Proposal No:

Name of the Prospect/Policyholder: Mr. Name of the Product: Max Life Monthly Income Advantage Plan
Age & Gender: 18 Years, Male Tag Line: A Non-Linked Participating Individual Life Insurance Savings Plan
Name of the Life Assured: Mr. Unique Identification No: 104N091V06
Age & Gender: 18 Years, Male GST Rate: 4.50%
Policy Term: 25 Years Max Life State: Haryana
Premium Payment Term: 15 Years Policyholder Residential State: Haryana
Amount of Installment Premium: `1,04,500
Mode of payment of premium: Annual

How to read and understand this benefit illustration?

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a.

Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. If your policy offers guaranteed benefits then these
will be clearly marked “guaranteed” in the illustration table on this page. If your policy offers variable benefits then the illustration on this page will show two different rates of assumed future investment returns, of
8%p.a. and 4% p.a. These assumed rates of return are not guaranteed and they are not the 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.

Policy Details
Policy Option Sum Assured (in Rs.) 19,52,744
Bonus Type Compound Reversionary Bonus Sum Assured on Death (at inception of the policy) (in Rs.) 19,52,744

Rider Details
Accidental Death & Dismemberment (ADD) Rider Term NA Accidental Death & Dismemberment (ADD) Rider Sum Assured (in Rs.) NA
Term Plus Rider Term NA Term Plus Rider Sum Assured (in Rs.) NA
COVID19 One Year Term Rider Term NA COVID19 One Year Term Rider Sum Assured (in Rs.) NA
Critical Illness and Disability Rider Term NA Critical Illness and Disability Rider Variant NA
Critical Illness and Disability Rider Sum Assured NA

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST (in Rs.) 1,00,000 - 1,00,000
Installment Premium with first year GST (in Rs.) 1,04,500 - 1,04,500
Installment Premium with GST 2nd year onwards (in Rs.) 1,02,250 - 1,02,250

UIN: 104N091V06 Page 1 of 3

 (Amount in Rupees)

Total Benefits including Guaranteed and Non- Guaranteed

Non-Guaranteed Benefits Non-Guaranteed Benefits Benefits
Guaranteed Benefits
@ 4% p.a. @ 8% p.a.
Maturity Benefit Death Benefit
Single/
Policy Total Maturity Total Death
Annualized Total Maturity Total Death
Year Benefit, incl. Benefit, incl.
Premium Benefit, incl. Benefit, incl.
Terminal of Terminal
Guaranteed Survival Surrender Death Maturity Reversionary Surrender Reversionary Surrender Terminal of Terminal
Cash Bonus Cash Bonus Bonus, if any Bonus, if any
Additions Benefit Benefit Benefit Benefit Bonus Benefit Bonus Benefit Bonus, if any Bonus, if any
@ @ 4%(6+8+9)
@ 4%(7+8+9) @
8%(7+11+12)
8%(6+11+12)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

1 1,00,000 - - - 19,52,744 - - - - - - - - - 19,52,744 19,52,744

2 1,00,000 - - 60,000 19,52,744 - 6,249 - 69,196 35,149 - 75,249 - - 19,52,744 19,52,744

3 1,00,000 - - 1,05,000 19,52,744 - 6,269 - 1,34,641 35,782 - 1,47,799 - - 19,52,744 19,52,744

4 1,00,000 - - 2,00,000 19,52,744 - 6,289 - 2,12,422 36,426 - 2,33,860 - - 19,52,744 19,52,744

5 1,00,000 - - 2,50,000 19,52,744 - 6,309 - 2,91,026 37,082 - 3,78,949 - - 19,52,744 19,52,744

6 1,00,000 - - 3,00,000 19,52,744 - 6,329 - 3,77,903 37,749 - 4,96,797 - - 19,52,744 19,52,744

7 1,00,000 - - 3,50,000 19,52,744 - 6,349 - 4,66,780 38,429 - 6,15,685 - - 19,52,744 19,52,744

8 1,00,000 - - 4,16,000 19,52,744 - 6,370 - 5,61,374 39,121 - 7,43,364 - - 19,52,744 19,52,744

9 1,00,000 - - 4,95,000 19,52,744 - 6,390 - 6,62,476 39,825 - 8,80,862 - - 19,52,744 19,52,744

10 1,00,000 - - 5,70,000 19,52,744 - 6,411 - 7,70,637 40,542 - 10,29,158 - - 19,52,744 19,52,744

11 1,00,000 - - 6,49,000 19,52,744 - 6,431 - 9,41,612 41,271 - 12,54,856 - - 19,52,744 19,52,744

12 1,00,000 - - 7,44,000 19,52,744 - 6,452 - 10,78,126 42,014 - 14,42,583 - - 19,52,744 19,52,744

13 1,00,000 - - 8,32,000 19,52,744 - 6,472 - 12,25,003 42,770 - 16,45,980 - - 19,52,744 19,52,744

14 1,00,000 - - 9,24,000 19,52,744 - 6,493 - 13,82,922 43,540 - 18,66,213 - - 19,52,744 19,52,744

15 1,00,000 - - 10,35,000 19,52,744 - 6,514 - 15,53,769 44,324 - 21,05,703 - - 19,52,744 19,52,744

16 - - 1,95,274 8,69,726 19,52,744 - 6,535 - 14,63,066 45,122 - 21,00,877 - - 19,52,744 19,52,744

17 - - 1,95,274 7,19,451 19,52,744 - 6,556 - 13,59,132 45,934 - 21,02,825 - - 19,52,744 19,52,744

18 - - 1,95,274 5,54,177 19,52,744 - 6,577 - 12,46,446 46,761 - 21,00,485 - - 19,52,744 19,52,744

19 - - 1,95,274 3,88,903 19,52,744 - 6,598 - 11,24,619 47,603 - 20,93,315 - - 19,52,744 19,52,744

UIN: 104N091V06 Page 2 of 3

 Total Benefits including Guaranteed and Non- Guaranteed
Non-Guaranteed Benefits Non-Guaranteed Benefits Benefits
Guaranteed Benefits
@ 4% p.a. @ 8% p.a.
Maturity Benefit Death Benefit
Single/
Policy Total Maturity Total Death
Annualized Total Maturity Total Death
Year Benefit, incl. Benefit, incl.
Premium Benefit, incl. Benefit, incl.
Terminal of Terminal
Guaranteed Survival Surrender Death Maturity Reversionary Surrender Reversionary Surrender Terminal of Terminal
Cash Bonus Cash Bonus Bonus, if any Bonus, if any
Additions Benefit Benefit Benefit Benefit Bonus Benefit Bonus Benefit Bonus, if any Bonus, if any
@ @ 4%(6+8+9)
@ 4%(7+8+9) @
8%(7+11+12)
8%(6+11+12)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

20 - - 1,95,274 2,38,628 19,52,744 - 6,619 - 9,93,232 48,459 - 20,80,731 - - 19,52,744 19,52,744

21 - - 1,95,274 73,354 19,52,744 - 6,640 - 8,51,975 49,332 - 20,62,333 - - 19,52,744 19,52,744

22 - - 1,95,274 - 19,52,744 - 6,661 - 7,00,392 50,220 - 20,37,459 - - 19,52,744 19,52,744

23 - - 1,95,274 - 19,52,744 - 6,682 - 5,38,002 51,124 - 20,05,429 - - 19,52,744 19,52,744

24 - - 1,95,274 - 19,52,744 - 6,704 - 3,58,256 52,044 - 19,65,364 - - 19,52,744 19,52,744

25 - - 1,95,274 - 19,52,744 - 6,725 - 1,55,621 52,981 - 18,71,792 1,55,621 18,71,792 19,52,744 19,52,744

Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Service Tax. Refer Sales literature for explanation of terms used in
this illustration.

I, ……………………………………………. (name), have explained the premiums, and benefits I, ……………………………………………. (name), having received the information with respect
under the product fully to the prospect / policyholder. to the above, have understood the above statement before entering into the contract.

Place:
Date: 4/26/21 Signature / OTP Confirmation Date / Thumb Impression / Date:4/26/21 Signature / OTP Confirmation Date / Thumb Impression /
Electronic Signature of Agent/ Intermediary / Official Electronic Signature of Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N091V06 Page 3 of 3

93,18,1952743,R,100000.00,M,a93