Insurance Product Suitability Matrix

This form will help us assess product suitability and recommend Insurance products for you.

For Bank's Use: CRN 715441853 KLI Application No. GN06110061

KLI Proposal No. 77199213

Life Insured Details

Insured Name: PEDDINTI RAMANA GOPALA SURYA GOKUL Insured Age: 22

Insured Total Income (A): 500000 Total Premium across All polices (including new proposed) (B): 48070

Insured Total liability (C): 0 Insured Existing Insurance Cover (D): 0

Proposer Details (To be filled only if Proposer is different from Life Insured)

Proposer Name: Proposer Age: Proposer Total Income:

Total regular Premium across All polices (including new proposed):

Life Insurance Cover Requirement

Age Income Multiplier

<18 N/A
18-30 10
30-40 20
40-50 15
50-58 10
58+ N/A (Case to case basis)

Recommended Insurance Cover (Income Multiplier basis Age *A + Total Liability (C) ) 5000000

Additional Insurance Cover Requirement of Life Insured ( E - D ) 5000000

Proposer’s Occupation (Tick whichever applicable):

X Salaried Self-Employed Professional

House wife Retired / Pensioner

For Housewife - Please collect Declaration "D3"

For Retired / Pensioner ? Please collect Declaration "D4".

Proposer's Investment Horizon:

Less Than 10 Years X 10 - 15 Years 15 years+

For Investment horizon less than 10 years, only Single Invest & Annuity is recommended.

In case of any other product, please collect Declaration “D1”

Proposer's Objective:

Pure Protection Retirement Planning Children's Marriage Children's Education

Asset Purchase One Time Surplus X Long Term Savings Income Replacement

Refer Table "X" to check if the product selected is recommended to meet that objective.

In case product is not recommended under that category, please collect Declaration “D1”

Proposer's Investment Risk Profile:

SECURE X MODERATE GROWTH

No risk on Capital & interest Take some risk on returns Take risk on both capital
even if returns are moderate for higher yield and returns for higher return

Refer Table "Y" to check if the product selected is recommended for the Investment Risk profile.
In case product is not recommended under that category, please collect Declaration "D1"

Proposer's Premium to Income Ratio:

Premium to Income Ratio : Total Premium across all policies (B) / Total Income (A) = 10

Refer Table "Z" to check if the premium to income ratio is in the range as recommended by the bank.
In case it is higher than the same, please collect Declaration "D2"

Customer Declaration

I hereby confirm that the the above information has been filled by me, basis which the product suitability may be ascertained by Kotak Mahindra Bank.
Mahindra Bank is a corporate Agent of Kotak Mahindra Life Insurance Company Limited (formerly known as Kotak Mahindra Old Mutual Life Insurance
KMBL/Mar-2020/V 1.3

Limited) and that the

Bank does not provide any guarantee for the performance of the investment and this is purely an informed decision on our part. The plan is offered and
underwritten by
Kotak Mahindra Life Insurance Company Limited.

Customer Name: Customer Signature

Place: Date:
This is system generated document for customer signature refer submitted CDF.

Insurance Product Suitability Matrix - Declarations

For all deviation cases, the below declarations need to be collected from the client as applicable.
Please tick whichever is applicable.

Declaration "D1" - Declaration for Investing in a Product not Suitable for the customer in Bank's view
I hereby confirm that the product selected by me for investment is not recommended by the bank as per the bank's product
suitability matrix. However, I have completely understood the same and would like to proceed with this investment with
complete cognizance of its features, benefits and risks associated with it.

Customer Name: Customer Signature:

Place: Date:

Declaration "D2" - Declaration for Premium to Income Ratio higher than Bank's Recommendation
Regular Premium - I declare that I have completely understood this plan and have to pay a premium of Rs.

each year for the next years. I hereby confirm that I have sufficient savings to take care of my mundane

expenses and can ensure regular premium payments in this investment so that the policy does not lapse and I continue
to enjoy the life cover and other features of the policy. I would like to go ahead with my chosen premium in this product.
Single Premium - I declare that I have completely understood this plan and have to pay a one-time premium of Rs.
. I hereby confirm that my current source of funds is (Savings/ MF or Equity Redemptions/
Sale of Property/Bonus/ Others, please specify). I would like to go ahead with my chosen premium in this product.

Customer Name: Customer Signature:

Place: Date:

Declaration "D3" - Declaration in case of Housewife

I declare that I have completely understood this plan and have to pay a premium of Rs. each year for the next

years.

I hereby confirm that I am making this investment from my own savings and adhoc income. My family earnings are
enough to take care of my regular household expenses and I can continue to pay this premium from my end.

Customer Name: Customer Signature:

Place: Date:

Declaration "D4" - Declaration in case of Retired/Pensioner

I declare that I have completely understood this plan and have to pay a premium of Rs. each year for the next

years.

I hereby confirm that I shall be able to pay the future premiums of this investment from my future income/ accrued
savings so that the policy does not lapse and I continue to enjoy the life cover and other features of the policy.

Customer Name: Customer Signature:

KMBL/Oct-2016/V 1.0

Place: Date:

Kotak Mahindra Bank Ltd. CIN: L65110MH1985PLC038137

Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400051. www.kotak.com