Dear Tushar Sunil Potekar,

Congratulations on choosing Tata AIA Life Insurance. You have taken a step ahead to secure the future of your loved ones with
a death cover of ₹ 1,50,00,000. Please go through the details of your quote and contact your advisor who will assist you to
purchase this plan.
Your Policy benefits are as follows:
Total Death benefit under SRS Vitality Protect: ₹ 1,50,00,000

Tata AIA Sampoorna Raksha Supreme ₹ 75,00,000 Refer Table A in Benefit Illustration
Powered by:
Term Booster ₹ 75,00,000 Refer Table B in Benefit Illustration
 What are the benefits of this Solution?
We are delighted that you have decided to secure your loved ones' financial future with a Death Benefit of ₹ 1,50,00,000 through our exclusive solution – Tata AIA Life Insurance
Sampoorna Raksha Supreme Vitality Protect.This solution is powered by Tata AIA Life Insurance Sampoorna Raksha Supreme and Term Booster (Tata AIA Life Insurance Vitality
Protect).
Your premium amount with respect to SRS Vitality Protect is ₹ 2,067, which is payable Monthly for 33 years. This amount is inclusive of Goods and Services Tax. Please refer Schedule
for details of other riders chosen, if any.
At Tata AIA Life Insurance, we are committed to help you with solutions that will provide Sampoorna Rakshakaran to your family so that you can enjoy life without any worries.
Best Wishes

Naveen Tahilliyani
CEO & Managing Director
Authorised Signatory
*The discount is available under TATA AIA Vitality Wellness Program. Please refer TATA AIA Vitality Protect terms and conditions for more details.
Vitality is a trademark licensed to Tata AIA Life by Amplify Health Assets PTE. Limited, a joint venture between Vitality Group International, INC. and AIA Company Limited. The assessment under the wellness program shall not be considered as a medical advice or a substitute to a
consultation/treatment by a professional medical practitioner.
SRS Vitality Protect is a term solution which includes TATA AIA Life Insurance Sampoorna Raksha Supreme, a non-linked, non-participating, individual life insurance plan (UIN: 110N160V03) and TATA Vitality Protect, a non-linked, non-participating, individual health rider (UIN: 110B046V01).
L&C/Misc/2022/Oct/0483
Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110) CIN: U66010MH2000PLC128403. Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group
Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor / Intermediary or visit Tata AIA Life's nearest branch office or call 1-860-266-9966 (local charges apply) or write to us
at customercare@tataaia.com. Visit us at: www.tataaia.com
BEWARE OF SPURIOUS PHONE IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public receiving such phone calls are requested to lodge a police complaint
CALLS AND FICTITIOUS / FRAUDULENT OFFERS
BENEFIT ILLUSTRATION
Tata AIA Life Insurance Sampoorna Raksha Supreme
Name of the Prospect/Policyholder : Tushar Sunil Potekar Proposal No: 7765816317411
Age (years) : 27 Name of the Product: Tata AIA Life Insurance Sampoorna Raksha Supreme
Gender: Male Tag Line: Non-Linked, Non-Participating Life Insurance Plan
Name of the Life Assured : Tushar Sunil Potekar Unique Identification Number: 110N160V03
Age (years) : 27 GST Rate Year 1: 18.00%
Gender: Male GST Rate Year 2 onwards: 18.00%
Smoker : No
Policy Term : 33 years 00 Months
Premium Payment Term : 33 years 00 Months
Amount of Instalment Premium (Rs.) : 2,067
Mode of Payment of Premium : Monthly

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.
Policy Details (A)
Policy Option: Life option Lumpsum(Rs): 75,00,000
Sum Assured (Rs): 75,00,000 Income Duration (months): 0
Sum Assured on Death (at inception of the policy) 75,00,000 Income p.a (Rs): 0
(Rs):

Rider Details (B)

Tata AIA Vitality (Wellness Program): Yes Utilisation of Rewards (if Wellness program opted) Premium Discount
Details of Life Insured/Partner under the Benefit Option Benefit Payout Return Benefit Premium Sum Premium Year 1
Rider Name / UIN^(Benefit Option / Income Income of p.a. Discount
Option Payment Assured without
Benefit Payout Option) Name Age(yrs) Gender Lumpsum (Rs.) p.a. Duration premium Term Term (Rs.) GST (Rs.) (Rs.)
(Rs.) (yrs) option
VP - Term Booster (Lumpsum Benefit)# Tushar Sunil Potekar 27 M 75,00,000 0 0 No 33 33 75,00,000 6,275 660
VP - Accidental Death (Lumpsum Benefit) Tushar Sunil Potekar 27 M 40,00,000 0 0 No 33 33 40,00,000 1,800 96
VP - Accidental Total & Permanent
Tushar Sunil Potekar 27 M 40,00,000 0 0 No 33 33 40,00,000 1,080 48
Disability (Lumpsum Benefit)
VP - CritiCare Plus (Lumpsum Benefit) Tushar Sunil Potekar 27 M 20,00,000 0 0 No 33 33 20,00,000 4,400 468

^VP: Tata AIA Vitality Protect, (A Non-Linked, Non- Participating Individual Health rider, UIN:110B046V01)
#Premium calculated for Term Booster on Tushar Sunil Potekar is considering underwriting class as Elite

Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST (Rs.) 554 1,197 1,751
Instalment Premium with First year GST (Rs.) 654 1,413 2,067
Instalment Premium post applicable discount with First year GST (Rs.) 654 1,287 1,941
Instalment Premium with GST 2nd year onwards (Rs.) 654 1,413 2,067
Discount applicable and Installment Premium payable 2nd year onwards will depend on the Wellness status of the Insured
(Amount in Rupees)

Guaranteed # Non - Guaranteed

Single/ Annualized
Policy Year Premium Survival Benefit / Min Guaranteed
Other Benefits, if any Maturity Benefit Death Benefit Special Surrender Value
Loyalty Additions Surrender Value
1 6,275 NA NA NA 75,00,000 0 NA
2 6,275 NA NA NA 75,00,000 0 NA
3 6,275 NA NA NA 75,00,000 0 NA
4 6,275 NA NA NA 75,00,000 0 NA
5 6,275 NA NA NA 75,00,000 0 NA
6 6,275 NA NA NA 75,00,000 0 NA
7 6,275 NA NA NA 75,00,000 0 NA
8 6,275 NA NA NA 75,00,000 0 NA
9 6,275 NA NA NA 75,00,000 0 NA
10 6,275 NA NA NA 75,00,000 0 NA
11 6,275 NA NA NA 75,00,000 0 NA
12 6,275 NA NA NA 75,00,000 0 NA
13 6,275 NA NA NA 75,00,000 0 NA
14 6,275 NA NA NA 75,00,000 0 NA
15 6,275 NA NA NA 75,00,000 0 NA
16 6,275 NA NA NA 75,00,000 0 NA
17 6,275 NA NA NA 75,00,000 0 NA
18 6,275 NA NA NA 75,00,000 0 NA
19 6,275 NA NA NA 75,00,000 0 NA
20 6,275 NA NA NA 75,00,000 0 NA
21 6,275 NA NA NA 75,00,000 0 NA
22 6,275 NA NA NA 75,00,000 0 NA
23 6,275 NA NA NA 75,00,000 0 NA
24 6,275 NA NA NA 75,00,000 0 NA
25 6,275 NA NA NA 75,00,000 0 NA
26 6,275 NA NA NA 75,00,000 0 NA
27 6,275 NA NA NA 75,00,000 0 NA
28 6,275 NA NA NA 75,00,000 0 NA
29 6,275 NA NA NA 75,00,000 0 NA
30 6,275 NA NA NA 75,00,000 0 NA
31 6,275 NA NA NA 75,00,000 0 NA
32 6,275 NA NA NA 75,00,000 0 NA
33 6,275 NA NA NA 75,00,000 0 NA
Note "Annualized Premium” shall be the premium payable in a year under a non-single pay option chosen by the policyholder, excluding the taxes, rider premiums, underwriting extra premiums, loading for modal
premiums, if any.
"Single Premium” shall be the premium payable under a single pay option chosen by the policyholder, excluding the taxes, rider premiums, underwriting extra premiums, if any.
#The benefits illustrated are as at the end of the policy year.
The rider sum assured shall remain unchanged for a period as specified under ‘Guaranteed Period’ from the Date of Commencement of the benefit option. Upon the completion of ‘Guaranteed Period’, the sum
assured as applicable for the benefit option may be revised or the policyholder may be given an option of top up premium to restore the benefit to original amount, subject to IRDAI’s approval. The top up premium
may be payable as a single premium/ level premium during the block of next guarantee period. The requirement of paying the Top up premium in order to continue with the current level of benefit may be
applicable even after expiry of limited pay premium term.
I, …...................... (name), have explained the premiums and benefits under the product fully to the I, Tushar Sunil Potekar, having received the information with respect to the above, have understood
prospect / policyholder. the above statement before entering into the contract.

Place:
Date: 16 Apr 2023 Date: 16 Apr 2023
Signature of Agent / Intermediary / Official Signature of Prospect / Policyholder
Unique Reference Number - L&C/Advt/2022/Jun/1419 (Rider - L&C/Advt/2022/Sep/2271)

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013
Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license.
For more information, Call the Tata AIA Life Insurance Company Ltd Helpline number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com
 Summary of Benefits

TATA AIA Life Insurance SRS Vitality Protect Total Death Benefit (₹) First Year Annual Premium (incl.tax) (₹)
TATA AIA Sampoorna Raksha Supreme 75,00,000 7,848
TATA AIA Vitality Protect - Term Booster* 75,00,000 7,068
Total 1,50,00,000 14,916

Summary of Additional Riders:

Sum Assured (₹) First Year Annual Premium (incl.tax) (₹)

Accidental Death (Lumpsum Benefit)* 40,00,000 2,136
Accidental Total & Permanent Disability (Lumpsum Benefit)* 40,00,000 1,284
CritiCare Plus (Lumpsum Benefit)* 20,00,000 4,956

Total premium payable in first year incl. taxes ₹ 23,292 *The premiums a re inclus ive of Ta ta AIA Vita lity Wellnes s dis count

Disclaimers: The a bove ta bles s umma rize firs t yea r premium. Renewa l premium will be s ubject to the wellnes s s ta tus a chieved by Life As s ured a s per the term a nd conditions of res pective rider. SRS Vita lity Protect is a term s olution which includes TATA
AIA Life Ins ura nce Sa mpoorna Ra ks ha Supreme, a non - linked, non - pa rticipa ting, individua l life ins ura nce pla n (UIN: 110N160V03) a nd TATA Vita lity Protect, a non - linked, non - pa rticipa ting, individua l hea lth rider(UIN: 110B046V01) •
L&C/Mis c/2022/Oct/0488.
Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110) CIN: U66010MH2000PLC128403. Registered & Corporate Office: 14th Floor, Tower A, Penins ula Bus ines s Pa rk, Sena pa ti Ba pa t Ma rg, Lower Pa rel, Mumba i - 400013. Tra de logo dis pla yed a bove belongs
to Ta ta Sons Ltd a nd AIA Group Ltd. a nd is us ed by Ta ta AIA Life Ins ura nce Compa ny Ltd under a licens e. For a ny informa tion including ca ncella tion, cla ims a nd compla ints , plea s e conta ct our Ins ura nce Advis or / Intermedia ry or vis it Ta ta AIA Life's
nea res t bra nch office or ca ll 1-860-266-9966 (loca l cha rges a pply) or write to us a t customercare@tataaia.com. Vis it us a t: www.tataaia.com
BEWARE OF SPURIOUS PHONE IRDAI is not involved in a ctivities like s elling ins ura nce policies , a nnouncing bonus or inves tment of premiums . Public receiving s uch phone ca lls a re reques ted to lodge a police
CALLS AND FICTITIOUS / FRAUDULENT OFFERS compla int