Bharti AXA Life Flexi Term Pro

A Non-Linked, Individual, Non-Participating Pure Risk Premium Life Insurance Plan

ILLUSTRATION OF BENEFITS FOR BHARTI AXA LIFE FLEXI TERM PRO

“Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. If your policy offers guaranteed benefits then
these will be clearly marked “guaranteed” in the illustration table on this page. If your policy offers variable benefits then the illustrations on this page will show two different rates of assumed future
investment returns. These assumed rates of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependent on a number of factors
including actual future investment performance.”

Proposer Details
Name of the Prospect/Policyholder : MANISH KUMAR MISHRA Quote No.: 10200001487090721
Age as on last birthday : 35 Years Proposal No :
Gender : Male Policy No.:

Life Insured Details Name of the Product: Bharti AXA Life Flexi Term Pro
Non-Linked, Individual, Non-Participating Pure Risk
Name of the Life Insured : MANISH KUMAR MISHRA Tag Line:
Premium Life Insurance Plan
Age as on last birthday : 35 Years Unique Identification No: 130N103V01
Gender : Male GST Rate (incl. cess, if any): GST Rate applicable is 18% for the base plan and riders.
Smoker (Yes/No) : YES

Policy Term (years): ToAge70 Product Code : WTR70S

Premium Payment Term (years) : 35 Rider Code : PWLCI35
Premium Mode: Annual
Amount of Instalment Premium (Rs.): 23472.89 Premium Category : Medical UW
(incl. rider premium and GST)
This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Base Policy Details

Policy Option: Without Return of Premium Option - Sum Assured Rs. 10000001.00
Single Life
Death Benefit Payout Option Lumpsum Sum Assured on Death (at inception of the policy) Rs. 10000001.00

Name of the Proposer: MANISH KUMAR MISHRA Signature of the Proposer:

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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 Rider Details
Rider 1
Rider Name Premium Waiver Rider on Critical Illness for Life Insured- UIN:130B005V04
Rider Term (years) 35
Rider Premium Payment Term (years) 35
Rider Sum Assured (Rs.) -

Premium Summary
Base Plan Rider 1 Total Instalment Premium
Instalment Premium without GST (Rs.) 18800.00 1092.28 19892.28
GST in the First Year 3384.00 196.61 3580.61
Instalment Premium with First Year GST (Rs.) 22184.00 1288.89 23472.89
GST from 2nd Year onwards 3384.00 196.61 3580.61
Instalment Premium with GST 2nd Year Onwards (Rs.) 22184.00 1288.89 23472.89
*GST rate applicable is 18%

(Amounts in Rupees.)
Illustration summary over the duration of the policy
Guaranteed Non Guaranteed
Single/ Annualized Sum Death Benefit Death Benefit Min
Policy Year Maturity Guaranteed
Premium Survival Benefits Other Benefits if any Assured/Death payable as payable as Special Surrender Value
Benefit Benefit Lumpsum*3(iii) Income*3(iii) Surrender
Value
1 18800 - - - 10000001 10000001 - - -
2 18800 - - - 10000001 10000001 - - -
3 18800 - - - 10000001 10000001 - - -
4 18800 - - - 10000001 10000001 - - -
5 18800 - - - 10000001 10000001 - - -

Name of the Proposer: MANISH KUMAR MISHRA Signature of the Proposer:

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
Page 2 of 5
 (Amounts in Rupees.)
Illustration summary over the duration of the policy
Guaranteed Non Guaranteed
Single/ Annualized Sum Death Benefit Death Benefit Min
Policy Year Maturity Guaranteed
Premium Survival Benefits Other Benefits if any Assured/Death payable as payable as Special Surrender Value
Benefit Benefit Lumpsum*3(iii) Income*3(iii) Surrender
Value
6 18800 - - - 10000001 10000001 - - -
7 18800 - - - 10000001 10000001 - - -
8 18800 - - - 10000001 10000001 - - -
9 18800 - - - 10000001 10000001 - - -
10 18800 - - - 10000001 10000001 - - -
11 18800 - - - 10000001 10000001 - - -
12 18800 - - - 10000001 10000001 - - -
13 18800 - - - 10000001 10000001 - - -
14 18800 - - - 10000001 10000001 - - -
15 18800 - - - 10000001 10000001 - - -
16 18800 - - - 10000001 10000001 - - -
17 18800 - - - 10000001 10000001 - - -
18 18800 - - - 10000001 10000001 - - -
19 18800 - - - 10000001 10000001 - - -
20 18800 - - - 10000001 10000001 - - -
21 18800 - - - 10000001 10000001 - - -
22 18800 - - - 10000001 10000001 - - -
23 18800 - - - 10000001 10000001 - - -
24 18800 - - - 10000001 10000001 - - -
25 18800 - - - 10000001 10000001 - - -

Name of the Proposer: MANISH KUMAR MISHRA Signature of the Proposer:

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
Page 3 of 5
 (Amounts in Rupees.)
Illustration summary over the duration of the policy
Guaranteed Non Guaranteed
Single/ Annualized Sum Death Benefit Death Benefit Min
Policy Year Maturity Guaranteed
Premium Survival Benefits Other Benefits if any Assured/Death payable as payable as Special Surrender Value
Benefit Benefit Lumpsum*3(iii) Income*3(iii) Surrender
Value
26 18800 - - - 10000001 10000001 - - -
27 18800 - - - 10000001 10000001 - - -
28 18800 - - - 10000001 10000001 - - -
29 18800 - - - 10000001 10000001 - - -
30 18800 - - - 10000001 10000001 - - -
31 18800 - - - 10000001 10000001 - - -
32 18800 - - - 10000001 10000001 - - -
33 18800 - - - 10000001 10000001 - - -
34 18800 - - - 10000001 10000001 - - -
35 18800 - - - 10000001 10000001 - - -

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

Name of the Proposer: MANISH KUMAR MISHRA Signature of the Proposer:

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
Page 4 of 5
 Explanation & Information
1. This benefit illustration explains the benefits and features of the proposed policy and is not a contract of insurance.
2. Under Without Return of Premium Option-Single Life - Life cover is provided for Single Life Assured. There is no Maturity benefit under this option.
3. The policy offers three Death Benefit Payout Options -
i. Under 'Lumpsum' option, 100% of the Death Benefit will be paid immediately on death as lumpsum
ii. Under 'Monthly Income' option, the Death Benefit will be paid as 1.04% of the Sum Assured every month in the form of Monthly Income, payable for 10 years with the first installment being payable
immediately on death.
iii. Under 'Lumpsum plus Monthly Income' option, 50% of the Death Benefit will be paid immediately on death as lumpsum and the remaining 50% of the Death Benefit will be paid as 0.93% of the total
Sum Assured every month in the form of Monthly Income, payable for 5 years with the first installment being payable immediately on death.
4. The illustration is based on the standard risk class, taking in to consideration your own circumstances.
5. All benefits under this plan are guaranteed
6. The Death benefit mentioned in the Benefit Illustration is payable in case of Death of Life Insured during the Policy Term.
7. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
8. 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.
9. Bharti AXA Life Insurance Company Ltd., Bharti AXA Life Flexi Term Pro is the name of the Insurance Company, Product and does not in any way indicate the quality of the contract, its future
prospects or returns.

Declaration by Advisor / Sales Person Declaration by Proposer

I, MANISH KUMAR MISHRA, having received the information with
I, ............ ...... ............ ... (name), have explained the premiums, and
respect to the above, have understood the above statement before
benefits under the product fully to the prospect / policyholder.
entering into the contract.
Place
Date: Signature of Agent/Intermediary/Official Date: Signature of Prospect / Policyholder

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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