Quote No.:09100000264060720 Proposal No.: Policy No.

:
Illustration of benefits for Bharti AXA Life Premier Protect Plan
UIN : 130N096V02 Illustration generated by: 285034
Product Code : PP5L35N Illustration Date: 06-07-2020
Rider Code : ADB
Personal Details Benefits and Premium Details
Life To Be Insured : XXX Accidental Death Benefit Rider
Plan Name Bharti AXA Life Premier Protect Plan
Age as on last birthday : 37 years (UIN:130B008V02)
Gender : Male Smoker(Yes/No) NO NO
Proposer Details Policy Benefit Period (in Years) 35 years 5 years
Proposer Name : XXX Premium Payment Term (in Years) 5 years 5 years
Proposer Gender : Male Premium Mode Annual Annual
Age as on last birthday : 37 years Premium Payment Type Limited 5 Pay -
Death Benefit Payout Option Lumpsum Payout -
Benefit Up to age (in Years) 72 years 42 years
Sum Assured (Rs.) 10000000.00 5000000.00
Annualized Premium (Rs.) 50800.00 4000.00
Total Annual Premium 50800.00 4000.00
Modal Premium Payable (Rs.) 50800.00 4000.00
GST For Modal Premium for First year 9144.00 720.00
GST For Modal Premium for 2nd year
9144.00 720.00
onwards
Modal Premium Payable By You for first year (Rs.) 64664.00
Modal Premium Payable By You for 2nd year onwards (Rs.) 64664.00

Name of the Proposer: XXX Signature of the Proposer:

Insurance is the subject matter of the solicitation.
Registered address- Unit No. 1904, 19th Floor, Parinee Crescenzo, 'G' Block, Bandra Kurla Complex, BKC Road, Behind MCA Ground, Bandra East, Mumbai -400051, Maharashtra
Service Unit address- Bharti AXA Life Insurance Company Limited, Spectrum tower, 3rd Floor,Malad link road, Malad (west), Mumbai 400064. Maharashtra
IRDA Regn no.-130. Website: www.bharti-axalife.com
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 Explanation & Information – Accidental Death Benefit Rider

1. This benefit illustration explains the benefits and features of the proposed policy and is not a contract of insurance.
2. The illustration is based on your risk class, taking in to consideration your circumstances.
3. All benefits under this plan are guaranteed.
4. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
5. Tax benefits are as per the current tax legislations and are subject to change in tax laws. Neither the company nor its agents can offer legal or tax advice.
Bharti AXA Life Insurance Company Ltd., Bharti AXA Life Accidental Death Benefit Rider is the name of the Insurance Company, Product and does not in any way indicate the quality of the
6.
contract, its future prospects or returns.

Declaration by Proposer
I confirm that before entering in to the contract of insurance I have read and understood the product brochure and the information provided in this Illustration of benefits and
understand that the policy Bond will be issued to me on this basis.
Name of Proposer : XXX Place:

Signature of proposer : Date: 06-07-2020

Declaration by Advisor / Sales Person
I certify that I have explained the product brochure and this benefit illustration to the proposer and have made no statements that are inconsistent with the same

Name of the advisor/sales person Signature of the advisor/sales person

Insurance is the subject matter of the solicitation.

Registered address- Unit No. 1904, 19th Floor, Parinee Crescenzo, 'G' Block, Bandra Kurla Complex, BKC Road, Behind MCA Ground, Bandra East, Mumbai -400051, Maharashtra
Service Unit address- Bharti AXA Life Insurance Company Limited, Spectrum tower, 3rd Floor,Malad link road, Malad (west), Mumbai 400064. Maharashtra
IRDA Regn no.-130. Website: www.bharti-axalife.com
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