Bharti Axa Life Guaranteed Income Pro

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

ILLUSTRATION OF BENEFITS FOR BHARTI AXA LIFE GUARANTEED INCOME PRO

“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.: 10200001876111021

Name of the Prospect/Policyholder : UMESH PANDAY Proposal No :
Age as on last birthday : 59 Years Policy No.:
Gender : Male

Life Insured Details Name of the Product: Bharti Axa Life Guaranteed Income Pro
Non Linked Non Participating Individual Life Insurance
Name of the Life Insured : UMESH PANDAY Tag Line:
Savings Plan
Age as on last birthday : 59 Years Unique Identification No: 130N101V01
Gender : Male 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

Policy Term (years): 24 Product Code : GED24L

Premium Payment Term (years) : 12 Rider Code :
Premium Mode: Annual
Amount of Instalment Premium (Rs.): 221435.50
This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Base Policy Details

Policy Option: Endowment Sum Assured Rs. 5000000.00
Sum Assured on Death (at inception of the policy) Rs. 5000000.00

Name of the Proposer: UMESH PANDAY 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.bhartiaxa.com
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 Premium Summary
Base Plan Total Instalment Premium
Instalment Premium without GST (Rs.) 211900.00 211900.00
GST in the First Year (Rs.) 9535.50 9535.50
Instalment Premium with First Year GST (Rs.) 221435.50 221435.50
GST from 2nd Year onwards (Rs.) 4767.75 4767.75
Instalment Premium with GST 2nd Year Onwards (Rs.) 216667.75 216667.75
*GST Rate applicable in 1st year is 4.5% and 2nd year onwards is 2.25%. For Riders, 18% GST rate is applicable

(Amounts in Rupees.)
Illustration summary over the duration of the policy
Guaranteed Benefits Non Guaranteed
Policy Year Annualized Premium Other Benefits if any Min Guaranteed
Survival Benefits (Cumulative Guaranteed Maturity Benefit Death Benefit Surrender Value Special Surrender Value
Additions) 2
1 211900 - 21190 - 5021190 - -
2 211900 - 42380 - 5042380 128835 125000
3 211900 - 63570 - 5063570 225038 225000
4 211900 - 84760 - 5084760 428038 425000
5 211900 - 105950 - 5105950 535048 530000
6 211900 - 127140 - 5127140 643328 635000
7 211900 - 148330 - 5148330 750550 785000
8 211900 - 169520 - 5169520 910322 1035000

Name of the Proposer: UMESH PANDAY 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.bhartiaxa.com
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 (Amounts in Rupees.)
Illustration summary over the duration of the policy
Guaranteed Benefits Non Guaranteed
Policy Year Annualized Premium Other Benefits if any Min Guaranteed
Survival Benefits (Cumulative Guaranteed Maturity Benefit Death Benefit Surrender Value Special Surrender Value
Additions) 2
9 211900 - 190710 - 5190710 1064162 1310000
10 211900 - 211900 - 5211900 1245972 1605000
11 211900 - 233090 - 5233090 1419518 1930000
12 211900 - 254280 - 5254280 1627392 2280000
13 - - 275470 - 5275470 1683122 2440000
14 - - 296660 - 5296660 1764703 2610000
15 - - 317850 - 5317850 1821281 2795000
16 - - 339040 - 5339040 1907100 2995000
17 - - 360230 - 5360230 1964737 3210000
18 - - 381420 - 5381420 2048225 3445000
19 - - 402610 - 5402610 2110736 3705000
20 - - 423800 - 5423800 2199522 3990000
21 - - 444990 - 5444990 2263728 4310000
22 - - 466180 - 5466180 2354209 4660000
23 - - 487370 - 5487370 2420110 5060000
24 - - 508560 5508560 5508560 2441088 5510000

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: UMESH PANDAY 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.bhartiaxa.com
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 Explanation & Information
1. This benefit illustration explains the benefits and features of the proposed policy and is not a contract of insurance.
2. Under Endowment Option - Maturity Benefit is the sum of Sum Assured on Maturity and Accrued Guaranteed Additions, where Sum Assured on Maturity is equal to the Sum Assured and Guaranteed
additions is defined as 10% of Annualized Premium accrued each year, starting from the end of the first policy year and shall be paid out as a lumpsum on death of the Life Insured, or maturity of the
policy
3. The illustration is based on the risk class, taking in to consideration your own circumstances.
4. All benefits under this plan are guaranteed.
5. The Death benefit mentioned in the Benefit Illustration is payable in case of Death of Life Insured during the Policy Term.
6. The minimum guaranteed surrender value under the policy is a percentage 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.
7. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
8. 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
9. Bharti AXA Life Insurance Company Ltd., Bharti AXA Life Guaranteed Income Pro 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, UMESH PANDAY, having received the information with respect to
I, ............ ...... ............ ... (name), have explained the premiums, and
the above, have understood the above statement before entering into the
benefits under the product fully to the prospect / policyholder.
contract.
Place
Date: Signature of Agent/Intermediary/Official Date: Signature of Prospect / Policyholder

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.bhartiaxa.com
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