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Quotation No : 60045551074

Bajaj Allianz Life POS Goal Suraksha

A Non-Par Non-linked Endowment Plan

Name of the Prospect/ Policyholder: Johny . Name of the Product: Bajaj Allianz Life POS Goal Suraksha
Age (Years): 27 Tag Line: A Non-Participating Non-Linked Life Insurance
Gender Male Plan
Name of the Life Assured: Johny . Unique Identification Number: 116N155V10
Age (Years): 27 GST Rate(First Year): 4.50%
Gender Male GST Rate(2nd Year onwards): 2.25%
Policy Term (Years): 15
Premium Payment Term (Years): 12
Amount of Instalment Premium (Rs.): 52,250
Mode of payment of Premium: Annual

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

Sum Assured (Rs.): 5,00,000 Sum Assured on Death (at inception of 5,00,000
the policy) (Rs.):

Premium Summary
Total Installment Premium
Installment Premium without GST 50,000
Instalment Premium with First Year GST including channel Premium 52,250
Installment Premium with GST 2nd year Onwards 51,125

(Amount in Rupees )
# ##

Guaranteed Non Guaranteed

Policy Life Assured Annualized Premium (Excl of Guaranteed Maturity Death Maturity Benefit under Paid-Up Guaranteed Surrender Value Special Surrender Value Surrender Value
Year Age GST) Additions Benefit Benefit^! Policy (GSV) (SSV) Receivable

EOTe EOTe EOYe EOTe EOYe EOYe EOYe

1 27 50,000 0 0 5,00,000 0 0 0 0
2 28 50,000 0 0 5,00,000 83,333 30,000 30,000 30,000
3 29 50,000 0 0 5,00,000 1,25,000 52,500 52,500 52,500
4 30 50,000 0 0 5,00,000 1,66,667 1,00,000 1,00,000 1,00,000
5 31 50,000 0 0 5,00,000 2,08,333 1,25,000 1,25,000 1,25,000
6 32 50,000 0 0 5,00,000 2,50,000 1,50,000 1,50,000 1,50,000
7 33 50,000 0 0 5,00,000 2,91,667 1,75,000 1,75,000 1,75,000
8 34 50,000 0 0 5,00,000 3,33,333 2,40,000 2,40,000 2,40,000
9 35 50,000 0 0 5,00,000 3,75,000 2,70,000 2,70,000 2,70,000
10 36 50,000 0 0 5,25,000 4,16,667 3,00,000 3,50,000 3,50,000
11 37 50,000 0 0 5,77,500 4,58,333 3,57,500 4,40,000 4,40,000
12 38 50,000 0 0 6,30,000 5,00,000 4,20,000 5,10,000 5,10,000
13 39 0 0 0 6,30,000 5,00,000 4,50,000 6,60,000 6,60,000
14 40 0 0 0 6,30,000 5,00,000 5,40,000 8,70,000 8,70,000
15 41 0 5,79,500 10,79,500 6,30,000 0 0 0 0

EOYe: End Of Policy Year EOTe: End Of Policy Term

^! In case of Death Benefit, the corresponding number in the 'Policy Year' column should be read as the Year in which Death happens at Year-End.
# In case of 'Paid-Up' Benefits, the corresponding number in the 'Policy Year' column should be read as the Number of Completed Years' Premiums Paid.
## In case of 'Surrender' Benefits, the corresponding number in the 'Policy Year' column should be read as the Year in which the Policy is Surrendered at Year-End.
Notes:
Annualized Premium excludes underwri ng extra premium, the premiums paid towards the riders, if any, and Goods & Service Tax. Refer Sales literature for explana on of terms
used in this illustration.

I, __ ____ , have explained the premiums, charges and benefits under the policy fully to I,__Johny . __ , having received the informa on with respect to the above, have
the prospect / policyholder. understood the above statement before entering into the contract.

Place:
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect / Policyholder

Disclaimers:
1. The a bove informa tion s hould be rea d in conjunction with the Sa les Litera ture.

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Quotation No : 60045551074

2. Further cla rifica tion ca n be s ought by conta cting compa ny's s a les repres enta tive or by s ending a n e-ma il on customercare@bajajallianz.co.in.
3. Waiting Period:
Waiting period is the first 90 days from the date of acceptance of risk (date of issuance of policy).
In case of death during the waiting period other than due to an accident, only 100% of Total Premium* paid will be paid.
*Total Premiums paid is equal to (Annualized Premium * number of years for which premiums have been paid)
4. Death Benefit (Death of life assured during the policy term & if the policy is in-force for full sum assured):
Death during Waiting Period other than due to an Accident: Return of all premium/s paid till date.
Death during Waiting Period due to Accident and Death after Waiting Period due to any cause: Sum Assured on Death as on date of death & policy will terminate on payment of death benefit.
5. Maturity Benefit:
On survival of life assured to the maturity date, Guaranteed Sum Assured on Maturity* plus Guaranteed additions will be payable and policy will terminate on the maturity date.
*Guaranteed Sum Assured on Maturity and Sum Assured is 10 times the Annualized Premium.
6. Guaranteed Addition:
At the end of the policy term, on the maturity date, Guaranteed Addi ons as a mul ple of one (1) Annualised Premium, as per the table given below, will be a ached to the policy; provided all
the due premiums have been paid.
Age Band PT 10 PT 12 PT 12 PT 12 PT 15 PT 15 PT 15 PT 15 PT 15 PT 15 PT 20 PT 20 PT 20 PT 20 PT 20 PT 20 PPT
(Age at PPT 7 PPT 6 PPT 7 PPT 8 PPT 5 PPT 6 PPT 7 PPT 8 PPT 10 PPT 12 PPT 5 PPT 6 PPT 7 PPT 8 PPT 10 12
Entry)
0-24 0.01 0.04 1.53 2.98 0.32 2.48 4.51 6.32 9.50 12.48 5.07 7.55 9.88 12.55 17.08 20.57
25-34 0.01 0.04 1.41 2.82 0.32 2.23 4.05 5.81 8.77 11.59 4.35 6.53 9.07 11.66 15.95 18.86
35-45 0.01 0.04 1.28 2.75 0.32 2.08 3.81 5.54 8.25 10.96 4.22 6.38 8.67 11.28 15.39 17.82
46-55 0.01 0.04 1.20 2.53 0.32 2.00 3.29 4.96 7.99 10.63 NA NA NA NA NA NA
7. Surrender Benefit:
The surrender value receivable will be the higher of the Guaranteed Surrender Value (GSV) and the Special Surrender Value (SSV).
8. Goods & Service Tax (GST) would be payable as per applicable tax law.
9. All the benefits under this plan are guaranteed.
10. Premiums payable and benefits receivable would be eligible for tax benefits, as per the then existing tax laws.

This illustration should be read along with the product brochure for detailed terms and conditions.

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116.
Tel:(020) 66026777.
Email: customercare@bajajallianz.co.in
www.bajajallianzlife.com

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