Bharti AXA Life Elite Advantage

A Non-Linked, Non-Participating Individual Life Insurance Savings Plan

ILLUSTRATION OF BENEFITS FOR BHARTI AXA LIFE ELITE ADVANTAGE

“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 illustrations on this page will show two different rates of assumed future investment
returns. 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 actual
future investment performance.”

Proposer Details Quote No.: 100000001473612

Name of the Prospect/Policyholder : Proposal No:
Age as on last birthday : Policy No.:
Gender :
Life Insured Details Name of the Product: Bharti AXA Life Elite Advantage
Name of the Life Insured : DHANANJAY BORSE Tag Line: A Non-Linked, Non-Participating Individual Life
Age as on last birthday : 40 years Insurance Savings Plan
Gender : Male Unique Identification No: 130N060V05
GST Rate (incl. cess, if any): GST Rate applicable in 1st year is 4.5% and 2nd
year onwards is 2.25%. For Riders, 18% GST rate
is applicable.
For With Return of Premium option in ATPD rider:
4.5% (1st year) and 2.25% (2nd year onwards)
otherwise 18% GST rate is applicable.
Policy Term (years): 12 years
Premium Payment Term (years) : 12 years Product Code: EA12A3
Premium Mode: Annual Rider Code:
Amount of lnstalment Premium (Rs.) 209000
(incl. rider premium and GST):
This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Base Policy Details

Policy Option : NA Sum Assured Rs. : 2332090

Sum Assured on Death (at inception of the policy) 2332090
Rs. :

Name of the Proposer: __________________________________________________ Signature of the Proposer: ________________________________

Registered address- Unit No. 1904, 19th Floor, Parinee Crescenzo, 'G' Block, Bandra Kurla Complex, BKC Road, Behind MCA Ground, Bandra East, Mumbai -400051, Maharashtra
Service Unit address- Bharti AXA Life Insurance Company Limited, Spectrum tower, 3rd Floor,Malad link road, Malad (west), Mumbai 400064. Maharashtra
IRDA Regn no.-130. Website: www.bharti-axalife.com
Abacus Ver. 3.6 Page: 1 of 3
 Premium Summary
Base Plan Total Instalment Premium
Instalment Premium without GST (Rs.) 200000 200000.00
GST in the First Year 9000 9000
Instalment Premium with First Year GST (Rs.) 209000 209000
GST from 2nd Year onwards 4500 4500
Instalment Premium with GST 2nd Year Onwards (Rs.) 204500 204500
*GST Rate applicable in 1st year is 4.5% and 2nd year onwards is 2.25%. For Riders, 18% GST rate is applicable. For With Return of Premium option in ATPD rider: 4.5% (1st year) and 2.25% (2nd year onwards) GST rate is applicable otherwise 18% GST rate is
applicable.

(Amounts in Rupees.)
Illustration summary over the duration of the policy
Guaranteed Benefits Non Guaranteed Benefit
Policy Year Annualized Premium Survival Benefits Other Benefits if any Maturity Benefit Death Benefit Min Guaranteed Surrender Value Special Surrender Value
1 200000 - - - 2332090 - -
2 200000 - - - 2332090 120000 125933
3 200000 - - - 2332090 210000 219216
4 200000 - - - 2332090 400000 417444
5 200000 - - - 2332090 550000 573694
6 200000 - - - 2332090 720000 750933
7 200000 - - - 2332090 910000 946829
8 200000 - - - 2332090 1120000 1166045
9 200000 - - - 2332090 1350000 1406250
10 200000 - - - 2332090 1600000 1665112
11 200000 - - - 2332090 1980000 2059235
12 200000 - - 221549 2520000 2160000 2332090
13 - - - 221549 - - -
14 - - - 221549 - - -
15 - - - 221549 - - -
16 - - - 221549 - - -
17 - - - 221549 - - -
18 - - - 221549 - - -
19 - - - 221549 - - -
20 - - - 2332090 - - -
Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any and Goods & Service Tax.

Name of the Proposer: __________________________________________________ Signature of the Proposer: ________________________________

Registered address- Unit No. 1904, 19th Floor, Parinee Crescenzo, 'G' Block, Bandra Kurla Complex, BKC Road, Behind MCA Ground, Bandra East, Mumbai -400051, Maharashtra
Service Unit address- Bharti AXA Life Insurance Company Limited, Spectrum tower, 3rd Floor,Malad link road, Malad (west), Mumbai 400064. Maharashtra
IRDA Regn no.-130. Website: www.bharti-axalife.com
Abacus Ver. 3.6 Page: 2 of 3
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Explanation & Informati on – Elite Advantage
--------------------------------------------------------------------------------------------------------------------------------------------------------

1. The Maturity Payout period for policy term of 10 years is from the end of 10th year till end of 20th year. The
th
Maturity Payout period for policy term of 12 years is from the end of 12th year till end of 20 year.
2. This benefit illustration explains the benefits and features of the proposed policy and is not a contract of
insurance.
3. The illustration is based on the standard risk class, taking in to consideration your own circumstances.
4. All benefits under this plan are guaranteed
5. The maturity benefit under the policy will be paid out in installments till end of 20th year.
6. For the purpose of illustration, the value mentioned under "Maturity Benefit" column is the amount that will be
paid annually. However, the actual amount payable will depend upon the frequency of Maturity payout chosen
by the Policyholder.
7. The Death benefit mentioned in the Benefit Illustration is payable in case of Death of Life Insured during the
Policy Term.
8. In case of Death of Life Insured during the Maturity Payout period the benefits will continue to be paid to the
nominee as per Schedule mentioned in Policy Bond.
9. The minimum guaranteed surrender value under the policy is 30% of all premiums paid till date if surrendered in
2nd policy year. The GSV is paid only if the policy acquires surrender value. The company may declare surrender
value that is higher than the guaranteed Surrender Values (i.e. Special Surrender Value). The Special Surrender
Values are not guaranteed and subject to declaration by The Company.
10. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a
sale.
11. Tax benefits may be available as per prevailing provisions of tax laws and are subject to change with the change
in tax laws. Neither the company nor its agents can offer legal or tax advice.
12. Bharti AXA Life Insurance Company Ltd., Bharti AXA Life Elite Advantage is the name of the Insurance Company,
Product and does not in any way indicate the quality of the contract, its future prospects or returns.

Declaration by Advisor / Sales Person Declaration by Proposer

I, ............ ...... ............ ... , have explained the premiums, I, ................ ........................ , having received the
and benefits under the product fully to the prospect / information with respect to the above, have
policyholder. understood the above statement before entering into
the contract.
Place
Date: Signature of Agent/Intermediary/Official Date: Signature of Prospect /Policyholder

Registered address- Unit No. 1904, 19th Floor, P arinee Crescenzo, 'G' Block, Bandra Kurla Complex, BKC Road, Behind MCA Ground, Bandra East, Mumb ai -
400051, Maharashtra
Service Unit address- Bharti AXA Life Insurance Company Limited, Spectrum tower, 3rd Floor,Malad link road, Malad (west), Mumbai 400064. Maharashtra
IRDA Regn no.-130. Website: www.bharti-axalife.com

Abacus Ver. 3.6 Page: 3 of 3