BENEFIT ILLUSTRATION

[Date and Time of Illustration – 28 January 2021, 02:21 PM]

Name of the Prospect/Policyholder: Mr. Debasis Proposal No:

Age & Gender: 33 Years, Male Name of the Product: Max Life Smart Wealth Plan
Name of the Life Assured: Mr. Debasis Tag Line: A Non-Linked Non Participating Individual Life Insurance Savings Plan
Age & Gender: 33 Years, Male Unique Identification No: 104N116V03
Policy Term: 11 Years GST Rate (Base Policy, First Year): 4.50%
Premium Payment Term: 10 Years GST Rate (Base Policy, Subsequent Year): 2.25%
Amount of Installment Premium: `10,241 GST Rate (Rider, First Year): NA
Mode of payment of premium: Monthly
GST Rate (Rider, Subsequent Year): NA
Annual Income Amount: `1,02,322
Income Period, if applicable: 25 Years Max Life State: Haryana
Mode of Income, if applicable: Annual Policyholder Residential State:

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

Policy Details
Policy Option Long Term Income Sum Assured (in Rs.) Not Applicable
Sum Assured on Death (at inception of the policy) (in Rs.) 12,22,222

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.) 9,800 0 0 0 0 0 9,800
Installment Premium with first year GST (in Rs.) 10,241 0 0 0 0 0 10,241
Installment Premium with GST 2nd year onwards (in Rs.) 10,225 0 0 0 0 0 10,225

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 3
 (Amount in Rupees)

Guaranteed Non Guaranteed

Single/ Annualized
Policy Year Total Annual Premium
Premium Other Benefits, if any Min Guaranteed Special Surrender Value
Income Benefit Maturity Benefit Death Benefit
(Terminal Benefit) Surrender Value

1 1,08,889 1,17,600 - - - 12,22,222 - -

2 1,11,111 1,20,000 - - - 12,22,222 72,000 73,333
3 1,11,111 1,20,000 - - - 12,22,222 1,26,000 1,28,333
4 1,11,111 1,20,000 - - - 12,22,222 2,40,000 2,44,444
5 1,11,111 1,20,000 - - - 12,22,222 3,00,000 3,19,833
6 1,11,111 1,20,000 - - - 12,22,222 3,60,000 4,22,133
7 1,11,111 1,20,000 - - - 12,22,222 4,20,000 5,41,800
8 1,11,111 1,20,000 - - - 12,32,444 6,07,968 6,81,067
9 1,11,111 1,20,000 - - - 14,46,900 8,28,036 8,42,800
10 1,11,111 1,20,000 - - - 16,78,556 10,80,000 10,30,111
11 - - - - - 18,12,778 10,80,000 11,33,111
12 - - 1,02,322 - - - - -
13 - - 1,02,322 - - - - -
14 - - 1,02,322 - - - - -
15 - - 1,02,322 - - - - -
16 - - 1,02,322 - - - - -
17 - - 1,02,322 - - - - -
18 - - 1,02,322 - - - - -
19 - - 1,02,322 - - - - -
20 - - 1,02,322 - - - - -
21 - - 1,02,322 - - - - -
22 - - 1,02,322 - - - - -
23 - - 1,02,322 - - - - -
24 - - 1,02,322 - - - - -
25 - - 1,02,322 - - - - -
26 - - 1,02,322 - - - - -
27 - - 1,02,322 - - - - -
28 - - 1,02,322 - - - - -
29 - - 1,02,322 - - - - -
30 - - 1,02,322 - - - - -
31 - - 1,02,322 - - - - -
32 - - 1,02,322 - - - - -
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 3
 Guaranteed Non Guaranteed
Single/ Annualized
Policy Year Total Annual Premium
Premium Other Benefits, if any Min Guaranteed Special Surrender Value
Income Benefit Maturity Benefit Death Benefit
(Terminal Benefit) Surrender Value

33 - - 1,02,322 - - - - -
34 - - 1,02,322 - - - - -
35 - - 1,02,322 - - - - -
36 - - 1,02,322 11,11,111 - - - -

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, debasis (name), having received the information with respect to the above, have understood
under the product fully to the prospect / policyholder. the above statement before entering into the contract.

Place: Signature / Thumb Impression / Electronic Signature of Date:1/28/21 Signature / Thumb Impression / Electronic Signature of
Date: 1/28/21 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 3 of 3
88,33,36,111111,9800,M,c88