BENEFIT ILLUSTRATION

[Date and Time of Illustration – 08 March 2023, 04:26 PM]

Name of the Prospect/Policyholder (Insured Person 1): Ms. REVATHY Proposal No:
Age & Gender: 57 Years, Female Name of the Product: Max Life Smart Wealth Plan
Name of the Insured Person 2: Mr. R Tag Line: A Non-Linked Non Participating Individual Life Insurance Savings Plan
Age & Gender: 65 Years, Male Unique Identification No: 104N116V08
Policy Term: 6 Years GST Rate (Base Policy, First Year): 4.50%
Premium Payment Term: 6 Years GST Rate (Base Policy, Subsequent Year): 2.25%
Amount of Installment Premium: `1,30,625 GST Rate (Rider, First Year): NA
Mode of payment of premium: Annual
GST Rate (Rider, Subsequent Year): NA
Annual Income Amount: `51,149
Income Period, if applicable: NA Max Life State: Tamil Nadu
Mode of Income, if applicable: Annual Policyholder Residential State: Tamil Nadu

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

Policy Details
Policy Option Whole Life Income Sum Assured (in Rs.) Not Applicable
Sum Assured on Death (at inception of the policy) (in Rs.) 8,75,000

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 Payment
NA Critical Illness and Disability Rider - Coverage Variant NA
Term and Rider Term
Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Accidental Death & Waiver of Premium Plus Critical Illness and Total Installment Premium
Base Plan Dismemberment Rider
Term Plus Rider Rider Disability Rider
Installment Premium without GST (in Rs.) 1,25,000 0 0 0 0 1,25,000
Installment Premium with first year GST (in Rs.) 1,30,625 0 0 0 0 1,30,625
Installment Premium with GST 2nd year onwards (in Rs.) 1,27,813 0 0 0 0 1,27,813

UIN: 104N116V08 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 1 of 3
 (Amount in Rupees)

Guaranteed Non Guaranteed

Single/ Annualized Total Annual
Policy Year
Premium Premium Death Benefit (First Death Benefit (Second Min Guaranteed Special Surrender Value
Income Benefit Other Benefits, if any Maturity Benefit
Death) Death) Surrender Value

1 1,25,000 1,25,000 - - - 8,75,000 12,50,000 - -

2 1,25,000 1,25,000 - - - 8,75,000 12,50,000 75,000 1,54,928
3 1,25,000 1,25,000 - - - 8,75,000 12,50,000 1,31,250 2,52,133
4 1,25,000 1,25,000 - - - 8,75,000 12,50,000 2,50,000 3,64,776
5 1,25,000 1,25,000 - - - 8,75,000 12,50,000 5,62,500 4,94,723
6 1,25,000 1,25,000 - - - 8,75,000 12,50,000 6,75,000 6,44,101
7 - - 51,149 - - - 7,50,000 - -
8 - - 51,149 - - - 7,50,000 - -
9 - - 51,149 - - - 7,50,000 - -
10 - - 51,149 - - - 7,50,000 - -
11 - - 51,149 - - - 7,50,000 - -
12 - - 51,149 - - - 7,50,000 - -
13 - - 51,149 - - - 7,50,000 - -
14 - - 51,149 - - - 7,50,000 - -
15 - - 51,149 - - - 7,50,000 - -
16 - - 51,149 - - - 7,50,000 - -
17 - - 51,149 - - - 7,50,000 - -
18 - - 51,149 - - - 7,50,000 - -
19 - - 51,149 - - - 7,50,000 - -
20 - - 51,149 - - - 7,50,000 - -
21 - - 51,149 - - - 7,50,000 - -
22 - - 51,149 - - - 7,50,000 - -
23 - - 51,149 - - - 7,50,000 - -
24 - - 51,149 - - - 7,50,000 - -
25 - - 51,149 - - - 7,50,000 - -
26 - - 51,149 - - - 7,50,000 - -
27 - - 51,149 - - - 7,50,000 - -
28 - - 51,149 - - - 7,50,000 - -
29 - - 51,149 - - - 7,50,000 - -
30 - - 51,149 - - - 7,50,000 - -
UIN: 104N116V08 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 2 of 3
 Guaranteed Non Guaranteed
Single/ Annualized Total Annual
Policy Year
Premium Premium Death Benefit (First Death Benefit (Second Min Guaranteed Special Surrender Value
Income Benefit Other Benefits, if any Maturity Benefit
Death) Death) Surrender Value

31 - - 51,149 - - - 7,50,000 - -
32 - - 51,149 - - - 7,50,000 - -
33 - - 51,149 - - - 7,50,000 - -
34 - - 51,149 - - - 7,50,000 - -
35 - - 51,149 - - - 7,50,000 - -
36 - - 51,149 - - - 7,50,000 - -
37 - - 51,149 - - - 7,50,000 - -
38 - - 51,149 - - - 7,50,000 - -
39 - - 51,149 - - - 7,50,000 - -
40 - - 51,149 - - - 7,50,000 - -
41 - - 51,149 - - - 7,50,000 - -
42 - - 51,149 - - - 7,50,000 - -
43 - - 51,149 - - - 7,50,000 - -

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

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

Place: Signature / Thumb Impression / Electronic Signature of Date:3/8/23 Signature / Thumb Impression / Electronic Signature of
Date: 3/8/23 Agent/ Intermediary / Official Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N116V08 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 3 of 3
Need analysis for REVATHY SANTHANA KRISHNAN Age: 57 years

Occupation: Self-employed (Salaried/ Self employed/ others)

(Details of prospect are mandatory)

Life stage: Select basis personal information of the customer (mandatory)

Close to retirement
Married with no
Single Single with Children Married with children or retired
children
(Prospect age >= 45 years)

Gross annual income(Rs.) (mandatory) Rs.600000

Purpose of Insurance (mandatory, maximum 1 goal at a time)

Insurance need / Children’s Wealth

Investment Protection marriage/ Retirement accumulation/ Regular Income
objective education Investment

Tick the one

applicable

Any existing life insurance cover already held(mandatory) Yes No

Total sum assured (if answer to the above question is yes) Rs.500000

Recommended products (as per standard product suitability matrix)

[Max Life Flexi Wealth Advantage Plan, Max Life Smart Wealth Plan, Max Life Flexi Wealth Plus Plan, Max Life Savings
Advantage Plan, Max Life Smart Wealth Advantage Guarantee Plan]
 Selected product

Max Life Smart Wealth Plan

Nature of the selected product

Traditional Static Text Combo

ULIP

Premium payment term Policy term Mode of premium payment

(recommended for selected product) (recommended for selected product) (recommended for selected product)

6 6 Annual

Mandatory field for all customers

Customer Name REVATHY SANTHANA KRISHNAN

Proposal no(s)
PSM Date 2023-03-08
(If proposal is applied)

I / We are aware that suitability information has been collected from me/us and recommendation on purchase of life
insurance product has been made only basis such information and any product selected by me/us that differs from such
recommendation is on the basis of my/our personal choice.

Seller signature
Customer signature (This system generated form shall be
(OTP confirmation date / Thumb treated as signed by me)
impression / Electronic signature of
SanthoshpriyanSubramaniya
prospect/ policyholder )
SP0069496063