Benefit Illustration for SHRIRAM LIFE SUPER INCOME PLAN V03

UIN: 128N087V03

(This Benefit Illustration forms part of the Policy Document)

Name: vishal Sum Assured: 1000000.00

Date Of Birth: 06/11/1984 Policy Term: 38
Age (in yrs): 37 PPT: 12
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 100000 - - 1000000 0 -
2 100000 - - 1000000 60000 43391
3 100000 - - 1000000 105000 79731
4 100000 - - 1000000 200000 125834
5 100000 - - 1000000 250000 181700
6 100000 - - 1000000 348000 247330
7 100000 - - 1000000 462000 324620
8 100000 - - 1000000 592000 414385
9 100000 - - 1000000 747000 512558
10 100000 - - 1050000 930000 626460
11 100000 - - 1155000 1078000 751752
12 100000 - - 1260000 1236000 885179
13 105936 - 1308000 1308000 956775
14 105936 - 1310064 1310064 994894
15 105936 - 1300128 1300128 1028353
16 105936 - 1278192 1278192 1060087
17 105936 - 1260000 1256256 1086947
18 105936 - 1260000 1234320 1108935
19 105936 - 1260000 1212384 1128668
20 105936 - 1260000 1178448 1143317
21 105936 - 1260000 1156512 1155287
22 105936 - 1260000 1134576 1161961
23 105936 - 1260000 1100640 1163337
24 105936 - 1260000 1066704 1161506
25 105936 - 1260000 1044768 1154167
26 105936 - 1260000 1010832 1143195
27 105936 - 1260000 976896 1126504
28 105936 - 1260000 930960 1104091
29 105936 - 1260000 897024 1077518
30 105936 - 1260000 851088 1045012
31 105936 - 1260000 805152 1007921
32 105936 - 1260000 759216 964686
33 105936 - 1260000 713280 915307
34 105936 - 1260000 655344 860812
35 105936 - 1260000 597408 799962
36 105936 - 1260000 539472 731938
37 105936 - 1260000 469536 657058
38 105936 500000 1260000 387600 576851

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. 1000000.00
Monthly Super Income Benefit 8828.00 Sum Assured on Death (at inception of the policy) Rs. 1000000.00

Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST 100000 3850 103850
Instalment Premium with First Year GST 104500 4543 109043
Instalment Premium with GST 2nd Year Onwards 102250 4543 106793
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