Benefit Illustration for SHRIRAM LIFE SUPER INCOME PLAN V03

UIN: 128N087V03

(This Benefit Illustration forms part of the Policy Document)

Name: ABC Sum Assured: 1500000.00

Date Of Birth: 08/04/1990 Policy Term: 43
Age (in yrs): 32 PPT: 15
Gender: Male Mode: Yearly

Guaranteed Non Guaranteed

Survival Benefits/  Guaranteed 
 Policy   Total Annualised Other Benefits If Special Surrender 
Loyalty Additions Maturity Benefit Death Benefit Surrender Benefit
Year  Premiums paid till date Any Benefit 
   
1 150000 - - 1500000 0 -
2 150000 - - 1500000 90000 58242
3 150000 - - 1500000 157500 107413
4 150000 - - 1500000 300000 169952
5 150000 - - 1500000 375000 248244
6 150000 - - 1500000 522000 340858
7 150000 - - 1500000 693000 447794
8 150000 - - 1500000 900000 569051
9 150000 - - 1500000 1134000 708927
10 150000 - - 1575000 1410000 864080
11 150000 - - 1732500 1617000 1045011
12 150000 - - 1890000 1854000 1243129
13 150000 - - 2125500 2125500 1477051
14 150000 - - 2394000 2394000 1717656
15 150000 - - 2700000 2700000 1983564
16 228960 - 2812500 2812500 2126781
17 228960 - 2763540 2763540 2197419
18 228960 - 2714580 2714580 2258898
19 228960 - 2665620 2665620 2317692
20 228960 - 2616660 2616660 2366870
21 228960 - 2545200 2545200 2406432
22 228960 - 2496240 2496240 2442165
23 228960 - 2467823 2447280 2467823
24 228960 - 2488736 2375820 2488736
25 228960 - 2499118 2304360 2499118
26 228960 - 2498967 2255400 2498967
27 228960 - 2492926 2183940 2492926
28 228960 - 2475895 2112480 2475895
29 228960 - 2452058 2041020 2452058
30 228960 - 2416774 1947060 2416774
31 228960 - 2373768 1875600 2373768
32 228960 - 2362500 1781640 2318856
33 228960 - 2362500 1687680 2252038
34 228960 - 2362500 1593720 2176354
35 228960 - 2362500 1499760 2088306
36 228960 - 2362500 1383300 1990475
37 228960 - 2362500 1266840 1879823
38 228960 - 2362500 1150380 1756350
39 228960 - 2362500 1011420 1621949
40 228960 - 2362500 872460 1474268
41 228960 - 2362500 711000 1307561
42 228960 - 2362500 527040 1126989
43 228960 750000 2362500 320580 935886

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 and acceptance of the proposal is subjected to underwriting.Premiums relating to
riders and non-standard risks are excluded from the above.
(3) The above amounts 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
Policy Option NA Sum Assured Rs. 1500000.00
Monthly Super Income Benefit 19080.00 Sum Assured on Death (at inception of the policy) Rs. 1500000.00
 Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST 150000 0 150000
Instalment Premium with First Year GST 156750 0 156750
Instalment Premium with GST 2nd Year Onwards 153375 0 153375

Notes: 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 I, .............................................

benefits 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