BENEFIT ILLUSTRATION

[Date and Time of Illustration – 27 July 2021, 08:31 PM]

Name of the Prospect/Policyholder: Mr. Vivek Proposal No:

Age & Gender: 35 Years, Male Name of the Product: Max Life Smart Wealth Plan
Name of the Life Assured: Mr. Vivek Tag Line: A Non-Linked Non Participating Individual Life Insurance Savings Plan
Age & Gender: 35 Years, Male Unique Identification No: 104N116V04
Policy Term: 12 Years GST Rate (Base Policy, First Year): 4.50%
Premium Payment Term: 10 Years GST Rate (Base Policy, Subsequent Year): 2.25%
Amount of Installment Premium: `52,930 GST Rate (Rider, First Year): 18.00%
Mode of payment of premium: Annual
GST Rate (Rider, Subsequent Year): 18.00%
Annual Income Amount: NA
Income Period, if applicable: NA Max Life State: Rajasthan
Mode of Income, if applicable: NA Policyholder Residential State: Rajasthan

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Policy Details
Policy Option Lump Sum Sum Assured (in Rs.) 5,50,000
Sum Assured on Death (at inception of the policy) (in Rs.) 5,50,000

Rider Details
Accidental Death & Dismemberment (ADD) Rider Premium
10 Pay 12 Accidental Death & Dismemberment (ADD) Rider Sum Assured (in Rs.) 5,00,000
Payment Term and Rider Term
Term Plus Rider Term NA Term Plus Rider Sum Assured (in Rs.) NA
Waiver of Premium (WOP) Plus Rider Term NA
Critical Illness and Disability Rider - Rider Premium Payment
NA Critical Illness and Disability Rider - Coverage Variant NA
Term and Rider Term
Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Accidental Death & Waiver of Premium Plus Critical Illness and Total Installment Premium
Base Plan Dismemberment Rider
Term Plus Rider Rider Disability Rider
Installment Premium without GST (in Rs.) 50,000 576 0 0 0 50,576
Installment Premium with first year GST (in Rs.) 52,250 680 0 0 0 52,930
Installment Premium with GST 2nd year onwards (in Rs.) 51,125 680 0 0 0 51,805

UIN: 104N116V04 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 1 of 2
 (Amount in Rupees)

Guaranteed Non Guaranteed

Single/ Annualized
Policy Year Total Annual Premium Other Benefits, if any
Premium Accrued Guaranteed Min Guaranteed Special Surrender Value
(Guaranteed Sum Maturity Benefit Death Benefit
Additions Surrender Value
Assured at Maturity)
1 50,000 50,576 - - - 5,50,000 - -
2 50,000 50,576 - - - 5,50,000 30,000 42,000
3 50,000 50,576 - - - 5,50,000 52,500 73,500
4 50,000 50,576 - - - 5,50,000 1,00,000 1,40,000
5 50,000 50,576 - - - 5,50,000 1,25,000 1,75,000
6 50,000 50,576 - - - 5,50,000 1,50,000 2,22,990
7 50,000 50,576 - - - 5,50,000 1,75,000 2,77,725
8 50,000 50,576 - - - 5,74,360 2,40,000 3,38,840
9 50,000 50,576 35,140 - - 6,74,325 3,25,542 4,24,505
10 50,000 50,576 70,280 - - 7,82,250 4,21,084 5,31,846
11 - - 1,05,420 - - 8,44,850 4,81,626 6,10,078
12 - - 1,40,560 5,50,000 6,90,560 9,12,450 4,92,168 6,90,560

Notes:
• Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Service Tax.
• Total Annual Premium includes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any but excludes Goods and Service Tax.
• Refer Sales literature (Prospectus) 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: Signature / Thumb Impression / Electronic Signature of Date:7/27/21 Signature / Thumb Impression / Electronic Signature of
Date: 7/27/21 Agent/ Intermediary / Official Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N116V04 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 2 of 2
84,35,12,550000,0,50576,M,d84