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Name: ABHISHEK PANDEY Sum Assured: 423000.

00
DateOf Birth: 10/03/1980 Policy Term: 15
Age in(yrs): 43 PPT: 15

Gender: Male Mode: Yearly

Benefit Illustration for SHRIRAM LIFE ASSURED INCOME PLAN V04 POS
128N053V04
(This Benefit Illustration forms part of the Policy Document)

Guaranteed Non Guaranteed


Policy Total Annualized Survival Benefits / Other Benefits Maturity Benefit Death Benefit Min Guaranteed Special Surrender Value
Year Premium paid till Loyalty Additions if any Surrender Value
date
1 28200 0.00 0 0 562590 0 0

2 28200 0.00 0 0 562590 16920 11252

3 28200 0.00 0 0 562590 29610 20928

4 28200 0.00 0 0 562590 56400 33905

5 28200 0.00 0 0 562590 77550 50633

6 28200 0.00 0 0 562590 101520 71561

7 28200 0.00 0 0 562590 128310 97141

8 28200 0.00 0 0 562590 157920 127820

9 28200 0.00 0 0 562590 192888 164051

10 28200 0.00 0 0 562590 231240 206283

11 28200 0.00 0 0 562590 272976 254966

12 28200 0.00 0 0 562590 318096 310550

13 28200 0.00 0 0 562590 366600 373485

14 28200 0.00 0 0 562590 418488 444221

15 28200 0.00 0 0 562590 473760 523209

16 0 0.00 0 562590 0 0 0

Disclosures:
(1) This is only an illustration and does not in any way create any rights and/or obligations.
(2) This illustration is applicable to a healthy individual acceptance of the proposal is subject to underwriting.Premiums relating to riders and non-
standard risks are excluded from the above.
(3) The above amounts assume that all premiums have been paid on due date.
(4) The surrender value payable will be the maximum of GSV and SSV.
(5) Please contact nearest branch office for latest surrender values payable on your policy.

Policy Details
Death Benefit Pay-Out Option Lumpsum Sum Assured Rs. 423000.00
Maturity Benefit Pay-Out Option Lumpsum Sum Assured on Death (at inception of the policy) Rs. 562590
Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST 28200 0 28200
Instalment Premium with First Year GST 29469 29469
Instalment Premium with GST 2nd Year Onwards 28835 28835
Notes:
1) Annualized premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders,
if any Goods & Service Tax.

IRDAI Regn No:128


I, .........................................., have explained the premiums, and benefits I, ........................................
under the product fully to the prospect / Policyholder. having received the information with respect to the above, have
understood the above statement before entering into the contract

Date: Signature of Agent / Intermediary / Date : Signature of the Prospect/


Official /Specified Person Policy holder's signature
Place:

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