Illustration Number:

Illustration Version: null.0

Dear Abc

Thank you for showing interest in our Canara HSBC Oriental Bank of Commerce Life Insurance Guaranteed Income Plan. Based on the details provided by you, and reproduced below,
the illustration customised to your requirements is appended.

Date : 02/12/2022 13:33 Proposal No: NA

Name of Prospect/Policyholder: Abc Name of the Product: Canara HSBC Oriental Bank of Commerce Life
Insurance Guaranteed Income Plan
Age & Gender: 39 Years Male
Tag Line: An Individual Non-Linked Non-Par Life Insurance
Name of Life Assured: Abc Savings cum Protection Plan
Age & Gender 39 Years Male Unique Identification 136N067V02
Policy Term 15 Years No:
Premium Payment Term 10 Years GST Rate(Year 1) 4.500%
Amount of Instalment Premium Rs. 30000 GST Rate(Year 2 2.250%
onwards):
Mode of Payment of Premium: Yearly

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy

Policy Details: Premium Summary

Policy Option Guaranteed Cashback Base Plan Riders Total Installment Premium
Sum Assured: Rs. 153951 Instalment Premium Without GST Rs. 30000 - Rs. 30000
Sum Assured at death: Rs. 330000 Instalment Premium in First Year with GST Rs. 31350 - Rs. 31350
(at inception of the policy Rs) Instalment Premium 2nd year onwards with GST Rs. 30675 - Rs. 30675

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 (Amount In Rupees)

Guaranteed Non Guaranteed

Policy Year Single/ Annualized Survival Benefits@/ Loyalty Other Benefits, if any# Maturity Benefit** Death Min Guaranteed Special Surrender
Premium Additions* Benefit Surrender Value Value
1 30000 0 3600 0 330000 0 0
2 30000 0 10800 0 333600 18432 16526
3 30000 0 21600 0 340800 33012 29120
4 30000 0 36000 0 351600 63456 45031
5 30000 0 54000 0 366000 86940 64586
6 30000 0 75600 0 384000 113580 88107
7 30000 0 100800 0 405600 143808 118615
8 30000 0 129600 0 430800 177552 158020
9 30000 0 162000 0 459600 215568 200871
10 30000 0 198000 0 492000 257640 259077
11 0 23093 198000 0 528000 280530 308824
12 0 23093 198000 0 528000 272407 314237
13 0 23093 198000 0 528000 264284 324402
14 0 23093 198000 0 528000 256161 339318
15 0 30790 198000 382741 528000 237028 358986

'@Survival Benefits refers to Guaranteed Annual Cashback paid at the end of the respective policy years

*Loyalty Additions refers to Guaranteed Loyalty Addition paid on Maturity

#Other Benefits refers to accrued Guaranteed Yearly Additions . Guaranteed Yearly Additions are calculated as % of cumulative Annualized Premiums added during Premium Payment Term

**Maturity benefit includes Guaranteed Sum Assured on Maturity plus Accrued Guaranteed Yearly Additions plus Guaranteed Loyalty Addition

Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any and Goods & Services Tax

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 Important Notes:

1. Maturity Benefit = Guaranteed Sum Assured on Maturity + Cumulative Guaranteed Yearly Additions + Guaranteed Loyalty Addition
2. a) Guaranteed Cash back Option ( Plan Option 1 ): The Death Benefit is the benefit payable on death of the Life Assured, which is Sum Assured on Death plus Guaranteed Yearly Additions
accrued till the date of death. Where Sum Assured on Death is defined as Higher of (11 times the Annualized Premium or Guaranteed Sum Assured on Maturity or Absolute amount assured to
be paid on death or 105% of {the Total Premiums Paid till the date of death). Survival benefits/guaranteed annual cash back already paid will not be deducted from the death benefit amount.
b) Guaranteed Cash back with Premium Protection Option (Plan Option 2): The Death Benefit is the benefit payable on death of the Life Assured, which is Sum Assured ion Death. In addition,
all remaining future premiums, if any, are not payable, all guaranteed annual cash back as scheduled will continue to be payable at the end of each of the last 4 Policy years before the maturity
year and on maturity, Guaranteed Sum Assured on Maturity plus Accrued Guaranteed Yearly Additions and Guaranteed Loyalty Addition, will be payable. Where Sum Assured on Death is
defined as Higher of (11 times the Annualized Premium or Guaranteed Sum Assured on Maturity or Absolute amount assured to be paid on death or 105% of {the Total Premiums Paid till the
date of death).
3. Minimum Guaranteed Surrender Value / Special Surrender Value is payable at the end of the Policy year before the payment of survival benefit.
4. Annualized Premium excludes underwriting extra premiums, rider premiums and loadings for modal premiums, if any, as well as excludes Goods and Services Tax & applicable cess
(es)/other levy, if any.
5. Installment premium mentioned is inclusive of underwriting extra premium & loadings for modal premium, if any.
6. A Policy shall acquire lapse status if the Policyholder fails to pay due premium within the Grace Period in the first 2 consecutive Policy years. In such case your Policy will lapse at the expiry
of the grace period and the insurance cover will cease immediately. No benefit shall be payable upon death or upon your request for termination of the Policy or on the expiry of the revival
period.
7. Guaranteed Yearly Additions will be calculated as a percentage of cumulative Annualized Premium(s) paid and vary by the Premium Payment Term. Guaranteed Yearly Additions will accrue
at the end of each Policy Year throughout the Premium Payment Term, provided all premiums due till the end of that Policy Year have been paid.
8. Survival Benefit/Guaranteed Annual Cash back will be paid at the end of the Policy year.
9. Total Premiums Paid means total of all premiums received excluding any rider premium and taxes.

Other points to note:

1. Guaranteed Yearly Addition (s) and Guaranteed Loyalty Addition will be payable provided all due premiums are paid and Policy is in in-force.
2. This is a traditional plan intended for long term savings and benefits. It is strongly advised that the Policy should be continued throughout the defined Policy term to realize the full benefits.
Early exit should not be opted for unless there is no other alternative available, as it will impact the Policy value. If premiums are discontinued after payment of at least first 2 consecutive Policy
years’ premiums then the Policy will acquire a Paid-up value. You will receive this Paid-up value on death or on maturity, provided you have not surrendered or revived the Policy.
3. Your Policy will acquire a guaranteed surrender value (GSV) after payment of at least first 2 consecutive Policy years’ premiums. However, the Company may offer a special surrender value
(SSV), and higher of {GSV or SSV} will be paid on surrender. The Illustration shows both the GSV as well as the current SSV payable on surrender of the Policy. SSV scales may be revised in
the future by the Company with the prior approval of the Authority.
4. You may be entitled for tax benefits under Section 80C and Section 10(10D), as per the Income Tax Act, 1961 as amended from time to time.
5. The premium shown is for a healthy individual. Your application will be assessed as per Board approved underwriting Policy of the Company. Basis underwriting, it may result in extra
premium to be paid, which shall be borne by you.
6. The illustration takes into account currently applicable Goods and Services Tax & applicable cess (es)/other levy, if any. However, the applicable taxes may change from time to time and total
premium payable will change accordingly.
7. For more details on product features and terms and conditions please read sales brochure or sample Policy contract carefully before concluding a sale.

Disclosures

Corporate Agent will receive commission basis the premium payment term (PPT) of the policy from the company for this transaction:-
10 years PPT :- 30% commission on 1st year premium, 5% from 2nd year onwards.
IRDA regulations do not permit Corporate Agent or its employees to pay such commission, whether in part or whole, as an inducement to any person to take out or renew or continue an
insurance policy of any kind.

I,...................................................(name), have explained the I,...................................................(name), having received the

premiums,charges and benefits under the product fully to the information, with respect to the above, have understood the

prospect/policy holder. above statement before entering into the contract.

Place:

Date: Signature of Agent/Intermediary/Official Date: Signature of Prospect/Policyholder.

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