Proposal No:

Name of the Prospect/Policyholder: Mr. Sanjay Name of the Product: Max Life Online Savings Plan
Tag Line: A Unit Linked Non Participating Individual Life Insurance Plan
Age & Gender: 33 Years, Male
Policy Option: Variant 2
Name of the Life Assured: Mr. Sanjay Unique Identification No: 104L098V05
GST Rate: 18.00%
Age & Gender: 33 Years, Male Max Life State: Haryana
Policyholder Residential State: Haryana
Sum Assured: `8,40,000 Investment Strategy Opted for: NA
Policy Term & Premium Payment Term: 30 Years & 5 Years
Funds opted for along with their risk level
Amount of Installment Premium: `7,000 [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.) 7,000 0 7,000

Installment Premium with first year GST (in Rs.) 7,000 0 7,000

Installment Premium with GST 2nd year onwards (in Rs.) 7,000 0 7,000

UIN: 104L098V05 Page 1 of 6

 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 84,000 2,212 448 479 82,607 76,759 12,60,000 2,212 455 480 84,325 78,378 12,60,000 -
2 84,000 2,242 1,291 636 1,67,471 1,63,506 12,60,000 2,242 1,333 643 1,74,287 1,70,323 12,60,000 -
3 84,000 2,306 2,157 803 2,54,611 2,51,637 12,60,000 2,306 2,270 824 2,70,222 2,67,248 12,60,000 -
4 84,000 2,358 3,046 973 3,44,105 3,42,123 12,60,000 2,358 3,269 1,013 3,72,545 3,70,563 12,60,000 -
5 84,000 2,417 3,959 1,148 4,36,012 4,36,012 12,60,000 2,417 4,335 1,215 4,81,680 4,81,680 12,60,000 -
6 - 2,532 4,434 1,254 4,45,073 4,45,073 12,60,000 2,532 5,002 1,356 5,10,985 5,10,985 12,60,000 -
7 - 2,716 4,525 1,303 4,54,166 4,54,166 12,60,000 2,716 5,306 1,444 5,42,037 5,42,037 12,60,000 -
8 - 2,941 4,616 1,360 4,63,241 4,63,241 12,60,000 2,941 5,628 1,542 5,74,902 5,74,902 12,60,000 -
9 - 3,206 4,707 1,424 4,72,251 4,72,251 12,60,000 3,206 5,969 1,651 6,09,654 6,09,654 12,60,000 -
10 - 3,492 4,797 1,492 4,81,168 4,81,168 12,60,000 3,492 6,329 1,768 6,46,394 6,46,394 12,60,000 -
11 - 3,839 4,886 1,571 4,89,916 4,89,916 12,60,000 3,839 6,709 1,899 6,85,181 6,85,181 12,60,000 -
12 - 4,227 4,973 1,656 4,98,442 4,98,442 12,60,000 4,227 7,111 2,041 7,26,102 7,26,102 12,60,000 -
13 - 4,697 5,057 1,756 5,06,643 5,06,643 12,60,000 4,697 7,534 2,202 7,69,202 7,69,202 12,60,000 -
14 - 5,228 5,137 1,866 5,14,434 5,14,434 12,60,000 5,228 7,980 2,377 8,14,552 8,14,552 12,60,000 -
15 - 5,820 5,213 1,986 5,21,733 5,21,733 12,60,000 5,820 8,448 2,568 8,62,228 8,62,228 12,60,000 -
16 - 6,515 5,283 2,124 5,28,403 5,28,403 12,60,000 6,515 8,940 2,782 9,12,262 9,12,262 12,60,000 -
17 - 7,270 5,346 2,271 5,34,352 5,34,352 12,60,000 7,270 9,457 3,011 9,64,738 9,64,738 12,60,000 -
18 - 8,087 5,401 2,428 5,39,488 5,39,488 12,60,000 8,087 9,998 3,255 10,19,746 10,19,746 12,60,000 -
19 - 8,965 5,448 2,594 5,43,715 5,43,715 12,60,000 8,965 10,565 3,516 10,77,380 10,77,380 12,60,000 -
20 - 9,884 5,485 2,767 5,46,959 5,46,959 12,60,000 9,884 11,160 3,788 11,37,767 11,37,767 12,60,000 -
21 - 10,685 5,513 2,916 5,49,333 5,49,333 12,60,000 10,685 11,784 4,044 12,01,237 12,01,237 12,60,000 -
22 - 11,309 5,533 3,032 5,51,026 5,51,026 12,60,000 11,309 12,441 4,275 12,68,214 12,68,214 12,60,000 -
23 - 11,888 5,547 3,138 5,52,073 5,52,073 12,60,000 11,888 13,135 4,504 13,38,988 13,38,988 12,60,000 -
24 - 12,394 5,554 3,231 5,52,543 5,52,543 12,60,000 12,394 13,869 4,727 14,13,905 14,13,905 12,60,000 -
25 - 12,851 5,556 3,313 5,52,478 5,52,478 12,60,000 12,851 14,647 4,950 14,93,303 14,93,303 12,60,000 -
26 - 13,245 5,553 3,384 5,51,940 5,51,940 12,60,000 13,245 15,471 5,169 15,77,559 15,77,559 12,60,000 -
27 - 13,561 5,545 3,439 5,51,008 5,51,008 12,60,000 13,561 16,347 5,384 16,67,096 16,67,096 12,60,000 -

UIN: 104L098V05 Page 2 of 6

 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
28 - 14,219 5,532 3,555 5,49,263 5,49,263 12,60,000 14,219 17,275 5,669 17,61,853 17,61,853 12,60,000 -
29 - 15,359 5,506 3,756 5,46,104 5,46,104 12,60,000 15,359 18,255 6,051 18,61,589 18,61,589 12,60,000 -
30 - 16,687 5,465 3,987 5,41,266 5,41,266 12,60,000 16,687 19,286 6,475 19,66,411 19,66,411 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.

I, ……………………………………………. (name), have explained the premiums, charges and I, Sanjay (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: 12/26/23 Signature / OTP Confirmation Date / Thumb Impression / Date:12/26/23 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 3 of 6

 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 84,000 - 84,000 2,212 480 - - - - 84,409 455 84,325 78,378 12,60,000
2 84,000 - 84,000 2,242 643 - - - - 1,74,460 1,333 1,74,287 1,70,323 12,60,000
3 84,000 - 84,000 2,306 824 - - - - 2,70,489 2,270 2,70,222 2,67,248 12,60,000
4 84,000 - 84,000 2,358 1,013 - - - - 3,72,914 3,269 3,72,545 3,70,563 12,60,000
5 84,000 - 84,000 2,417 1,215 - - - - 4,82,157 4,335 4,81,680 4,81,680 12,60,000
6 - - - 2,532 1,356 - - - - 5,11,490 5,002 5,10,985 5,10,985 12,60,000
7 - - - 2,716 1,444 - - - - 5,42,573 5,306 5,42,037 5,42,037 12,60,000
8 - - - 2,941 1,542 - - - - 5,75,471 5,628 5,74,902 5,74,902 12,60,000
9 - - - 3,206 1,651 - - - - 6,10,257 5,969 6,09,654 6,09,654 12,60,000
10 - - - 3,492 1,768 - - - - 6,47,033 6,329 6,46,394 6,46,394 12,60,000
11 - - - 3,839 1,899 - - - - 6,85,858 6,709 6,85,181 6,85,181 12,60,000
12 - - - 4,227 2,041 - - - - 7,26,820 7,111 7,26,102 7,26,102 12,60,000
13 - - - 4,697 2,202 - - - - 7,69,962 7,534 7,69,202 7,69,202 12,60,000
14 - - - 5,228 2,377 - - - - 8,15,357 7,980 8,14,552 8,14,552 12,60,000
15 - - - 5,820 2,568 - - - - 8,63,080 8,448 8,62,228 8,62,228 12,60,000
16 - - - 6,515 2,782 - - - - 9,13,164 8,940 9,12,262 9,12,262 12,60,000
17 - - - 7,270 3,011 - - - - 9,65,692 9,457 9,64,738 9,64,738 12,60,000
18 - - - 8,087 3,255 - - - - 10,20,754 9,998 10,19,746 10,19,746 12,60,000
19 - - - 8,965 3,516 - - - - 10,78,445 10,565 10,77,380 10,77,380 12,60,000
20 - - - 9,884 3,788 - - - - 11,38,892 11,160 11,37,767 11,37,767 12,60,000
21 - - - 10,685 4,044 - - - - 12,02,425 11,784 12,01,237 12,01,237 12,60,000
22 - - - 11,309 4,275 - - - - 12,69,468 12,441 12,68,214 12,68,214 12,60,000
23 - - - 11,888 4,504 - - - - 13,40,312 13,135 13,38,988 13,38,988 12,60,000
24 - - - 12,394 4,727 - - - - 14,15,304 13,869 14,13,905 14,13,905 12,60,000
25 - - - 12,851 4,950 - - - - 14,94,780 14,647 14,93,303 14,93,303 12,60,000
26 - - - 13,245 5,169 - - - - 15,79,119 15,471 15,77,559 15,77,559 12,60,000
27 - - - 13,561 5,384 - - - - 16,68,745 16,347 16,67,096 16,67,096 12,60,000
28 - - - 14,219 5,669 - - - - 17,63,595 17,275 17,61,853 17,61,853 12,60,000
29 - - - 15,359 6,051 - - - - 18,63,430 18,255 18,61,589 18,61,589 12,60,000

UIN: 104L098V05 Page 4 of 6

 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
30 - - - 16,687 6,475 - - - - 19,68,355 19,286 19,66,411 19,66,411 12,60,000

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 84,000 - 84,000 2,212 479 - - - - 82,689 448 82,607 76,759 12,60,000
2 84,000 - 84,000 2,242 636 - - - - 1,67,636 1,291 1,67,471 1,63,506 12,60,000
3 84,000 - 84,000 2,306 803 - - - - 2,54,862 2,157 2,54,611 2,51,637 12,60,000
4 84,000 - 84,000 2,358 973 - - - - 3,44,446 3,046 3,44,105 3,42,123 12,60,000
5 84,000 - 84,000 2,417 1,148 - - - - 4,36,443 3,959 4,36,012 4,36,012 12,60,000
6 - - - 2,532 1,254 - - - - 4,45,513 4,434 4,45,073 4,45,073 12,60,000
7 - - - 2,716 1,303 - - - - 4,54,615 4,525 4,54,166 4,54,166 12,60,000
8 - - - 2,941 1,360 - - - - 4,63,699 4,616 4,63,241 4,63,241 12,60,000
9 - - - 3,206 1,424 - - - - 4,72,718 4,707 4,72,251 4,72,251 12,60,000
10 - - - 3,492 1,492 - - - - 4,81,643 4,797 4,81,168 4,81,168 12,60,000
11 - - - 3,839 1,571 - - - - 4,90,400 4,886 4,89,916 4,89,916 12,60,000
12 - - - 4,227 1,656 - - - - 4,98,935 4,973 4,98,442 4,98,442 12,60,000
13 - - - 4,697 1,756 - - - - 5,07,144 5,057 5,06,643 5,06,643 12,60,000
14 - - - 5,228 1,866 - - - - 5,14,943 5,137 5,14,434 5,14,434 12,60,000
15 - - - 5,820 1,986 - - - - 5,22,249 5,213 5,21,733 5,21,733 12,60,000
16 - - - 6,515 2,124 - - - - 5,28,925 5,283 5,28,403 5,28,403 12,60,000
17 - - - 7,270 2,271 - - - - 5,34,881 5,346 5,34,352 5,34,352 12,60,000
18 - - - 8,087 2,428 - - - - 5,40,022 5,401 5,39,488 5,39,488 12,60,000
19 - - - 8,965 2,594 - - - - 5,44,253 5,448 5,43,715 5,43,715 12,60,000

UIN: 104L098V05 Page 5 of 6

 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
20 - - - 9,884 2,767 - - - - 5,47,500 5,485 5,46,959 5,46,959 12,60,000
21 - - - 10,685 2,916 - - - - 5,49,876 5,513 5,49,333 5,49,333 12,60,000
22 - - - 11,309 3,032 - - - - 5,51,571 5,533 5,51,026 5,51,026 12,60,000
23 - - - 11,888 3,138 - - - - 5,52,618 5,547 5,52,073 5,52,073 12,60,000
24 - - - 12,394 3,231 - - - - 5,53,089 5,554 5,52,543 5,52,543 12,60,000
25 - - - 12,851 3,313 - - - - 5,53,025 5,556 5,52,478 5,52,478 12,60,000
26 - - - 13,245 3,384 - - - - 5,52,486 5,553 5,51,940 5,51,940 12,60,000
27 - - - 13,561 3,439 - - - - 5,51,553 5,545 5,51,008 5,51,008 12,60,000
28 - - - 14,219 3,555 - - - - 5,49,806 5,532 5,49,263 5,49,263 12,60,000
29 - - - 15,359 3,756 - - - - 5,46,644 5,506 5,46,104 5,46,104 12,60,000
30 - - - 16,687 3,987 - - - - 5,41,801 5,465 5,41,266 5,41,266 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.

I, ……………………………………………. (name), have explained the premiums, charges and I, Sanjay (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: 12/26/23 Signature / OTP Confirmation Date / Thumb Impression / Date:12/26/23 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 6 of 6