product, Health Product or UL Policy, the
effective date cannot be taken to a date prior to the application
date.
• Hence in case, while processing a case, the processing goes
beyond the Birth date of the proposed insured, a pending will be
raised for confirmation of the effective date. In such
circumstances, proposed Insured can opt for an effective date
between application date and his Birth date or can pay extra
premium as per his next age premium and provide fresh SIS. Even
at the stage of counter offer, if the birth date of insured is within
30 days of application, again the Applicant can change his
effective date prior to his birth date or sign the counter offer at
higher age ( if he is signing on a date post his birth date) and
additional premium if required.

158. Effective date- Risk commencement date
• To reduce last minute pendings of confirmation of effective date,
any proposed insured, who has birth date within 3 months of the
application date, can submit a confirmation of effective date
through general amendment form, at the point of submission of
application form itself.
• If the case is completed prior to birth date of the Insured, the
same would be taken as the effective date, however if processing
of the case goes beyond the birth date of the Insured, than
effective date confirmed by the insured is taken as the policy
anniversary date.

159. Reopening
• An application for insurance which has been closed (NTU) for non-
compliance of pending requirements can be reopened within 6
months from the date of closure. The guidelines to be followed
are as follows:
• Request for reopening received within a month of closure :
Reopen the case with a simple declaration/GAF with new app
date.
• Request for reopening received a month after the closure and
Medicals more than 3 months old : Reopen the case with Health
Certificate (instead of Fresh application form) & a GAF clearly
indicating a new app date which must be the same as the HC
date.

160. Reinstatement
• If a premium is in default beyond the Grace Period and policy is
not surrendered for its cash value, policy may be reinstated, at
company‟s discretion, within five years after the due date of the
premium in default, subject to:
– Written application for reinstatement, along with payment of all
overdue premiums with interest
– Insured‟s Current health certificate and other evidence of insurability
satisfactory to us
– Policies with Payor Benefit Rider, evidence of insurability should be
provided on owner also
– Repayment or reinstatement of any indebtedness outstanding at the
due date of the premium in default plus interest.

161. General Requirements for reinstatement
Conditions New Requirements
Up to 120 days of nil No requirements, can be revived based
being lapsed on the renewal premium received at the
branch for payment
Reinstatement in 1. Face amount (FA) of the policy to be HC
121 days – 180 reinstated < = 1,000,000
days - Attained age < = 50 yrs or < MR“B”
2. FA of the policy > 1,000,000 or attained HC + ME
age >50 yrs or > MR “B”
3. Total Face Amount (inclusive of all HC + ME
existing covers) >= 3,000,000 for all
ages, irrespective of the previous decision.
Reinstatement in 1. Face amount (FA) of the policy to be HC
181 – 365 days reinstated < = 1,000,000
- Attained age < = 45 yrs or < MR“B”
2 FA of the policy > Rs1,000,000 and/or HC + ME
Attained age >45 yrs or > MR “B”
3.Total Face amount (inclusive of all HC + ME
existing covers)>= 3,000,000 for all ages,
irrespective of the previous decision.
Reinstatement in 1.For cases of all ages and Sum Assured Underwriting as per new business rules
366 days or over and EMR Refer to the new medical grid on attained
age.

162. Important notes on Reinstatement Requirement
• Additional requirements pertaining to the reason for the medical rating
may be required.
• FA includes all Basic, Term Rider and CI rider.
• Company reserves the right to ask for additional medical requirements
whenever appropriate.
• Any examination fees including the fee applicable to medical report are
paid by the Policy owner.
• For children below 13yrs of age a JMR would be required instead of
ME.
• Note:
– Reinstatement requirements for juvenile policies are applicable as above.
– In a scenario, when a fresh case comes to us and there is a previous case, in
lapsed state, irrespective of it being in the lapsed state, we will consider it,
for the total face value on that life, (policies in the lapsed state for more than
5 years, however, will not be considered) so that we do not miss on any
medicals.

163. AML Guidelines
• Documents required as per Premium:
• KYC norms based on TALIC AML Guidelines
KYC Layers Annualized Premium Nature of Documents
Layer I 10,000 (premium of all Photo Identity Proof
covers)
Layer II 10,001 - < Rs. 100,000 Recent photograph of the payor
(premium of TALIC covers) Photo Identity Proof
Residence Proof
Layer III ≥ Rs. 100,000 (premium of Recent photograph of the payor
TALIC covers) Photo Identity Proof
Residence Proof
Income Proof / Source
For the purpose of determining the threshold of Rs. 10000/-, premiums on all policies
(including other companies policies) held by an individual has to be aggregated.
Exemption on photograph and address proof will be available till such time that the
aggregate premium does not exceed Rs. 10000/-. Once aggregate annual premium
exceeds Rs.10000/-, no exemption will be available on future policies including the
policy, premium on which resulted in excess).

164. TOP UP
• The Policy owner has an option of investing excess amount by
doing top-up in his existing Unit linked policy.
• The policy owner can submit single top-up request after the policy
is accepted and issued.
• As per AML requirements, If total amount paid as per total
premium and top up is more than 100,000, proof of source of
income would have to be provided.
• The customer has to specify the allocation.
• No Top-up can be done during the Premium Holiday. If still a top-
up is done, it gets allocated first towards the premium payable
and only the balance may be used for top-up.
• For Invest assure II and subsequent unit link plans, if the top up
premium is more than 25% of total regular premium paid till date,
Sum assured has to be attached to it and will be underwritten as
per the total cover.

165. TOP UP
• For Invest Assure Gold the amount should be greater than or
equals to Rs 25000/-
• For Invest Assure II & Plus the amount should be greater than or
equals to Rs 10000/- & & Rs 5000/- respectively
• Requirements
Duly filled Unit Link RFC with Health Certificate and Sales
Illustration Sheet for top-up is required where the top-up amount
exceed 25% of the total basic premium paid up to date

166. Workflow for underwritten cases

167. Workflow for underwritten cases
A. Outstanding Customer Requirements

168. Workflow for underwritten cases
B. Medical Requirements (based on Age & SA)

169. Workflow for underwritten cases
C. Client Declaring Significant Medical History