BENEFIT ILLUSTRATION

Name of the First Annuitant: Mr. Proposal No:

Age & Gender: 65 Years, Male Name of the Product: Max Life Guaranteed Lifetime Income Plan

Name of the Second Annuitant, if any: Not Applicable Tag Line: A Non-Linked Non Participating Individual General Annuity Savings Plan

Age & Gender: 59 Years, Female Unique Identification No: 104N076V17

Policy Term: Not Applicable

Premium Payment Mode: Single
Premium Payment Term: 1 Max Life State: Rajasthan

Amount of Installment Premium (excl. taxes): `15,00,000 Policyholder Residential State: Rajasthan
Amount allocated for Investment (First Year): `14,33,250 GST Rate: 18%*
Amount allocated for Investment (Second Year onwards): `0
Amount of Installment Premium (First Year incl. taxes): `15,12,015
Annuity Payment Frequency: Monthly Issue Date of Quote: 21 September 2023
Annuity Purchased From: Agent Assisted Annuity Start Date: 21 October 2023
Monthly Income Amount Starting On 21-Oct-2023
`8,028
(Guaranteed)

*0% if qualifies as zero-rated supply under GST law

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

Policy Details
Policy Option Immediate Annuity - Joint Life Sum Assured (in Rs.) Not Applicable
Deferment Period, if applicable Not Applicable Sum Assured on Death (at inception of the policy) (in Rs.) `15,00,000
Death Benefit Opted Yes Payment Option Single Pay

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST (in Rs.) 15,00,000 NA 15,00,000
Installment Premium with first year GST (in Rs.) 15,12,015 NA 15,12,015
Installment Premium with GST 2nd year onwards (in Rs.) NA NA NA

UIN: 104N076V17 Page 1 of 3

 (Amount in Rupees)

Guaranteed Non Guaranteed

Single/ Annualized
Policy Year
Premium ~Acrued Guranteed Additions Min Guaranteed Surrender Value Special Surrender Value
Annuity Amount Maturity Benefit Death Benefit

1 15,00,000 96,336 0 0 15,00,000 10,28,664 11,73,098

2 0 96,336 0 0 15,00,000 9,32,328 11,76,181
3 0 96,336 0 0 15,00,000 8,35,992 11,79,455
4 0 96,336 0 0 15,00,000 9,64,656 11,82,982
5 0 96,336 0 0 15,00,000 8,68,320 11,86,856
6 0 96,336 0 0 15,00,000 7,71,984 11,91,015
7 0 96,336 0 0 15,00,000 6,75,648 11,95,406
8 0 96,336 0 0 15,00,000 5,79,312 11,99,974
9 0 96,336 0 0 15,00,000 4,82,976 12,04,646
10 0 96,336 0 0 15,00,000 3,86,640 12,09,519
11 0 96,336 0 0 15,00,000 2,90,304 12,14,521
12 0 96,336 0 0 15,00,000 1,93,968 12,19,736
13 0 96,336 0 0 15,00,000 97,632 12,24,925
14 0 96,336 0 0 15,00,000 1,296 12,30,313
15 0 96,336 0 0 15,00,000 0 12,35,648
16 0 96,336 0 0 15,00,000 0 12,41,159
17 0 96,336 0 0 15,00,000 0 12,46,582
18 0 96,336 0 0 15,00,000 0 12,51,948
19 0 96,336 0 0 15,00,000 0 12,57,464
20 0 96,336 0 0 15,00,000 0 12,62,839
21 0 96,336 0 0 15,00,000 0 12,68,253
22 0 96,336 0 0 15,00,000 0 12,73,716
23 0 96,336 0 0 15,00,000 0 12,79,216
24 0 96,336 0 0 15,00,000 0 12,84,586
25 0 96,336 0 0 15,00,000 0 12,89,966
26 0 96,336 0 0 15,00,000 0 12,95,307
27 0 96,336 0 0 15,00,000 0 13,00,842
28 0 96,336 0 0 15,00,000 0 13,06,325
29 0 96,336 0 0 15,00,000 0 13,11,949

UIN: 104N076V17 Page 2 of 3

 Guaranteed Non Guaranteed
Single/ Annualized
Policy Year
Premium ~Acrued Guranteed Additions Min Guaranteed Surrender Value Special Surrender Value
Annuity Amount Maturity Benefit Death Benefit

30 0 96,336 0 0 15,00,000 0 13,17,692

31 0 96,336 0 0 15,00,000 0 13,23,641
32 0 96,336 0 0 15,00,000 0 13,29,808
33 0 96,336 0 0 15,00,000 0 13,36,426
34 0 96,336 0 0 15,00,000 0 13,43,435
35 0 96,336 0 0 15,00,000 0 13,51,369

Notes:
1.Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Service Tax.
2.Refer Sales literature for explanation of terms used in this illustration.
3.~ Accrued Guaranteed Additions refers to the Guaranteed Additions which accrue during deferment period in respect of inforce premium paying and fully paid policies. Amount illustrated in this column is already factored in
within “Death Benefit” section and is payable in case of Death only.

*GST of 18% is applied only on premium amount derived as per Rule 32(4) of CGST Rule (i.e. the non-investable component of premium amount).

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

Place:
Date: 9/21/23 Signature / OTP Confirmation Date / Thumb Impression / Date:9/21/23 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: 104N076V17 Page 3 of 3