Name: MANAN Sum Assured: 240000.

00
DateOf Birth: 31/08/2008 Policy Term: 12
Age in(yrs): 12 PPT: 12

Gender: Male Mode: Yearly

Benefit Illustration for SHRIRAM LIFE ASSURED INCOME PLAN V03

128N053V03
(This Benefit Illustration forms part of the Policy Document)

Guaranteed Non Guaranteed

 Policy  Total Annualized   Survival Benefits /   Other Benefits   Maturity Benefit   Death Benefit   Min Guaranteed   Special Surrender Value 
  Year  Premium paid till Loyalty Additions  if any  Surrender Value  
date    
1 20000.00 0.00 0.00 0 20000 0 0

2 40000.00 0.00 0.00 0 308400 12000 7710

3 60000.00 0.00 0.00 0 308400 21000 15497

4 80000.00 0.00 0.00 0 308400 40000 26522

5 100000.00 0.00 0.00 0 308400 57000 41249

6 120000.00 0.00 0.00 0 308400 76800 60138

7 140000.00 0.00 0.00 0 308400 99400 83654

8 160000.00 0.00 0.00 0 308400 124800 112258

9 180000.00 0.00 0.00 0 308400 153000 146413

10 200000.00 0.00 0.00 0 308400 184000 186582

11 220000.00 0.00 0.00 0 308400 217800 233228

12 240000.00 0.00 0.00 0 308400 256800 286812

13 0.00 0.00 0.00 37368 0 0 0

14 0.00 0.00 0.00 37368 0 0 0

15 0.00 0.00 0.00 37368 0 0 0

16 0.00 0.00 0.00 37368 0 0 0

17 0.00 0.00 0.00 37368 0 0 0

18 0.00 0.00 0.00 37368 0 0 0

19 0.00 0.00 0.00 37368 0 0 0

20 0.00 0.00 0.00 37368 0 0 0

21 0.00 0.00 0.00 37368 0 0 0

22 0.00 0.00 0.00 37368 0 0 0

23 0.00 0.00 0.00 37368 0 0 0

24 0.00 0.00 0.00 37368 0 0 0

Disclosures:
(1) This is only an illustration and does not in any way create any rights and/or obligations.
(2) This illustration is applicable to a healthy individual acceptance of the proposal is subject to underwriting.Premiums relating to riders and non-
standard risks are excluded from the above.
(3) The above amounts assume that all premiums have been paid on due date.
(4) The surrender value payable will be the maximum of GSV and SSV.
(5) Please contact nearest branch office for latest surrender values payable on your policy.

Policy Details
Death Benefit Pay-Out Option Lumpsum Sum Assured Rs. 240000.00
Maturity Benefit Pay-Out Option Payout Sum Assured on Death (at inception of the policy) Rs. 20000
Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST 20000 0 20000
Instalment Premium with First Year GST 20900 20900
Instalment Premium with GST 2nd Year Onwards 20450 20450
Notes:
1) Annualized premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders,
if any Goods & Service Tax.

IRDAI Regn No:128

I, .........................................., have explained the premiums, and benefits I, ........................................
under the product fully to the prospect / Policyholder. having received the information with respect to the above, have
understood the above statement before entering into the contract
Date: Signature of Agent / Intermediary / Date: Signature of the Prospect/
Official /Specified Person Policy holder's signature
Place: