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    Pradhan Mantri Suraksha Bima Yojana
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    • I declare that I am not insured under Pradhan Mantri Suraksha Bima Yojana under any other Saving Bank Account. In case the same is found to exist, premium shall stand forfeited and no claims would be paid.
    • I agree that the cover shall commence from the 1st of the month subsequent to the date of enrollment in the scheme.
    • I agree to pay full annual premium even if I join the scheme after commencement of the Group Policy.
    • I agree to your conveying my personal details, as required, regarding my admission into the Pradhan Mantri Suraksha Bima scheme to ICICI Lombard General Insurance Company Ltd., under Group Policy No. 4005/151804272/00/000 certifying coverage as per the Scheme, and in accordance to the information available and your authorization for auto deduction of the premium amount.
    • I hereby declare that the above statements are true in all respects and that I agree and declare that the above information shall form the basis of admission to the above scheme and if any, information to be found untrue, my membership to the scheme, shall be treated as cancelled from my date of joining the scheme and all monies paid in respect thereof shall stand forfeited.
    • I authorize to carry forward the nomination details as available in the Savings Account into the scheme and understand that to have a different nomination, I need to enroll for the scheme by visiting the branch.
    • I understand that ICICI Bank is the Group Administrator for this scheme.
    Pradhan Mantri Jeevan Jyoti Bima Yojana
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    • I, hereby give my consent to become a member of ‘Pradhan Mantri Jeevan Jyoti Bima Yojana’ of ICICI Prudential Life Insurance Co. Ltd which will be administered by your bank under Master Policy No. 000022773.
    • I have not authorised any other bank to debit premium in respect of this scheme. I am aware that my life cover shall be restricted to Rs 2,00,000 only in the event of my death. I declare that I am not insured under Pradhan Mantri Jeevan Jyoti Yojana under any other Savings Bank Account. In case the same is found to exist, premium shall stand forfeited and no claims would be paid.
    • I agree that the cover shall commence from the date of request for enrolment into the scheme and end on May 31.
    • Below is the Premium Structure for enrolments through ONLINE mode:
    • June, July and August – Annual Premium of Rs 406 is payable
    • September, October and November – Premium of Rs 319.5 is payable
    • December, January and February – Premium of Rs 213 is payable
    • March, April and May – Premium of Rs 106.5 is payable.
    • Below is the Premium Structure for enrolments through OFFLINE mode:
    • June, July and August – Annual Premium of Rs 406 is payable
    • September, October and November – Premium of Rs 319.5 is payable
    • December, January and February – Premium of Rs 213 is payable
    • March, April and May – Premium of Rs 106.5 is payable.
    • I agree to your conveying my personal details, as required, regarding my admission into the Pradhan Mantri Jeevan Jyoti Bima Yojana scheme, to ICICI Prudential Life Insurance Company Ltd., under Group Policy No. 000022773 certifying coverage as per the scheme, subject to correctness of information provided regarding eligibility and receipt of consideration amount.
    • I hereby declare that the above statements are true in all respects and that I agree and declare that the above information shall form the basis of admission to the above scheme and if any, information is to be found untrue, my membership to the scheme, shall be treated as cancelled from my date of joining the scheme and all monies paid in respect thereof shall stand forfeited.
    • I understand that ICICI Bank is the Group Administrator for this scheme.
    • I have read and understood the Scheme rules and I hereby give my consent to become a member of the Scheme.
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