Bajaj Allianz Life

Income Assure
A Non-linked Participating Guaranteed
Monthly Income Life Insurance Plan

Key Features of the plan

Aim of the Bajaj Allianz Life Income Assure is a non-linked, participating, life, individual, limited premium payment, monthly income endowment savings plan.
policy

Survival Benefit - Provided the life assured is alive at the end of the premium payment term, the Guaranteed Monthly Income (GMI)+ (irrespective of
the variant chosen) will be paid every month for 144 months, starting from the end of premium payment term.
In case of death of the life assured during the installment period of the Survival Benefit, the GMI will be stopped immediately. Any GMI paid during the
period from the date of death to the date of intimation will be deducted from the death benefit.
+
The GMI has to be selected at the inception of the policy and is fixed throughout the term of the policy.
Benefits
under the Maturity Benefit - Provided the policy is in-force and the life assured is alive, vested bonus plus terminal bonus, if any, will be paid.
Policy Death Benefit - Provided all due premiums are paid, then, in case of unfortunate death of the life assured during the policy term, the death benefit will
be higher of:
Sum Assured on Death# plus vested bonus plus terminal bonus, if any, or 105% of the total premium** paid
Payment of death benefit as per the variant chosen is as follows:
Income Variant Assure Variant
•Vested bonus plus terminal bonus, if any, will be paid immediately •Death benefit will be paid as a lump sum
•The sum assured on death will be paid to the nominee as monthly income, over •The policy will terminate on the date of death of the
the next 144 equated monthly installments (over the next 12 years), and the first life assured
installment will start from date of death
•The nominee will not have the option of taking the installments in lump sum
•All risk cover under the policy will cease as on the date of death of the life assured
•The policy will terminate on payment of the 144th monthly installment
#
Sum Assured on Death is higher of (i) sum assured (ii) 10 times of Annualised Premium*.
*Annualised Premium is exclusive of extra premium, rider premium, Goods and Service Tax, /any other applicable tax levied, subject to changes in tax
laws if any.
**Total Premium is exclusive of extra premium, rider premium, Goods and Service Tax/any other applicable tax levied, subject to changes in tax laws, if
any. Goods and Service Tax/any other applicable tax levied, subject to changes in tax laws will be collected over and above the premium under the policy.
Bajaj Allianz Life Insurance Co. Ltd.,
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
Premium Premiums at regular intervals are payable for the entire premium payment term as chosen by you. The premium payment term chosen by you is the basis
payment on which Benefit Illustration has been drawn and shall also be mentioned in the Policy Schedule.

Bajaj Allianz Accidental Death Benefit Rider UIN:116B034V02

Bajaj Allianz Accidental Permanent Total/ Partial Disability Benefit Rider UIN:116B036V02
Riders Bajaj Allianz Critical Illness Benefit Rider UIN:116B035V02
Available Bajaj Allianz Family Income Benefit Rider UIN:116B037V02
Bajaj Allianz Waiver of Premium Benefit Rider UIN:116B031V02
Please refer to respective product/ rider sales literature or visit Company website or consult your “Insurance Consultant” for more details and eligibility
conditions.

If you have not paid at least 2 years’ premiums
in full, then your policy will lapse at the expiry
Non-payment
of premium of the grace period and no benefits under the
plan will be paid.
If you have paid at least 2 years’ premiums in full and subsequent premium are not paid, then
your policy will be converted to a paid-up policy at the expiry of the grace period.
a)The Sum Assured and the Sum Assured on Death under the policy will be reduced to the
paid-up Sum Assured and paid-up Sum Assured on Death respectively.
b)The vested bonuses as on the paid-up date shall remain attached to the policy. A paid-up
policy will not accrue any further bonus.

a) The Maturity Benefit under a paid-up policy will be the vested bonuses attached in the policy till the policy became a paid-up policy.
b) The Survival Benefit under a paid-up policy will be the paid-up GMI i.e. paid-up Sum Assured, divided by 144 months and is payable every month
starting from the end of premium payment term as long as the life assured is alive, till the end of the policy term. If paid-up GMI is less than Rs. 400 per
month, then, the benefit will be paid annually which will be equal to paid-up Sum Assured in 12 yearly installments over the next 12 years.
c) The Death Benefit under a paid-up policy will be the paid-up Sum Assured on Death plus vested bonus plus terminal bonus, if any attached in the policy
till the policy became a paid-up policy, subject to a minimum of 105% of total premiums paid. The Death Benefit will be paid as per the life cover variant
chosen at inception.
d) In case ‘Assure’ variant was chosen at inception, the paid-up sum assured on death plus vested bonuses, if any will be paid to the nominee as a lump-
Paid-Up Benefit sum.
e) In case ‘Income’ variant was chosen at inception, the vested bonus, plus terminal bonus, if any, will be paid immediately and the paid-up sum assured
on death will be paid to the nominee as monthly income, over the next 144 equated monthly installments (over the next 12 years). The first
installment will start from date of death. If the monthly income is less than Rs. 400 per month, then the benefit will be paid annually in 12 yearly
installments over the next 12 years.
f) The paid-up GMI paid during the period from the date of death to the date of intimation will be recovered from the monthly income/s.
You may revive a lapsed/ paid-up policy during the revival period of 5 years from the due date of first unpaid premium, subject to the revival conditions
mentioned under the plan.

Although it is not advisable to surrender your policy unless there is an extreme urgency, you will have the option to surrender your policy anytime, provided
at least 2 full years’ premiums in full have been paid.
Surrender
The surrender value shall be higher of the Guaranteed Surrender Value (GSV) and the Special Surrender Value (SSV).

You may revive your lapsed/ paid-up policy during the revival period of five (5) years from the due date of first unpaid premium, subject to the revival
Revival conditions under the policy

The policy will terminate on the earlier occurrence of either of the following events:
• on payment of surrender value
• on the maturity date
Termination • on the expiry of the revival period of five (5) years from the date of first unpaid premium, in case of a lapsed policy
• on date of death of the life assured in case of ‘Assure’
• on payment of the 144th installment in case of ‘Income’, however the risk cover under the policy will terminate on date of death
• on free look cancellation

You will have the option to review the terms and conditions of the policy and if you disagree to any of the terms & conditions, you will have an
Free Look option to return the policy within 15 days of the receipt of this policy and thirty (30) days in case of electronic policy and policy obtained
Cancelation through distance mode. You will be entitled to a refund comprising of all premiums (excluding applicable taxes) paid, less the proportionate
amount of risk premium including proportionate amount of rider risk premium for the period the life assured was provided cover and the
expenses incurred by the company on account of medical examination and stamp duty charges stating the reasons for your objections.

Regd. Office Address: Bajaj Allianz Life insurance Company Ltd, Bajaj Allianz House, Airport Road, Pune - 411006 | Reg.No.: 116. | Visit us:
Contact us www.bajajallianzlife.com | BALIC CIN:U66010PN2001PLC015959 | Mail us : customercare@bajajallianz.co.in | Fax No: 02066026789 Call on :
Toll free no. 1800 209 7272

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
 Do's and Don'ts
• Do fill the proposal form very carefully and personally in CAPITAL letters in blue ink only
• Do provide true and complete information
• Do provide correct contact number, address and email ID, and update in case of any change, so that you can receive necessary communication
• Do sign on all the documents provided by you (Self Attestation)
• Do provide your recent passport photograph
Do’s
• Do draw cheque/ DD, in favour of “Bajaj Allianz Life Insurance Co. Ltd.”
• Do read the policy bond carefully upon receipt of the same.
• Do contact us if you do not receive the policy bond or any other communication from the Company within 30 days.
• Do read the enclosed Benefit Illustration carefully before signing
• Do register for Auto Debit Instructions/ ECS to ensure timely payments of your premium on due dates.

• Do not sign any blank proposal form

• Do not leave any column blank in the proposal form
Don’ts • Do not conceal any facts as this could lead to dispute at the time of a claim
• Do not miss or delay your premium payment
• Do not rely on any commitments of any additional benefits made by anyone apart from what has been highlighted herein above.

Disclaimer
This document contains the highlights of the product Bajaj Allianz Life Income Assure UIN: 116N139V02 and is subject to the terms and conditions as contained in the policy
document. The terms and conditions as contained in the policy document shall govern the contractual relationship and shall be binding. For details on any of the matters
highlighted herein above, please refer to policy document upon receipt of the same by you. The standard terms and conditions of the product is also available on the Company
website at www.bajajallianzlife.com. | Mail us : customercare@bajajallianz.co.in | Call on : Toll free no. 1800 209 7272 | Fax No: 02066026789

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
Quotation No : 60038658070

Bajaj Allianz Life Income Assure

A Non-linked Participating Guaranteed Monthly Income Life Insurance Plan

Name of the Prospect/ Policyholder: Dear Mam Name of the Product: Bajaj Allianz Life Income Assure
Age (Years): 39 Tag Line: A Non-linked Participating Guaranteed Monthly
Gender Female Income Life Insurance Plan
Name of the Life Assured: Dear Mam Unique Identification Number: 116N139V02
Age (Years): 39 GST Rate(First Year): 4.50%
Gender Female GST Rate(2nd Year onwards): 2.25%
Policy Term (Years): 24
Premium Payment Term (Years): 12
Amount of Instalment Premium (Rs.): 50,008
Mode of Payment of Premium: Annual

How to read and understand this benefit illustration?

This benefit illustration is intented 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 illustrations 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: Income Sum Assured (Rs.): 6,76,656

Bonus Type: Compound Reversionary Bonus Sum Assured on death( at inception of the 6,76,656
policy ) of first life (Rs.):

Premium Summary
Base Plan Riders Total Installment Premium
Installment Premium without GST 50,008 0 50,008
Installment Premium with First Year GST 52,258 0 52,258
Installment Premium with GST 2nd year Onwards 51,133 0 51,133

(Amount in Rupees )
Total Benefits including Guaranteed and Non Guaranteed Benefits
Guaranteed Benefits
Non Guaranteed Benefit @4% p.a. Non Guaranteed Benefit @8% p.a. Surrender Benefit## Maturity Benefit Death Benefit

Accrued Maturity Accrued Maturity

Death Compound Guaranteed Special Benefit Compound Guaranteed Special Benefit Surrender Surrender Total Total Total Total
Benefit Maturity Rev. Surrender Surrender Under Rev. Surrender Surrender Under Value Value Maturity Maturity Death Death
Life Annualized Survival ^! Benefit Bonus (if Value Value Paid-Up Bonus (if Value Value Paid-Up Receivable Receivable Benefit Benefit Benefit Benefit
Policy Premium (GSV) (SSV) (GSV) (SSV) ** ** incl incl incl incl
Year Assured's
Age (Excl of Benefit
~
declared) Policy# declared) Policy# Terminal Terminal Terminal Terminal
GST) Bonus, if Bonus, if Bonus, if Bonus, if
any any any any
EOYe EOTe EOYe EOYe EOYe EOYe EOYe EOYe EOYe EOTe EOYe 4% EOYe8% @4% @8% @4% @8%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 39 50,008 0 6,76,656 0 3,383 0 0 0 20,976 0 0 0 0 0 0 0 680039* 697632*
2 40 50,008 0 6,76,656 0 6,783 30,982 39,480 6,783 42,603 36,140 51,308 42,603 39,480 51,308 0 0 683439* 719259*
3 41 50,008 0 6,76,656 0 10,201 54,108 62,268 10,201 64,900 62,685 81,257 64,900 62,268 81,257 0 0 686857* 741556*
4 42 50,008 0 6,76,656 0 13,635 1,02,344 87,291 13,635 87,888 1,15,025 1,14,390 87,888 1,02,344 1,15,025 0 0 690291* 764544*
5 43 50,008 0 6,76,656 0 17,086 1,28,198 1,14,712 17,086 1,11,589 1,45,773 1,50,965 1,11,589 1,28,198 1,50,965 0 0 693742* 788245*
6 44 50,008 0 6,76,656 0 20,555 1,54,187 1,44,704 20,555 1,36,025 1,77,574 1,91,262 1,36,025 1,54,187 1,91,262 0 0 697211* 812681*
7 45 50,008 0 6,76,656 0 24,041 1,80,331 1,77,452 24,041 1,61,218 2,10,587 2,35,581 1,61,218 1,80,331 2,35,581 0 0 700697* 837874*
8 46 50,008 0 6,76,656 0 27,545 2,14,650 2,13,148 27,545 1,87,192 2,52,997 2,84,241 1,87,192 2,14,650 2,84,241 0 0 704201* 863848*
9 47 50,008 0 6,76,656 0 31,066 2,55,666 2,52,007 31,066 2,13,971 3,03,513 3,37,594 2,13,971 2,55,666 3,37,594 0 0 707722* 890627*
10 48 50,008 0 6,76,656 0 34,604 2,94,905 2,94,251 34,604 2,41,581 3,53,874 3,96,014 2,41,581 2,94,905 3,96,014 0 0 711260* 918237*
11 49 50,008 0 6,76,656 0 38,161 3,41,896 3,40,132 38,161 2,70,046 4,13,860 4,59,920 2,70,046 3,41,896 4,59,920 0 0 714817* 946702*
12 50 50,008 0 6,76,656 0 41,735 3,86,171 3,89,920 0 2,99,394 4,73,293 5,29,770 0 3,89,920 5,29,770 0 0 718391* 976050*
13 51 0 56,388 6,76,656 0 45,327 3,50,378 3,83,265 0 3,29,651 4,55,156 5,45,419 0 3,83,265 5,45,419 0 0 721983* 1006307*
14 52 0 56,388 6,76,656 0 48,937 3,08,951 3,74,405 0 3,60,847 4,34,275 5,61,337 0 3,74,405 5,61,337 0 0 725593* 1037503*
15 53 0 56,388 6,76,656 0 52,564 2,73,943 3,63,073 0 3,93,009 4,23,162 5,77,513 0 3,63,073 5,77,513 0 0 729220* 1069665*
16 54 0 56,388 6,76,656 0 56,211 2,33,409 3,48,974 0 4,26,169 4,10,402 5,93,938 0 3,48,974 5,93,938 0 0 732867* 1102825*
17 55 0 56,388 6,76,656 0 59,875 1,99,419 3,31,774 0 4,60,357 4,08,687 6,10,598 0 3,31,774 6,10,598 0 0 736531* 1137013*
18 56 0 56,388 6,76,656 0 63,558 1,60,047 3,11,100 0 4,95,604 4,06,813 6,27,475 0 3,11,100 6,27,475 0 0 740214* 1172260*
19 57 0 56,388 6,76,656 0 67,259 1,27,384 2,86,532 0 5,31,944 4,17,716 6,44,546 0 2,86,532 6,44,546 0 0 743915* 1208600*
20 58 0 56,388 6,76,656 0 70,978 89,527 2,57,592 0 5,69,411 4,30,479 6,61,777 0 2,57,592 6,61,777 0 0 747634* 1246067*
21 59 0 56,388 6,76,656 0 74,716 58,597 2,23,738 0 6,08,039 4,58,379 6,79,127 0 2,23,738 6,79,127 0 0 751372* 1284695*
22 60 0 56,388 6,76,656 0 78,473 64,524 1,84,353 0 6,47,864 5,32,702 6,96,541 0 1,84,353 6,96,541 0 0 755129* 1324520*
23 61 0 56,388 6,76,656 0 82,249 74,259 1,38,726 0 6,88,924 6,21,997 7,13,948 0 1,38,726 7,13,948 0 0 758905* 1365580*
24 62 0 56,388 6,76,656 0 86,043 0 0 0 7,31,257 0 0 0 0 0 86,043 7,31,257 762699* 1407913*
Notes: Annualized premium excludes underwri ng extra premium, the premiums paid towards the riders, if any and Goods and Service Tax. Refer Sales literature for explana on of

1
Quotation No : 60038658070

terms used in this illustration. 

 
EOYe :  End Of Policy Year              &nbs p;EOTe :  End Of Policy Term
 
~ Survival Benefit will be paid in monthly installments (unless each installment is less than Rs.400/-). As such, the displayed values of Income Benefit are the sums of monthly benefits
paid over the course of the corresponding years.
 
^! In case of Death Benefit, the corresponding number in the 'Policy Year' column should be read as the Year in which Death happens at Year-End.
 
* In case of Plan-Variant 'INCOME', the vested bonus & terminal bonus, if any, will be paid immediately. The amount of (death benefit minus the vested bonus &
terminal bonus, if any) will be paid in 144 equated monthly  installments starting from date of settlement of the death benefit as income to the nominee. 
 
# In case of 'Paid-Up' Benefits, the corresponding number in the 'Policy Year' column should be read as the Number of Completed Years' Premiums Paid.In
case of Paid up, the Survival Benefit will also be payable which is equal to paid up GMI(paid up GMI is GMI mul plied by no. of premiums paid divided by no. of premiums payable)
and will be paid in monthly installments (over the next 12 years). If the paid up GMI (Paid-up SA / 144) is less than Rs. 400 per month, then, the benefit will be paid annually, which will
be equal to paid-up Sum Assured in 12 yearly installments over the next 12 years.
 
## In case of 'Surrender' Benefits, the corresponding number in the 'Policy Year' column should be read as the Year in which the Policy is Surrendered at Year-End.
 
** 'Surrender Value Receivable' includes Base Policy Surrender Value and Rider Surrender Value, if any.
 
I, ___ _____, have explained the premiums, charges and benefits under the policy fully I, _ Dear Mam __ , having received the informa on with respect to the above, have
to the prospect / policyholder. understood the above statement before entering into the contract.

Place:  
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect / Policyholder
 
 
Disclaimers:
 
1. The above information should be read in conjunction with the Sales Literature.
 
2. Further clarification can be sought by contacting company's sales representative or by sending an e-mail to customercare@bajajallianz.co.in
 
3. Income Benefit: Star ng from the end of PPT, Guaranteed Monthly Income (GMI) shall be receivable every month ll either the Life Assured dies, surrenders the Policy or the Policy
matures.
 
4. The company may declare a rate of Compound Reversionary Bonus in a year applicable for that year. This rate will be expressed as a percentage of the Sum Assured. This percentage
will be applied on the Sum Assured plus reversionary bonuses already a ached to the policy to determine the amount of reversionary bonus to be added to the policy at that year
end. An interim bonus may also be declared. Furthermore, for a policy that has completed ten (10) years and where all due premiums have been paid, the company may declare a
terminal bonus. The compound reversionary bonus, interim bonus and terminal bonus may vary with the policy term chosen by the policyholder.
 
5. The illustrated figures of 'Surrender Value Receivable' include the respective 'Base Policy Surrender Value' and 'Rider Surrender Value'.
 
6. The investment returns illustrated above are only for the illustra ve purpose as mandated by the IRDA and do not in any way indicate the upper and lower limits of investment
return.
 
7. Goods & Service Tax and Cess, if any would be payable as per applicable tax laws. 
 
8. Premiums payable and benefits receivable would be eligible for tax benefits, as per the then existing tax laws.
 
9. Investment return shown at 8% & 4% are not guaranteed and are for illustrative purpose only.
 
10.The Maturity Benefit demonstrated at 4% and 8% does not include Terminal Bonus. Terminal Bonus, if any, shall become payable along with Maturity Benefit or Death Benefit.
 
Insurance is a subject matter of solicitation.
 
This illustration should be read along with the product brochure for detailed terms and conditions.
 
Bajaj Allianz Life Insurance Co. Ltd.,
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116.
Tel:(020) 66026777. Fax:(020) 66026789.
Email: customercare@bajajallianz.co.in
www.bajajallianzlife.com
 
&nbs p;