Name of the Prospect / Idfc Proposal No: 169368

Policyholder:
Name of the Product: Tata AIA Life Insurance Fortune Guarantee
Age (years) : 35 Gender: Male Plus

Tag Line : Individual, Non-Linked Non-Participating

Name of the Life Assured 1 : Idfc Life Insurance Savings Plan
Age (years) : 35 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 107126

(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. 1200000
Policy Option Regular Income
Basic Sum Assured (Second Death, if any) Rs. NA

Income Period (years) 25

Sum Assured on First Death (at inception of the policy) Rs. 1200000
Income starts from Year 14

Income ends on Year 38

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)
Tata AIA Benefit Protection
Rider (110B049V02) - Idfc 35 M NA NA NA NA 13 12 * 2513 NA
(Benefit Assure)

* The benefit equals all future premiums payable under the base policy and rider(if any) from the date of claim for a period as specified in the policy contract.
Please refer to the policy contract for more details.

Premium Summary
Base Plan Riders Total Instalment Premium

Instalment Premium without GST (Rs.) 100000 2513 102513

Instalment Premium with First year GST (Rs.) 104500 2626 107126

Instalment Premium post applicable discount with First year GST

104500 2626 107126
(Rs.)

Instalment Premium with GST 2nd year onwards (Rs.) 102250 2570 104820
 (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 1200000 NA 0 0

2 100000 NA NA 0 1200000 NA 60000 102298

3 100000 NA NA 0 1200000 NA 105000 167720

4 100000 NA NA 0 1200000 NA 200000 237901

5 100000 NA NA 0 1200000 NA 250000 321167

6 100000 NA NA 0 1200000 NA 300000 421085

7 100000 NA NA 0 1200000 NA 350000 524572

8 100000 NA NA 0 1200000 NA 464000 647091

9 100000 NA NA 0 1200000 NA 594000 792211

10 100000 NA NA 0 1200000 NA 740000 939710

11 100000 NA NA 0 1200000 NA 902000 1125273

12 100000 NA NA 0 1260000 NA 1080000 1327489

13 0 NA NA 0 1260000 NA 1080000 1427407

14 0 NA NA 120760 0 NA 0 0

15 0 NA NA 120760 0 NA 0 0

16 0 NA NA 120760 0 NA 0 0

17 0 NA NA 120760 0 NA 0 0

18 0 NA NA 120760 0 NA 0 0

19 0 NA NA 120760 0 NA 0 0

20 0 NA NA 120760 0 NA 0 0

21 0 NA NA 120760 0 NA 0 0

22 0 NA NA 120760 0 NA 0 0

23 0 NA NA 120760 0 NA 0 0

24 0 NA NA 120760 0 NA 0 0

25 0 NA NA 120760 0 NA 0 0

26 0 NA NA 120760 0 NA 0 0

27 0 NA NA 120760 0 NA 0 0

28 0 NA NA 120760 0 NA 0 0

29 0 NA NA 120760 0 NA 0 0

30 0 NA NA 120760 0 NA 0 0

31 0 NA NA 120760 0 NA 0 0

32 0 NA NA 120760 0 NA 0 0

33 0 NA NA 120760 0 NA 0 0

34 0 NA NA 120760 0 NA 0 0

35 0 NA NA 120760 0 NA 0 0

36 0 NA NA 120760 0 NA 0 0

37 0 NA NA 120760 0 NA 0 0

38 0 NA NA 1320760 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.
##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/FY2023-2024_Q2/RELEASE 01-07-24/EXPIRY 30-09-2024 004044777SEFGPSLV8N1 02-07-2024,09:58 AM

 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 Benefit Protection Rider (UIN: 110B049V02) Policy
Product/ Rider Schedule

2 Policy Number 169368 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 Policy

(Basis)(Along with Schedule
Amount) In case of any change in Sum Assured after submission of proposal, please refer to
your latest Benefit Illustration Document. Please refer to insured/proposer details in
policy schedule in case Waiver of Premium has been opted.

5 Policy Coverage (What Benefit Option: Clause of

the policy covers) Part C
and Part F
Benefit Assure : On death/Terminal Illness to the Life Assured, all the future
premiums of the base policy payable, if any, shall be waived off. Further, upon
death of the Life Assured, the Base Policy shall continue as in-force till the end of
the Policy Term with all the future survival / maturity benefits remaining intact as
per the Base Policy.

6 Exclusions (What the Exclusion in case of Suicide Clause of

policy does not cover) Part C
and Part
In case of death due to suicide by the Life Assured, within 12 months from the F.
date 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 Refer
entitled to at least 80% of the total premiums paid till the date of death or the Definition
surrender value available as on the date of death whichever is higher, provided and
the policy is in force. Exclusions
Annexure

Exclusion for Terminal Illness Benefit:

No claim will be payable if the condition arises directly or indirectly because of

attempted suicide in the first year from inception or revival of policy.

In case a Terminal Illness claim is not payable due to the above exclusions, the
policy will continue with the applicable death cover.

7 Waiting Period Benefit Option Waiting Period Applicable Clause of

Part C
Benefit Protection Rider Not Applicanble and Part F

8 Financial Limits of Not Applicable. Clause of

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

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 15 days from the date of receipt of the Policy/ 30 days in Part C
case of electronic policies/ policies obtained through distance mode, You can return and Part
the policy for cancellation stating the reasons for the same, if You disagree to any of D
the terms or 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

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

c. I am aware that on request I can avail of the CIS in local language.

Place:
Date:
(Signature of Policy)