Proposal No:

Name of the Prospect/Policyholder: Mr. Vijay Shankar Choubey Name of the Product: Max Life Savings Advantage Plan
Age & Gender: 27 Years, Male Tag Line: A Non-Linked Participating Individual Life Insurance Savings Plan
Name of the Life Assured: Ms. Mrs Unique Identification No: 104N111V02
Age & Gender: 35 Years, Female GST Rate: 4.50%
Policy Term: 20 Years Max Life State: Delhi
Premium Payment Term: 20 Years Policyholder Residential State: Delhi
Amount of Installment Premium: `1,04,500
Mode of payment of premium: Annual

How to read and understand this benefit illustration?

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a.

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 illustration on this page will show two different rates of assumed future investment returns, of
8%p.a. and 4% p.a. 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
future investment performance.

Policy Details
Policy Option Sum Assured (in Rs.) 17,15,266
Bonus Type Paid Up Additions Sum Assured on Death (at inception of the policy) (in Rs.) 18,86,792

Rider Details
Accidental Death & Dismemberment (ADD) Rider Premium
NA Accidental Death & Dismemberment (ADD) Rider Sum Assured (in Rs.) NA
Payment Term and Rider Term
Term Plus Rider Term NA Term Plus Rider Sum Assured (in Rs.) NA
Waiver of Premium (WOP) Plus Rider Term NA
Critical Illness and Disability Rider - Rider Premium
NA Critical Illness and Disability Rider - Coverage Variant NA
Payment Term and Rider Term
Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST (in Rs.) 1,00,000 - 1,00,000
Installment Premium with first year GST (in Rs.) 1,04,500 - 1,04,500
Installment Premium with GST 2nd year onwards (in Rs.) 1,02,250 - 1,02,250

UIN: 104N111V02 Page 1 of 3

 (Amount in Rupees)

Total Benefits including Guaranteed and Non- Guaranteed

Non-Guaranteed Benefits Non-Guaranteed Benefits Benefits
Guaranteed Benefits
@ 4% p.a. @ 8% p.a.
Maturity Benefit Death Benefit
Single/
Policy Total Maturity Total Death
Annualized Total Maturity Total Death
Year Benefit, incl. Benefit, incl.
Premium Benefit, incl. Benefit, incl.
Terminal of Terminal
Guaranteed Survival Surrender Death Maturity Paid Up Surrender Paid Up Surrender Terminal of Terminal
Cash Bonus Cash Bonus Bonus, if any Bonus, if any
Additions Benefit Benefit Benefit Benefit Additions Benefit Additions Benefit Bonus, if any Bonus, if any
@ @ 4%(6+8+9)
@ 4%(7+8+9) @
8%(7+11+12)
8%(6+11+12)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

1 1,00,000 94,340 - - 18,86,792 - - - - - - - - - 19,81,132 19,81,132

2 1,00,000 94,340 - 85,962 18,86,792 - 11,865 6,672 87,595 27,404 9,177 89,733 - - 20,87,337 21,02,875

3 1,00,000 94,340 - 1,48,373 18,86,792 - 11,960 13,831 1,52,024 27,881 19,662 1,56,845 - - 21,93,637 22,25,096

4 1,00,000 94,340 - 2,64,430 18,86,792 - 12,043 21,495 2,70,554 28,312 31,577 2,78,703 - - 23,00,020 23,47,747

5 1,00,000 94,340 - 3,49,759 18,86,792 - 12,115 29,685 3,58,890 28,740 45,070 3,71,136 - - 24,06,474 30,32,266

6 1,00,000 - - 4,24,061 18,86,792 - 12,203 38,439 4,36,829 29,205 60,319 4,54,086 - - 24,18,677 30,70,442

7 1,00,000 - - 5,03,575 18,86,792 - 12,279 47,778 5,20,717 29,696 77,517 5,44,080 - - 24,30,956 31,09,261

8 1,00,000 - - 5,94,843 18,86,792 - 12,371 57,744 6,17,225 30,168 96,852 6,72,539 - - 24,43,327 31,48,697

9 1,00,000 - - 6,94,130 18,86,792 - 12,476 68,379 7,37,653 30,653 1,18,547 8,41,695 - - 24,55,803 31,88,767

10 1,00,000 - - 7,99,915 18,86,792 - 12,543 79,691 8,77,863 31,145 1,42,846 10,34,187 - - 24,68,346 32,29,479

11 1,00,000 - - 9,13,201 20,75,472 - 12,648 91,744 10,08,914 31,636 1,70,004 12,18,989 - - 26,69,674 34,59,513

12 1,00,000 - - 10,35,428 20,75,472 - 12,717 1,04,548 11,52,130 32,154 2,00,329 14,22,796 - - 26,82,390 35,01,546

13 1,00,000 - - 11,64,552 20,75,472 - 12,820 1,18,172 13,08,302 32,658 2,34,126 16,46,944 - - 26,95,210 35,44,237

14 1,00,000 - - 13,01,974 20,75,472 - 12,909 1,32,648 14,78,502 33,173 2,71,749 18,93,299 - - 27,08,119 35,87,601

15 1,00,000 - - 14,49,533 20,75,472 - 12,987 1,48,011 16,63,659 33,719 3,13,608 21,63,566 - - 27,21,106 36,31,678

16 1,00,000 - - 16,04,726 20,75,472 - 13,072 1,64,321 18,65,058 34,257 3,60,130 24,59,944 - - 27,34,178 36,76,458

17 1,00,000 - - 17,69,392 20,75,472 - 13,166 1,81,636 20,83,396 34,806 4,11,799 27,83,997 - - 27,47,344 37,21,956

18 1,00,000 - - 19,45,845 20,79,000 - 13,265 2,00,020 23,15,831 35,356 4,69,147 31,38,111 - - 27,64,137 37,71,701

UIN: 104N111V02 Page 2 of 3

 Total Benefits including Guaranteed and Non- Guaranteed
Non-Guaranteed Benefits Non-Guaranteed Benefits Benefits
Guaranteed Benefits
@ 4% p.a. @ 8% p.a.
Maturity Benefit Death Benefit
Single/
Policy Total Maturity Total Death
Annualized Total Maturity Total Death
Year Benefit, incl. Benefit, incl.
Premium Benefit, incl. Benefit, incl.
Terminal of Terminal
Guaranteed Survival Surrender Death Maturity Paid Up Surrender Paid Up Surrender Terminal of Terminal
Cash Bonus Cash Bonus Bonus, if any Bonus, if any
Additions Benefit Benefit Benefit Benefit Additions Benefit Additions Benefit Bonus, if any Bonus, if any
@ @ 4%(6+8+9)
@ 4%(7+8+9) @
8%(7+11+12)
8%(6+11+12)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

19 1,00,000 - - 21,31,160 21,94,500 - 13,350 2,19,527 25,36,417 35,921 5,32,786 35,24,961 - - 28,92,987 39,34,158

20 1,00,000 - - 22,71,698 23,10,000 23,58,491 13,439 2,40,228 25,98,719 36,492 6,03,375 36,74,152 25,98,719 36,74,152 30,21,926 40,97,360

Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Service Tax. Refer Sales literature for explanation of terms used in
this illustration.

I, ……………………………………………. (name), have explained the premiums, and benefits I, Vijay Shankar Choubey (name), having received the information with respect to the above,
under the product fully to the prospect / policyholder. have understood the above statement before entering into the contract.

Place:
Date: 1/6/23 Signature / OTP Confirmation Date / Thumb Impression / Date:1/6/23 Signature / OTP Confirmation Date / Thumb Impression /
Electronic Signature of Agent/ Intermediary / Official Electronic Signature of Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N111V02 Page 3 of 3

55,35,1715265,3,100000.00,F,b55