Proposal No:

Name of the Prospect/Policyholder: Mr. Abc Name of the Product: Max Life Savings Advantage Plan
Age & Gender: 20 Years, Male Tag Line: A Non-Linked Participating Individual Life Insurance Savings Plan
Name of the Life Assured: Mr. Abc Unique Identification No: 104N111V02
Age & Gender: 20 Years, Male GST Rate: 4.50%
Policy Term: 15 Years Max Life State: Rajasthan
Premium Payment Term: 10 Years Policyholder Residential State: Rajasthan
Amount of Installment Premium: `26,125
Mode of payment of premium: Annual

How to read and understand this benefit illustration?

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a.

Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. If your policy offers guaranteed benefits then these
will be clearly marked “guaranteed” in the illustration table on this page. If your policy offers variable benefits then the illustration on this page will show two different rates of assumed future investment returns, of
8%p.a. and 4% p.a. These assumed rates of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependent on a number of factors including
future investment performance.

Policy Details
Policy Option Sum Assured (in Rs.) 2,11,381
Bonus Type Premium Offset Sum Assured on Death (at inception of the policy) (in Rs.) 2,75,000

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

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST (in Rs.) 25,000 - 25,000
Installment Premium with first year GST (in Rs.) 26,125 - 26,125
Installment Premium with GST 2nd year onwards (in Rs.) 25,563 - 25,563

UIN: 104N111V02 Page 1 of 3

 (Amount in Rupees)

Total Benefits including Guaranteed and Non- Guaranteed

Non-Guaranteed Benefits Non-Guaranteed Benefits Benefits
Guaranteed Benefits
@ 4% p.a. @ 8% p.a.
Maturity Benefit Death Benefit
Single/
Policy Total Maturity Total Death
Annualized Total Maturity Total Death
Year Benefit, incl. Benefit, incl.
Premium Benefit, incl. Benefit, incl.
Terminal of Terminal
Guaranteed Survival Surrender Death Maturity Paid Up Surrender Paid Up Surrender Terminal of Terminal
Cash Bonus Cash Bonus Bonus, if any Bonus, if any
Additions Benefit Benefit Benefit Benefit Additions Benefit Additions Benefit Bonus, if any Bonus, if any
@ @ 4%(6+8+9)
@ 4%(7+8+9) @
8%(7+11+12)
8%(6+11+12)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

1 25,000 11,626 - - 2,75,000 - - - - - - - - - 2,86,626 2,86,626

2 25,000 11,626 - 20,384 2,75,000 - - 1,351 20,384 - 1,596 20,384 - - 2,98,252 2,98,252

3 25,000 11,626 - 35,278 2,75,000 - - 1,393 35,278 - 1,695 35,278 - - 3,09,878 3,09,878

4 25,000 11,626 - 63,460 2,75,000 - - 1,435 63,460 - 1,801 63,460 - - 3,21,504 3,21,504

5 25,000 11,626 - 83,817 2,75,000 - - 1,478 83,817 - 1,915 83,817 - - 3,33,130 4,02,399

6 25,000 - - 1,02,049 2,75,000 - - 1,522 1,02,049 - 2,033 1,02,049 - - 3,33,130 4,02,399

7 25,000 - - 1,21,551 2,75,000 - - 1,568 1,21,551 - 2,162 1,21,551 - - 3,33,130 4,02,399

8 25,000 - - 1,48,155 2,75,000 - - 1,617 1,48,155 - 2,298 1,48,155 - - 3,33,130 4,02,399

9 25,000 - - 1,77,322 2,75,000 - - 1,666 1,77,322 - 2,444 1,77,322 - - 3,33,130 4,02,399

10 25,000 - - 2,09,518 2,75,000 - - 1,716 2,09,518 - 2,596 2,17,262 - - 3,33,130 4,02,399

11 - - - 2,25,465 3,02,500 - - 1,769 2,25,465 - 2,761 2,41,421 - - 3,60,630 4,29,899

12 - - - 2,42,138 3,02,500 - - 1,822 2,42,138 - 2,934 2,66,041 - - 3,60,630 4,29,899

13 - - - 2,59,095 3,02,500 - - 1,879 2,59,095 - 3,120 2,92,589 - - 3,60,630 4,29,899

14 - - - 2,76,902 3,02,500 - - 1,936 2,76,902 - 3,319 3,21,171 - - 3,60,630 4,29,899

15 - - - 2,83,130 3,02,500 2,32,519 - 1,995 2,92,644 - 3,528 3,63,446 2,92,644 3,63,446 3,60,630 4,29,899

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

UIN: 104N111V02 Page 2 of 3

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:
Date: 8/8/21 Signature / OTP Confirmation Date / Thumb Impression / Date:8/8/21 Signature / OTP Confirmation Date / Thumb Impression /
Electronic Signature of Agent/ Intermediary / Official Electronic Signature of Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N111V02 Page 3 of 3

54,20,211380,2,25000.00,M,b54