A Specimen Policy Document - A money back policy

 ----------------------------------NAME OF THE COMPANY----------------------------------------

--------------------------------------------ADDRESS-----------------------------------------------------

Website------------------------

SPECIMEN POLICY DOCUMENT

The policy is subject to terms and conditions contained herein, the schedule and any attached riders and endorsements

The company agrees to pay the benefits stated under the policy upon satisfaction of the happening of the insured event, while the policy is in force and effect to the lawfully entitled person.

The effective date and number of this policy are as set out in the schedule.

Signed by and on behalf of 

-------------Name of the Company---------------

(Company's Seal)

                                                         THE SCHEDULE

1) Details of the Insured

Name of the policy holder                       Sex

Address

Identification

Name of the Life Assured (LA)             Sex

Date of birth of L.A.                              Age at entry

Address

Source of identification

2) Policy features

Date of the application                             Issuing office and policy number

Face amount of Insurance

Policy term                                               Premium paying term

Date of commencement                           Date of Maturity
of the policy

Plan of Insurance                                    
(Whether the policy
is participating or non-
participating policy) 

Insured Event on which Benefits            1) Upon death during the policy term: Face amt + accrued
are payable                                                                                                             guaranteed additions

                                                                  2) Upon survival at the end 5 years:  'x'% of face amount
                                                                  Upon survival at the end of 10 years: 'y'% of face amount
                                                                  Upon survival at the end of 15 years: 'z'% of face amount                                       Upon survival to Maturity : 40% of face value + total guaranteed additions

3) Beneficiary details

Name of the beneficiary                          Share(s)
1)
2)

4) Rider details

Name of the rider  (Accidental death benefit or term rider)
Period of Coverage
Amount of coverage
Annexure reference

5) Other special provisions/options

Guaranteed Additions: Provided the policy is in force, a guaranteed addition of Rs 'X' per 1000 of face amount will be added to the face amount at the end of each policy anniversary and will be payable either on the date of maturity or on earlier death of the life assured.

6) Premium Summary

Policy type
Base policy premium
Accidental Death Benefit
Term rider
Total premium
Mode of payment
Due date(s) of (installment) premium        
Date of last installment premium due