Aviva Life Insurance Company India Limited Benefit Illustration

Prepared on: 25/4/2021

Name of the Prospect /

Proposal No:
Policyholder:
40
Age: Name of Product: Aviva Dhan Samruddhi
years
An Individual Non-Linked Non-Participating Savings Life
Name of Life Assured: Tag Line:
insurance plan
40 Unique Identification No
Age: 122N097V04
years (UIN):
15
Policy Term: GST Rate Year 1: 4.50%
years
10GST Rate Year 2
Premium Payment Term: 2.25%
years
Onwards:
Amount of Installment Premium Premium Payment
95,694 Yearly
(Rs.): Frequency

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

Policy Details
Policy Option - Basic Sum Assured (Rs.) 1,356,781
Sum Assured on Death (at inception of the Policy (Rs.)) 1,356,781

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST (Rs.) 95,694 - 95,694
Installment Premium with First Year GST (Rs.) 100,000 - 100,000
Installment Premium with GST 2nd Year Onwards
97,847 - 97,847
(Rs.)

(Amount in Rupees)

Guaranteed Non-Guaranteed
Survival Other Benefits, Maturity Death Benefit Minimum
Special Surrender
Benefits / if any Benefit (inclusive of Guaranteed
Policy Annualized Value
Loyalty (Guaranteed (At the Accrued Surrender Value
Year Premium* (At end of policy
Additions Additions end of Guaranteed (At end of policy
year after payment
(payable at accrued at year policy Additions at year year after payment
of survival benefit)
year end) end) year) end) of survival benefit)
1 95,694 - 7,656 - 1,364,437 - -
2 95,694 - 15,311 - 1,372,092 57,416 80,267
3 95,694 - 22,967 - 1,379,748 100,479 133,300
4 95,694 - 30,622 - 1,387,403 191,388 200,667
5 95,694 119,618 38,278 - 1,395,059 119,618 238,717
6 95,694 - 45,933 - 1,402,714 167,465 379,183
7 95,694 - 53,589 - 1,410,370 215,312 502,450
8 95,694 - 61,244 - 1,418,025 454,547 660,117
9 95,694 - 68,900 - 1,425,681 569,379 809,184
10 95,694 119,618 76,555 - 1,433,336 622,011 850,101
11 - - 84,211 - 1,440,992 622,011 927,968
12 - - 91,866 - 1,448,647 622,011 992,115
13 - - 99,522 - 1,456,303 622,011 1,071,437
14 - - 107,177 - 1,463,958 622,011 1,151,525
15 - - 114,833 1,232,379 1,471,614 622,011 1,232,379

*Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the
riders, if any and Goods and Services Tax.

Notes:

All the benefits shown in the above table are guaranteed provided all the due premiums are paid, except the special surrender values.
Special Surrender Values may change as decided by the company from time to time with prior approval of IRDAI.
Taxes including but not limited to Goods and Services Tax, Cesses as applicable shall also be levied as notified by government from time
to time. Tax laws are subject to change.
This illustration does not include any additional premium payable due to underwriting.
During the first 2 policy years, if the due premium has not been paid before expiry of the grace period, the policy will lapse.
If such a lapsed policy is not revived within the Revival Period of five years from the due date of the first unpaid premium, 30% of Total
premiums paid will be payable at the end of the revival period and the policy shall terminate.
If death occurs during the Revival period, 30% of Total premiums paid shall be payable at the time of death and the policy shall terminate
thereafter.
For more details on terms and conditions please read sales brochure of this plan carefully before concluding a sale.
There is no rider available under this product.
 I, _______________(name), having received the
I, _______________(name), have explained the
information with respect to the above, have
premiums, and benefits under the product fully to the
understood the above statement before entering
prospect/policyholder.
into the contract.
Place:
Place:
Date: Signature of
Date: Signature of
Agent/intermediary/Official
Prospect/Policyholder

Aviva Dhan Samruddhi

Important points you must know about this policy
What is Aviva Dhan Aviva Dhan Samruddhi is a money back plan that pays guaranteed cash back every 5 years and
Samruddhi? a guaranteed lump sum at maturity.
The plan offers guaranteed additions every year on your one year’s premium depending upon the Policy
Term as defined below.The Guaranteed Additions will only accrue if all due premiums have been paid.

Policy Term in years 10 15 20

What is the guarantee under Guaranteed Additions as percentage of one
7% 8% 9%
this plan? year’s Premium

The Guaranteed Additions applicable for your proposal will be 8% of one year’s premium per

year.
Please refer to the Key Feature brochure for details
You can select a term of 10, 15, 20 years subject to maximum maturity age of 70 years.
What is the Term of this policy?
You have selected the policy term of 15 years.
This plan offers fixed policy term of 10, 15, 20 years and premium payment term as 10 years for all options.
What are the Premium Payment The premium payment frequency allowed is Yearly, Half-yearly, Quarterly & Monthly. (For monthly mode,
Term options under this plan? ECS or Direct Debit is mandatory)
You have selected the policy term of 15 years and opted to pay premium at Annual frequency.
   •Death Benefit: The amount payable on death shall be highest of the following amounts:

1. 10 times of Annualized premium, or

2. 105% of the Total Premium paid as on date of death, or
3. Sum Assured of the policy plus the Guaranteed Additions accrued till the date of death without any
What are the benefits under deduction of any survival benefits already paid.
this plan?
   •Survival Benefit: Guaranteed survival benefit is 125% of one year’s premium at the end of every 5
policy years except at maturity, if all due premiums have been paid up to such date.

   •Maturity Benefit: Sum Assured plus guaranteed additions accrued under the policy less all Survival
Benefits paid.
   •If at least two year’s premiums have not been paid; before the expiry of the grace period, the policy
will lapse.
      • A lapsed policy can be revived within 5 years from the date of first unpaid premium. 
      • If not revived, the policy will be terminated by paying 30% of Total Premiums paid at the end of revival
period.
      • If death occurs during the Revival period, 30% of Total Premiums paid shall be payable at the time of
death and the policy shall terminate thereafter.
What happens if I stop paying
my premiums?    •If at least two years premiums have been paid: If any due premium is not paid before expiry of
grace period, the policy becomes a paid-up policy. A paid up policy can be revived within 5 years from the
date of first unpaid premium. If the paid up policy is not revived :
      •Survival and Death benefits will be reduced depending on the ratio of premiums paid to premiums
payable.
      •No future Guaranteed Additions are paid. 

Please refer to the Key Feature brochure for details.

Can I cash in (surrender) the
policy during the term of the
policy?
What is not covered under this from the date of revival of the policy, as applicable, the nominee or beneficiary of the policyholder shall be
policy (Exclusions)?
Do I have a right to review my
purchase?
You do have an option to cash-in (surrender) this policy if premiums were paid for at least 2 years, after
deduction of applicable surrender penalty. The surrender amount will be less than the amount of premiums
paid in most cases.
Please refer to the Key Feature brochure and Illustration for details.
In case of death due to suicide within 12 months from the date of commencement of risk under the policy or
entitled to at least 80% of the Total Premiums paid till the date of death or the surrender value available as
on the date of death whichever is higher, provided the policy is in force.
The policyholder has the right to review the policy terms and conditions during the freelook period which is
15 days (30 days if policy is solicited through distance marketing) from the date of receipt of the policy
document. If the policyholder cancels the policy during the freelook period, the company will refund the
premium on the date of cancellation, after deducting expenses incurred on medicals and stamp duty.

We request you to personally fill the proposal form and provide accurate information to ensure that your claim is not reduced or
declined because of non-disclosure or misrepresentation of information.
Please note:
   •Aviva is not liable for any claim until receipt of premium in full, completion of underwriting and acceptance of risk.
  • This document does not contain the full terms and conditions of the Policy. Details of the terms and conditions, and exclusions of the
insurance contract are contained in the Key Feature brochure. It is important that you read the entire Key Feature brochure.
I confirm that I have read the Key Feature brochure and the Official Illustration of the insurance product along with this document and understand
the features such as policy benefits, premium payable including the number of years for which premium is required to be paid, lock-in period,
whether any guarantee is available and if yes then subject to what conditions.

I agree and confirm to the use of electronic medium, including email, as a mode of communication from and to the Company.

Signature of Life Assured

Signature of the Proposer _____________________________ _____________________________
(In case different from Proposer)

Proposer Name Name of Life Assured

Proposal Number Proposal Date