BENEFIT ILLUSTRATION

[Date and Time of Illustration – 08 October 2024, 11:17 AM]

Name of the Prospect/Policyholder: Mr. Prateek Proposal No:

Age & Gender: 33 Years, Male Name of the Product: Max Life Smart Total Elite Protection Term Plan
Tag Line: A Non-Linked Non-Participating Individual Pure Risk Premium Life Insurance Plan
Name of the Life Insured: Mr. Prateek
Unique Identification No: 104N125V05
Age & Gender: 33 Years, Male GST Rate (Base Policy, First Year): 18.00%
Risk Class: Non Smoker GST Rate (Base Policy, Subsequent Year): 18.00%

Policy Term: 32 Years GST Rate (Rider, First Year): NA

Premium Payment Term: 32 Years GST Rate (Rider, Subsequent Year): NA

Amount of Installment Premium: `814 Max Life State: Haryana

Mode of payment of premium: Monthly Policyholder Residential State: Gujarat

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.
Policy Details
Sum Assured (in Rs.) 50,00,000
Sum Assured on Death (at inception of the policy) (in Rs.) 50,00,000

Optional Benefit Details

Optional Benefit Name Applicability/ Opted Sum Assured Coverage Term Payment Term

Accelerated Critical Illness Cover No NA NA NA

Accident Cover No NA NA NA

Rider Details

Rider Name Applicability/ Opted Sum Assured Coverage Term Payment Term

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

Critical Illness and Disability Rider No NA NA NA

Premium Summary

Accelerated Critical Accidental Cover Waiver of Premium Critical Illness and Total Installment
Base Plan
Illness Cover Benefit Benefit Plus Rider Disability Rider Premium

Installment Premium without GST (in Rs.) 690 0 0 0 0 690

Installment Premium with first year GST (in Rs.) 814 0 0 0 0 814
Installment Premium with GST 2nd year onwards (in Rs.) 925 0 0 0 0 925

UIN: 104N125V05 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 3
 (Amount in Rupees)

Guaranteed Benefits
Single/ Annualized Premium
Policy Year
Survival Benefits/ Loyalty
Other Benefits, if any Maturity Benefit Death Benefit Exit Value Special Exit Value*
Additions

1 7,837 - - NA 50,00,000 - -

2 8,906 - - NA 50,00,000 - -

3 8,906 - - NA 50,00,000 - -

4 8,906 - - NA 50,00,000 - -

5 8,906 - - NA 50,00,000 - -

6 8,906 - - NA 50,00,000 - -

7 8,906 - - NA 50,00,000 - -

8 8,906 - - NA 50,00,000 - -

9 8,906 - - NA 50,00,000 - -

10 8,906 - - NA 50,00,000 - -

11 8,906 - - NA 50,00,000 - -

12 8,906 - - NA 50,00,000 - -

13 8,906 - - NA 50,00,000 - -

14 8,906 - - NA 50,00,000 - -

15 8,906 - - NA 50,00,000 - -

16 8,906 - - NA 50,00,000 - -

17 8,906 - - NA 50,00,000 - -

18 8,906 - - NA 50,00,000 - -

19 8,906 - - NA 50,00,000 - -

20 8,906 - - NA 50,00,000 - -

21 8,906 - - NA 50,00,000 - -

22 8,906 - - NA 50,00,000 - -

23 8,906 - - NA 50,00,000 - -

24 8,906 - - NA 50,00,000 - -

25 8,906 - - NA 50,00,000 - -

26 8,906 - - NA 50,00,000 - -

27 8,906 - - NA 50,00,000 - -

28 8,906 - - NA 50,00,000 - -

29 8,906 - - NA 50,00,000 - -

30 8,906 - - NA 50,00,000 - -

UIN: 104N125V05 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 3
 Guaranteed Benefits
Single/ Annualized Premium
Policy Year
Survival Benefits/ Loyalty
Other Benefits, if any Maturity Benefit Death Benefit Exit Value Special Exit Value*
Additions

31 8,906 - - NA 50,00,000 - -

32 8,906 - - NA 50,00,000 - -

Notes:
• Annualized Premium includes base policy and additional benefits premium, if opted. It excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and
Service Tax.
• *Special Exit Value - The policyholder has an option to terminate the policy and get back all the premiums they have paid till date, excluding taxes. This option can be exercised in any policy year starting 30th Policy year, but
not during the last 4 policy years. This shall be allowed to policyholders who have opted for a Policy Term of 40 years and above.
• Refer Sales literature (Prospectus) for explanation of terms used in this illustration.

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

Place: Signature / Thumb Impression / Electronic Signature of Date:10/8/24 Signature / Thumb Impression / Electronic Signature of
Date: 10/8/24 Agent / Intermediary / Official of the insurer Prospect / Policyholder
This system generated benefit illustration shall be treated as signed by me.

UIN: 104N125V05 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 3