BENEFIT ILLUSTRATION

Proposal No:
Name of
Ms.
the
60First
Years,
Annuitant:
Female
Name of the Product: Max Life Guaranteed Lifetime Income Plan
Age & Gender: Name of the Second Annuitant,Not
Not Applicable if any:
Applicable Not Applicable
Age & Gender: Policy Term: 1 Year Tag Line: A Non-Linked Non Participating Individual General Annuity Savings Plan
Premium Payment Term: `50,03,672 Unique Identification No: 104N076V11
Amount of Installment Premium: Annuity Payment Frequency: Annuity Purchased From:Monthly Agent Assisted
Monthly Income Amount Starting On 04-Nov-2021 `24,159 GST Rate: 1.80%
(Guaranteed) Max Life State: Maharashtra
Policyholder Residential State: Maharashtra
Issue Date of Quote: 30 September 2021
Annuity Start Date: 30 October 2021

This quote is valid for a period of 10 calendar days from the date of issue. Please ensure that your proposal form is submitted at any of our offices within this duration as annuity rates change
frequently. This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Policy Details
Policy Option Immediate Annuity - Single Life Sum Assured (in Rs.) Not Applicable
Deferment Period, if applicable Not Applicable Sum Assured on Death (at inception of the policy) (in Rs.) `49,15,198
Death Benefit Opted Yes

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST (in Rs.) 49,15,198 NA 49,15,198
Installment Premium with first year GST (in Rs.) 50,03,672 NA 50,03,672
Installment Premium with GST 2nd year onwards (in Rs.) NA NA NA

UIN: 104N076V11 Page 1 of 2

 (Amount in Rupees)

Guaranteed Non Guaranteed

Single/ Annualized
Policy Year
Premium Survival Benefits / Loyalty Min Guaranteed Surrender Value Special Surrender Value
Other Benefits, if any Maturity Benefit Death Benefit
Additions

1 49,15,198 2,89,910 0 0 49,15,198 33,96,488 38,47,672

2 0 2,89,910 0 0 49,15,198 31,06,578 38,58,057
3 0 2,89,910 0 0 49,15,198 28,16,668 38,69,845
4 0 2,89,910 0 0 49,15,198 32,64,038 38,82,546
5 0 2,89,910 0 0 49,15,198 29,74,127 38,99,179
6 0 2,89,910 0 0 49,15,198 26,84,217 39,13,213
7 0 2,89,910 0 0 49,15,198 23,94,307 39,27,176
8 0 2,89,910 0 0 49,15,198 21,04,397 39,43,597
9 0 2,89,910 0 0 49,15,198 18,14,487 39,62,475
10 0 2,89,910 0 0 49,15,198 15,24,576 39,76,788
11 0 2,89,910 0 0 49,15,198 12,34,666 39,96,087
16 0 2,89,910 0 0 49,15,198 0 40,87,734
21 0 2,89,910 0 0 49,15,198 0 41,77,273
26 0 2,89,910 0 0 49,15,198 0 42,69,412
31 0 2,89,910 0 0 49,15,198 0 43,65,970
36 0 2,89,910 0 0 49,15,198 0 44,99,368
40 0 2,89,910 0 0 49,15,198 0 47,15,641

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.

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

Place:
Date: 9/30/21 Signature / OTP Confirmation Date / Thumb Impression / Electronic Signature of Agent/ Intermediary
Date:9/30/2112111109/30/21
/ Official Signature / OTP Confirmation Date / Thumb Impression / Electronic Signature of Prospect/ Po

This system generated benefit illustration shall be treated as signed by me.