IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER

Sep 5 2021
To,

ANIL GURJAR Policy No : U172121066

CHC ROAD WARD 10 Policy Issue Date : Mar 22, 2021
BARA VARADA PRATAPGARH RAJASTHAN Next Due Date : Sep 22, 2021
PRATAPGARH RAJASTHAN Insured : ANIL GURJAR
NEAR HANUMAN TEMPLE Owner : ANIL GURJAR
PRATAPGARH RAJASTHAN Premium : 2749.00
RAJASTHAN 312616 Premium Mode : Monthly
INDIA

Dear Policyowner,

Transaction Type: Unit Transaction History

We are pleased to enclose the Fund Activity statement for your reference.

Please feel free to contact your servicing agent or call our Helpline No 1-860-266-9966(local charges apply)
or email us at customercare@tataaia.com or SMS'SERVICE' to 58888 should you require any assistance. We shall
be glad to be of assistance to you.

Fund Value as on : Sep 03 2021

Fund Portfolio Net Asset Regular Premium Top Up Premium Surrender

Value(INR) Units Value(INR) Units Value(INR) Value
(INR)*
Large Cap Equity Fund 45.0852 0.000000 0.00 0.000000 0.00 0.00
(ULIF 017 07/01/08 TLC 110)
Whole Life Mid Cap Equity Fund 83.1941 70.663727 5878.81 0.000000 0.00 4878.75
(ULIF 009 04/01/07 WLE 110)
Whole Life Income Fund 31.9178 40.310883 1286.63 0.000000 0.00 716.13
(ULIF 012 04/01/07 WLI 110)
Whole Life Short Term Fixed Income Fund 28.3806 45.071720 1279.16 0.000000 0.00 641.29
(ULIF 013 04/01/07 WLF 110)
Multi Cap Fund 34.5849 0.000000 0.00 0.000000 0.00 0.00
(ULIF 060 15/07/14 MCF 110)
Top - 50 Fund 58.5185 22.972942 1344.34 0.000000 0.00 1019.21
(ULIF 026 12/01/09 ITF 110)
Top - 200 Fund 93.5470 71.113910 6652.49 0.000000 0.00 5646.06
(ULIF 027 12/01/09 ITT 110)
TOTAL 16441.43 0.00 12901.44

* For Requested Surrender, Payout will be made after Lock-in period if not over. Refer policy contract for
details.

PREMIUM INFORMATION DETAILS Amount

Total Regular Premium(s) Paid Rs.16494.00
Total Regular Premium(s) Invested Rs.15326.22
Total Policy Allocation Charge(s) Rs.989.64
Total Goods and Services Tax on Premium Allocation Charge(s) Rs.178.14
Total Top-up Premium(s) Paid Rs.0.00
Total Top-up Premium(s) Invested Rs.0.00
Total Top-up Premium Allocation Charge(s) Rs.0.00
Total Goods and Services Tax on Top-up Premium Allocation Charge(s) Rs.0.00
Total Fund Switch Charge(s) Rs.0.00
Total Goods and Services Tax on Fund Switch Charge(s) Rs.0.00
Total Monthly Administration Charge(s) Rs.123.78
Total Goods and Services Tax on Monthly Administration Charge(s) Rs.22.26
Total Mortality Charge(s) on Basic Sum Assured Rs.217.51
Total Goods and Services Tax on Mortality charge(s)of Basic Sum Assured Rs.39.16

Tata AIA Life Insurance Company Ltd.(IRDA of India Regn. No. 110). CIN:U66010MH2000PLC128403
(Corporate & Regd. Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.
For more Information, contact your advisor or call us on 1-860-266-9966 (local charges apply) or
SMS “Service” to 58888 or e-mail us at customercare@tataaia.com. Visit our website: - www.tataaia.com)
Total Mortality Charge(s) on Top-up Sum Assured Rs.0.00
Total Goods and Services Tax on Mortality charge(s) of Top-up Sum Assured Rs.0.00
Total Partial Withdrawal Charge(s) Rs.0.00
Total Goods and Services Tax on Partial Withdrawal Charge(s) Rs.0.00
Your current premium allocation instructions to the respective funds :-

Fund Description Regular (%) Top Up (%)

Top - 50 Fund 25 0
Whole Life Mid Cap Equity Fund 25 0
Whole Life Short Term Fixed Income Fund 25 0
Whole Life Income Fund 25 0

COVERAGE INFORMATION DETAILS

Benefit Type Sum Assured(INR) Effective Date Expiry Date
Tata AIA Life Fortune Pro 10/15/20 Pay Limited term - Age Band (30-35) 346500.00 Mar 22, 2021 Mar 22, 2042
Total Top-up Sum Assured 0.00

Transaction details for the Given Period

DealingDate Txn Type Fund Action No. of units Unit Price Amount Charge(INR) Balance Units
22-03-2021 Regular Premium ITF Buy 12.882819 49.5699 638.60 48.66 12.882819
22-03-2021 Regular Premium WLE Buy 9.213786 69.3081 638.59 48.66 9.213786
22-03-2021 Regular Premium WLF Buy 23.043143 27.7128 638.59 48.66 23.043143
22-03-2021 Regular Premium WLI Buy 20.683077 30.8750 638.59 48.66 20.683077
22-03-2021 Monthly Charges ITF Sell -0.341740 49.5699 -16.94 0.00 12.541079
22-03-2021 Monthly Charges WLE Sell -0.244272 69.3081 -16.93 0.00 8.969514
22-03-2021 Monthly Charges WLF Sell -0.610910 27.7128 -16.93 0.00 22.432233
22-03-2021 Monthly Charges WLI Sell -0.548341 30.8750 -16.93 0.00 20.134736
22-04-2021 Monthly Charges ITF Sell -0.344173 48.2607 -16.61 0.00 12.196906
22-04-2021 Monthly Charges WLE Sell -0.246220 68.1507 -16.78 0.00 8.723294
22-04-2021 Monthly Charges WLF Sell -0.615642 27.8409 -17.14 0.00 21.816591
22-04-2021 Monthly Charges WLI Sell -0.552251 31.1634 -17.21 0.00 19.582485
27-04-2021 Regular Premium ITF Buy 13.001794 49.1163 638.60 48.66 25.198700
27-04-2021 Regular Premium WLE Buy 9.182017 69.5479 638.59 48.66 17.905311
27-04-2021 Regular Premium WLF Buy 22.905690 27.8791 638.59 48.66 44.722281
27-04-2021 Regular Premium WLI Buy 20.439721 31.2426 638.59 48.66 40.022206
21-05-2021 Fund Switch ITF Sell -25.198700 51.3600 -1294.21 0.00 0.000000
21-05-2021 Fund Switch ITT Buy 15.810921 80.6158 1274.61 0.00 15.810921
21-05-2021 Fund Switch MCF Buy 43.010967 29.6350 1274.63 0.00 43.010967
21-05-2021 Fund Switch TLC Buy 32.582567 39.1200 1274.63 0.00 32.582567
21-05-2021 Fund Switch WLE Buy 17.629835 72.2996 1274.63 0.00 35.535146
21-05-2021 Fund Switch WLE Sell -17.905311 72.2996 -1294.55 0.00 0.000000
21-05-2021 Fund Switch WLF Sell -44.722281 27.9693 -1250.85 0.00 0.000000
21-05-2021 Fund Switch WLI Sell -40.022206 31.4548 -1258.89 0.00 0.000000
21-05-2021 Force-in Adjustment ITF Buy 0.137502 51.3600 7.06 0.00 0.137502
21-05-2021 Force-in Adjustment WLE Buy 0.126604 72.2996 9.15 0.00 17.756439
21-05-2021 Force-in Adjustment WLF Buy 0.004355 27.9693 0.12 0.00 0.004355
21-05-2021 Force-in Adjustment WLI Buy 0.005365 31.4548 0.17 0.00 0.005365
22-05-2021 Regular Premium ITF Buy 12.359825 51.6674 638.60 48.66 12.497327
22-05-2021 Regular Premium WLE Buy 8.761924 72.8824 638.59 48.66 26.518363
22-05-2021 Regular Premium WLF Buy 22.822436 27.9808 638.59 48.66 22.826791
22-05-2021 Regular Premium WLI Buy 20.293443 31.4678 638.59 48.66 20.298808
22-05-2021 Monthly Charges ITF Sell -0.108773 51.6674 -5.62 0.00 12.388554
22-05-2021 Monthly Charges ITT Sell -0.137595 81.3261 -11.19 0.00 15.673326
22-05-2021 Monthly Charges MCF Sell -0.374707 29.8634 -11.19 0.00 42.636260
22-05-2021 Monthly Charges TLC Sell -0.283413 39.3420 -11.15 0.00 32.299154
22-05-2021 Monthly Charges WLE Sell -0.230646 72.8824 -16.81 0.00 26.287717
22-05-2021 Monthly Charges WLF Sell -0.198708 27.9808 -5.56 0.00 22.628083
22-05-2021 Monthly Charges WLI Sell -0.176689 31.4678 -5.56 0.00 20.122119
22-06-2021 Monthly Charges ITF Sell -0.104479 53.5036 -5.59 0.00 12.284075
22-06-2021 Monthly Charges ITT Sell -0.132220 85.3128 -11.28 0.00 15.541106
22-06-2021 Monthly Charges MCF Sell -0.359258 31.3146 -11.25 0.00 42.277002
22-06-2021 Monthly Charges TLC Sell -0.272303 41.0940 -11.19 0.00 32.026851

Tata AIA Life Insurance Company Ltd.(IRDA of India Regn. No. 110). CIN:U66010MH2000PLC128403
(Corporate & Regd. Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.
For more Information, contact your advisor or call us on 1-860-266-9966 (local charges apply) or
SMS “Service” to 58888 or e-mail us at customercare@tataaia.com. Visit our website: - www.tataaia.com)
22-06-2021 Monthly Charges WLE Sell -0.221713 76.9015 -17.05 0.00 26.066004
22-06-2021 Monthly Charges WLF Sell -0.191199 28.0337 -5.36 0.00 22.436884
22-06-2021 Monthly Charges WLI Sell -0.169817 31.4457 -5.34 0.00 19.952302
23-06-2021 Regular Premium ITF Buy 11.963977 53.3769 638.60 48.66 24.248052
23-06-2021 Regular Premium WLE Buy 8.322213 76.7332 638.59 48.66 34.388217
23-06-2021 Regular Premium WLF Buy 22.779938 28.0330 638.59 48.66 45.216822
23-06-2021 Regular Premium WLI Buy 20.312744 31.4379 638.59 48.66 40.265046
28-06-2021 Fund Switch ITF Sell -24.248052 54.1009 -1311.84 0.00 0.000000
28-06-2021 Fund Switch ITT Buy 56.379307 86.7751 4892.32 0.00 71.920413
28-06-2021 Fund Switch MCF Sell -42.277002 31.8318 -1345.75 0.00 0.000000
28-06-2021 Fund Switch TLC Sell -32.026851 41.6580 -1334.17 0.00 0.000000
28-06-2021 Fund Switch WLE Buy 20.901273 78.0230 1630.78 0.00 55.289490
28-06-2021 Fund Switch WLF Sell -45.216822 28.0344 -1267.63 0.00 0.000000
28-06-2021 Fund Switch WLI Sell -40.265046 31.3848 -1263.71 0.00 0.000000
29-06-2021 Fund Switch ITF Sell 0.000000 53.8889 0.00 0.00 0.000000
29-06-2021 Fund Switch ITT Buy 0.000000 86.3717 0.00 0.00 71.920413
29-06-2021 Fund Switch MCF Sell 0.000000 31.6851 0.00 0.00 0.000000
29-06-2021 Fund Switch TLC Sell 0.000000 41.4486 0.00 0.00 0.000000
29-06-2021 Fund Switch WLE Buy 0.000000 77.9702 0.00 0.00 55.289490
29-06-2021 Fund Switch WLF Sell 0.000000 28.0247 0.00 0.00 0.000000
29-06-2021 Fund Switch WLI Sell 0.000000 31.4038 0.00 0.00 0.000000
22-07-2021 Monthly Charges ITT Sell -0.446010 88.1148 -39.30 0.00 71.474403
22-07-2021 Monthly Charges WLE Sell -0.342851 79.9183 -27.40 0.00 54.946639
24-07-2021 Regular Premium ITF Buy 11.671367 54.7151 638.60 48.66 11.671367
24-07-2021 Regular Premium WLE Buy 7.973276 80.0913 638.59 48.66 62.919915
24-07-2021 Regular Premium WLF Buy 22.646963 28.1976 638.59 48.66 22.646963
24-07-2021 Regular Premium WLI Buy 20.256365 31.5254 638.59 48.66 20.256365
22-08-2021 Monthly Charges ITF Sell -0.058747 55.4925 -3.26 0.00 11.612620
22-08-2021 Monthly Charges ITT Sell -0.360493 88.0739 -31.75 0.00 71.113910
22-08-2021 Monthly Charges WLE Sell -0.317229 78.5239 -24.91 0.00 62.602686
22-08-2021 Monthly Charges WLF Sell -0.114377 28.3275 -3.24 0.00 22.532586
22-08-2021 Monthly Charges WLI Sell -0.102295 31.6734 -3.24 0.00 20.154070
24-08-2021 Regular Premium ITF Buy 11.360322 56.2132 638.60 48.66 22.972942
24-08-2021 Regular Premium WLE Buy 8.061041 79.2193 638.59 48.66 70.663727
24-08-2021 Regular Premium WLF Buy 22.539134 28.3325 638.59 48.66 45.071720
24-08-2021 Regular Premium WLI Buy 20.156813 31.6811 638.59 48.66 40.310883
The monthly charges mentioned above in the transaction type consist of Mortality Charges, Policy
Administration Charges, Morbidity Charges etc & Goods and Services Tax which would be recovered every month by
cancellation of existing units

Whilst every care has been taken in the preparation of this statement, it is subject to correction and this
statement should be read along with the policy document and does not individually confer any legal rights.

For Surrender charges please refer to the policy document.

As this is a computer-generated statement, no signature is required.

All applicable taxes, duties, surcharge, cesses or levies, as may be imposed by Government any statutory or
administrative authority from time to time, on the premiums payable and benefits secured under Policy, shall
be borne and paid by the Policyholder.PAN: AABCT3784C

Tata AIA Life Insurance Company Ltd.(IRDA of India Regn. No. 110). CIN:U66010MH2000PLC128403
(Corporate & Regd. Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.
For more Information, contact your advisor or call us on 1-860-266-9966 (local charges apply) or
SMS “Service” to 58888 or e-mail us at customercare@tataaia.com. Visit our website: - www.tataaia.com)