For Office Use Only (w.e.f. Jan 22 / Ver 1.

0)
Illustration No: KFMP-1669M-5852-Y50
Quotation Number:BB110723111936054
Proposal No:
Policy No:

Name of the Prospect/Policyholder Mr Man Singh Name of the Product Kotak Fortune Maximiser

Name of Life Insured Master Bhavishya Chaudhary Tag Line A Non-Linked Participating
Savings Life Insurance plan
Age of the Prospect/Policyholder(in yrs) 67
Unique Identification No UIN: 107N125V01
DOB of Life Insured 13 February 2007
Taxes and Cess(Year 1) 4.5%
Age of the Life Insured (in yrs) 16
Taxes and Cess(Year 2) 2.25%
Gender of the Life Insured Male
Tax and Cess Rate-Riders 18%
Spouse Cover Option (if opted for) No
Back-dation Option No
Name of Secondary Life Insured (Spouse) NA
Chosen(Yes/No)
DOB of Secondary Life Insured NA
If Yes, Back-dation Date Not Applicable
(Spouse)(in yrs)
Agent's Branch Location Haryana
Age of Secondary Life Insured (Spouse) NA
Prospect/Policyholder's Haryana
Gender of Secondary Life Insured NA
Current Location
(Spouse)
Sales Channel Individual Agents
Policy Term(in yrs) 69

Premium Payment Term(in yrs) 12

Amount of installment Premium(in Rs.) 50,000

Mode of Payment of Premium Yearly

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 illustrations 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

Plan Option Life Goal Maximiser

Sum Insured on Death for
Bonus Type Cash Payout Immediate
Primary Life Insured(at inception 5,88,376
Cash Payout Frequency Yearly of the policy)(Rs.)

Deferment Period Not Applicable Sum Insured on Death for

Secondary Life Insured(at NA
Survival Benefit Payout Period Not Applicable
inception of the policy) (Rs.)
Accumulation Period (in years) Not Applicable

Page 1 of 8
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Quotation Number:BB110723111936054
Rider Details
Rider Premium Paying
Rider Name Rider Sum Assured Rider Policy Term Rider Premiums(Rs.)
Term
Kotak Accidental Death Benefit Rider (UIN:
Not Selected
107B001V03)
Kotak Permanent Disability Benefit Rider (UIN:
Not Selected
107B002V03)
Kotak Term Benefit Rider (UIN: 107B003V03) Not Selected
Kotak Life Guardian Benefit Rider (UIN:
Not Selected
107B012V02)
Kotak Accidental Disability Guardian Benefit Rider
Not Selected
(UIN: 107B011V02)
Kotak Critical Illness Plus Benefit Rider
Not Selected
(UIN:107B020V01)
Note: Rider Premiums will have to be paid additionally

PREMIUM SUMMARY

Total Rider Premium

Base Plan Premium (Please refer Rider
Base Plan Premium Total Instalment
for Secondary Life Details table)(Rs.)
for Life Insured(Rs.) Premium (Rs.)
Insured(Spouse)(Rs.) (applicable only for
Life Insured)

Installment Premium (without Taxes & Cess) 50,000 NA 0 50,000

Installment Premium(with First Year Taxes &

52,250 NA 0 52,250
Cess)

Installment Premium(with Taxes & Cess,Second

51,125 NA 0 51,125
Year onwards)

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Quotation Number:BB110723111936054
(Amount in Rupees.)

BENEFIT ILLUSTRATION TABLE

Total Benefits including Guaranteed and Non-Guaranteed Benefits

Guaranteed Benefits Non - Guaranteed Benefits @4%p.a. Non - Guaranteed Benefits @8%p.a.
Maturity Benefits Death Benefits

End of Policy Age of Life Annualized

Total Maturity Total Maturity Total Death
Year Insured Premium Total Death
Guaranteed Special Guaranteed Special Benefit, incl, Benefit, incl, Benefit, incl,
Accrued Paid- Accrued Paid- Benefit, incl,
Death Benefit Maturity Benefit Survival Benefit Surrender Surrender Survival Benefit Surrender Surrender Terminal Bonus, Terminal Bonus, Terminal Bonus,
Up Additions Up Additions Terminal Bonus,
Benefit * Benefit * Benefit * Benefit* if any @4% if any @8% if any @8%
if any @4% (4+6)
(5+6+7) (5+10+11) (4+10)

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

1 17 50,000 5,88,376 0 0 10,962 0 0 0 19,046 0 0 0 0 5,88,376 5,88,376

2 18 50,000 5,88,376 0 0 10,962 8,076 8,076 0 19,046 0 0 0 0 5,88,376 5,88,376

3 19 50,000 5,88,376 0 0 10,962 19,614 27,114 0 19,046 0 2,861 0 0 5,88,376 5,88,376

4 20 50,000 5,88,376 0 0 10,962 56,152 56,152 0 19,046 23,815 26,692 0 0 5,88,376 5,88,376

5 21 50,000 5,88,376 0 0 10,962 70,190 70,190 0 19,046 29,769 43,559 0 0 5,88,376 5,88,376

6 22 50,000 5,88,376 0 0 10,962 84,229 88,927 0 19,046 35,722 64,601 0 0 5,88,376 5,88,376

7 23 50,000 5,88,376 0 0 10,962 98,267 1,19,848 0 19,046 41,676 90,260 0 0 5,88,376 5,88,376

8 24 50,000 5,88,376 0 0 10,962 1,44,305 1,54,021 0 19,046 79,630 1,19,352 0 0 5,88,376 5,88,376

9 25 50,000 5,88,376 0 0 10,962 2,02,843 2,02,843 0 19,046 1,30,084 1,58,159 0 0 5,88,376 5,88,376

10 26 50,000 5,88,376 0 0 10,962 2,65,381 2,65,381 0 19,046 1,84,537 1,98,764 0 0 5,88,376 5,88,376

11 27 50,000 5,88,376 0 0 10,962 3,19,419 3,35,919 0 19,046 2,30,491 2,60,527 0 0 5,88,376 5,88,376

12 28 50,000 6,30,000 0 0 10,962 3,78,457 4,08,457 0 19,046 2,81,445 3,42,731 0 0 6,30,000 6,30,000

13 29 0 6,30,000 0 0 10,962 3,97,495 3,97,495 0 19,046 2,92,399 3,46,311 0 0 6,30,000 6,30,000

14 30 0 6,30,000 0 0 10,962 3,86,533 3,97,835 0 19,046 2,73,352 3,50,164 0 0 6,30,000 6,30,000

15 31 0 6,30,000 0 0 10,962 3,75,571 3,98,903 0 19,046 2,54,306 3,54,311 0 0 6,30,000 6,30,000

16 32 0 6,30,000 0 0 10,962 3,64,610 4,00,014 0 19,046 2,35,260 3,58,771 0 0 6,30,000 6,30,000

Note: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards riders, if any, and Goods & Service Tax. The annualized premium, will be with respect to the
life insured or Primary life insured (in case of Spouse Cover option). For more details and for explanation of terms used in this illustration, please refer Sales Literature.

* Surrender Benefit is higher of Guaranteed or Special Surrender Value. Special Surrender Value mentioned above also includes Terminal Bonus (if any), Interim Bonus (if any) as may be payable. Surrender Benefit
shown is after deduction of Total Applicable Survival Benefit already paid or utilized to purchase Paid-Up Additions.

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New Page1

Quotation Number:BB110723111936054
(Amount in Rupees.)

BENEFIT ILLUSTRATION TABLE

Total Benefits including Guaranteed and Non-Guaranteed Benefits

Guaranteed Benefits Non - Guaranteed Benefits @4%p.a. Non - Guaranteed Benefits @8%p.a.
Maturity Benefits Death Benefits

End of Policy Age of Life Annualized

Total Maturity Total Maturity Total Death
Year Insured Premium Total Death
Guaranteed Special Guaranteed Special Benefit, incl, Benefit, incl, Benefit, incl,
Accrued Paid- Accrued Paid- Benefit, incl,
Death Benefit Maturity Benefit Survival Benefit Surrender Surrender Survival Benefit Surrender Surrender Terminal Bonus, Terminal Bonus, Terminal Bonus,
Up Additions Up Additions Terminal Bonus,
Benefit * Benefit * Benefit * Benefit* if any @4% if any @8% if any @8%
if any @4% (4+6)
(5+6+7) (5+10+11) (4+10)

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

17 33 0 6,30,000 0 0 10,962 3,53,648 4,01,168 0 19,046 2,16,214 3,63,567 0 0 6,30,000 6,30,000

18 34 0 6,30,000 0 0 10,962 3,42,686 4,02,367 0 19,046 1,97,167 3,68,724 0 0 6,30,000 6,30,000

19 35 0 6,30,000 0 0 10,962 3,31,724 4,03,610 0 19,046 1,78,121 3,74,268 0 0 6,30,000 6,30,000

20 36 0 6,30,000 0 0 10,962 3,20,762 4,04,897 0 19,046 1,59,075 3,80,226 0 0 6,30,000 6,30,000

21 37 0 6,30,000 0 0 10,962 3,09,800 4,06,225 0 19,046 1,40,029 3,86,624 0 0 6,30,000 6,30,000

22 38 0 6,30,000 0 0 10,962 2,98,838 4,07,590 0 19,046 1,20,982 3,93,492 0 0 6,30,000 6,30,000

23 39 0 6,30,000 0 0 10,962 2,87,876 4,08,991 0 19,046 1,01,936 4,00,864 0 0 6,30,000 6,30,000

24 40 0 6,30,000 0 0 10,962 2,76,914 4,10,428 0 19,046 82,890 4,08,777 0 0 6,30,000 6,30,000

25 41 0 6,30,000 0 0 10,962 2,65,952 4,11,900 0 19,046 63,844 4,17,273 0 0 6,30,000 6,30,000

26 42 0 6,30,000 0 0 10,962 2,54,991 4,13,394 0 19,046 44,797 4,25,541 0 0 6,35,884 9,84,497

27 43 0 6,30,000 0 0 10,962 2,44,029 4,14,919 0 19,046 25,751 4,34,313 0 0 6,36,119 9,98,676

28 44 0 6,30,000 0 0 10,962 2,33,067 4,16,474 0 19,046 6,705 4,43,613 0 0 6,36,354 10,12,856

29 45 0 6,30,000 0 0 10,962 2,22,105 4,18,054 0 19,046 0 4,58,862 0 0 6,36,590 10,27,036

30 46 0 6,30,000 0 0 10,962 2,11,143 4,19,658 0 19,046 0 4,69,278 0 0 6,36,825 10,41,216

31 47 0 6,30,000 0 0 10,962 2,00,181 4,21,279 0 19,046 0 4,80,280 0 0 6,37,061 10,55,396

32 48 0 6,30,000 0 0 10,962 1,89,219 4,22,913 0 19,046 0 4,91,879 0 0 6,37,296 10,69,576

Note: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards riders, if any, and Goods & Service Tax. The annualized premium, will be with respect to the
life insured or Primary life insured (in case of Spouse Cover option). For more details and for explanation of terms used in this illustration, please refer Sales Literature.

* Surrender Benefit is higher of Guaranteed or Special Surrender Value. Special Surrender Value mentioned above also includes Terminal Bonus (if any), Interim Bonus (if any) as may be payable. Surrender Benefit
shown is after deduction of Total Applicable Survival Benefit already paid or utilized to purchase Paid-Up Additions.

Page 4 of 8
New Page1

Quotation Number:BB110723111936054
(Amount in Rupees.)

BENEFIT ILLUSTRATION TABLE

Total Benefits including Guaranteed and Non-Guaranteed Benefits

Guaranteed Benefits Non - Guaranteed Benefits @4%p.a. Non - Guaranteed Benefits @8%p.a.
Maturity Benefits Death Benefits

End of Policy Age of Life Annualized

Total Maturity Total Maturity Total Death
Year Insured Premium Total Death
Guaranteed Special Guaranteed Special Benefit, incl, Benefit, incl, Benefit, incl,
Accrued Paid- Accrued Paid- Benefit, incl,
Death Benefit Maturity Benefit Survival Benefit Surrender Surrender Survival Benefit Surrender Surrender Terminal Bonus, Terminal Bonus, Terminal Bonus,
Up Additions Up Additions Terminal Bonus,
Benefit * Benefit * Benefit * Benefit* if any @4% if any @8% if any @8%
if any @4% (4+6)
(5+6+7) (5+10+11) (4+10)

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

33 49 0 6,30,000 0 0 10,962 1,78,257 4,24,553 0 19,046 0 5,04,086 0 0 6,37,531 10,83,756

34 50 0 6,30,000 0 0 10,962 1,67,295 4,26,191 0 19,046 0 5,16,911 0 0 6,37,767 10,97,935

35 51 0 6,30,000 0 0 10,962 1,56,333 4,27,820 0 19,046 0 5,30,359 0 0 6,38,002 11,12,115

36 52 0 6,30,000 0 0 10,962 1,45,372 4,29,433 0 19,046 0 5,44,441 0 0 6,38,237 11,26,295

37 53 0 6,30,000 0 0 10,962 1,34,410 4,31,023 0 19,046 0 5,59,170 0 0 6,38,473 11,40,475

38 54 0 6,30,000 0 0 10,962 1,23,448 4,32,584 0 19,046 0 5,74,564 0 0 6,38,708 11,54,655

39 55 0 6,30,000 0 0 10,962 1,12,486 4,34,113 0 19,046 0 5,90,650 0 0 6,38,943 11,68,835

40 56 0 6,30,000 0 0 10,962 1,01,524 4,35,604 0 19,046 0 6,07,464 0 0 6,39,179 11,83,015

41 57 0 6,30,000 0 0 10,962 90,562 4,37,057 0 19,046 0 6,25,047 0 0 6,39,414 11,97,194

42 58 0 6,30,000 0 0 10,962 79,600 4,38,467 0 19,046 0 6,43,449 0 0 6,39,649 12,11,374

43 59 0 6,30,000 0 0 10,962 68,638 4,39,832 0 19,046 0 6,62,725 0 0 6,39,885 12,25,554

44 60 0 6,30,000 0 0 10,962 57,676 4,41,149 0 19,046 0 6,82,936 0 0 6,40,120 12,39,734

45 61 0 6,30,000 0 0 10,962 46,714 4,42,412 0 19,046 0 7,04,138 0 0 6,40,355 12,53,914

46 62 0 6,30,000 0 0 10,962 35,753 4,43,614 0 19,046 0 7,26,390 0 0 6,40,591 12,68,094

47 63 0 6,30,000 0 0 10,962 24,791 4,44,744 0 19,046 0 7,49,745 0 0 6,40,826 12,82,274

48 64 0 6,30,000 0 0 10,962 13,829 4,45,789 0 19,046 0 7,74,255 0 0 6,41,061 12,96,453

Note: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards riders, if any, and Goods & Service Tax. The annualized premium, will be with respect to the
life insured or Primary life insured (in case of Spouse Cover option). For more details and for explanation of terms used in this illustration, please refer Sales Literature.

* Surrender Benefit is higher of Guaranteed or Special Surrender Value. Special Surrender Value mentioned above also includes Terminal Bonus (if any), Interim Bonus (if any) as may be payable. Surrender Benefit
shown is after deduction of Total Applicable Survival Benefit already paid or utilized to purchase Paid-Up Additions.

Page 5 of 8
New Page1

Quotation Number:BB110723111936054
(Amount in Rupees.)

BENEFIT ILLUSTRATION TABLE

Total Benefits including Guaranteed and Non-Guaranteed Benefits

Guaranteed Benefits Non - Guaranteed Benefits @4%p.a. Non - Guaranteed Benefits @8%p.a.
Maturity Benefits Death Benefits

End of Policy Age of Life Annualized

Total Maturity Total Maturity Total Death
Year Insured Premium Total Death
Guaranteed Special Guaranteed Special Benefit, incl, Benefit, incl, Benefit, incl,
Accrued Paid- Accrued Paid- Benefit, incl,
Death Benefit Maturity Benefit Survival Benefit Surrender Surrender Survival Benefit Surrender Surrender Terminal Bonus, Terminal Bonus, Terminal Bonus,
Up Additions Up Additions Terminal Bonus,
Benefit * Benefit * Benefit * Benefit* if any @4% if any @8% if any @8%
if any @4% (4+6)
(5+6+7) (5+10+11) (4+10)

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

49 65 0 6,30,000 0 0 10,962 2,867 4,46,731 0 19,046 0 7,99,963 0 0 6,41,297 13,10,633

50 66 0 6,30,000 0 0 10,962 0 4,52,952 0 19,046 0 8,26,910 0 0 6,41,532 13,24,813

51 67 0 6,30,000 0 0 10,962 0 4,53,624 0 19,046 0 8,55,133 0 0 6,41,768 13,38,993

52 68 0 6,30,000 0 0 10,962 0 4,54,120 0 19,046 0 8,84,662 0 0 6,42,003 13,53,173

53 69 0 6,30,000 0 0 10,962 0 4,54,403 0 19,046 0 9,15,531 0 0 6,42,238 13,67,353

54 70 0 6,30,000 0 0 10,962 0 4,54,435 0 19,046 0 9,47,770 0 0 6,42,474 13,81,533

55 71 0 6,30,000 0 0 10,962 0 4,54,166 0 19,046 0 9,81,413 0 0 6,42,709 13,95,713

56 72 0 6,30,000 0 0 10,962 0 4,53,542 0 19,046 0 10,16,499 0 0 6,42,944 14,09,892

57 73 0 6,30,000 0 0 10,962 0 4,52,497 0 19,046 0 10,53,072 0 0 6,43,180 14,24,072

58 74 0 6,30,000 0 0 10,962 0 4,50,952 0 19,046 0 10,91,188 0 0 6,43,415 14,38,252

59 75 0 6,30,000 0 0 10,962 0 4,48,815 0 19,046 0 11,30,917 0 0 6,43,650 14,52,432

60 76 0 6,30,000 0 0 10,962 0 4,45,972 0 19,046 0 11,72,346 0 0 6,43,886 14,66,612

61 77 0 6,30,000 0 0 10,962 0 4,42,286 0 19,046 0 12,15,590 0 0 6,44,121 14,80,792

62 78 0 6,30,000 0 0 10,962 0 4,37,587 0 19,046 0 12,60,798 0 0 6,44,356 14,94,972

63 79 0 6,30,000 0 0 10,962 0 4,31,666 0 19,046 0 13,08,165 0 0 6,44,592 15,09,151

64 80 0 6,30,000 0 0 10,962 0 4,24,259 0 19,046 0 13,57,948 0 0 6,44,827 15,23,331

Note: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards riders, if any, and Goods & Service Tax. The annualized premium, will be with respect to the
life insured or Primary life insured (in case of Spouse Cover option). For more details and for explanation of terms used in this illustration, please refer Sales Literature.

* Surrender Benefit is higher of Guaranteed or Special Surrender Value. Special Surrender Value mentioned above also includes Terminal Bonus (if any), Interim Bonus (if any) as may be payable. Surrender Benefit
shown is after deduction of Total Applicable Survival Benefit already paid or utilized to purchase Paid-Up Additions.

Page 6 of 8
New Page1

Quotation Number:BB110723111936054
(Amount in Rupees.)

BENEFIT ILLUSTRATION TABLE

Total Benefits including Guaranteed and Non-Guaranteed Benefits

Guaranteed Benefits Non - Guaranteed Benefits @4%p.a. Non - Guaranteed Benefits @8%p.a.
Maturity Benefits Death Benefits

End of Policy Age of Life Annualized

Total Maturity Total Maturity Total Death
Year Insured Premium Total Death
Guaranteed Special Guaranteed Special Benefit, incl, Benefit, incl, Benefit, incl,
Accrued Paid- Accrued Paid- Benefit, incl,
Death Benefit Maturity Benefit Survival Benefit Surrender Surrender Survival Benefit Surrender Surrender Terminal Bonus, Terminal Bonus, Terminal Bonus,
Up Additions Up Additions Terminal Bonus,
Benefit * Benefit * Benefit * Benefit* if any @4% if any @8% if any @8%
if any @4% (4+6)
(5+6+7) (5+10+11) (4+10)

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

65 81 0 6,30,000 0 0 10,962 0 4,15,031 0 19,046 0 14,10,490 0 0 6,45,062 15,37,511

66 82 0 6,30,000 0 0 10,962 0 4,03,553 0 19,046 0 14,66,252 0 0 6,45,298 15,51,691

67 83 0 6,30,000 0 0 10,962 0 3,89,268 0 19,046 0 15,25,855 0 0 6,45,533 15,65,871

68 84 0 6,30,000 0 0 10,962 0 3,71,443 0 19,046 0 15,90,148 0 0 6,45,768 15,80,051

69 85 0 6,30,000 5,88,376 0 10,962 0 0 0 19,046 0 0 9,83,519 42,31,440 6,46,239 16,08,410

Note: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards riders, if any, and Goods & Service Tax. The annualized premium, will be with respect to the
life insured or Primary life insured (in case of Spouse Cover option). For more details and for explanation of terms used in this illustration, please refer Sales Literature.

* Surrender Benefit is higher of Guaranteed or Special Surrender Value. Special Surrender Value mentioned above also includes Terminal Bonus (if any), Interim Bonus (if any) as may be payable. Surrender Benefit
shown is after deduction of Total Applicable Survival Benefit already paid or utilized to purchase Paid-Up Additions.

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Quotation Number:BB110723111936054

Terms & Conditions:

1. This is a Limited Pay, Non- Linked, Participating Savings Life Insurance Plan. The illustration stated is for a healthy individual and under the
assumption that this is the only policy the client has with Kotak Life Insurance and would be subject to underwriting.

2. Kotak Fortune Maximiser is only the name of the plan and does not in any way indicate the quality of the plan, its future prospects or returns.

3. The main objective of the illustration is that the policyholder is able to understand the features of the product and the nature of benefits under
different circumstances. The above illustrated benefits are derived on the basis of details of the life insured provided at the time of filling the
proposal form. If the details are found inaccurate or there are any changes before or at the time of the policy issuance for eg: change in age, the
illustrated benefits will be subject to revision. The values shown herein are for illustrative purposes only. For more details on the risk factors, terms
and conditions, please read sales brochure carefully before concluding a sale.

4. The policy will acquire a surrender value after payment of two full years' premium. The surrender value payable will be Guaranteed Surrender
Value, if any, at the point of surrender or Special Surrender Value, whichever is higher. The displayed Special Surrender Values are not
guaranteed and only indicative. These may change from time to time. The policyholder is advised to check the Special surrender value payable
with the company before surrendering.

5. If Monthly Cash Bonus option is chosen then the monthly cash bonus amount will be equal to 96%* Annual cash bonus / 12

6. The maturity, bonus and surrender values are illustrated assuming that all due premiums in a policy year are paid and that the event occurs at the
end of the policy year.

7. In case of any conflict between this benefit illustration and your policy document, the latter shall prevail.

8. Taxes & Cess, as applicable shall be levied at the applicable Tax rates in accordance with the prevailing Tax Laws. Prevailing tax laws are
applicable on this policy which may vary from time to time.

9. TDS at prevailing rate will be deducted from any amount paid under a life insurance policy subject to the provisions of prevailing tax laws. In case
of non-availability of valid PAN, TDS will be deducted at higher rate. Tax laws are subject to changes from time to time. Kindly consult your tax
advisor for tax implication of your policy.

I, _____________________________(Name), have explained the I, Mr Man Singh (Name), having received the information with respect

premiums and benefits under the product fully to the prospect to the above, have understood the above statement before entering

/policyholder. into the contract.

(Accepted vide a declaration (Customer

Declaration Form) signed by him/her)

Place :_____________ __________________________________ Place :_____________ __________________________________

Date : 11-Jul-2023 Signature of Agent /Intermediary/Official Date : 11-Jul-2023 Signature of Prospect/Policyholder

Kotak Mahindra Life Insurance Company Limited.

CIN: U66030MH2000PLC128503
Regd. Off: 8th Floor, Plot # C- 12, G- Block, BKC, Bandra (E), Mumbai - 400051
Regn. No: 107. Toll Free No.: 1800 209 8800. WhatsApp : 9321003007. Website: https://www.kotaklife.com

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