Proposal No:

Name of the Prospect/Policyholder: Mr. Rayees Name of the Product: Max Life Online Savings Plan
Tag Line: A Unit Linked Non Participating Individual Life Insurance Plan
Age & Gender: 36 Years, Male
Policy Option: Variant 2
Name of the Life Assured: Mr. Rayees Unique Identification No: 104L098V05
GST Rate: 18.00%
Age & Gender: 36 Years, Male Max Life State: Haryana
Policyholder Residential State: Haryana
Sum Assured: `12,00,000 Investment Strategy Opted for: NA
Policy Term & Premium Payment Term: 20 Years & 10 Years
Funds opted for along with their risk level
Amount of Installment Premium: `10,000 [Please specify the customer specific fund
Mode of payment of premium: Monthly option): NIFTY Smallcap Quality Index Fund (Risk Rating-Very High) :
100%

How to read and understand this benefit illustration?

This benefit illustration is intended to show what charges are deducted from your premiums and how the unit fund, net of charges and taxes, may grow over the years of the policy term if the fund earns a gross
return of 8% p.a. or 4% p.a. These rates, i.e., 8% p.a. and 4% p.a. are assumed only for the purpose of illustrating the flow of benefits if the returns are at this level. It should not be interpreted that the returns
under the plan are going to be either 8% p.a. or 4% p.a.

Net Yield mentioned corresponds to the gross investment return of 8% p.a., net of all charges but does not consider mortality, morbidity charges, underwriting extra, if any, guarantee charges and cost of riders, if
deducted by cancellation of units. It demonstrates the impact of charges exclusive of taxes on the net yield. Please note that the mortality charges per thousand sum assured in general, increases with age.

The actual returns can vary depending on the performance of the chosen fund, charges towards mortality, morbidity, underwriting extra, cost of riders, etc. The investment risk in this policy is borne by the
policyholder, hence, for more details on terms and conditions please read sales literature carefully.

Part A of this statement presents a summary view of year-by-year charges deducted under the policy, fund value, surrender value and the death benefit, at two assumed rates of return. Part B of this statement
presents a detailed break-up of the charges, and other values.

Note: 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. 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.
Rider Details

Critical Illness and Disability-Secure Rider - Rider Premium Payment Term and Rider Term NA Critical Illness and Disability Rider - Coverage Variant NA

Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Max Life Critical Illness and Disability-Secure Rider
Base Plan Total Installment Premium

Installment Premium without GST (in Rs.) 10,000 0 10,000

Installment Premium with first year GST (in Rs.) 10,000 0 10,000

Installment Premium with GST 2nd year onwards (in Rs.) 10,000 0 10,000

UIN: 104L098V05 Page 1 of 5

 Part A

(Amount in Rupees.)
At 4% p.a. Gross Investment Return At 8% p.a. Gross Investment Return
Commission
Policy Annualized
payable to
Year Premium Mortality, Morbidity Fund at End Surrender Mortality, Fund at End Surrender
Other Charges* GST Death Benefit Other Charges* GST Death Benefit intermediary
Charges of Year Value Morbidity Charges of Year Value

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 1,20,000 3,502 638 745 1,17,601 1,10,521 12,00,000 3,502 647 747 1,20,047 1,12,967 12,00,000 -
2 1,20,000 3,641 1,837 986 2,38,298 2,32,634 12,00,000 3,641 1,897 997 2,48,000 2,42,336 12,00,000 -
3 1,20,000 3,795 3,068 1,235 3,62,158 3,57,910 12,00,000 3,795 3,229 1,264 3,84,371 3,80,123 12,00,000 -
4 1,20,000 3,960 4,331 1,492 4,89,256 4,86,896 12,00,000 3,960 4,649 1,550 5,29,714 5,27,354 12,00,000 -
5 1,20,000 4,162 5,627 1,762 6,19,638 6,19,638 12,00,000 4,162 6,162 1,858 6,84,586 6,84,586 12,00,000 -
6 1,20,000 4,394 6,956 2,043 7,53,359 7,53,359 12,00,000 4,394 7,774 2,190 8,49,593 8,49,593 12,00,000 -
7 1,20,000 4,619 8,320 2,329 8,90,519 8,90,519 12,00,000 4,619 9,492 2,540 10,25,424 10,25,424 12,00,000 -
8 1,20,000 4,886 9,718 2,629 10,31,164 10,31,164 12,00,000 4,886 11,322 2,917 12,12,756 12,12,756 12,00,000 -
9 1,20,000 5,156 11,152 2,935 11,75,387 11,75,387 12,00,000 5,156 13,272 3,317 14,12,359 14,12,359 12,00,000 -
10 1,20,000 5,506 12,622 3,263 13,23,192 13,23,192 12,60,000 5,506 15,349 3,754 16,24,962 16,24,962 12,60,000 -
11 - 5,977 13,466 3,500 13,52,737 13,52,737 12,60,000 5,977 16,891 4,116 17,26,961 17,26,961 12,60,000 -
12 - 6,400 13,765 3,630 13,82,595 13,82,595 12,60,000 6,400 17,951 4,383 18,35,304 18,35,304 12,60,000 -
13 - 6,863 14,067 3,767 14,12,725 14,12,725 12,60,000 6,863 19,076 4,669 19,50,367 19,50,367 12,60,000 -
14 - 7,306 14,372 3,902 14,43,162 14,43,162 12,60,000 7,306 20,272 4,964 20,72,630 20,72,630 12,60,000 -
15 - 7,712 14,680 4,031 14,73,956 14,73,956 12,60,000 7,712 21,544 5,266 22,02,620 22,02,620 12,60,000 -
16 - 8,065 14,992 4,150 15,05,181 15,05,181 12,60,000 8,065 22,896 5,573 23,40,922 23,40,922 12,60,000 -
17 - 8,328 15,309 4,255 15,36,958 15,36,958 12,60,000 8,328 24,335 5,879 24,88,207 24,88,207 12,60,000 -
18 - 8,818 15,630 4,401 15,69,030 15,69,030 12,60,000 8,818 25,866 6,243 26,44,799 26,44,799 12,60,000 -
19 - 9,671 15,952 4,612 16,00,970 16,00,970 12,60,000 9,671 27,492 6,689 28,10,882 28,10,882 12,60,000 -
20 - 10,611 16,271 4,839 16,32,669 16,32,669 12,60,000 10,611 29,216 7,169 29,86,987 29,86,987 12,60,000 -
*See Part B for details

IN THIS POLICY, THE INVESTMENT RISK IS BORNE BY THE POLICYHOLDER AND THE ABOVE INTEREST RATES ARE ONLY FOR ILLUSTRATIVE PURPOSE.

I ALSO UNDERSTAND THAT WHILST 100% OF MY FIRST YEAR PREMIUM WILL BE INVESTED IN UNIT LINKED INVESTMENT FUNDS THERE ARE CHARGES DURING THE FIRST POLICY
YEAR AS GIVEN IN THE BENEFIT ILLUSTRATION.

UIN: 104L098V05 Page 2 of 5

 I, ……………………………………………. (name), have explained the premiums, charges and I, Rayees (name), having received the information with respect to the above, have understood
benefits under the policy fully to the prospect / policyholder. the above statement before entering into the contract.

Place:
Date: 11/21/23 Signature / OTP Confirmation Date / Thumb Impression / Date:11/21/23 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.

Part B
Gross Yield 8% p.a. Net Yield 6.92% Amount in Rupees
Premium Annualized Premium - Policy
Policy Annualized Mortality Guarantee Other Additions to the Fund before Fund at End of Surrender Death
Allocation Premium Allocation GST Admin. FMC
Year Premium (AP) Charge Charge Charges* fund* FMC the Year Value Benefit
Charge (PAC) Charges Charge
1 1,20,000 - 1,20,000 3,502 747 - - - - 1,20,166 647 1,20,047 1,12,967 12,00,000
2 1,20,000 - 1,20,000 3,641 997 - - - - 2,48,245 1,897 2,48,000 2,42,336 12,00,000
3 1,20,000 - 1,20,000 3,795 1,264 - - - - 3,84,751 3,229 3,84,371 3,80,123 12,00,000
4 1,20,000 - 1,20,000 3,960 1,550 - - - - 5,30,237 4,649 5,29,714 5,27,354 12,00,000
5 1,20,000 - 1,20,000 4,162 1,858 - - - - 6,85,263 6,162 6,84,586 6,84,586 12,00,000
6 1,20,000 - 1,20,000 4,394 2,190 - - - - 8,50,433 7,774 8,49,593 8,49,593 12,00,000
7 1,20,000 - 1,20,000 4,619 2,540 - - - - 10,26,438 9,492 10,25,424 10,25,424 12,00,000
8 1,20,000 - 1,20,000 4,886 2,917 - - - - 12,13,955 11,322 12,12,756 12,12,756 12,00,000
9 1,20,000 - 1,20,000 5,156 3,317 - - - - 14,13,756 13,272 14,12,359 14,12,359 12,00,000
10 1,20,000 - 1,20,000 5,506 3,754 - - - - 16,26,569 15,349 16,24,962 16,24,962 12,60,000
11 - - - 5,977 4,116 - - - - 17,28,669 16,891 17,26,961 17,26,961 12,60,000
12 - - - 6,400 4,383 - - - - 18,37,119 17,951 18,35,304 18,35,304 12,60,000
13 - - - 6,863 4,669 - - - - 19,52,296 19,076 19,50,367 19,50,367 12,60,000
14 - - - 7,306 4,964 - - - - 20,74,679 20,272 20,72,630 20,72,630 12,60,000
15 - - - 7,712 5,266 - - - - 22,04,798 21,544 22,02,620 22,02,620 12,60,000
16 - - - 8,065 5,573 - - - - 23,43,237 22,896 23,40,922 23,40,922 12,60,000
17 - - - 8,328 5,879 - - - - 24,90,667 24,335 24,88,207 24,88,207 12,60,000
18 - - - 8,818 6,243 - - - - 26,47,414 25,866 26,44,799 26,44,799 12,60,000
19 - - - 9,671 6,689 - - - - 28,13,662 27,492 28,10,882 28,10,882 12,60,000
20 - - - 10,611 7,169 - - - - 29,89,941 29,216 29,86,987 29,86,987 12,60,000

UIN: 104L098V05 Page 3 of 5

 Gross Yield 4% p.a. Amount in Rupees
Premium Annualized Premium - Policy
Policy Annualized Mortality Guarantee Other Additions to the Fund before Fund at End of Surrender Death
Allocation Premium Allocation GST Admin. FMC
Year Premium (AP) Charge Charge Charges* fund* FMC the Year Value Benefit
Charge (PAC) Charges Charge
1 1,20,000 - 1,20,000 3,502 745 - - - - 1,17,717 638 1,17,601 1,10,521 12,00,000
2 1,20,000 - 1,20,000 3,641 986 - - - - 2,38,533 1,837 2,38,298 2,32,634 12,00,000
3 1,20,000 - 1,20,000 3,795 1,235 - - - - 3,62,516 3,068 3,62,158 3,57,910 12,00,000
4 1,20,000 - 1,20,000 3,960 1,492 - - - - 4,89,740 4,331 4,89,256 4,86,896 12,00,000
5 1,20,000 - 1,20,000 4,162 1,762 - - - - 6,20,250 5,627 6,19,638 6,19,638 12,00,000
6 1,20,000 - 1,20,000 4,394 2,043 - - - - 7,54,104 6,956 7,53,359 7,53,359 12,00,000
7 1,20,000 - 1,20,000 4,619 2,329 - - - - 8,91,399 8,320 8,90,519 8,90,519 12,00,000
8 1,20,000 - 1,20,000 4,886 2,629 - - - - 10,32,184 9,718 10,31,164 10,31,164 12,00,000
9 1,20,000 - 1,20,000 5,156 2,935 - - - - 11,76,549 11,152 11,75,387 11,75,387 12,00,000
10 1,20,000 - 1,20,000 5,506 3,263 - - - - 13,24,500 12,622 13,23,192 13,23,192 12,60,000
11 - - - 5,977 3,500 - - - - 13,54,074 13,466 13,52,737 13,52,737 12,60,000
12 - - - 6,400 3,630 - - - - 13,83,962 13,765 13,82,595 13,82,595 12,60,000
13 - - - 6,863 3,767 - - - - 14,14,122 14,067 14,12,725 14,12,725 12,60,000
14 - - - 7,306 3,902 - - - - 14,44,589 14,372 14,43,162 14,43,162 12,60,000
15 - - - 7,712 4,031 - - - - 14,75,413 14,680 14,73,956 14,73,956 12,60,000
16 - - - 8,065 4,150 - - - - 15,06,670 14,992 15,05,181 15,05,181 12,60,000
17 - - - 8,328 4,255 - - - - 15,38,478 15,309 15,36,958 15,36,958 12,60,000
18 - - - 8,818 4,401 - - - - 15,70,581 15,630 15,69,030 15,69,030 12,60,000
19 - - - 9,671 4,612 - - - - 16,02,553 15,952 16,00,970 16,00,970 12,60,000
20 - - - 10,611 4,839 - - - - 16,34,283 16,271 16,32,669 16,32,669 12,60,000

*There are no charges included in other charges. There are no additions included on Additions to the fund.
Notes: 1. Refer the sales literature for explanation of terms used in this illustration.
2. Fund management charge is based on the specific fund option(s) chosen.
3. In case rider charges are collected explicitly through collection of rider premium, and not by way of cancellation of units, then, such charges are not considered in this illustration. In other cases, rider charges are included in
other charges.

UIN: 104L098V05 Page 4 of 5

I, ……………………………………………. (name), have explained the premiums, charges and I, Rayees (name), having received the information with respect to the above, have understood
benefits under the policy fully to the prospect / policyholder. the above statement before entering into the contract.

Place:
Date: 11/21/23 Signature / OTP Confirmation Date / Thumb Impression / Date:11/21/23 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: 104L098V05 Page 5 of 5