Name of the Prospect / Idfc bank Proposal No: 12991606

Policyholder:
Name of the Product: Tata AIA Life Insurance Fortune Guarantee
Age (years) : 62 Gender: Male Plus

Tag Line : Individual, Non-Linked Non-Participating

Name of the Life Assured 1 : Idfc Life Insurance Savings Plan
Age (years) : 52 Gender: Male Unique Identification No.: 110N158V12

i GST Rate: 4.5% for first year

Name of the Life Assured 2 : NA
am
red 2.25% second year onwards
Age (years) : NA Gender: NA

Policy Term (years) : 13

Premium Payment Term (years) : 12

Amount of Instalment Premium 112184

(Rs.):

Mode of Payment of Premium : Annual

This benefit illustration is intended to show year-wise premiums payable and

benefits under the policy.

Policy Details
Basic Sum Assured (First Death) Rs. 1040000
Policy Option Regular Income
Basic Sum Assured (Second Death, if any) Rs. NA

Income Period (years) 30

Sum Assured on First Death (at inception of the policy) Rs. 1040000
Income starts from Year 14

Income ends on Year 43

Sum Assured on Second Death, if any (at inception of the policy) Rs. NA
Guaranteed Annual Income (GAI)* Annual

*GAI shall commence from the end of the Policy Year, following Date of Maturity of Policy. In case of monthly frequency, GAI shall commence from the end
of the policy month following Date of Maturity of Policy.

Rider Details

Tata AIA Vitality (Wellness

No
Program)

Details of Life
Insured/Partner under Benefit Payout
Rider Name/UIN^ the Benefit Option Return of Benefit Premium Sum Premium Year 1
(Benefit Option/Benefit premium Option Payment Assured p.a. without Discount
Payout Option) Income option Term Term (Rs.) GST (Rs.) (Rs.)
Lumpsum Income
Name Age(yrs) Gender Duration
(Rs.) p.a.(Rs.)
(yrs)
CPR - Term and Terminal
Illness (Lumpsum and Fixed Idfc 52 M 1040000 NA NA No 13 12 1040000 7353 NA
Income)#

^CfPR: Tata AIA Life Insurance Non-Linked Comprehensive Protection Rider, UIN:110B033V03
#Premium calculated for Term Booster on Idfc is considering underwriting class as preferred.

Premium Summary
Base Plan Riders Total Instalment Premium

Instalment Premium without GST (Rs.) 100000 7353 107353

Instalment Premium with First year GST (Rs.) 104500 7684 112184

Instalment Premium post applicable discount with First year GST

104500 7684 112184
(Rs.)

Instalment Premium with GST 2nd year onwards (Rs.) 102250 7518 109768
 (Amount in Rupees)
Guaranteed Non - Guaranteed
Death
Policy Single/ Annualised Survival Death
Other Maturity Benefit
Year Premium Benefit / Benefit #Min Guaranteed #Special Surrender
Benefits, if (Second
Loyalty
any Benefit ## (First
Death,
Surrender Value Value
Additions Death)
if any)
1 100000 NA NA 0 1040000 NA 0 0

2 100000 NA NA 0 1040000 NA 60000 100880

3 100000 NA NA 0 1040000 NA 105000 165397

4 100000 NA NA 0 1040000 NA 200000 234605

5 100000 NA NA 0 1040000 NA 250000 316717

6 100000 NA NA 0 1040000 NA 300000 415251

7 100000 NA NA 0 1040000 NA 350000 517304

8 100000 NA NA 0 1040000 NA 464000 638126

9 100000 NA NA 0 1040000 NA 594000 781235

10 100000 NA NA 0 1050000 NA 740000 926690

11 100000 NA NA 0 1155000 NA 902000 1109682

12 100000 NA NA 0 1260000 NA 1080000 1309096

13 0 NA NA 0 1260000 NA 1080000 1407630

14 0 NA NA 117880 0 NA 0 0

15 0 NA NA 117880 0 NA 0 0

16 0 NA NA 117880 0 NA 0 0

17 0 NA NA 117880 0 NA 0 0

18 0 NA NA 117880 0 NA 0 0

19 0 NA NA 117880 0 NA 0 0

20 0 NA NA 117880 0 NA 0 0

21 0 NA NA 117880 0 NA 0 0

22 0 NA NA 117880 0 NA 0 0

23 0 NA NA 117880 0 NA 0 0

24 0 NA NA 117880 0 NA 0 0

25 0 NA NA 117880 0 NA 0 0

26 0 NA NA 117880 0 NA 0 0

27 0 NA NA 117880 0 NA 0 0

28 0 NA NA 117880 0 NA 0 0

29 0 NA NA 117880 0 NA 0 0

30 0 NA NA 117880 0 NA 0 0

31 0 NA NA 117880 0 NA 0 0

32 0 NA NA 117880 0 NA 0 0

33 0 NA NA 117880 0 NA 0 0

34 0 NA NA 117880 0 NA 0 0

35 0 NA NA 117880 0 NA 0 0

36 0 NA NA 117880 0 NA 0 0

37 0 NA NA 117880 0 NA 0 0

38 0 NA NA 117880 0 NA 0 0

39 0 NA NA 117880 0 NA 0 0

40 0 NA NA 117880 0 NA 0 0

41 0 NA NA 117880 0 NA 0 0

42 0 NA NA 117880 0 NA 0 0

43 0 NA NA 1317880 0 NA 0 0

Note: "Annualised Premium" shall be the premium payable in a year under a non-single pay option chosen by the policyholder, excluding the taxes, rider
premiums, underwriting extra premiums, loading for modal premiums, if any.
"Single Premium" shall be the premium payable under a single pay option chosen by the policyholder, excluding the taxes, rider premiums, underwriting

extra premiums, if any.

extra premiums, if any.
##The policyholder shall also be given the option to receive the Guaranteed Annual Income (GAI) on a monthly basis. This option has to be chosen at
inception and cannot be altered once chosen. The GAI illustrated above is the total amount payable in a year on selection of monthly mode.

#Surrender value illustrated above is the end of the policy year value.

#Special Surrender Value may be revised depending upon the prevailing marketing conditions.
#Surrender value will be higher of Guaranteed Surrender Value and Special Surrender Value

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

Place: i am red
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect/ Policyholder

Unique Reference Number - L&C/Advt/2024/Apr/1101 (Rider - L&C/Advt/2022/Sep/2271)

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013
Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license.
For more information, Call the Tata AIA Life Insurance Company Ltd Helpline number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com

(I)V.99.00/FY2024-2025_Q2/RELEASE 01-07-24/EXPIRY 30-09-2024 00WEBSITENQFGPSLV8N1 02-07-2024,12:14 PM

 Tata AIA Life Insurance - IRDA of India Regn no. 110

Customer Information Sheet/Know Your Policy

This document provides key information about your policy. You are also advised to go through your policy document.

Policy
SR. Description
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
1 Name of Insurance Tata AIA Life Insurance Non-Linked Comprehensive Protection Rider (UIN Policy
Product/ Rider 110B033V03) (A Non-Linked, Non-Participating Individual Health Rider) Schedule

2 Policy Number 12991606 Policy

Schedule

3 Type of Insurance Benefit (Where your insurance policy pays fixed amount on the occurrence of a Clause of
Product/Policy covered event) Part C

4 Sum Insured Sum Lumpsum Income Income Policy

(Basis)(Along with Benefit Option Schedule
Assured (Rs.) p.a.(Rs.) Duration (Yrs)
Amount)
Term Benefit with Accelerated
1040000 1040000 NA NA
Terminal Illness

In case of any change in Sum Assured after submission of proposal, please refer to
your latest Benefit Illustration Document.

5 Policy Coverage (What Benefit Option: Clause of

the policy covers) Term Benefit with Accelerated Terminal Illness:: Part C
and Part F

The Insured Amount under this option is payable on earlier of death or diagnosis
of Terminal illness of the Life Insured.

Maturity Benefit:
If you have chosen Return of Premium option at inception of the rider, on survival
till end of the Coverage Term provided the rider/benefit option is notterminated,
the Total Premiums Paid (Excluding loading for Modal Rider Premiums) towards
the respective benefit option shall be returned, after deduction of any claim payout
made under the respective benefit option and
In case the payout under Return of Premium option is triggered, the premiums
waived (if any) shall be added to the Total Premiums Paid by the Policyholder for
the calculation of the Return of Balance Premium for the respective Benefit
Option.

6 Exclusions (What the
policy does not cover)
Term Benefit with Accelerated Terminal Illness: Clause of
Part C
and Part
Suicide Exclusion:In case of death due to suicide within 12 months from the date F.
of commencement of risk under the policy or from the date of revival of the policy,
as applicable, the nominee or beneficiary of the policyholder shall be entitled to at Refer
least 80% of the totalpremiums paid till the date of death or the surrender value Definition
available as on the date of death whichever is higher, provided the policy is in and
force. Exclusions
No other claim would be entertained by the Company except the refund of 80% Annexure
Total Premiums Paid or the acquired surrender value, as applicable.
Apart from Suicide exclusion detailed above, no other exclusion is applicable in
the event of death.
Terminal Illness Exclusion: The Life Insured will not be entitled to any Terminal
Illness benefit if it is causeddirectly or indirectly due to or occasioned, accelerated
or aggravated by intentional self-inflicted injury or attempted suicide, whether
medically sane or insane.

7 Waiting Period Benefit Option Waiting Period Applicable Clause of

Part C
Term Benefit with Accelerated Terminal Illness Not Applicanble and Part F

8 Financial Limits of Not Applicable. Clause of

coverage Part C
 Tata AIA Life Insurance - IRDA of India Regn no. 110

coverage Part C

9 Claims/Claims To register claim, please visit the Company through any service touch points Clause of
Procedure mentioned in Policy servicing section. Part C
Reimbursement Claim Process: and Part F

1. Get treatment in hospital/nursing home as per the norm.

2. After paying the bills Intimate the claim to Company for reimbursement of the
amount
3. Register and submit all relevant and mandatory claim documents.
4. Company verifies/scrutinizes the documents and claim submitted basis your
policy coverage and details.
5. If claim is approved, Payment is settled into customer's account.

Please note that,

1. If any queries, a query letter will be sent to you.

2. If claim is rejected/denied, a rejection letter mentioning the reason for rejection
will be sent to you.

10 Policy Servicing Clause of

i. E-mail us at customercare@tataaia.com Part D
ii. Contact your Tata AIA Life Agent / Distributor and Part
iii. Call our helpline number 1-860-266-9966 (Call charges apply) G
iv. Visit the nearest the Tata AIA Life branch or CAMS Service Center
v. Log on to Online Customer Portal by visiting www.tataaia.com
vi. Write to us on the following address:
Tata AIA Life Insurance Company Limited 9th Floor, B - Wing, I-Think Techno
Campus, Behind TCS (Lodha), Pokhran Road No.2, Thane (West), Mumbai - 400
607

11 Grievances/Complaints You can register grievances through below modes: Clause of

Part G
i. Email us at life.complaints@tataaia.com
ii. Service avenues as mentioned above for Policyholder Servicing [other than email
].

Kindly address your complaints to "Grievance Redressal Department"

For escalations, (In case not satisfied with the decision or not receipt of any
response), customers can email to GRO@tataaia.com or write to - Grievance
Redressal Officer (GRO) Tata AIA Life Insurance Company Limited, 9th Floor, B -
Wing, I-Think Techno Campus, Behind TCS (Lodha), Thane (West), Mumbai - 400
607.
Insurance Ombudsman:
Where the redressal is not satisfactory despite the escalations, you may represent to
the Ombudsman. For contact details, contact number and email of the relevant
Ombudsman office, kindly refer the policy document or visit the IRDA of India
website http://www.policyholder.gov.in - Ombudsman / List of Insurance
Ombudsmen or our website www.tataaia.com.

12 Things to remember Freelook Period Clause of

Within a free look period of 30 days from the date of receipt of the Policy whether the Part C
policy is sourced electronically or otherwise You can return the policy for and Part
cancellation stating the reasons for the same, if You disagree to any of the terms or D
conditions of the Policy. Within Freelook You are entitled to a refund of the premium
paid without interest after deduction of proportionate risk premium stamp duty and
medical examination cost along with applicable taxes and cesses or levies, if any.
In respect of a linked insurance product, You shall receive the non-allocated
Premium plus charges levied by cancellation of Units plus Fund Value at the date of
cancellation less the deductions mentioned above.

Fraud, Mis-statement or Suppression: Clause of

Any fraud, mis-statement or suppression of a material fact under the Policy shall be Part C
dealt in accordance with Section 45 of the Insurance Act, 1938 as amended from and Part F
time to time.

13 Your Obligations Clause of

Please disclose all pre-existing disease/s or condition/s before buying a Policy. Part C
Non-disclosure may result in claim not being paid. and Part F
All information sought in the Proposal form is Material for issuance of the policy and
and settlement of claim. Annexure
Disclosure of Material Information and any changes therein during the Policy 1/
period should be communicated to us by Annexure
Sending an email to customercare@tataaia.com from your email id registered A
with us
Submission of the Request for Change form* (filled and signed) at any Tata
AIA Life Insurance Branch or Service Centre
 Tata AIA Life Insurance - IRDA of India Regn no. 110

AIA Life Insurance Branch or Service Centre

*Request for Change form is available on our website - www.tataaia.com

"We", "Us", "Our", "Insurer" or "Company" refers to Tata AIA Life Insurance Company Limited.

Declaration by the Policy Holder:

I have read the above and confirm having noted the details. I further confirm the below that:

a. In case of any change to the Sum Insured/ Rider after submission of the proposal, the details in the revised Benefit
Illustration and Customer Information Sheet would be applicable.
b. I have received a copy of the CIS through the download utility/ through my Salesperson.
c. I am aware that on request I can avail of the CIS in local language.

Place:
Date:
(Signature of Policy)