Name: Mahesh Sum Assured: 200000.

00
Date Of Birth: 22/09/2000 Policy Term: 10
Age (in yrs): 21 PPT: 5
Gender: Male Mode: Quarterly

Benefit Illustration for SHRIRAM LIFE ASSURED INCOME PLUS V03

128N060V03

(This Benefit Illustration forms part of the Policy Document)

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 23858 - - 238580 - -

2 47716 - - 238580 14315 9600

3 71574 - - 238580 28630 17760

4 95432 - - 238580 47716 37600

5 119290 - - 238580 77539 76600

6 119290 - - 238580 95432 118000

7 119290 - - 238580 104975 125000

8 119290 - - 238580 114518 133200

9 119290 - - 238580 125255 142600

10 119290 - - 238580 135991 153200

11 - 40000 - - -

12 - 40000 - - -

13 - 40000 - - -

14 - 40000 - - -

15 - 40000 - - -

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
Sum Assured Rs. 200000.00
Policy Option Not Applicable Sum Assured on Death (at inception of the policy) Rs. 238580.00

Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST 6124 0.00 6124.00
Instalment Premium with First Year GST 6400.00 6400.00
Instalment Premium with GST 2nd Year Onwards 6262 6262
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