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 : MAYANK VISHWAKARMA Quote No.: 10200001722290821
Age as on last birthday : 38 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 : MAYANK VISHWAKARMA Tag Line:
Premium Life Insurance Plan
Age as on last birthday : 38 Years Unique Identification No: 130N103V01
Gender : Male GST Rate (incl. cess, if any): GST Rate applicable in 1st year is 4.5% and 2nd year
onwards is 2.25%. For Riders, 18% GST rate is applicable
Smoker (Yes/No) : NO

Policy Term (years): ToAge75 Product Code : WRR75N

Premium Payment Term (years) : 37 Rider Code :
Premium Mode: Annual
Amount of Instalment Premium (Rs.): 29364.50 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: With Return of Premium Option Sum Assured Rs. 10000001.00
Death Benefit Payout Option Lumpsum Sum Assured on Death (at inception of the policy) Rs. 10000001.00

Name of the Proposer: MAYANK VISHWAKARMA 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.bhartiaxa.com
Page 1 of 5
 Premium Summary
Base Plan Total Instalment Premium
Instalment Premium without GST (Rs.) 28100.00 28100.00
GST in the First Year 1264.50 1264.50
Instalment Premium with First Year GST (Rs.) 29364.50 29364.50
GST from 2nd Year onwards 632.25 632.25
Instalment Premium with GST 2nd Year Onwards (Rs.) 28732.25 28732.25
*GST Rate applicable in 1st year is 4.5% and 2nd year onwards is 2.25%. For Riders, 18% GST rate is applicable

(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 28100 - - - 10000001 10000001 - - -
2 28100 - - - 10000001 10000001 - 16860 2585
3 28100 - - - 10000001 10000001 - 29505 4215
4 28100 - - - 10000001 10000001 - 56200 6070
5 28100 - - - 10000001 10000001 - 70250 8290

Name of the Proposer: MAYANK VISHWAKARMA 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.bhartiaxa.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 28100 - - - 10000001 10000001 - 84300 10959
7 28100 - - - 10000001 10000001 - 98350 13966
8 28100 - - - 10000001 10000001 - 115501 17310
9 28100 - - - 10000001 10000001 - 133427 21244
10 28100 - - - 10000001 10000001 - 152128 25852
11 28100 - - - 10000001 10000001 - 171604 31219
12 28100 - - - 10000001 10000001 - 191855 37092
13 28100 - - - 10000001 10000001 - 212882 43836
14 28100 - - - 10000001 10000001 - 234683 51535
15 28100 - - - 10000001 10000001 - 257260 60275
16 28100 - - - 10000001 10000001 - 280612 70587
17 28100 - - - 10000001 10000001 - 304740 81687
18 28100 - - - 10000001 10000001 - 329642 94585
19 28100 - - - 10000001 10000001 - 355320 108916
20 28100 - - - 10000001 10000001 - 381772 125326
21 28100 - - - 10000001 10000001 - 409000 143394
22 28100 - - - 10000001 10000001 - 437003 164441
23 28100 - - - 10000001 10000001 - 465782 187427
24 28100 - - - 10000001 10000001 - 495335 213785
25 28100 - - - 10000001 10000001 - 525664 243065

Name of the Proposer: MAYANK VISHWAKARMA 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.bhartiaxa.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 28100 - - - 10000001 10000001 - 556768 276167
27 28100 - - - 10000001 10000001 - 588647 313343
28 28100 - - - 10000001 10000001 - 621301 355634
29 28100 - - - 10000001 10000001 - 654730 401746
30 28100 - - - 10000001 10000001 - 688934 454377
31 28100 - - - 10000001 10000001 - 723914 513078
32 28100 - - - 10000001 10000001 - 759669 578186
33 28100 - - - 10000001 10000001 - 796199 650965
34 28100 - - - 10000001 10000001 - 833504 732792
35 28100 - - - 10000001 10000001 - 871584 824173
36 28100 - - - 10000001 10000001 - 910440 926626
37 28100 - - 1039700 10000001 10000001 - 935730 1039700

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: MAYANK VISHWAKARMA 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.bhartiaxa.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 With Return of Premium Option - On maturity of the policy, the Sum Assured on Maturity will be payable where Sum Assured is equal to sum of the all premiums paid (excluding tax & cess and
any underwriting extra) till the date of maturity of the policy.
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. The minimum guaranteed surrender value under the policy is a percentage of all premiums paid till date if surrendered in 2nd policy year. The GSV is paid only if the policy acquires surrender value. The
company may declare surrender value that is higher than the Guaranteed Surrender Values (i.e. Special Surrender Value). The Special Surrender Values are not guaranteed and subject to declaration by
The Company.
8. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
9. 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.
10. 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, MAYANK VISHWAKARMA, 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.bhartiaxa.com
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