Bajaj Allianz Life Insurance Company Ltd.

Statement of Product Value FORM-D02

Registration No: 116 Login Date: 22/06/2020

Policy holder ID. 0334583203 Name of Policyholder RAFEEQ ANSARI

Address PREM COLONY STREET NO-1,NANDPUR KHURD NEAR JISCO RESORT~SANEHWAL,SANEHWAL,LUDHIANA,PUNJAB,141120

PART A
Product Name UIN Premium Amt. Inc Premium Allocation Fund Allocated (Rs) Units as per Policy Admin Value per Product Value
Top-up(Rs) Charge(Rs) System (PAS) Unit (Rs) (Rs)
Bajaj Allianz Future Gain Size 1 116L124V01 35000 525 34475 1509.55 0 -.01 (A)

PART - B

Particulars ULIF05206/01/10 ULIF02610/07/06 ULIF05106/01/10 ULIF07026/03/13 ULIF06026/10/10 Total

ACCMIDCA02116 BONDFUNDLI116 EQTYGROW02116 DISCONLIFE116 BLUECHIPEQ116
Name of the Fund ACCELERATOR MID BOND FUND EQUITY GROWTH DISCONTINUED LIFE BLUE CHIP EQUITY
CAP FUND - 2 FUND - 2 POLICY FUND FUND

Units (as per Investment Management System) 0 0 0 2654.5 0 2654.5

Percentage of Allocation (as on Login Dt) 0 % 0 % 0 % 100 % 0 % 100 %

Funds Allocated 5171.25 1723.75 13790 0 13790 34475

Switch In (Rs) 0 0 0 0 0 0

Switch Out (Rs) 0 0 0 0 0 0

Withdrawals 0 0 0 0 0 0

Charges (Rs)

Allocation charges 78.75 26.25 210 0 210 525

Switch charge 0 0 0 0 0 0
Policy administration charge 52.07 16.44 136.08 0 134.99 339.58
Mortality charges
122.06 38.62 319.05 0 316.56 796.29
Other charges (specify) 0 0 0 0 0 0
Service tax/GST
Total amount invested in segregated funds 5171.25 1723.75 13790 0 13790 34475 (B)
Current NAV 28.1386 32.9517 30.3026 13.3094 18.1686
Fund value as on login Dt: .01 0 -.01 35329.85 -.01 35,329.84

PART - C (Product Statistics)

Insurance Cover over the interim reporting period from 28/05/2017 To 22/06/2020 6,00,000

Total Premium Paid from inception(D) 35,000

Total Risk premium from inception, for insurance cover(E) 796

Total Charges and deductions other than Mortality including Allocation charges till Login Dt. (including Service Charges)(F) 1,154

Difference between (A) (B) (unrealised Gain / Loss) -34,475

Portfolio value on Net Investment as per Benefit Illustration at 4% rate as prescribed in the regulations 33618.94

Portfolio value on Net Investment as per Benefit Illustration at 8% rate as prescribed in the regulations 37424.08

Note: Considering the transactions in the statement, benefit illustration value is not comparable.