BENEFIT ILLUSTRATION

[Date and Time of Illustration – 29 April 2022, 05:05 PM]

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

Age & Gender: 24 Years, Male Name of the Product: Max Life Smart Wealth Plan
Name of the Life Assured: Mr. Tag Line: A Non-Linked Non Participating Individual Life Insurance Savings Plan
Age & Gender: 24 Years, Male Unique Identification No: 104N116V06
Policy Term: 20 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: `1,05,255 GST Rate (Rider, First Year): 18.00%
Mode of payment of premium: Annual
GST Rate (Rider, Subsequent Year): 18.00%
Annual Income Amount: NA
Income Period, if applicable: NA Max Life State: Uttarakhand
Mode of Income, if applicable: NA Policyholder Residential State: Uttarakhand

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.) 16,00,000
Sum Assured on Death (at inception of the policy) (in Rs.) 11,00,000

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 10 Years
Critical Illness and Disability Rider - Rider Premium Payment
NA Critical Illness and Disability Rider - Coverage Variant NA
Term and Rider Term
Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Accidental Death & Waiver of Premium Plus Critical Illness and Total Installment Premium
Base Plan Dismemberment Rider
Term Plus Rider Rider Disability Rider
Installment Premium without GST (in Rs.) 1,00,000 0 0 640 0 1,00,640
Installment Premium with first year GST (in Rs.) 1,04,500 0 0 755 0 1,05,255
Installment Premium with GST 2nd year onwards (in Rs.) 1,02,250 0 0 755 0 1,03,005

UIN: 104N116V06 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 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 1,00,000 1,00,640 - - - 11,00,000 - -
2 1,00,000 1,00,640 - - - 11,00,000 60,000 72,000
3 1,00,000 1,00,640 - - - 11,00,000 1,05,000 1,26,000
4 1,00,000 1,00,640 - - - 11,00,000 2,00,000 2,40,000
5 1,00,000 1,00,640 - - - 11,00,000 2,50,000 3,00,300
6 1,00,000 1,00,640 - - - 11,00,000 3,00,000 3,84,720
7 1,00,000 1,00,640 - - - 11,00,000 3,50,000 4,79,080
8 1,00,000 1,00,640 - - - 11,48,720 4,26,640 5,84,480
9 1,00,000 1,00,640 - - - 13,48,650 5,10,030 7,02,000
10 1,00,000 1,00,640 - - - 15,64,500 6,00,000 8,32,600
11 - - - - - 16,89,700 6,33,300 8,88,800
12 - - - - - 18,24,900 6,66,700 9,48,800
13 - - - - - 19,70,900 7,00,000 10,12,800
14 - - - - - 21,28,600 7,33,300 10,81,200
15 - - - - - 22,98,800 7,66,700 11,54,200
16 - - - - - 24,82,700 8,00,000 12,32,100
17 - - 2,00,410 - - 26,81,400 8,93,423 14,15,505
18 - - 4,00,820 - - 28,95,900 9,86,946 16,84,674
19 - - 6,01,230 - - 31,27,500 10,80,369 20,39,907
20 - - 8,01,640 16,00,000 24,01,640 33,77,700 11,40,492 24,01,640

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.

UIN: 104N116V06 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
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:4/29/22 Signature / Thumb Impression / Electronic Signature of
Date: 4/29/22 Agent/ Intermediary / Official Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N116V06 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
84,24,20,1600000,0,100640,M,f84