LifeBooster R17070922080013077

Combo ID: R17070922080013077
Dear Mr. Mr Mr ,
It doesn¶t matter where you are, you are nowhere compared to where you can go. In this
rush through life, it is you and your family that matters the most and that makes the entire
journey happy & deeply satisfying. Make these moments extra special with Kotak "Life
Booster" which provides Guaranteed Income every year at important stages of your life
and also financial protection in case of unfortunate event.
Pay Guaranteed Guaranteed High

Premiums Income Lumpsum Protection
just for every year from Benefit at
10 years 11th year important
onwards stages
of your life
"Life Booster" Solution is a combination solution consisting of multiple policies of Kotak Assured Savings Plan (UIN No.: 107N081V04) and Kotak
Assured Income Accelerator (UIN No.: 107N089V03) .This product is also available without this combination solution.
Page 1 of 21
Combo ID: R17070922080013077
Guarantee
Year
Income payable
1
every year
during the
Pay only Payout Period
2,00,000 p.a.
for
10 years
Income Boosters
Year increases the
10 Guaranteed
73,335 Income by 6%
every year
Year
11
77,735
Year Guaranteed
12
Loyalty Addition
82,135 @20% added to
Year your savings at
13 maturity
86,535
Year
14
Guaranteed
At the end of 15th year 90,935
Yearly Additions
11,04,013 Year
15
@10% on
cumulative
95,335 annual
Year
premiums
16
99,735
Year
17 Guaranteed
1,04,135
Maturity
Year
Benefit
18
1,08,536
Year
19
At the end of 20th year 1,12,936 Pay a fixed
16,09,791 Year Premium
20
just for 10 years
Please Note : Additional Benefit Rider is also available with this plan (if selected)
only
Guaranteed : Provided all premiums are paid and policy is in force
Page 2 of 21
Combo ID: R17070922080013077
MySolutions : Life Booster Report Date : 07/09/2022
Life Insured's Name : Mr. Mr Mr Life Insured's Age : 48 yrs Life Proposer's Age : 48 yrs
Benefit Illustration
Life Accrued
Policy Annual Guaranteed Guaranteed Death
Insured's Guaranteed
Year Premium* Income Maturity Benefit Benefit
Age Additions
1 49 2,00,000 13,334 - - 25,57,156
2 50 2,00,000 40,000 - - 25,83,822
3 51 2,00,000 80,000 - - 26,23,822
4 52 2,00,000 1,33,332 - - 26,77,155
5 53 2,00,000 1,99,998 - - 27,43,821
6 54 2,00,000 2,79,998 - - 28,23,820
7 55 2,00,000 3,73,330 - - 29,17,152
8 56 2,00,000 4,79,996 - - 30,23,818
9 57 2,00,000 5,99,994 - - 31,43,817
10 58 2,00,000 7,33,326 - - 32,77,149
11 59 - 7,33,326 73,335 - 32,77,149
12 60 - 7,33,326 77,735 - 32,77,149
13 61 - 7,33,326 82,135 - 32,77,149
14 62 - 7,33,326 86,535 - 32,77,149
15 63 - 7,33,326 90,935 11,04,013 32,77,149
16 64 - 3,66,663 95,335 - 21,73,136
17 65 - 3,66,663 99,735 - 21,73,136
18 66 - 3,66,663 1,04,135 - 21,73,136
19 67 - 3,66,663 1,08,536 - 21,73,136
20 68 - 3,66,663 1,12,936 16,09,791 21,73,136
*The above premium figures are exclusive of Goods and Services Tax and Cess. Goods and Services Tax and Cess rates are subject to change from time
to time as per the prevailing tax laws and/or any other laws. Riders are not included in the above illustration.
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Combo ID: R17070922080013077
Plan & Rider Details**
Modal Basic Sum

Product Policy Term Payment Term Payment Mode
Premium* Assured
Kotak Assured Savings Plan 15 10 Yearly 66,666 6,14,458
Kotak Accidental Death Benefit Rider - - - - -
Kotak Permanent Disability Benefit Rider - - - - -
Kotak Term Benefit Rider - - - - -
Kotak Life Guardian Benefit Rider - - - - -
Kotak Assured Savings Plan 20 10 Yearly 66,666 8,94,271
Kotak Income Accelerator Plan 20 10 Yearly 66,668 6,66,680
** The above illustration has been calculated for a 48 year old healthy Male
Page 4 of 21
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Combo ID: R17070922080013077

Advertisement Disclaimers:
“This advertisement is designed for combination of benefits of two or more policies of Kotak Assured Savings Plan and Kotak Assured Income
Accelerator. The customer has the choice of purchasing any one or more policies as per his/her need and choice and there is no compulsion whatsoever
that these policies are to be taken together as suggested by the insurer and presented in this advertisement. The customer is expected to ask questions,
understand and satisfy himself that the combination meets his/her specific needs better before deciding to purchase the combination. This benefit
illustration is the arithmetic combination and chronological listing of combined benefits of individual policies. The customer is advised to refer the detailed
sales brochure of Kotak Assured Savings Plan and Kotak Assured Income Accelerator.”
Other Disclaimers
1. This combination solution comprises of set of policies and riders of Kotak Assured Savings Plan (UIN No.: 107N081V04) and Kotak Assured Income
Accelerator (UIN No.: 107N089V03), Kotak Accidental Death Benefit Rider (UIN: 107B001V03), Kotak Permanent Disability Benefit Rider
(UIN:107B002V03), Kotak Life Guardian Benefit Rider (UIN: 107B012V02), Kotak Term Benefit Rider (UIN: 107B003V03).
2. These products are available individually with the Company and it is not mandatory for you to apply for this combination only.
3. Kotak Assured Savings is a savings-cum-protection oriented non-participating endowment assurance plan and Kotak Assured Income Accelerator is a
non-participating guaranteed income anticipated endowment plan.
4. The benefits available under the combination solution shall be as per the product policies terms and conditions.
5. The benefit of this combination solution shall become payable only if all premiums for the entire premium payment term is paid in full and the policy is
in force.
6. The given premium figures are exclusive of Goods and Services Tax and Cess, as applicable.Goods and Services Tax and Cess rates are subject to
change from time to time as per the prevalling tax laws and/or any other laws.
7. The values shown are for illustrative purposes only. For more details on risk factors, terms and conditions please read sales brochure carefully before
concluding a sale.
8. TDS at prevailing rate will be deducted from any amount paid under a life insurance policy subject to the provisions of prevailing tax laws. In case of
non availability of valid PAN, TDS will be deducted at higher rate. Tax laws are subject to changes from time to time. Kindly consult your tax advisor for
tax implication of your policy.
9. Based on the combination option selected, after paying all premiums for the full premium payment term, the payout for each policy term will be paid as
per the intervals selected by the policyholder.
10. Trade Logo displayed above belongs to Kotak Mahindra Bank Limited and is used by Kotak Mahindra Life Insurance Company Ltd under license.
11. To know the details of this combination solution, please go through the benefit illustrations of Individual products as provided to you.
BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS
IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums.
Public receiving such phone calls are requested to lodge a police complaint.
_______________________________________________________________________________________________________________
Kotak Assured Savings Plan UIN No.: 107N081V04, Form No N081,
Kotak Assured Income Accelerator UIN No.: 107N089V03, Form No. N089.
Kotak Mahindra Life Insurance Company Ltd.
CIN: U66030MH2000PLC128503, Regn. No.: 107, Regd. Office: 8th Floor, Plot # C- 12, G- Block, BKC, Bandra (E), Mumbai-
400 051, Website: https://www.kotaklife.com | Email: clientservicedesk@kotak.com | Toll Free No. - 1800 209 8800
Page 5 of 21
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Combo ID: R17070922080013077

LifeBoosterStrip
Customer Declaration Letter Cum Proposal Form Addendum

I Mr. Mr Mr declare & understand that I have opted for the MySolutions 'Life Booster', a combination solution offered by Kotak Life Insurance. This
combination solution consists of 2 policies of Kotak Assured Savings Plan UIN No.: 107N081V04 and 1 policy of Kotak Assured Income Accelerator UIN
No.: 107N089V03. I have filled the proposal application form No. (as given below) for the Master Policy No. (MPN) ______________ and submitted all
required documents.
Individual Sum Modal Rider Total
Proposal Product Frequency
Sr. No. Quotation PPT1 (Yrs.) PT2 (Yrs.) Assured Premium Premium GST (Rs.) Premium
No. Name of Payment
No (Rs.) (Rs.) (Rs.) (Rs.)
Kotak Assured BB07092208001
1 10 15 6,14,458 Yearly 66,666 0 3,000 69,666
Savings Plan 3596
Kotak Assured BB07092208001
2 10 20 8,94,271 Yearly 66,666 0 3,000 69,666
Savings Plan 3334
Kotak Income BB07092208001
3 10 20 6,66,680 Yearly 66,668 0 3,000 69,668
Accelerator Plan 3649
3. Goods and Services Tax and Cess (GST) on Premium would include GST on Modal Premium and Rider Premium. Please note that this GST is only applicable for First Year only.
Note : 1. Premium Payment term (PPT).
Please refer to Individual Benefit Illustrations for GST Applicability from second policy year onwards
4. Total Premium = Modal Premium + Rider Premium + GST on Premium. Please note that the Value refers to First Year Premium only. Please refer to Individual Benefit Illustration to
2. Policy Term (PT).
check Premium payable from Second Policy Year onwards
I understand that this combination solution comprises of a set of policies across one or more products of the Company. I have been made aware that
these products are also available individually and separately with the company and it is not mandatory for me to apply for this combination only.
I have separately gone through the product brochure of the above products and have taken the decision to opt for this combination solution after having
fully understood the risk factors, product terms and conditions.
I understand that the benefit of this combination solution are guaranteed provided all policies are in force and all premiums are paid upto date.
I declare that I have answered the questions in the proposal form to which this addendum is attached, after fully understanding the nature of the
questions and the importance of disclosing all information while answering such questions. I further declare that the details given by me to all the
questions in this addendum to the proposal form are true and complete in every respect and that I have not withheld any material information or
suppressed any fact. I further understand that the details given in the addendum shall form part of the proposal form. I understand that all polices of this
combination solution will either be converted or declined collectively, as per the underwriting rules of the company.
I declare that the contents in the proposal form, this addendum to the proposal form and documents forming part of this proposal form have been fully
explained to me and I have fully understood the significance of the proposed contract for each plan.
Date:_____________
Place:_____________
Signature / thumb impression of Life Assured
Signature / thumb impression of the Proposer
(If different from Proposer)
_________________________________________________________________________________________________________________________
Section 41 of the Insurance Act, 1938 states:
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance in
respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium
shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in
accordance with the published prospectuses or tables of the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakhs rupees.
Section 38, 39 & 45 of the Insurance Act, 1938 states:
The above Proposal will be governed by the provisions of Section 38, Section 39 and Section 45 of the Insurance Act, 1938 and amendments thereto
from time to time.
_________________________________________________________________________________________________________________________
Kotak Mahindra Life Insurance Company Ltd.

CIN: U66030MH2000PLC128503. Regd. Office: 8th Floor, Plot# C-12, G-Block, BKC, Bandra (E), Mumbai - 400 051
Page 6 of 21
New Page
For Office Use Only (w.e.f. June 22/ Ver 1.11)
Illustration No: KASP-4815M-8726-Y67

Quotation Number: BB070922080013596
Combo ID: R17070922080013077
Proposal No:
Policy No.:
Name of the Mr. Mr Mr Name of the Product Kotak Assured Savings Plan
Prospect/Policyholder
Tag Line A Non-Participating Endowment
Age of the 48 Assurance Plan
Prospect/Policyholder (in yrs)
Unique Identification No UIN : 107N081V04
DOB of the 01 September 1974
Base Goods and Services Tax and Cess Rate 4.50%
(GST) (1st Year)
Name of Life Assured Mr. Mr Mr
DOB of Life Assured 01 September 1974 (GST) (2nd Year)
Age of Life Assured (in yrs) 48 Rider Goods and Services Tax and Cess Rate 18%
(GST)
Gender of Life Assured Male
Channel Name Individual Agents
Policy Term (in yrs) 15
Premium Payment Term (in 10

yrs)
Agent's Branch Location Uttar Pradesh
Amount of Installment 66,666
Prospect/Policyholder's Current Location Uttar Pradesh
Premium (in Rs.)
Mode of Payment of Premium Yearly
This Benefit Illustration is intended to show year-wise premiums payable and benefits under the policy.
POLICY DETAILS
Policy Option : Not Applicable Base Sum Assured (Rs.) : 6,14,458
Base Sum Assured on Death (at

: 7,37,350
inception of the policy) Rs.
Page 7 of 21
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Rider Details
Rider Premium Paying

Rider Name Rider Sum Assured Rider Policy Term Rider Premium (Rs.)
Term
Kotak Term Benefit Rider (UIN: 107B003V03) Not Selected
Kotak Accidental Death Benefit Rider

Not Selected
(UIN:107B001V03)
Kotak Permanent Disability Benefit Rider

Not Selected
(UIN:107B002V03)
Kotak Life Guardian Rider (UIN: 107B012V02) Not Selected
Kotak Accidental Disability Guardian Rider (UIN

Not Selected
107B011V02)
Kotak Critical Illness Plus Benefit Rider (UIN

Not Selected
107B020V01)
PREMIUM SUMMARY
Riders (Please refer Rider

Base Plan Total Installment Premium
Details table)
Installment Premium (without GST) 66,666 0 66,666
Installment Premium (with First Year GST) 69,666 0 69,666
Installment Premium (with GST, Second Year onwards) 68,166 0 68,166
Page 8 of 21
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Quotation Number:BB070922080013596
BENEFIT ILLUSTRATION TABLE
Non-
Guaranteed Benefits Guaranteed
Benefits
End of Policy Age of Life Annualised
Year Insured Premium Accrued
Guaranteed Guaranteed Guaranteed Special
Basic Sum Guaranteed Maturity Death
Yearly Loyalty Surrender Surrender
Assured Yearly Benefit4 Benefit3
Addition Additions Value5 Value6
Additions
1 49 66,666 6,14,458 6,667 6,667 0 0 7,44,016 0 0
2 50 66,666 6,14,458 13,333 20,000 0 0 7,57,349 45,564 40,175
3 51 66,666 6,14,458 20,000 40,000 0 0 7,77,349 82,251 68,829
4 52 66,666 6,14,458 26,666 66,666 0 0 8,04,016 1,55,818 1,04,692
5 53 66,666 6,14,458 33,333 99,999 0 0 8,37,349 2,03,845 1,49,058
6 54 66,666 6,14,458 40,000 1,39,999 0 0 8,77,348 2,57,383 2,03,495
7 55 66,666 6,14,458 46,666 1,86,665 0 0 9,24,014 3,17,722 2,69,726
8 56 66,666 6,14,458 53,333 2,39,998 0 0 9,77,347 3,91,732 3,49,878
9 57 66,666 6,14,458 59,999 2,99,997 0 0 10,37,347 4,83,175 4,46,269
10 58 66,666 6,14,458 66,666 3,66,663 0 0 11,04,013 5,96,224 5,61,682
11 59 0 6,14,458 0 3,66,663 0 0 11,04,013 6,39,470 6,14,662
12 60 0 6,14,458 0 3,66,663 0 0 11,04,013 7,05,210 6,72,764
13 61 0 6,14,458 0 3,66,663 0 0 11,04,013 8,00,329 7,36,518
14 62 0 6,14,458 0 3,66,663 0 0 11,04,013 9,31,824 8,06,364
15 63 0 6,14,458 0 3,66,663 1,22,892 11,04,013 11,04,013

Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any and Goods and
Services Tax.
Page 9 of 21
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Terms & Conditions:
1. This is a limited pay non-participating endowment plan. The Illustration stated is for a healthy individual and would be subject to underwriting.
2. High Premium Benefit is available for annual premiums of Rs. 30,000 and above by way of increase in the Basic Sum Assured Rates. For details,
please refer to Sales Brochure.
3. Death Benefit shall be Basic Death Benefit Plus Guaranteed Yearly Additions accrued as on the date of death where Basic Death Benefit will be
higher of
11 times Annualized Premium for entry ages less than 50 years or 7 times Annualized Premium for entry ages 50 and above or
Guaranteed Minimum Death Benefit* or,
105% of total premiums paid (excluding any extra premiums)
* Guaranteed Minimum Death Benefit will be 110% for PPT of 5 years, 112% for PPT of 6 years, 114% for PPT of 7 years and 120% for PPT of
10 years.
4. Guaranteed Maturity benefit is Basic Sum Assured plus Accrued Guaranteed Yearly Additions plus Guaranteed Loyalty Addition.
5. The policy will acquire Guaranteed Surrender Value provided premiums due for at least 2 policy years have been paid in full.
The Guaranteed Surrender Value shall be a 'X' percent of total Premiums paid (excluding Goods and Services tax and Cess, Rider premium and
Extra Premium, if any) Plus the value of accrued Guaranteed Yearly Additions where 'X' percent varies by year of surrender, Premium Payment
Term and Policy Term and is mentioned in the table below:
Policy Year: 1 2 3 4 5 6 7
N.A 30% 35% 50% 50% 50% 50%
Policy Year: 8 9 10 11 12 13 14
51% 53% 56% 59% 65% 75% 90%
Policy Year: 15 16 17 18 19 20
90% N.A N.A N.A N.A N.A
6. Once policy acquires Surrender Value, the Company may consider paying a Special Surrender Value and the same will be quoted in writing by
the Company, on receipt of a written request from the policyholder. In any case, higher of the Guaranteed Surrender Value or Special Surrender
Value will be payable. For more details, please refer the sales brochure.
7. The policy is automatically made Reduced Paid-Up where policy has acquired Surrender Value and due premiums are not received within the
grace period. Paid-Up policies shall not be eligible for future Guaranteed Yearly Additions and Guaranteed Loyalty Additions.
The Maturity Benefit is reduced to Reduced Paid-Up Basic Sum Assured PLUS accrued Guaranteed Yearly Additions; where Reduced Paid-Up
Basic Sum Assured = (Total Premiums paid / Total premiums payable over the term) × Basic Sum Assured
On death of the life insured during the policy term after being Reduced Paid-Up, the benefit payable will be the sum of Reduced Paid-Up Basic
Death Benefit and accrued Guaranteed Yearly Additions. For more details, please refer to Sales Brochure.
Rider benefit will be available as per Reduced Paid-Up Sum Assured of Rider (if applicable).
8. A lapsed or Paid-Up policy can be revived with or without riders within 5 years from the date of the first unpaid premium. Revival can be done
without evidence of good health on payment of the outstanding premiums and revival charges, if the payment is made within six months from the
date of the first unpaid premium. Thereafter to revive the policy, evidence of good health would be required along with payment of the outstanding
premiums and revival charges. On revival, all benefits under the policy will be reinstated.
9. The above illustrated benefits are derived on the basis of details of life insured provided at the time of filling the proposal form. If the details are
found inaccurate or there are any changes before or at the time of the policy issuance for eg: change in age, the illustrated benefits will be subject
to revision.
10. Goods and Services Tax & Cess, as applicable are levied at the applicable Tax rates in accordance with the prevailing Tax Laws. Prevailing tax
laws are applicable on this policy which may vary from time to time.
11. The values shown are for illustrative purposes only. For more details on risk factors, terms and conditions please read sales brochure carefully
before concluding a sale.
12. TDS at prevailing rate will be deducted from any amount paid under a life insurance policy subject to the provisions of prevailing tax laws. In case
of non-availability of valid PAN, TDS will be deducted at higher rate. Tax laws are subject to changes from time to time. Kindly consult your tax
advisor for tax implication of your policy.
Page 10 of 21
New Page
Section 41 of the Insurance Act, 1938 states as amended from time to time
(1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance in
respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the
premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be
allowed in accordance with the published prospectuses or tables of the insurer:
(2) Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
I, _____________________________(Name), have explained the I, ____________________________(Name), having received the
premiums and benefits under the product fully to the prospect / information with respect to the above, have understood the above
policyholder. statement before entering into the contract.
Place :_____________ __________________________________ Place :_____________ ______________________________
Date :_____________ Signature of Agent /Intermediary/Official Date :_____________ Signature of Prospect / Policyholder
Kotak Mahindra Life Insurance Company Limited.

CIN: U66030MH2000PLC128503
Regd. Office: 8th Floor, Plot# C-12, G-Block, BKC, Bandra (E), Mumbai - 400 051
Regn. No: 107. Toll Free No.: 1800 209 8800.WhatsApp: 9321003007 Website: https://www.kotaklife.com
Page 11 of 21
New Page
For Office Use Only (w.e.f. June 22/ Ver 1.11)
Illustration No: KASP-4820M-3494-Y67

Combo ID: R17070922080013077
Proposal No:
Policy No.:
Name of the Mr. Mr Mr Name of the Product Kotak Assured Savings Plan
Tag Line A Non-Participating Endowment
Age of the 48 Assurance Plan
Prospect/Policyholder (in yrs)
Unique Identification No UIN : 107N081V04
DOB of the 01 September 1974
(GST) (1st Year)
Name of Life Assured Mr. Mr Mr
DOB of Life Assured 01 September 1974 (GST) (2nd Year)
Age of Life Assured (in yrs) 48 Rider Goods and Services Tax and Cess Rate 18%
(GST)

yrs)
Agent's Branch Location Uttar Pradesh
Amount of Installment 66,666
Premium (in Rs.)
POLICY DETAILS
Base Sum Assured on Death (at

: 10,73,125
inception of the policy) Rs.
Page 12 of 21
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Rider Details

Rider Name Rider Sum Assured Rider Policy Term Rider Premium (Rs.)
Term

Not Selected
(UIN:107B001V03)

Not Selected
(UIN:107B002V03)

Not Selected
107B011V02)
Kotak Critical Illness Plus Benefit Rider (UIN

Not Selected
107B020V01)
PREMIUM SUMMARY
Riders (Please refer Rider

Details table)
Installment Premium (with First Year GST) 69,666 0 69,666
Installment Premium (with GST, Second Year onwards) 68,166 0 68,166
Page 13 of 21
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Non-
Benefits
End of Policy Age of Life Annualised
Year Insured Premium Accrued
Guaranteed Guaranteed Guaranteed Special
Basic Sum Guaranteed Maturity Death
Yearly Loyalty Surrender Surrender
Assured Yearly Benefit4 Benefit3
Addition Additions Value5 Value6
Additions
1 49 66,666 8,94,271 6,667 6,667 0 0 10,79,792 0 0
2 50 66,666 8,94,271 13,333 20,000 0 0 10,93,125 43,486 36,492
3 51 66,666 8,94,271 20,000 40,000 0 0 11,13,125 77,639 61,484
4 52 66,666 8,94,271 26,666 66,666 0 0 11,39,791 1,47,299 92,123
5 53 66,666 8,94,271 33,333 99,999 0 0 11,73,124 1,89,675 1,29,359
6 54 66,666 8,94,271 40,000 1,39,999 0 0 12,13,124 2,35,404 1,74,390
7 55 66,666 8,94,271 46,666 1,86,665 0 0 12,59,790 2,85,261 2,28,486
8 56 66,666 8,94,271 53,333 2,39,998 0 0 13,13,123 3,45,509 2,93,131
9 57 66,666 8,94,271 59,999 2,99,997 0 0 13,73,122 4,25,186 3,70,199
10 58 66,666 8,94,271 66,666 3,66,663 0 0 14,39,788 5,09,655 4,61,540
11 59 0 8,94,271 0 3,66,663 0 0 14,39,788 5,50,291 5,04,437
12 60 0 8,94,271 0 3,66,663 0 0 14,39,788 5,85,764 5,51,419
13 61 0 8,94,271 0 3,66,663 0 0 14,39,788 6,36,257 6,03,054
14 62 0 8,94,271 0 3,66,663 0 0 14,39,788 6,81,880 6,59,683
15 63 0 8,94,271 0 3,66,663 0 0 14,39,788 7,36,223 7,21,872
16 64 0 8,94,271 0 3,66,663 0 0 14,39,788 7,99,469 7,89,963
17 65 0 8,94,271 0 3,66,663 0 0 14,39,788 8,65,208 8,64,635
18 66 0 8,94,271 0 3,66,663 0 0 14,39,788 9,33,661 9,46,571
19 67 0 8,94,271 0 3,66,663 0 0 14,39,788 10,11,823 10,36,336
20 68 0 8,94,271 0 3,66,663 1,78,854 14,39,788 14,39,788

Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any and Goods and
Services Tax.
Page 14 of 21
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Terms & Conditions:
1. This is a limited pay non-participating endowment plan. The Illustration stated is for a healthy individual and would be subject to underwriting.
2. High Premium Benefit is available for annual premiums of Rs. 30,000 and above by way of increase in the Basic Sum Assured Rates. For details,
please refer to Sales Brochure.
3. Death Benefit shall be Basic Death Benefit Plus Guaranteed Yearly Additions accrued as on the date of death where Basic Death Benefit will be
higher of
11 times Annualized Premium for entry ages less than 50 years or 7 times Annualized Premium for entry ages 50 and above or
Guaranteed Minimum Death Benefit* or,
105% of total premiums paid (excluding any extra premiums)
* Guaranteed Minimum Death Benefit will be 110% for PPT of 5 years, 112% for PPT of 6 years, 114% for PPT of 7 years and 120% for PPT of
10 years.
4. Guaranteed Maturity benefit is Basic Sum Assured plus Accrued Guaranteed Yearly Additions plus Guaranteed Loyalty Addition.
5. The policy will acquire Guaranteed Surrender Value provided premiums due for at least 2 policy years have been paid in full.
The Guaranteed Surrender Value shall be a 'X' percent of total Premiums paid (excluding Goods and Services tax and Cess, Rider premium and
Extra Premium, if any) Plus the value of accrued Guaranteed Yearly Additions where 'X' percent varies by year of surrender, Premium Payment
Term and Policy Term and is mentioned in the table below:
Policy Year: 1 2 3 4 5 6 7
N.A 30% 35% 50% 50% 50% 50%
Policy Year: 8 9 10 11 12 13 14
51% 54% 56% 60% 63% 68% 72%
Policy Year: 15 16 17 18 19 20
77% 83% 89% 95% 102% 110%
6. Once policy acquires Surrender Value, the Company may consider paying a Special Surrender Value and the same will be quoted in writing by
the Company, on receipt of a written request from the policyholder. In any case, higher of the Guaranteed Surrender Value or Special Surrender
Value will be payable. For more details, please refer the sales brochure.
grace period. Paid-Up policies shall not be eligible for future Guaranteed Yearly Additions and Guaranteed Loyalty Additions.
The Maturity Benefit is reduced to Reduced Paid-Up Basic Sum Assured PLUS accrued Guaranteed Yearly Additions; where Reduced Paid-Up
Basic Sum Assured = (Total Premiums paid / Total premiums payable over the term) × Basic Sum Assured
On death of the life insured during the policy term after being Reduced Paid-Up, the benefit payable will be the sum of Reduced Paid-Up Basic
Death Benefit and accrued Guaranteed Yearly Additions. For more details, please refer to Sales Brochure.
8. A lapsed or Paid-Up policy can be revived with or without riders within 5 years from the date of the first unpaid premium. Revival can be done
without evidence of good health on payment of the outstanding premiums and revival charges, if the payment is made within six months from the
date of the first unpaid premium. Thereafter to revive the policy, evidence of good health would be required along with payment of the outstanding
premiums and revival charges. On revival, all benefits under the policy will be reinstated.
to revision.
laws are applicable on this policy which may vary from time to time.
Page 15 of 21
New Page
Section 41 of the Insurance Act, 1938 states as amended from time to time
premiums and benefits under the product fully to the prospect / information with respect to the above, have understood the above
policyholder. statement before entering into the contract.
Place :_____________ __________________________________ Place :_____________ ______________________________
Date :_____________ Signature of Agent /Intermediary/Official Date :_____________ Signature of Prospect / Policyholder

CIN: U66030MH2000PLC128503
Regn. No: 107. Toll Free No.: 1800 209 8800.WhatsApp: 9321003007 Website: https://www.kotaklife.com
Page 16 of 21
New Page
For Office Use Only (w.e.f. Dec 21/ Ver 1.0)
Illustration No: KAIA-4820M-2247-Y67

Combo ID: R17070922080013077
Proposal No:
Policy No.:
Name of the Mr. Mr Mr Name of the Product Kotak Assured Income Accelerator
Tag Line Individual, Non-Linked,
Age of the 48 Participating, Savings Life
Prospect/Policyholder (in yrs) Insurance Plan
DOB of the 01 September 1974 Unique Identification No UIN : 107N089V03

Name of Life Assured Mr. Mr Mr (GST) (1st Year)
DOB of Life Assured 01 September 1974 Base Goods and Services Tax and Cess Rate 2.25%
(GST) (2nd Year)
Age of Life Assured (in yrs) 48
Rider Goods and Services Tax and Cess Rate 18.00%
(GST)
yrs)
Amount of Installment 66,668 Agent's Branch Location Uttar Pradesh

Premium (in Rs.)
POLICY DETAILS
Income Benefit Payout Option : Yearly Base Sum Assured on Death : 7,33,348
(at inception of the policy) Rs.
Page 17 of 21
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Rider Details

Rider Name Rider Sum Assured Rider Policy Term Rider Premium (in Rs.)
Term

Not Selected
(UIN:107B001V03)

Not Selected
(UIN:107B002V03)

Not Selected
107B011V02)
Kotak Critical Illness Plus Rider

Not Selected
(UIN:107B020V01)
PREMIUM SUMMARY
Riders (Please refer Rider Details

table)
Installment Premium (with First Year

69,668 0 69,668
GST)
Installment Premium (with GST,

68,168 0 68,168
Second Year onwards)
Page 18 of 21
New Page
Non-
End of Policy Age of Life Annualized Benefits
Year Assured Premium Guaranteed Special
Basic Sum Guaranteed Maturity
Death Benefit3 Surrender Surrender
Assured Income$ Benefit4
Value5 Value6
1 49 66,668 6,66,680 0 0 7,33,348 0 0
2 50 66,668 6,66,680 0 0 7,33,348 40,001 0
3 51 66,668 6,66,680 0 0 7,33,348 70,001 0
4 52 66,668 6,66,680 0 0 7,33,348 1,33,336 26,667
5 53 66,668 6,66,680 0 0 7,33,348 1,66,670 96,669
6 54 66,668 6,66,680 0 0 7,33,348 2,00,004 1,72,003
7 55 66,668 6,66,680 0 0 7,33,348 2,33,338 2,52,005
8 56 66,668 6,66,680 0 0 7,33,348 2,82,672 3,41,340
9 57 66,668 6,66,680 0 0 7,33,348 3,42,007 4,38,009
10 58 66,668 6,66,680 0 0 7,33,348 4,00,008 5,40,011
11 59 0 6,66,680 73,335 0 7,33,348 4,20,008 5,93,345
12 60 0 6,66,680 77,735 0 7,33,348 3,73,341 5,66,678
13 61 0 6,66,680 82,135 0 7,33,348 3,15,606 5,35,611
14 62 0 6,66,680 86,535 0 7,33,348 2,53,472 5,00,143
15 63 0 6,66,680 90,935 0 7,33,348 1,93,604 4,60,276
16 64 0 6,66,680 95,335 0 7,33,348 1,22,669 4,09,342
17 65 0 6,66,680 99,735 0 7,33,348 47,334 3,47,340
18 66 0 6,66,680 1,04,135 0 7,33,348 0 2,80,939
19 67 0 6,66,680 1,08,536 0 7,33,348 0 2,03,471
20 68 0 6,66,680 1,12,936 1,70,003 7,33,348 0 1,01,602
Notes: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any and
Goods and Services Tax.
$The Guaranteed Income Benefit shall be payable annually on completion of one policy year from the end of premium paying term to the end
of policy term.
Page 19 of 21
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Terms & Conditions:
1. This is a non-linked, non-participating anticipated Endowment Assurance Plan. The illustration stated is for a healthy individual and is under the
assumption that this is the only policy the client has with Kotak Life Insurance and would be subject to underwriting.
2. The benefits under this product are guaranteed for inforce premium paying policy.
3. Death Benefit shall be Sum Assured on death, where Sum Assured on death will be higher of
(i) 11 times Annualized Premium for entry ages less than or equal to 50 years or 7 times Annualized Premium for entry ages 51 and above or
(ii) Basic Sum Assured, or
(iii) 105% of total premiums paid (excluding any extra premiums)
(iv) Guaranteed Maturity Benefit
Due Premiums and Outstanding premiums for the year in which death occurs (applicable for non-annual premium paying policies) will be adjusted
from the Death Benefit mentioned above.
4. Guaranteed Maturity Benefit is paid at maturity and expressed as a % of Basic Sum Assured that varies based on Age and Policy Term. For more
information please refer Sales Brochure.
5. The policy acquires surrender value provided the premiums have been paid for at least two consecutive years. The Surrender Value shall be
higher of Guaranteed Surrender Value or Special Surrender Value and it is prior to the payment of Guaranteed Income due in that policy year.
The Guaranteed Surrender Value will be 'X' percent of total Premiums paid (excluding Goods and Services Tax and Cess, Rider premium and
Extra Premium, if any) less Guaranteed Income already paid, where 'X' percent varies by year of surrender and is mentioned in the table below:
1 2 3 4 5 6 7 8 9
Policy Year:
0% 30% 35% 50% 50% 50% 50% 53% 57%
10 11 12 13 14 15 16 17 18
Policy Year:
60% 63% 67% 70% 73% 77% 80% 83% 87%
19 20 21 22 23 24 25 26 27
Policy Year:
90% 90% 0% 0% 0% 0% 0% 0% 0%
28 29 30
Policy Year:
0% 0% 0%
6. Once policy acquires Surrender Value, the Company shall pay a Special Surrender Value and the same will be quoted in writing by the Company,
on receipt of a written request from the policyholder.In any case, higher of the Guaranteed Surrender Value or Special Surrender Value will be
payable. For more details, please refer the sales brochure.For more details, please refer the sales brochure.
grace period. The Guaranteed Maturity Benefit and Guaranteed income will be based on Reduced Paid-Up Basic Sum Assured where Reduced
Paid-Up Basic Sum Assured = Basic Sum Assured × (Total Premiums paid / Total premiums payable over the term)
On death of the life insured during the policy term after being Reduced Paid-Up, Reduced Paid-Up Sum Assured on death will be paid.
Where Reduced Paid-Up Sum Assured on death = Sum Assured on death × (Total Premiums paid / Total premiums payable over the term)
For more details, please refer to Sales Brochure.

8. A lapsed or a Reduced Paid-Up policy can be revived with or without riders within 5 years from the date of the first unpaid premium. Revival can
be done without evidence of good health on payment of the outstanding premiums and late payment charges, if the payment is made within six
months from the date of the first unpaid premium. Thereafter to revive the policy, evidence of good health would be required along with payment
of the outstanding premiums and late payment charges. On revival, only future benefits shall be reinstated to their original level.
to revision.
Page 20 of 21
New Page
laws are applicable on this policy which may vary from time to time
Section 41 of the Insurance Act, 1938 states
premiums and benefits under the product fully to the prospect information with respect to the above, have understood the above
/policyholder. statement before entering into the contract.
Place :_____________ __________________________________ Place :_____________ __________________________________
Date :_____________ Signature of Agent /Intermediary/Official Date :_____________ Signature of Prospect/Policyholder

CIN: U66030MH2000PLC128503
Regn. No: 107. Toll Free No.: 1800 209 8800. Website: https://www.kotaklife.com
Page 21 of 21

LifeBooster R17070922080013077

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Combo ID: R17070922080013077

Pay Guaranteed Guaranteed High

MySolutions : Life Booster Report Date : 07/09/2022

1 49 2,00,000 13,334 - - 25,57,156

2 50 2,00,000 40,000 - - 25,83,822

3 51 2,00,000 80,000 - - 26,23,822

4 52 2,00,000 1,33,332 - - 26,77,155

5 53 2,00,000 1,99,998 - - 27,43,821

6 54 2,00,000 2,79,998 - - 28,23,820

7 55 2,00,000 3,73,330 - - 29,17,152

8 56 2,00,000 4,79,996 - - 30,23,818

9 57 2,00,000 5,99,994 - - 31,43,817

10 58 2,00,000 7,33,326 - - 32,77,149

11 59 - 7,33,326 73,335 - 32,77,149

12 60 - 7,33,326 77,735 - 32,77,149

13 61 - 7,33,326 82,135 - 32,77,149

14 62 - 7,33,326 86,535 - 32,77,149

15 63 - 7,33,326 90,935 11,04,013 32,77,149

16 64 - 3,66,663 95,335 - 21,73,136

17 65 - 3,66,663 99,735 - 21,73,136

18 66 - 3,66,663 1,04,135 - 21,73,136

19 67 - 3,66,663 1,08,536 - 21,73,136

20 68 - 3,66,663 1,12,936 16,09,791 21,73,136

Combo ID: R17070922080013077

Plan & Rider Details**

Modal Basic Sum

Kotak Accidental Death Benefit Rider - - - - -

Kotak Permanent Disability Benefit Rider - - - - -

Kotak Term Benefit Rider - - - - -

Kotak Life Guardian Benefit Rider - - - - -

Kotak Assured Savings Plan 20 10 Yearly 66,666 8,94,271

Kotak Accidental Death Benefit Rider - - - - -

Kotak Permanent Disability Benefit Rider - - - - -

Kotak Term Benefit Rider - - - - -

Kotak Life Guardian Benefit Rider - - - - -

Kotak Income Accelerator Plan 20 10 Yearly 66,668 6,66,680

Kotak Accidental Death Benefit Rider - - - - -

Kotak Permanent Disability Benefit Rider - - - - -

Kotak Term Benefit Rider - - - - -

Kotak Life Guardian Benefit Rider - - - - -

Combo ID: R17070922080013077

BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS

Combo ID: R17070922080013077

Customer Declaration Letter Cum Proposal Form Addendum

Kotak Mahindra Life Insurance Company Ltd.

For Office Use Only (w.e.f. June 22/ Ver 1.11)

Illustration No: KASP-4815M-8726-Y67

Premium Payment Term (in 10

Mode of Payment of Premium Yearly

Policy Option : Not Applicable Base Sum Assured (Rs.) : 6,14,458

Base Sum Assured on Death (at

Rider Premium Paying

Kotak Term Benefit Rider (UIN: 107B003V03) Not Selected

Kotak Accidental Death Benefit Rider

Kotak Permanent Disability Benefit Rider

Kotak Life Guardian Rider (UIN: 107B012V02) Not Selected

Kotak Accidental Disability Guardian Rider (UIN

Kotak Critical Illness Plus Benefit Rider (UIN

I, _(Name), have explained the I, (Name), having received the

Place :_ ________________ Place :_ ________________________

I, _(Name), have explained the I, (Name), having received the

Place :_ ________________ Place :_ ________________________