BENEFIT ILLUSTRATION

[Date and Time of Illustration – 03 February 2024, 03:38 PM]

Name of the First Annuitant: Mr. Proposal No:

Age & Gender: 60 Years, Male
Name of the Second Annuitant, if any: Not Applicable Name of the Product: Max Life Smart Wealth Annuity Guaranteed Pension Plan
Age & Gender: Not Applicable
Non-linked Non Participating Individual/ Group General Annuity Savings
Policy Term: Not Applicable Tag Line:
Plan
Premium Payment Mode Single Pay
Unique Identification No: 104N137V02
Premium Payment Term 1 Year
Policy Sourced under: Individual
Amount of Installment Premium (excl. taxes) 2,00,000
Amount of Installment Premium (First Year Incl. taxes) 2,01,476 Max Life State: Delhi

Amount allocated for investment (First Year) 1,91,800 Policyholder Residential State: Delhi

<<Amount allocated for investment (Second Year)>> NA GST Rate: 18%*

Annuity Payment Mode Annual

Annuity Purchased From Agent Assisted Issue Date of Quote: 03-Feb-24

Annual Income Amount Starting On 03-Apr-2026 (Guaranteed) 14,326 Annuity Start Date: 03-Apr-26

*0% if qualifies as zero-rated supply under GST law

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Policy Details
Deferred Annuity - Single Life with Death Benefit for Life -
Annuity Variant Deferred Annuity Sub-Variant
Single Premium

Premium Payment Type Single Pay Deferment Period 1 Years 2 Months

Sum Assured on Death (at inception of the

Sum Assured Rs. 2,00,000 2,10,000
policy) Rs.

Waiver of Premium (WOP) Plus Rider Opted No Waiver of Premium (WOP) Plus Rider Term NA

Premium Summary

Base Plan Waiver of Premium Plus Rider Total Installment Premium

Installment Premium without GST (in Rs.) 2,00,000 0 2,00,000

Installment Premium with first year GST (in Rs.) 2,01,476 0 2,01,476
Installment Premium with GST 2nd year onwards (in Rs.) NA NA NA

UIN: 104N137V02 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 1 of 4
 (Amount in Rupees)

Guaranteed Non Guaranteed

Policy Single/ Annualized Minimum

Death Benefit (On <<Death Benefit (On
Year Premium (BOY) Base Annuity (EOY) Loyalty Annuity (EOY) Annuity Amount Guaranteed Special Surrender Value
Maturity Benefit Milestone Benefit first death of the death of Last
(EOY) Surrender Value (EOY)
annuitant(s)) Survivor) (EOY)>>
(EOY)

1 2,00,000 - - - - - 2,11,823 - 1,50,000 1,60,003

2 - - - - - - 2,11,823 - 1,50,000 1,61,619
3 - 14,326 - 14,326 - - 2,11,823 - 1,35,674 1,62,160
4 - 14,326 - 14,326 - - 2,10,000 - 1,51,348 1,62,678
5 - 14,326 - 14,326 - - 2,10,000 - 1,37,022 1,63,335
6 - 14,326 - 14,326 - - 2,10,000 - 1,22,696 1,63,950
7 - 14,326 - 14,326 - - 2,10,000 - 1,08,370 1,64,561
8 - 14,326 - 14,326 - - 2,10,000 - 94,044 1,65,292
9 - 14,326 - 14,326 - - 2,10,000 - 79,718 1,66,020
10 - 14,326 - 14,326 - - 2,10,000 - 65,392 1,66,744
11 - 14,326 - 14,326 - - 2,10,000 - 51,066 1,67,589
12 - 14,326 - 14,326 - - 2,10,000 - 36,740 1,68,267
13 - 14,326 - 14,326 - - 2,10,000 - 22,414 1,69,228
14 - 14,326 - 14,326 - - 2,10,000 - 8,088 1,70,023
15 - 14,326 - 14,326 - - 2,10,000 - - 1,70,938
16 - 14,326 - 14,326 - - 2,10,000 - - 1,71,829
17 - 14,326 - 14,326 - - 2,10,000 - - 1,72,821
18 - 14,326 - 14,326 - - 2,10,000 - - 1,73,789
19 - 14,326 - 14,326 - - 2,10,000 - - 1,74,694
20 - 14,326 - 14,326 - - 2,10,000 - - 1,75,679
21 - 14,326 - 14,326 - - 2,10,000 - - 1,76,744
22 - 14,326 - 14,326 - - 2,10,000 - - 1,77,849
23 - 14,326 - 14,326 - - 2,10,000 - - 1,78,871
24 - 14,326 - 14,326 - - 2,10,000 - - 1,79,913
25 - 14,326 - 14,326 - - 2,10,000 - - 1,80,974
26 - 14,326 - 14,326 - - 2,10,000 - - 1,82,016
27 - 14,326 - 14,326 - - 2,10,000 - - 1,83,038
28 - 14,326 - 14,326 - - 2,10,000 - - 1,84,163

UIN: 104N137V02 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 2 of 4
 Guaranteed Non Guaranteed

Policy Single/ Annualized Minimum

Death Benefit (On <<Death Benefit (On
Year Premium (BOY) Base Annuity (EOY) Loyalty Annuity (EOY) Annuity Amount Guaranteed Special Surrender Value
Maturity Benefit Milestone Benefit first death of the death of Last
(EOY) Surrender Value (EOY)
annuitant(s)) Survivor) (EOY)>>
(EOY)

29 - 14,326 - 14,326 - - 2,10,000 - - 1,85,105

30 - 14,326 - 14,326 - - 2,10,000 - - 1,86,110
31 - 14,326 - 14,326 - - 2,10,000 - - 1,87,158
32 - 14,326 - 14,326 - - 2,10,000 - - 1,88,086
33 - 14,326 - 14,326 - - 2,10,000 - - 1,89,058
34 - 14,326 - 14,326 - - 2,10,000 - - 1,90,033
35 - 14,326 - 14,326 - - 2,10,000 - - 1,90,847
36 - 14,326 - 14,326 - - 2,10,000 - - 1,91,645
37 - 14,326 - 14,326 - - 2,10,000 - - 1,92,427
38 - 14,326 - 14,326 - - 2,10,000 - - 1,93,171
39 - 14,326 - 14,326 - - 2,10,000 - - 1,93,899
40 - 14,326 - 14,326 - - 2,10,000 - - 1,94,570
41 - 14,326 - 14,326 - - 2,10,000 - - 1,95,225
42 - 14,326 - 14,326 - - 2,10,000 - - 1,95,822
43 - 14,326 - 14,326 - - 2,10,000 - - 1,96,260
44 - 14,326 - 14,326 - - 2,10,000 - - 1,96,804
45 - 14,326 - 14,326 - - 2,10,000 - - 1,97,331
46 - 14,326 - 14,326 - - 2,10,000 - - 1,97,699
47 - 14,326 - 14,326 - - 2,10,000 - - 1,98,070
48 - 14,326 - 14,326 - - 2,10,000 - - 1,98,423
49 - 14,326 - 14,326 - - 2,10,000 - - 1,98,821
50 - 14,326 - 14,326 - - 2,10,000 - - 1,99,078
51 - 14,326 - 14,326 - - 2,10,000 - - 1,99,378
52 - 14,326 - 14,326 - - 2,10,000 - - 1,99,579
53 - 14,326 - 14,326 - - 2,10,000 - - 1,99,822
54 - 14,326 - 14,326 - - 2,10,000 - - 1,99,986
55 - 14,326 - 14,326 - - 2,10,000 - - 2,00,233
56 - 14,326 - 14,326 - - 2,10,000 - - 2,00,400
57 - 14,326 - 14,326 - - 2,10,000 - - 2,00,400
UIN: 104N137V02 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 3 of 4
 Guaranteed Non Guaranteed

Policy Single/ Annualized Minimum

Death Benefit (On <<Death Benefit (On
Year Premium (BOY) Base Annuity (EOY) Loyalty Annuity (EOY) Annuity Amount Guaranteed Special Surrender Value
Maturity Benefit Milestone Benefit first death of the death of Last
(EOY) Surrender Value (EOY)
annuitant(s)) Survivor) (EOY)>>
(EOY)

58 - 14,326 - 14,326 - - 2,10,000 - - 2,00,400

59 - 14,326 - 14,326 - - 2,10,000 - - 2,00,400
60 - 14,326 - 14,326 - - 2,10,000 - - 2,00,400
61 - 14,326 - 14,326 - - 2,10,000 - - -
Notes:
• EOY: End of Year, BOY: Beginning of Year
• Annualized Premium excludes underwriting extra Premium, frequency loadings on premiums, the Premium paid towards the riders, if any, and Goods and Service Tax.
• This illustration must be read in conjunction with the Sales literature (Prospectus) and Policy Document for explanation of the terms used in the illustration.
• This quote is valid for a period of 10 calendar days from the date of issue. Please ensure that your proposal form is submitted at any of our offices within this duration as annuity rates change frequently.
• The Annuity Amount, Death Benefit, Surrender Benefit shown above are illustrated assuming that the event occurs at the end of the year.
• Surrender value paid will be higher of Guaranteed Surrender Value and Special Surrender Value.
• Tax benefits under the policy may be as per the prevailing Income Tax laws. Please consult your Tax advisor for more details.

*GST of 18% is applied only on premium amount derived as per Rule 32(4) of CGST Rule (i.e. the amount of rider premium, if any, and the non-investible component of premium amount for base policy).

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

Place: Signature / Thumb Impression / Electronic Signature of Date:2/3/24 Signature / Thumb Impression / Electronic Signature of
Date: 2/3/24 Agent/ Intermediary / Official Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N137V02 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 4 of 4