MAX LIFE INSURANCE CO. LTD.

11th Floor, DLF Square, Jacaranda Marg,

DLF City, Phase II, Gurugram 122 002
Phone: +91 124 2561717, Fax: 2561764

Master Policyholder: Systopic Laboratories Pvt. Ltd. NEW BUSINESS

GSTIN : GST Registered State:
Client Address:
Nature of Group Employer-Employee Number of Members Covered 1,174
Illustration No.: 23DELGTKS1850 Illustration Date: 20-Feb-23 Valid Till: 27-Feb-23
Basic Coverage Offered: Max Life Group Term Life Platinum Assurance (UIN-104N112V01) Broker/Agent X

Retirement Age: Riders Offered: ATI ADB TPDA CI

Effective Date of Coverage: Annual X Semi-annual Quarterly Monthly

Details of the Max Life Insurance: GSTIN: 06AACCM3201E1Z7 GST Registered State: Haryana
10 Times of CTC subject to a minimum of INR 30 lakh or 10 times of CTC whichever is less &
Basic Coverage Structure:
maximum of INR 10 Cr.
TI (Accelerated) Rider (UIN-104B028V02): Nil
ADB Rider (UIN - 104B024V02): Nil
TPD(A) Rider (UIN - 104B030V02): Nil
CI (Additional) Rider (UIN-104B031V02): Nil
Scope of Coverage:- All full time and permanent employees on payroll of the company and drawing regular salary
Premium Rates are expressed as rupees A19per 1000 sum assured and all amounts mentioned in table below are in Indian Rupees.
Riders
Basic Group Life
Terminal Illness Accidental Death TPD (due to Critical Illness
Coverage
(TI) Benefit (ADB) Accident) (CI) (Additional)
Premium Rate Including GST at the
2.18 NA NA NA NA
prevailing rate of 18%:
Premium Rate Before GST: 1.85
Total Sum Assured: 7,306,169,640
Premium Before GST: 13,516,414
GST @ 18% : 2,432,954
Total Annual Amt. (Incl. GST): 15,949,368
Total Amt. Payable per Period (Including GST) 15,949,368
Free Cover Limit (FCL)- Base Life Cover 35,000,000/- up to age 65 yrs last birthday Number of members above FCL 5
Free Cover Limit (FCL)- CI (Additional) Not Applicable Number of members above FCL NA
Claims/deaths details as provided by the client:
Policy Year Lives at the Beginning Lives at the End No. of Deaths (BP)
2022 - 23 1,165 1,174 2
2021 - 22 1,162 1,165 3
2020 - 21 1,173 1,162 4
This quotation is subject to Systopic Laboratories Pvt. Ltd. confirming the above claims information to Max Life on its letterhead
signed by an authorized HR official.
Important Terms & Conditions and assumptions:
♦ This quotation is for the proposed insurance coverage of all full time and permanent employees of Systopic Laboratories Pvt. Ltd. who are
aged 18 years age last birthday and above and are up to 80 years age last birthday. The employees should be Actively At Work (AAW) on
the day/date of commencement of coverage. (See the definition of AAW in Annexure - I). However the AAW clause requirement is not
applicable for members existing on the annual date of renewal in respect of existing schemes and also takeover schemes (policies existing
with other insurer and takeover by Max Life).
♦ The terms including premiums quoted here are based on the year wise no. of members, deaths details, member data and other details as
furnished by the proposer. The terms may vary if there is change in any material information provided to Max Life Insurance Co. Ltd.
♦ All eligible member(s) whose cover(s) is above the FCL/for whom FCL is not applicable will be required to provide evidence of health as
determined by Max Life Insurance Co. Ltd. The final coverage for such members will be determined after the individual underwriting
process is satisfactorily completed and confirmed by Max Life Insurance Co. Ltd.
♦ One year suicide clause is not applicable as coverage for all eligible employees is on a compulsory basis.
♦ The sum assured is not more than 10 times the annual CTC of the employee subject to a maximum of INR 10 crore.
♦ Mid policy year increase in sum assured for employees will be allowed only once during the policy year. Any such increase will be subject to
underwriting and should be supported by appropriate documents as required by Max Life.

Acceptance of the Illustration:

Name of the Officer: Designation:

Signature Official Stamp: Date:

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 MAX LIFE INSURANCE CO. LTD.
11th Floor, DLF Square, Jacaranda Marg,
DLF City, Phase II, Gurugram 122 002
Phone: +91 124 2561717, Fax: 2561764

♦ Details pertaining to salary/sum assured increase cycle date/month should be informed in advance to Max Life at the time of policy
placement. Revised employee/member data (post data changes, if any) with updated sum assured should be shared with Max Life within 30
days of such change. Intimation of increase/changes in sum assured/cover during claims stage will not be accepted.
♦ If the increase in employee/member sum assured is higher than 20% of existing employee/member sum assured or the increase of
employee/member sum assured is more than INR 50 lacs during the policy year, to accommodate such increase, salary slip will be required.
♦ This quotation is subject to furnishing of employee ID/ customer ID with other details such as name, date of birth, gender, occupation, sum
assured etc. for each member to be covered, before the commencement of the scheme.
♦ We assume that the entire premium for the scheme is borne by the employer. In case employees are also contributing to the scheme, please
note that the employer is prohibited from collecting any amount other than the insurance premium payable to the Insurer with regard to the
underlying Group Insurance.
♦ This quotation is based on the assumption that no employees are working in any hazardous occupations. However if there are an y such
employees, then please provide details of such employees separately before the risk commencement date.
♦ Employees working and residing in India and drawing regular salaries from the Indian Employer, shall be covered without any r esidential
extra as per the terms of this illustration. Employees working and residing in overseas locations shall be considered for cover subject to Max
Life Insurance Co. Ltd Overseas Residential guidelines. To consider cover for these employees working and residing overseas, please
provide following details for each such employee: (i) Nationality (ii) Name of the country and location of posting (iii) Duration of overseas
posting.
♦ Please refer Annexure -1, for the members, if any, whose sum assured is exceeding the FCL/members to whom no FCL is applicable/
members excluded from the coverage benefit.
♦ In case of any contradiction between this Illustration and final Policy Contract document, the Policy Contract will prevail.
♦ Applicable Taxes, Cesses & Levies, as per prevailing laws, shall be borne by the Master Policyholder.
♦ All other terms and conditions shall be as per Max Life Insurance Co. Ltd. Policy Contract Document.

I/We authorize Max Life to send all communications by E-mail, SMS or any other mode. I/We agree to receive regular reminders /
alerts from Maxlife.

Quote Approved by: Group Underwriting Signature:

ANNEXURE – I

Actively at Work (AAW) Clause:

"Actively At Work" shall mean on the date the coverage commences, the member is performing in the usual way, all of the regular duties of his/her
job on a full time basis and he/she is not on leave due to any illness or injury or is on maternity leave. If the member is absent on the date the coverage
commences, due to illness, injury or maternity, the coverage shall not commence until the date of his/her joining to duties and performing in the usual
way all of the regular duties of his/her job on a full time basis and submit health declaration. The insurance cover will commence for a sum assured up
to FCL or actual sum assured whichever is lower, provided the health declaration submitted is satisfactory. If any abnormality is found in the health
declaration, then the Max Life shall reserve the right to call for further evidence of health in respect of such members. The sum assured in excess of
FCL is considered subject to Max Life Insurance Co. Underwriting guidelines.

Further, if the member is not at work on the date the coverage commences, solely because such a day is a scheduled day off or a public holiday,
he/she will be regarded as being actively at work subject to his/her satisfying the criteria of actively at work on the immediate next working day."

The sum assured in respect of the following employee(s) has exceeded the FCL for Base Plan. So, the cover for sum assured in excess of FCL
will be considered subject to individual underwriting as per Max Life Insurance Co. Ltd. underwriting guidelines:-
S.No. Emp Code Employee Name Date of Birth Sum Assured BP Emp Age
2 000013 NAVEEN SEITH 26-Mar-1965 70,098,000 57
3 000016 SUSHEEL RAJPAL 11-Oct-1965 75,900,000 57
42 000077 ANIL DARGAN 23-Jun-1968 63,390,000 54
157 000347 MAMTA KATARIA 23-Feb-1978 47,175,000 45
1030 003920 VINOD KUMAR SHARMA 11-Nov-1961 67,020,000 61

Acceptance of the Illustration:

Name of the Officer: Designation:

Signature Official Stamp: Date:

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