BENEFIT ILLUSTRATION

[Date and Time of Illustration – 29 April 2021, 01:08 PM]

Name of the Prospect/Policyholder: Ms. Proposal No:

Age & Gender: 60 Years, Female Name of the Product: Max Life Smart Wealth Plan
Name of the Life Assured: Ms. Tag Line: A Non-Linked Non Participating Individual Life Insurance Savings Plan
Age & Gender: 60 Years, Female Unique Identification No: 104N116V03
Policy Term: 20 Years GST Rate (Base Policy, First Year): 4.50%
Premium Payment Term: 5 Years GST Rate (Base Policy, Subsequent Year): 2.25%
Amount of Installment Premium: `52,250 GST Rate (Rider, First Year): NA
Mode of payment of premium: Annual
GST Rate (Rider, Subsequent Year): NA
Annual Income Amount: NA
Income Period, if applicable: NA Max Life State: Punjab
Mode of Income, if applicable: NA Policyholder Residential State: Punjab

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

Policy Details
Policy Option Lump Sum Sum Assured (in Rs.) 4,00,000
Sum Assured on Death (at inception of the policy) (in Rs.) 5,50,000

Rider Details
Accidental Death & Dismemberment (ADD) Rider Term NA Accidental Death & Dismemberment (ADD) Rider Sum Assured (in Rs.) NA
Term Plus Rider Term NA Term Plus Rider Sum Assured (in Rs.) NA
Waiver of Premium (WOP) Plus Rider Term NA
COVID19 One Year Term Rider Term NA COVID19 One Year Term Rider Sum Assured (in Rs.) NA
Critical Illness and Disability Rider - Rider Premium Payment Term and Rider Term NA Critical Illness and Disability Rider - Coverage Variant NA
Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Accidental Death & Term Plus Waiver of Premium COVID19 One Year Critical Illness and Total Installment
Base Plan Dismemberment Rider Plus Rider
Rider Term Rider Disability Rider Premium
Installment Premium without GST (in Rs.) 50,000 0 0 0 0 0 50,000
Installment Premium with first year GST (in Rs.) 52,250 0 0 0 0 0 52,250
Installment Premium with GST 2nd year onwards (in Rs.) 51,125 0 0 0 0 0 51,125

UIN: 104N116V03 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 1 of 2
 (Amount in Rupees)

Guaranteed Non Guaranteed

Single/ Annualized
Policy Year Total Annual Premium Other Benefits, if any
Premium Accrued Guaranteed Min Guaranteed Special Surrender Value
(Guaranteed Sum Maturity Benefit Death Benefit
Additions Surrender Value
Assured at Maturity)
1 50,000 50,000 - - - 5,50,000 - -
2 50,000 50,000 - - - 5,50,000 30,000 36,000
3 50,000 50,000 - - - 5,50,000 52,500 63,000
4 50,000 50,000 - - - 5,50,000 1,00,000 1,20,000
5 50,000 50,000 - - - 5,50,000 1,25,000 1,50,150
6 - - - - - 5,50,000 1,25,000 1,60,300
7 - - - - - 5,50,000 1,25,000 1,71,100
8 - - - - - 5,50,000 1,33,325 1,82,650
9 - - - - - 5,50,000 1,41,675 1,95,000
10 - - - - - 5,50,000 1,50,000 2,08,150
11 - - - - - 5,50,000 1,58,325 2,22,200
12 - - - - - 5,50,000 1,66,675 2,37,200
13 - - - - - 5,86,375 1,75,000 2,53,200
14 - - - - - 6,33,275 1,83,325 2,70,300
15 - - - - - 6,83,950 1,91,675 2,88,550
16 - - - - - 7,38,650 2,00,000 3,08,025
17 - - 11,430 - - 7,97,750 2,11,754 3,34,540
18 - - 22,860 - - 8,61,575 2,23,533 3,67,027
19 - - 34,290 - - 9,30,500 2,35,287 4,05,561
20 - - 45,720 4,00,000 4,45,720 10,04,925 2,38,716 4,45,720

Notes:
• Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Service Tax.
• Total Annual Premium includes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any but excludes Goods and Service Tax.
• Refer Sales literature (Prospectus) for explanation of terms used in this illustration.

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: Signature / Thumb Impression / Electronic Signature of Date:4/29/21 Signature / Thumb Impression / Electronic Signature of
Date: 4/29/21 Agent/ Intermediary / Official Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N116V03 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 2 of 2
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