For Office Use Only (w.e.f. Jun 16 / V 1.

6)
Illustration No: KPEP-3015M-8273-Y20
Quotation Number:BB220317234025657
Proposal No:
Policy No:

Kotak Premier Endowment Plan - Benefit Illustration

A Life Insurance Plan
UIN:107N079V01
This shall form a part of the policy document
Dear Mr. KARTHIK V,

The illustration is approved by the Board of Directors of the Company and takes into account the guidelines for illustrations set by the Life Insurance
Council and the IRDAI. Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your life insurance
company. If your policy offers guaranteed returns then these will be clearly marked guaranteed in the illustration table on this page. If your policy offers
variable returns then the illustrations on this page will show two different rates of assumed investment returns. These assumed rates return are not
guaranteed and they are not upper or lower limits of what you might get back as the value of your policy is dependent on a number of factors including
future investment performance.
Plan Details

Name of Life Insured Mr. KARTHIK V Name of the Product Kotak Premier Endowment Plan

Date of Birth of Life Insured 20 June 1986 Unique Identification Number 107N079V01

Age of the Life Insured (in yrs) 30 Basic Sum Assured (in Rs.) 1,75,000

Amount of Installment Premium (in

Gender of Life Insured Male 19,409
Rs.)

Name of the Proposer Ms. CHRISTY S Age of the Proposer (in yrs) 28

Policy Term (in yrs) 15 Mode Yearly

Premium Payment Term (in yrs) 10 Region Rest of India

Is the Life Insured a Tobacco User? No Not Applicable

Rider Details

Rider Premium
Rider Name Rider Sum Assured Rider Term Rider Premiums
Payment Term

Kotak Accidental Death Benefit Rider

1,74,000 15 10 148
(UIN:107B001V03)

Kotak Permanent Disability Benefit Rider

Not Selected
(UIN:107B002V03)

Kotak Term Benefit (UIN: 107B003V03) Not Selected

Kotak Life Guardian Rider (UIN 107B012V02) Not Selected

Kotak Accidental Disability Guardian Benefit (UIN

Not Selected
107B011V02)

Kotak Critical Illness Benefit (UIN 107B004V03) Not Selected

Please Note: Rider Premiums will have to be paid additionally

Total Yearly Premium (excluding Service Tax and Cess) 19,557

Add: Service Tax and Cess applicable during first policy year 750

Total Yearly Premium (Including Service Tax and Cess) payable in the First Policy Year 20,307

Add: Service Tax and Cess applicable from second year and onwards 386

Total Yearly Premium (Including Service Tax and Cess) payable from second year and onwards 19,943

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 Quotation Number:BB220317234025657
Non - Guaranteed Benefits
General Details Guaranteed Benefits
Benefits at Lower Rate3 Benefits at Higher Rate3

Annualized
Premium for Accrued Accrued Accrued
Age of Life Minimum Death Guaranteed
End of Year Basic Plan Guaranteed Reversionary Terminal Bonus Total Benefits^ Reversionary Terminal Bonus Total Benefits^
Insured Benefit 2 Surrender Value*
(excluding ST & Additions Bonus Bonus
Cess)

1 31 19,409 2,13,499 8,750 0 0 0 0 0 0 0

2 32 19,409 2,13,499 17,500 0 0 0 0 0 0 0

3 33 19,409 2,13,499 26,250 17,468 0 0 0 0 0 0

4 34 19,409 2,13,499 35,000 38,818 0 0 0 0 0 0

5 35 19,409 2,13,499 43,750 48,523 0 0 0 0 0 0

6 36 19,409 2,13,499 43,750 58,227 1,772 0 0 7,088 0 0

7 37 19,409 2,13,499 43,750 67,932 3,544 0 0 14,175 0 0

8 38 19,409 2,13,499 43,750 83,459 5,316 0 0 21,263 0 0

9 39 19,409 2,13,499 43,750 1,00,442 7,088 0 0 28,350 0 0

10 40 19,409 2,13,499 43,750 1,18,880 8,859 0 0 35,438 0 0

11 41 0 2,13,499 43,750 1,26,159 10,828 0 0 43,313 0 0

12 42 0 2,13,499 43,750 1,33,437 12,797 0 0 51,188 0 0

13 43 0 2,13,499 43,750 1,40,715 14,766 0 0 59,063 0 0

14 44 0 2,13,499 43,750 1,47,994 16,734 0 0 66,938 0 0

15 45 0 2,13,499 43,750 1,55,272 18,703 2,100 2,39,553 74,813 41,213 3,34,776

^ Total Benefits excludes the Death Benefits that are paid separately. It represents the Accrued Guaranteed Additions, Accrued Reversionary Bonus (if
any) and the Terminal Bonus (if any) along with the Basic Sum Assured.

* In addition to this, the Value of Subsisting Bonuses and/or Guaranteed Additions may be payable as a part of Guaranteed Surrender Value. The
company may pay a Special Surrender Value, if higher, as mentioned in the terms and conditions overleaf.

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 Quotation Number:BB220317234025657

Terms & Conditions:

1. The Illustration is for a healthy individual and would be subject to underwriting.

2. On death, Minimum Death Benefit will be payable along with the Accrued Guaranteed Additions, Accrued Reversionary Bonus (if any) and
Terminal Bonus (if any).

where Minimum Death Benefit is:

If the age at entry is less than 45 years:
Higher of
(i) Basic Sum Assured
(ii) 11 times Annual Premium
(iii) 105% of the total premiums paid

If the age at entry is greater than or equal to 45 years:

Higher of
(i) Basic Sum Assured
(ii) 7 times Annual Premium
(iii) 105% of the total premiums paid

Due Premiums and Outstanding premiums for the year in which death occurs (applicable for non-annual premium paying policies) will be adjusted
from the Death Benefit mentioned above.

3. The benefits at lower rate and higher rate are consistent with the projected return assumption of 4% p.a. and 8% p.a. respectively.

4. If the Premium Paying Term is less than 10 years, the policy acquires surrender value provided the premiums have been paid for at least two
consecutive years. If the Premium Paying Term is greater than or equal to 10 years, the policy acquires surrender value provided the premiums
have been paid for at least three consecutive years.
The Guaranteed Surrender Value (GSV) would be X% of total Premiums paid (excluding Service Tax and Cess, Rider premium and Extra
Premium, if any) plus The Value of Subsisting Bonuses and/or Guaranteed Additions; where X varies by year of surrender and is mentioned
below:

2nd & 3rd year 30%

4th to 7th year 50%

8th onwards 50%+(Year of surrender -7)x(Y-50%)/(Policy Term-7)

Where Y:70% for Regular Premium Paying Term

80% for Limited Premium Paying Term

The Company shall pay a Special Surrender Value and the same will be quoted in writing by the Company, on receipt of a written request from the
policyholder.

5. The policy is automatically made Reduced Paid-Up where policy has acquired Surrender Value and due premiums are not received within the
grace period. Paid-Up policies shall not be eligible to participate in the future Reversionary Bonuses or Guaranteed Additions. Rider Benefits, if
any attached to the base policy, may fall off depending on the features of the Rider.
The Basic Sum Assured is reduced to Reduced Paid-Up Basic Sum Assured as follows:
Reduced Paid-Up Basic Sum Assured = Basic Sum Assured [(Total Premiums received / Total premiums payable over the term)]
The Basic Death Benefit mentioned above is reduced to Reduced Paid-Up Basic Death Benefit as follows:
Reduced Paid-Up Basic Death Benefit = Basic Death Benefit as at the date of paid-up [(Total Premiums received / Total premiums payable over
the term)]
The vested Reversionary Bonus and vested Guaranteed Additions will continue to be the part of Benefit payout.

6. A lapsed or Paid-Up policy can be revived with or without riders within 2 years from the date of the first unpaid premium. Revival can be done
without proof of good health on payment of the outstanding premiums and handling charges, if the payment is made within six months from the
date of the first unpaid premium. Thereafter to revive the policy proof of good health would be required along with payment of the outstanding
premiums and handling charges. On revival, benefits shall be reinstated to their original level.

7. The above illustrated benefits are derived on the basis of details of life insured provided at the time of filling the proposal form. If the details are
found inaccurate or there are any changes before or at the time of the policy issuance for eg: change in age, the illustrated benefits will be subject
to revision.

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 Quotation Number:BB220317234025657

8. Service Tax and Cess, as applicable are levied at the applicable Tax rates in accordance with the prevailing Tax Laws. Prevailing tax laws are
applicable on this policy which may vary from time to time.

9. The values shown are for illustrative purposes only. For more details on risk factors, terms and conditions please read sales brochure carefully
before concluding a sale.

10. TDS at prevailing rate will be deducted from any amount paid under a life insurance policy subject to the provisions of prevailing tax laws. In
case of non-availability of valid PAN, TDS will be deducted at higher rate. Tax laws are subject to changes from time to time. Kindly consult your
tax advisor for tax implication of your policy.

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 Quotation Number:BB220317234025657

Statement of Consent by the Proposer

I..............................................................................(Full Name), having received this benefit illustration and all other information with respect to the
above, have read and understood the structure/features of benefits, charges (if any), terms and conditions and risk factors under the proposed plan and
duly acknowledge the benefit illustration before entering into the contract.

_______________________________ |_______________________________| __________________________________________

Place Date Signature/Right thumb impression of the Proposer

Statement of Consent by the Life Advisor/Specified person of Corporate Agent/Authorised Employee of Broker /Relationship Officer

I..............................................................................(Full Name), declare that I have explained all the contents of this benefit illustration including the
features, charges (if any), terms & conditions and risk factors of the proposed plan to the Proposer.

_______________________________ |_______________________________| __________________________________________

Place Date Name and Signature of the Life Advisor/Specified person of

Corporate Agent/Authorised Employee of Broker /Relationship
Officer

_ _

________________________________________________________________________________________________________________________
Kotak Mahindra Old Mutual Life Insurance Limited.
CIN: U66030MH2000PLC128503
Regd. Office: 2nd Floor, Plot# C-12, G-Block, BKC, Bandra (E), Mumbai - 400 051
Toll Free No.: 1800 209 8800. Website: http://insurance.kotak.com

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 Quotation Number:BB220317234025657

Category Occupation of Proposer Income Of Proposer

Non Rural Employed 2,00,000

LIST OF DOCUMENTS TO BE ATTACHED

1. Proposal Form
2. Photo ID Proof
3. Address Proof of Proposer
4. Age Proof of Insured
5. Photocopy of Cancel Cheque
6. DNC Format
7. Latest Benefit Illustration
8. Age Proof of Proposer
9. Agent Confidentiality Report
10. Income Proof of the Secondary Life to be Insured

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