"IN T Dear Customer

,

The illustration is approved by the Board of Directors of the Company and tak 10% p.a. and 6% p.a. as prescribed by the Life Insurance Council, with the int the future performance of the company. If the policy offers guaranteed retur assumed future investment returns. These assumed rates of return are not gu investment performance. Name of Life Insured Date of Birth of Life Insured Age of the Life Insured (in yrs) Basic Sum Assured Amount of Installment Premium (in Rs.) Gender of Life Insured Mode of Premium Payment Date of Birth of 1st Beneficiary Age as on last birthday of 1st Beneficiary Rider Name Accidental Death Benefit (UIN:107C001V01) Permanent Disability Benefit (UIN:107C002V01)

Mahesh Chit 15 May 197 36 125,000 25,000 Male Cheque 15 May 200 4

Rider Sum Ass

Not Selecte

Not Selecte

Critical Illness Benefit (UIN:107C004V02) Accidental Disability Guardian Benefit (UIN:107C011V01) Please Note: Rider Premiums will be deducted from the fund Total Premium for Yearly Mode (Rs.)

Not Selecte No

Basic Premium

Money Market Fund 0.00%

Gilt Fund 0.00%

Statement of various cha

Policy Year

Annualized Premium

Premium Allocation Charges

Amount available for investment (out of premium)

1 2 3 4 5 6

25,000 25,000 25,000 25,000 25,000 25,000

7,500 3,500 1,750 -

16,728 21,140 23,070 25,000 25,000 25,000

7 8 9 10 11 12 13 14 15

25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000

-

25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000

Policy Year

Annualized Premium

Premium Allocation Charges

Amount available for investment (out of premium)

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

25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000

7,500 3,500 1,750 -

16,728 21,140 23,070 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000 25,000

*Maturity Benefit is equal to the Fund Value plus Survival Units, provided your The Net Yield is calculated as per IRDA Circular on Cap on Charges dated 22nd

1. This is non-participating unit-linked endowment plan.The illustration s underwriting.

2. If during the first three policy years, any premiums due are not paid in premium. If the policy is not revived within two years from the first unpa later. The Surrender Charge applicable on the due date of first unpaid pr

3. On discontinuance of premiums after completion of first three policy y end of two years from the due date of first unpaid premium, the policy w Surrender charge applicable at the end of two years from the due date o one year’s premium, the policy will be terminated by paying at least one benefits will continue after deduction of applicable charges. 4. The policy may be revived within two years from the due date of first date of the first unpaid premium. Thereafter to revive the policy, proof

5. The policy can be surrendered after completion of three policy years a Surrender. 6. Premium alterations are only permitted after the first 3 policy years. Additional Death Benefit will apply on the premium prior to alteration fo

7. The NAV is calculated on daily basis. NAV = (Market value of investment held by the fund+/- The expenses

The basis used for unit pricing would be appropriation price or the expro allocate the units at the valuation date. The Expropriation price shall ap

8. The above illustrated benefits are derived on the basis of details of lif for eg: change in age, the illustrated benefits will be subject to revision. 9. This illustration is subject to future change in tax rates or any other la 10. The values shown are for illustrative purposes only. This illustration i 11. The current Service Tax rate is 10.3%.

Risk Factors · Unit Linked Life Insurance products are different from the traditional i · The premium paid in Unit Linked Life Insurance policies are subject to capital market and the insured is responsible for his/her decisions. · Kotak Mahindra Old Mutual Life Insurance Ltd. is only the name of the indicate the quality of the contract, its future prospects or returns. The

· Please know the associated risks and the applicable charges, from your Section 41 of the Insurance Act, 1938 states

(1) No person shall allow or offer to allow, either directly or indirectly, a whole or part of the commission payable or any rebate of the premium s the published prospectuses or tables of the insurer.Provided that accepta of a rebate of premium within the meaning of this sub section if at the ti

(2) Any person making default in complying with the provision of this sec Declaration by the Proposer

I..............................................................................(Full Nam terms and conditions and risk factors of the proposed plan and duly ackn Place

Re

Kotak Headstart Future Protect (Single Life Plan) - Be UIN: 107L037V02 This shall form a part of the Policy Docum "IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO I

e Company and takes into account the guidelines for illustrations set by the Life Insura uncil, with the intention of allowing prospective policyholders to compare products o s guaranteed returns, then these will be clearly marked “Guaranteed” in the illustrati f return are not guaranteed and they are not the upper and lower limits of what you m Product Details Mahesh Chitte 15 May 1974 36 125,000 25,000 Male Cheque 15 May 2006 4 Rider Details Rider Sum Assured Not Selected Not Selected

Not Selected No

und

Bond Fund 0.00%

Floating Rate Fund 0.00%

Allocation of Premium Balanced Fund 0.00%

ment of various charges along with growth of the Fund expected over the duration of t

Mortality Charges

Service Tax

Policy Administration Charges

Guarantee Charge

751 756 763 770 786 786

950 569 426 288 334 383

750 750 750 750 750 750

-

772 755 742 731 718 702 677 641 590

435 490 551 618 689 767 850 940 1,035

750 750 750 750 750 750 750 750 750

-

Mortality Charges

Service Tax

Policy Administration Charges

Guarantee Charge

751 756 763 770 786 786 772 755 742 731 718 702 677 641 590

950 567 421 278 319 359 400 443 488 535 584 635 687 741 796

750 750 750 750 750 750 750 750 750 750 750 750 750 750 750

-

nits, provided your premiums are fully paid up to date. Charges dated 22nd July 2009. Terms and Conditions

.The illustration stated is for a healthy individual and under the assumption that

ue are not paid in full and within the grace period, all policy benefits including A rom the first unpaid premium, the contract shall be terminated by paying Surren of first unpaid premium will be applied to calculate the Surrender Value.

irst three policy years and provided three years’ premiums are paid in full, the f mium, the policy will be terminated by paying the applicable surrender value, un m the due date of the first unpaid premium will be used to calculate the surrend aying at least one Annualized Premium. The Additional Death Benefit and the Ac rges.

due date of first unpaid premium. The policy revival can be done without proof the policy, proof of good health would be required with payment of outstanding

hree policy years and provided all the premiums for three policy years are paid in

st 3 policy years. In case of a policy alteration, where premiums are reduced, th or to alteration for one policy year and on the increased premium thereafter. Pre

+/- The expenses incurred in the purchase/sale of asset + Value of current asset Number of units existing at the valuation

price or the expropriation price, whichever prevails on the valuation date. The Ap tion price shall apply in a situation when the company is required to sell assets t

sis of details of life insured provided at the time of filling the proposal form. If th bject to revision. es or any other laws, regulations or guidelines affecting the life insurance policie This illustration is not a contract of insurance and must be read in conjunction w

m the traditional insurance products and are subject to the risk factors. es are subject to investment risks associated with capital markets and the NAVs r decisions.

the name of the Insurance Company and Kotak Headstart Future Protect (Single s or returns. The various funds offered under this contract are the names of the

harges, from your Insurance agent or Corporate Agent/Insurance Broker or policy

tly or indirectly, as an inducement to any person to take out or renew or continu of the premium shown on the policy, nor shall any person taking out or renewing vided that acceptance by an insurance agent of commission in connection with a section if at the time of such acceptance the insurance agent satisfies the prescr

ovision of this section shall be punishable with fine, which may extend to five hu

...........(Full Name), having received this benefit illustration and all other inform lan and duly acknowledge the benefit illustration before entering into the contra

Kotak Mahindra Old Mutual Life Insurance L Regd. Off: 9th Floor, Godrej Coliseum,Behind Everard Nagar,Sion Regn. No: 107. Toll Free No.: 1800 209 8800.Website: www. Insurance is the subject matter of the solic

For Office Use Only (w.e.f. D Proposal No: Policy No:

(Single Life Plan) - Benefit Illustration 107L037V02 art of the Policy Document STMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER"

s set by the Life Insurance Council and the IRDA. Benefits have been illustrated assum to compare products on a consistent basis. Some benefits are guaranteed and some be nteed” in the illustration table. If the policy offers variable returns, then the illustrat er limits of what you might get back, as the value of your policy is dependent on a nu

duct Details Name of the Product Unique Identification Number Service Tax Rate Policy Term (in yrs) Premium Payment Term (in yrs) Mode Funds Opted for Date of Birth of 2nd Beneficiary (if any) Age as on last birthday of 2nd Beneficiary er Details Rider Term

Kotak Headstart F

Please refer to the

Rider Ch

on of Premium Dynamic Floor Fund II 100.00% Frontline Equity Fund 0.00%

over the duration of the policy with assumed rate of interest as mentioned: Gross Yield Net Yield 10.00% 7.82%

Other Charges

Addtions to the Fund (if any)

Fund Before FMC

FMC

-

-

16,622 39,460 66,320 97,536 131,346 167,982

225 521 868 1,273 1,710 2,184

-

17,725

207,699 250,758 297,433 348,024 402,860 462,302 526,743 596,617 672,393

2,698 3,256 3,860 4,514 5,224 5,993 6,827 7,731 8,712

Survival Units Maturity Benefit (Rs.) *

17,725 681,406

Gross Yield

6.00%

Other Charges

Addtions to the Fund (if any)

Fund Before FMC

FMC

-

13,058

15,993 37,345 61,675 89,117 117,754 147,658 178,900 211,543 245,645 281,268 318,480 357,358 397,982 440,445 484,844

221 502 822 1,183 1,560 1,953 2,364 2,794 3,243 3,711 4,201 4,712 5,247 5,805 6,389

Survival Units Maturity Benefit (Rs.) *

13,058 491,513

and Conditions

r the assumption that this is the only policy the client has with Kotak Life Insuran

y benefits including Additional Death Benefit and Rider Benefits, if any, will cea ated by paying Surrender Value at the end of the third policy anniversary or at th rrender Value.

are paid in full, the facility of Automatic Cover Maintenance(ACM) is available fo e surrender value, unless the policyholder expresses in writing his/her wish to co calculate the surrender value. During ACM mode, if the surrender value in the M ath Benefit and the Accidental Disabilty Guardian Rider (if opted for) will cease in

e done without proof of good health, if the payment of the outstanding premium ment of outstanding revised premiums, subject to underwriting. All policy bene

olicy years are paid in full. The amount payable on Surrender is the Fund Value le

iums are reduced, the Additional Death Benefit will apply on the revised premiu mium thereafter. Premium alterations beyond initial level are not allowed.

alue of current assets + Any accrued income net of fund management charges - V sting at the valuation date

aluation date. The Appropriation price shall apply in a situation when the compa quired to sell assets to redeem the units at the valuation date.

e proposal form. If the details are found inaccurate / there are any changes befo

e life insurance policies. read in conjunction with the Product Brochure and Policy Document.

risk factors. markets and the NAVs of the units may go up or down based on the performance o

uture Protect (Single Life Plan) is only the name of the unit linked life insurance are the names of the funds and do not in any way indicate the quality of these pl

rance Broker or policy document of the insurer.

t or renew or continue an insurance in respect of any kind of risk relating to lives aking out or renewing or continuing a policy accept any rebate, except such reba in connection with a policy of life insurance taken out by himself on his own life nt satisfies the prescribed conditions establishing that he is a bona fide insurance

may extend to five hundred rupees.

on and all other information with respect to the above, have read and understood tering into the contract. Date

Signature/Right thumb impression of the Propose

NAME SIGNAT Name and Signature of the Life Advisor/Specified person of Corpora Employee of Broker /Relationship Officer utual Life Insurance Limited. d Everard Nagar,Sion (East),Mumbai - 400 022,India. 8800.Website: www.kotaklifeinsurance.com. ct matter of the solicitation.

Use Only (w.e.f. Dec 09 / Ver 1.0)

n illustrated assuming two investments return scenarios of nteed and some benefits are variable with returns based on , then the illustration will show two different rates of dependent on a number of factors including future

Kotak Headstart Future Protect (Single Life Plan) 107L037V02 10.30% 15 15 Yearly Please refer to the section "Allocation of Premium" N/A

Rider Charges (per installment)

25,000.00

Classic Opportunities Fund 0.00%

entioned:

(All Charges are in Rupees)

Fund at End

Surrender Value

Death Benefit

16,397 38,940 65,451 96,264 129,636 165,798

85,646 122,486 165,798

491,397 488,940 490,451 496,264 504,636 515,798

205,001 247,502 293,573 343,509 397,636 456,308 519,916 588,885 663,681

205,001 247,502 293,573 343,509 397,636 456,308 519,916 588,885

530,001 547,502 568,573 593,509 622,636 656,308 694,916 738,885

(All Charges are in Rupees)

Fund at End

Surrender Value

Death Benefit

15,772 36,843 60,854 87,934 116,194 145,704 176,536 208,749 242,403 277,557 314,280 352,645 392,736 434,640 478,455

0 0 0 78,235 109,786 145,704 176,536 208,749 242,403 277,557 314,280 352,645 392,736 434,640

490,772 486,843 485,854 487,934 491,194 495,704 501,536 508,749 517,403 527,557 539,280 552,645 567,736 584,640

Kotak Life Insurance and would be subject to

s, if any, will cease from the due date of first unpaid nniversary or at the end of the revival period whichever is

CM) is available for a maximum period of two years. At the his/her wish to continue the policy in ACM mode. der value in the Main Account reduces to a level equal to d for) will cease in ACM mode. However, other rider

standing premiums is made within six months from due g. All policy benefits will be reinstated on revival. the Fund Value less Surrender Charges in the year of

he revised premium. Where premiums are increased, the not allowed.

gement charges - Value of current liabilities - Provisions)

n when the company is required to purchase the assets to

e any changes before or at the time of the policy issuance

ment.

the performance of fund and factors influencing the

ked life insurance contract and does not in any way quality of these plans, their future prospects and returns.

sk relating to lives or property in India, any rebate of the except such rebate as may be allowed in accordance with elf on his own life shall not be deemed to be acceptance ona fide insurance agent employed by the insurer.

ad and understood the structure of benefits, charges,

ion of the Proposer

SIGNATURE person of Corporate Agent/Authorised ionship Officer