Proposal No:

Name of the Prospect/Policyholder: Mr. Name of the Product: Max Life Monthly Income Advantage Plan
Age & Gender: 31 Years, Male Tag Line: A Non-Linked Participating Individual Life Insurance Savings Plan
Name of the Life Assured: Mr. Unique Identification No: 104N091V06
Age & Gender: 31 Years, Male GST Rate: 4.50%
Policy Term: 18 Years Max Life State: Uttar Pradesh
Premium Payment Term: 8 Years Policyholder Residential State: Uttar Pradesh
Amount of Installment Premium: `1,25,400
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.) 11,22,860
Bonus Type Compound Reversionary Bonus Sum Assured on Death (at inception of the policy) (in Rs.) 13,20,000

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
Critical Illness and Disability Rider Term NA Critical Illness and Disability Rider Variant NA
Critical Illness and Disability Rider Sum Assured NA

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST (in Rs.) 1,20,000 - 1,20,000
Installment Premium with first year GST (in Rs.) 1,25,400 - 1,25,400
Installment Premium with GST 2nd year onwards (in Rs.) 1,22,700 - 1,22,700

UIN: 104N091V06 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 Reversionary Surrender Reversionary Surrender Terminal of Terminal
Cash Bonus Cash Bonus Bonus, if any Bonus, if any
Additions Benefit Benefit Benefit Benefit Bonus Benefit Bonus 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 1,20,000 - - - 13,20,000 - - - - - - - - - 13,20,000 13,20,000

2 1,20,000 - - 72,000 13,20,000 - 1,572 - 1,21,236 15,271 - 1,26,136 - - 13,20,000 13,20,000

3 1,20,000 - - 1,26,000 13,20,000 - 1,574 - 2,03,887 15,479 - 2,14,416 - - 13,20,000 13,20,000

4 1,20,000 - - 2,40,000 13,20,000 - 1,576 - 3,03,336 15,689 - 3,20,304 - - 13,20,000 13,20,000

5 1,20,000 - - 3,00,000 13,20,000 - 1,579 - 4,03,468 15,902 - 5,02,602 - - 13,20,000 13,20,000

6 1,20,000 - - 3,60,000 13,20,000 - 1,581 - 5,11,215 16,119 - 6,37,151 - - 13,20,000 13,20,000

7 1,20,000 - - 4,20,000 13,20,000 - 1,583 - 6,27,025 16,338 - 7,82,383 - - 13,20,000 13,20,000

8 1,20,000 - - 5,18,400 13,20,000 - 1,585 - 7,52,727 16,560 - 9,40,167 - - 13,20,000 13,20,000

9 - - 1,12,286 4,44,514 13,20,000 - 1,587 - 7,09,650 16,785 - 9,21,324 - - 13,20,000 13,20,000

10 - - 1,12,286 3,70,628 13,20,000 - 1,590 - 6,57,264 17,014 - 8,93,896 - - 13,20,000 13,20,000

11 - - 1,12,286 2,96,742 13,20,000 - 1,592 - 5,99,781 17,245 - 8,63,933 - - 13,20,000 13,20,000

12 - - 1,12,286 2,22,856 13,20,000 - 1,594 - 5,46,077 17,480 - 8,57,383 - - 13,20,000 13,20,000

13 - - 1,12,286 1,48,970 13,20,000 - 1,596 - 4,81,806 17,717 - 8,45,205 - - 13,20,000 13,20,000

14 - - 1,12,286 75,084 13,20,000 - 1,599 - 4,09,253 17,958 - 8,26,759 - - 13,20,000 13,20,000

15 - - 1,12,286 1,198 13,20,000 - 1,601 - 3,28,023 18,202 - 8,01,335 - - 13,20,000 13,20,000

16 - - 1,12,286 - 13,20,000 - 1,603 - 2,37,687 18,450 - 7,68,169 - - 13,20,000 13,20,000

17 - - 1,12,286 - 13,20,000 - 1,605 - 1,37,818 18,701 - 7,26,408 - - 13,20,000 13,20,000

18 - - 1,12,286 - 13,20,000 - 1,608 - 27,025 18,955 - 6,76,246 27,025 6,76,246 13,20,000 13,20,000

UIN: 104N091V06 Page 2 of 3

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.

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: 3/15/23 Signature / OTP Confirmation Date / Thumb Impression / Date:3/15/23 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: 104N091V06 Page 3 of 3

93,31,1122859,R,120000.00,M,a93