10/5/2019 ICICI Prudential Life Insurance

Statement of Product Value

FORM - D02
Login Date :05-Oct-2019
Registration Number :105
Policy Holder Name :ARJUN BHATNAGAR
Policy Holder ID : 30414010
Address of Policy Holder :
54- E/28
DABAULI 2
..
KANPUR - 208022

PART-A
Premium Premium Funds Unit as per Value as
Paid incl. Allocation Allocated Policy Admin per unit Product
Product UIN Top-up (Rs) charges (Rs) (Rs) System (PAS) (Rs) value (Rs)
Elite 105L156V02 300000.00 15000.00 285000.00 12024.51 22.82 274456.01
Life
Super

PART-B
Particulars 085 089 088 090 086 24/11/09 139 114 T
24/11/09 24/11/09 24/11/09 24/11/09 LOpport 105 24/11/17 15/03/11
LMCapGro LIncome LMCapBal LMoneyMkt VEF 105 LMaximis5
105 105 105 105 105
Name of the Multi Cap Income Multi Cap Money Opportunities Value Maximiser -
Fund Growt Fund Balan Market Fu F Enhancer V

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10/5/2019 ICICI Prudential Life Insurance

Units (as per 1654.21 2545.43 2628.25 1753.24 1373.40 0.00 2069.98 1
Investment
Management
System)
Percentage of 14.38 % 21.08 % 21.67 % 13.32 % 11.98 % 0.00 % 17.57 % 1
Allocation (as
on Login Dt)
Fund 0.00 150000.00 0.00 0.00 0.00 150000.00 0.00 3
allocated
Switch In 39982.84 36578.00 59964.04 36576.95 33315.56 0.00 125000.00 3
Switch Out 0.00 125000.00 0.00 0.00 0.00 133336.83 73080.56 3
Withdrawals 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0
Charges
Allocation 0.00 7500.00 0.00 0.00 0.00 7500.00 0.00 1
Charges
Switch Charge 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0
Policy 0.00 1099.00 0.00 0.00 0.00 1696.66 704.32 34
Administration
Charge
Mortality 0.00 790.45 0.00 0.00 0.00 1224.04 510.94 2
Charges
Goods and 0.00 1690.09 0.00 0.00 0.00 1875.73 218.75 3
Services Tax /
Cess (if any)
Bonus Unit 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0
Allocation
Total Amount 0.00 142500.00 0.00 0.00 0.00 142500.00 0.00 2
Invested In
Segregated
funds
Current NAV 23.86 22.73 22.63 20.87 23.95 8.87 23.26 2
Fund Value as 39470.20 57866.85 59488.06 36583.96 32891.45 0.00 48155.47 2
on Login Date

PART-C(Product Statistics)
Insurance Cover over the interim reporting period from 13-Dec-2018 to 05-Oct-2019 3000000.00
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10/5/2019 ICICI Prudential Life Insurance

Premium Paid from inception 300000.00

Total Risk premium from inception, for insurance cover 2525.45
Total Charges and deductions other than Mortality including Allocation charges till Login Dt. (including 22284.58
Service Charges)
Difference Between (B) (C) (Unrealized Gain/Loss) 734.85
Portfolio value on Net Investment as per Benefit Illustration at the lower rate as prescribed in the 280654
regulations
Portfolio value on Net Investment as per Benefit Illustration at the upper rate prescribed in the 291606
regulations

Note:
Product Portfolio value would be aggregate of all fund values in a product.
Product value per unit would be arrived at post dividing aggregate fund value by initial units
Consolidated Product Value would be a derived by aggregating the product values and divding the same by
consolidated initial units
Product Value would be in addition to all the existing disclosures and calculations
Current prescribed practices shall continue
ICICI Prudential Life Insurance Company. IRDAI Regn No. 105. CIN: U66010MH2000PLC127837
Call us on 1860-266-7766 (10am-7pm, Monday to Saturday, except national holidays. Valid only for calls made from
India). You can visit us at www.iciciprulife.com. ICICI Prudential Life Insurance Co. Ltd. Registered Address:- 1089,
Appasaheb Marathe Marg, Prabhadevi, Mumbai-400025. Insurance is the subject matter of the solicitation. Trade Logo
displayed above belongs to M/s ICICI Bank Ltd & Prudential IP services Ltd which shall be used by ICICI Prudential Life
Insurance Company Ltd under Registered License No.105.
BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS
IRDAI clarifies to public that
IRDAI or Its officials do not involve in activities like sale of any kind of insurance or financial products nor invest
premiums.
IRDAI does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along
with details of phone call, number.

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