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Benefit Illustration of ICICI Pru Wealth Builder - unit osttx / Page 1 of linked insurance plan 3
This shall form a part of the policy document

Prepared For : Mr.

Kumar

Product Features
IC IC I Name of the Product : Builde r A ge : 27 Ye ars Sum A ssured1 : R s.240,000/Policy Term : 20 Ye ars Premium Payment Term : 20 Ye ars Premium Payment : R e gular Pay Option Pru W e alth Mode Of Premium Payment : Ye arly A mount of Base Installment premium : R s.24,000/A nnualised Base Premium : 24,000 A nnualised Rider Premium : 0 Total A nnualised Premium : 24,000 (Base+Rider) Service Tax Rate : 12.36% Funds Opted for : Max im ise r V : 100% Statement of various premium, charges and commissions in respect of the unit linked benefits along with growth of the fund over the duration of the policy with assumed rate of interest (Gross Yield) as mentioned. Gross Yield Projected Net Yield Am ount Pre m ium available Policy Fund Fund Inve stm e nt Loyalty Fund at Surre nde r De ath Policy Annualise d Allocation for Mortality Se rvice O the r Adm in be fore Managm e nt Guarante e Ye ar Pre m ium 2 inve stm e nt C harge Tax C harge Additions 4 End 5 Value 6 Be ne fit 3 C harge FMC C harge C harge C harge (out of 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 720 480 240 240 240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pre m ium ) 23280 23520 23760 23760 23760 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 348 350 350 350 358 367 382 398 420 446 475 509 552 595 636 677 730 794 869 955 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 338 349 364 413 466 495 559 628 703 786 885 988 1100 1222 1354 1498 1655 1828 2017 2223 0 23442 0 49120 0 77236 0 107699 0 140695 0 176729 0 215752 0 258011 0 303771 0 353317 0 413890 0 475582 0 542853 0 616194 0 696160 0 783355 0 878422 0 982064 0 1095048 0 1218212 313 643 1005 1396 1821 2284 2786 3329 3918 4555 5334 6128 6993 7936 8965 10086 11309 12642 14096 15680 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10% 8.60% Unique Identification No. : 105L129V01 Proposal No. : _________ Policy No. : _________ Proposer from J&K / NRI and communication address not of : No India SalesChannel : Proprie tary

C om m ission/ Brok e rage

0 23129 0 263129 0 48477 0 288477 0 76232 0 316232 0 106303 0 346303 0 138874 138874 378874 0 174445 174445 414445 0 212966 212966 452966 0 254682 254682 494682 0 299853 299853 539853 6310 355073 355073 595073 2762 411318 411318 651318 3202 472656 472656 712656 3665 539525 539525 779525 4170 612428 612428 852428 4721 691917 691917 931917 5322 778591 778591 1018591 5977 873090 873090 1113090 6691 976113 976113 1216113 7470 1088422 1088422 1328422 8319 1210851 1210851 1450851 Gross Yield 6%

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Pre m ium Policy Annualise d Allocation Ye ar Pre m ium 2 C harge 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 720 480 240 240 240 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Am ount available for Policy Fund Fund Inve stm e nt Loyalty Fund at Surre nde r De ath Mortality Se rvice O the r C om m ission/ inve stm e nt Adm in be fore Managm e nt Guarante e Be ne fit C harge Tax C harge Brok e rage Additions 4 End 5 Value 6 6 (out of C harge FMC C harge C harge Pre m ium ) 23280 348 1354 337 0 22562 307 0 0 22255 0 262255 0 23520 350 1354 346 0 46387 618 0 0 45769 0 285769 0 23760 23760 23760 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 350 350 358 367 382 398 420 446 475 509 552 595 636 677 730 794 869 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 1354 357 400 445 463 514 567 622 681 751 820 893 969 1049 1132 1221 1316 1416 0 71547 0 97816 0 125232 0 154131 0 184285 0 215748 0 248571 0 282809 0 323996 0 363827 0 405674 0 449629 0 495802 0 544309 0 595255 0 648753 0 704924 947 1290 1649 2027 2421 2832 3262 3709 4248 4769 5316 5891 6495 7130 7796 8496 9231 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70600 0 96525 0 123583 0 152104 0 181864 0 212915 0 245309 5175 284275 2216 321963 2511 361569 2808 403166 3121 446858 3449 492756 3794 540973 4157 591616 4537 644795 4937 700630 0 310600 0 336525 123583 363583 152104 392104 181864 421864 212915 452915 245309 485309 284275 524275 321963 561963 361569 601569 403166 643166 446858 686858 492756 732756 540973 780973 591616 831616 644795 884795 700630 940630 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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19 20

24000 24000

0 0

24000 24000

869 955

1354 1354

1416 1522

0 704924 0 763890

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9231 10002

0 0

4937 700630 5356 759244

700630 940630 759244 999244

0 0

osttx / Page 2 of 3

IN THIS POLICY, THE INVESTMENT RISK IS BORNE BY THE POLICYHOLDER A ND THE A BOVE INTEREST RA TES A RE ONLY FOR ILLUSTRA TION PURPOSE. ICICI Pru Wealth Builder is only the name of the policy and does not in any way indicate the quality of the policy, its future prospects or returns. Multi Cap Growth Fund(ULIF 085 24/11/09 LMCapGro 105), Bluechip Fund (ULIF 087 24/11/09 LBluChip 105), Opportunities Fund(ULIF 086 24/11/09 LOpport 105), Multi Cap Balanced Fund(ULIF 088 24/11/09 LMCapBal 105), Income Fund(ULIF 089 24/11/09 LIncome 105), Money Market Fund(ULIF 090 24/11/09 LMoneyMkt 105) and Maximiser V Fund(ULIF 114 15/03/11 LMaximis5 105) are the names of the different fund options and do not in any manner indicate the quality of the fund, its future prospects or returns.
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Include s Top up Sum Assure d (if any). Include s Top up pre m ium (if any). R ide r Pre m ium is payable se parate ly. Include s Top up charge (if any).

At the e nd of e ve ry policy ye ar, starting from the e nd of the 10th policy ye ar, the re will be Loyalty Additions to the policy, provide d all due pre m ium s have be e n paid. The Loyalty Additions will be calculate d as a pe rce ntage of the ave rage of the Fund Value on the last day of e ight policy quarte rs pre ce ding the said allocation, de pe nding upon the pre m ium paym e nt option chose n.
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O n m aturity of the policy, the following shall be payable : Fund Value = Pre vailing NAV on the day of m aturity X Units at m aturity The De ath Be ne fit and Surre nde r Value s illustrate d assum e that the e ve nt occurs at the e nd of the policy ye ar. R ide r Pre m ium is inclusive of se rvice tax . R ide r Pre m ium is payable throughout the R ide r Te rm .

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Disclaimers

osttx / Page 3 of 3 Som e be ne fits are guarante e d and som e be ne fits are variable with re turns base d on the future pe rform ance of your life insurance com pany. If your policy offe rs guarante e d re turns the n the se will be cle arly m ark e d 'guarante e d' in the illustration table on this page . If your policy offe rs variable re turns the n the illustration on this page will show two diffe re nt rate s of assum e d future inve stm e nt re turns. The se assum e d rate s of re turns are not guarante e d and the y are not the uppe r or lowe r lim its of what you m ight ge t back as the value of your policy as it is de pe ndant on a num be r of factors including future inve stm e nt pe rform ance . For the purpose of illustrations, we have use d 6% and 10% as the lowe r and the highe r rate s of inve stm e nt re turns re spe ctive ly, in the calculations. The se are in accordance with the guide line s issue d by the Life Insurance C ouncil and in no way signify our e x pe ctations of inve stm e nt re turn on the funds. For e ach of the funds, the actual inve stm e nt re turn m ay be highe r or lowe r than the above rate s base d on the asse t classe s and the risk tak e n. The Ne t yie lds have be e n calculate d afte r applying all the charge s (e x ce pt se rvice tax , e ducation ce ss, charge for inve stm e nt guarante e , m ortality charge s and ride r pre m ium ). This docum e nt is for illustration purpose s only. The inve stm e nts in the units are subje ct to m ark e t and othe r risk s and the re can be no assurance that the obje ctive s of any of the funds will be achie ve d. The unit value of the units of e ach of the funds can go up or down de pe nding on the factors and force s affe cting the financial m ark e ts from tim e to tim e and m ay also be affe cte d by change s in the ge ne ral le ve l of inte re st rate s. If pre m ium paym e nt is discontinue d be fore the com ple tion of five policy ye ars, the Fund Value , including Top up Fund Value , if any, shall be transfe rre d to the discontinue d policy fund afte r de duction of applicable discontinuance charge . At the e nd of the fifth policy ye ar, the discontinue d policy fund value shall be paid to the Policyholde r. All guarante e s, rights, be ne fits and inte re sts unde r the Policy will be e x tinguishe d can be adde d for m ore clarity to the policyholde r. Fund Value at start shall be : For 1st ye ar, it is the am ount available for inve stm e nt; the re afte r, it is pre vious ye ar's e nd Fund Value plus the am ount available for inve stm e nt in the curre nt ye ar. R ide r Pre m ium is not include d in the Fund Value calculations. The funds do not offe r a guarante e d or assure d re turn . Past pe rform ance of any plan/ fund of the com pany is not ne ce ssarily indicative of the future pe rform ance of any of the plans. The above inform ation m ust be re ad in conjunction with the sale s brochure & policy docum e nt. This illustration is base d on the te rm s and conditions of the life insurance policy as on date of the illustration. This be ne fit illustration is m e re ly an e x am ple and is base d on the data provide d by you in the application form . The illustration is base d on the basic m ortality charge . Howe ve r the illustration could change in case we charge e x tra pre m ium base d on unde rwriting guide line s. Tax be ne fits would be available as pe r the pre vailing Incom e Tax laws. Se rvice tax include s tax on all applicable charge s. Se rvice tax rate and am ounts shown are inclusive of the applicable e ducation ce ss. The Policyholde r shall be re quire d to pay se rvice tax , e ducation ce ss or any othe r form of tax e s or charge s or le vie s as pe r pre vailing laws and re gulations, whiche ve r applicable . Tax laws are subje ct to am e ndm e nt from tim e to tim e . An additional charge of R s.2.50 pe r R s.1,000 Sum Assure d will be le vie d pe r annum in case of a non-standard age proof. This will be charge d by cance llation of units. For IC IC I Pru W aive r of Pre m ium on C ritical Illne ss R ide r, an additional ride r pre m ium loading of 15% for age s le ss than or e qual to 40 ye ars, 25% for age s gre ate r than 40 ye ars and le ss than or e qual to 55 ye ars and 35% for age s gre ate r than 55 ye ars would be le vie d in case of a non-standard age proof. The pre m ium rate s for this ride r are re vie wable from tim e to tim e subje ct to prior approval from IR DA. Any change in the above pre m ium s will tak e place subje ct to IR DA approval and afte r giving notice to the policyholde r. This ride r doe s not acquire any surre nde r value . C om m ission/ Brok e rage , as m e ntione d in the table above , only indicate s the am ount payble , if any, to the age nt / brok e r, and is not a se parate charge in the policy. For any furthe r clarifications, ple ase fe e l fre e to contact your advisor or FSC or e -m ail us on life line @iciciprulife .com . Insurance is the subje ct m atte r of this solicitation. I ________________________________________, having re ce ive d the inform ation with re spe ct to the above ,have unde rstood the above illustration be fore e nte ring into the contract.

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Policyholder's Signature:______________________________

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Marketing official's Signature: Company Seal: Place Date:

GenerateOutput Policyholder's Signature:______________________________

IC IC I Prude ntial Life Insurance C om pany Lim ite d. 1089, Appasahe b Marathe Marg, Prabhade vi, Mum bai - 400025 Em ail: life line @iciciprulife .com www.iciciprulife .com

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