Max Life Life Gain Premier (UIN No:104N079V01)

Savings - Traditional Participating Endowment Insurance Plan

Policy/Proposal No: 265561001
Date of Illustration - Feb 10, 2016 11:12:02 AM
Personal Details

Product Features

Rider Details

Name of Policyholder

Teerthraj

Guaranteed Maturity Sum Assured

` 6,03,719

ADD Rider Sum Assured,if opted

Rs. 0.00

Age of Policyholder as at last

birthday on the Effective Date

31 Years

Policy Term

20 Years

ADD Rider Term,if opted

0 Years

Gender of Policyholder

Male

Premium Payment Term

10 Years

Term Plus Rider Sum Assured,if

opted

Rs. 0.00

Name of Life Insured

Teerthraj

Bonus Option

Paid Up Additions

Term Plus Rider Term,if opted

0 Years

Age of Life Insured as at last

birthday on the Effective Date

31 Years

Payment Mode

Annual

WOP Plus Rider Term,if opted

0 Years

Gender of Life Insured

Male

State

Other

PREMIUM SUMMARY
First Year Premium

Renewal Year Premium

Base Modal Premium

` 50,000.04

` 50,000.04

Service Tax including Cess on Base and Rider Modal Premium, if opted

` 1,812.50

` 906.25

Total Premium Payable on Due Date along with Service Tax & Cess

` 51,812.54

` 50,906.29

Total Premium Payable for the policy year

` 50,000.04

` 50,000.04

Total Premium Payable for the policy year along with Service Tax and Cess

` 51,812.54

` 50,906.29

Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your Insurer carrying on life insurance business. If your policy offers guaranteed returns then these will be clearly marked "guaranteed" in
the illustration table on this page.If your policy offers variable returns then the illustrations on this page will show two different rates of assumed future investment returns.These assumed rates of return are not guaranteed and they are not the upper
or lower limits of what you might get back, as the value of your policy is dependent on a number of factors including future investment performance.

This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 4% and 8% are used as an illustration.
MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 1 of 5

YEARLY ILLUSTRATIVE DETAILS

(This shall form a part of the policy document)
All cash flows are in `

General Details
Policy
Year

Guaranteed

Non Guaranteed (Assumed rate of return on investment is 4% p.a.)

Non Guaranteed (Assumed rate of return on investment is 8% p.a.)

Age of
Life
Assured

Premium

Death
Benefit
(Including
Rider
Benefit(If
Any))

Guarantee
d
Surrender
Value

Survival /
Maturity
Benefit

Cash
Bonus

Net Outlay

Death
Benefit

Surrender
Value of
PUA*

Terminal
Bonus

Special
Surrender
Value

Cash
Bonus

Net Outlay

Death
Benefit

Surrender
Value of
PUA*

Terminal
Bonus

Special
Surrender
Value

(BOY)

(BOY)

(BOY)

(EOY)

(EOY)

(EOY)

(BOY)

(BOY)

(EOY)

(EOY)

(EOY)

(EOY)

(BOY)

(BOY)

(EOY)

(EOY)

(EOY)

31

50,000

6,03,719

50,000

6,03,719

50,000

6,03,719

32

50,000

6,03,719

1,962

50,000

6,03,719

7,716

50,000

6,03,719

33

50,000

6,03,719

45,000

2,034

50,000

6,07,273

4,062

81,565

8,336

50,000

6,22,054

16,428

83,564

34

50,000

6,03,719

1,00,000

2,120

50,000

6,10,838

6,317

1,23,067

9,012

50,000

6,40,940

26,243

1,28,177

35

50,000

6,03,719

1,25,000

2,200

50,000

6,14,433

8,727

1,65,966

9,734

50,000

6,60,406

37,262

1,75,873

36

50,000

6,03,719

1,50,000

2,287

50,000

6,18,043

11,305

2,23,443

10,520

50,000

6,80,453

49,606

2,41,056

37

50,000

6,03,719

1,75,000

2,381

50,000

6,21,675

14,064

2,72,165

11,365

50,000

7,01,105

63,402

2,98,986

38

50,000

6,03,719

2,12,000

2,476

50,000

6,25,335

17,010

3,22,545

12,280

50,000

7,22,374

78,792

3,60,927

39

50,000

6,03,719

2,56,500

2,573

50,000

6,29,018

20,152

3,74,642

13,271

50,000

7,44,281

95,929

4,27,159

10

40

50,000

6,03,719

3,00,000

2,676

50,000

6,32,720

23,502

15,911

4,39,957

14,348

50,000

7,66,848

1,14,988

19,753

5,10,180

11

41

6,03,719

3,15,000

2,781

6,52,358

27,070

16,005

4,79,229

15,502

8,09,857

1,36,143

20,351

5,73,586

12

42

6,03,719

3,35,000

2,887

6,56,200

30,864

16,099

4,98,507

16,753

8,34,405

1,59,596

20,968

6,15,668

13

43

6,03,719

3,50,000

3,007

6,60,058

34,906

16,194

5,18,536

18,108

8,59,691

1,85,565

21,603

6,60,715

14

44

6,03,719

3,65,000

3,122

6,63,946

39,199

16,289

5,39,318

19,573

8,85,739

2,14,288

22,258

7,08,937

15

45

6,03,719

3,85,000

3,251

6,67,852

43,768

16,385

5,60,910

21,154

9,12,570

2,46,023

22,932

7,60,539

16

46

6,03,719

4,00,000

3,375

6,71,788

48,616

16,481

5,83,328

22,868

9,40,204

2,81,060

23,626

8,15,759

17

47

6,03,719

4,15,000

3,514

6,75,740

53,769

16,579

6,06,617

24,722

9,68,669

3,19,711

24,341

8,74,847

18

48

6,03,719

4,35,000

3,654

6,79,721

59,239

16,676

6,30,815

26,727

9,97,990

3,62,319

25,078

9,38,070

19

49

6,03,719

4,50,000

3,802

6,83,724

65,049

16,774

6,55,970

28,910

10,28,188

4,09,281

25,837

10,05,736

20

50

6,03,719

4,50,000

6,03,719

3,952

6,87,754

71,212

16,873

6,91,805

31,262

10,59,302

4,61,008

26,618

10,91,346

Maturity Benefit:

` 6,03,719

` 6,91,805

This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 4% and 8% are used as an illustration.
MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 2 of 5

` 10,91,346

(BOY) - Beginning of Year Value

(EOY) - End of Year value
* The Policyholder can take the cash value of the accrued PUA (partially or in full) subject to a minimum withdrawal limit of Rs. 5,000 and maximum withdrawal limit according to the PUA cash value available. The remaining PUA will continue to
participate in bonuses.

This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 4% and 8% are used as an illustration.
MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 3 of 5

Important Notes:
Section A
--Guaranteed Surrender Value (GSV): Guaranteed Surrender Value is the guaranteed amount that will be payable to the Policyholder on surrender of the policy.
--Special Surrender Value (SSV): Special surrender value is the non guaranteed amount that will be payable to the Policyholder on surrender of the policy. SSV will be determined from time to time in consultation and with approval of IRDAI and is not
guaranteed. The SSV will always be equal to or higher than GSV.
--Cash Bonus: Cash bonus means a share in the Actuarial Valuation Surplus declared from time to time and communicated to the Policyholder.
--Net Outlay: Net Outlay is defined as the difference between premiums paid and the policy proceeds.
--Surrender Value of Paid-Up-Addition (PUA): The surrender value of PUA is applicable in case the policyholder has chosen PUA bonus option. The surrender value of PUA is the cash value of total accumulated Paid-Up-Additions sum assured.
--Terminal Bonus: Terminal Bonus is an additional bonus paid only ONCE, at the discretion of the company, on Death, Surrender or Maturity, whichever is earlier, provided the policy has been in force for at least ten complete policy years from the
effective date.

Section B
-- This is only an illustrative document. It does not purport to be a contract of insurance and does not in any way create any rights and/or obligations. Bonuses (if applicable and shown in the illustration) are not guaranteed, and bonus rates will be
based on the actual company experience from time to time.
-- Paid Up Additions (PUA) withdrawals (if any) shown are illustrative. In case you wish to withdraw the money, then you will have to give a request at that point of time.
-- Benefits secured under your Policy shall become payable provided all contractual premiums are paid as and when they are due. The illustrative benefits above assume that all the contractual premiums will be paid on the due dates.
-- Please refer to the product brochures, for understanding the product features and explanation of the terms used in this illustration.
-- Service tax, education cess and other applicable taxes would be levied as per applicable laws and would be borne by the Policyholder. Tax laws and the benefits arising under the Policy are subject to change.
-- You may be entitled to certain applicable tax benefits on your premiums and Policy benefits. Please note that all the tax benefits are subject to tax laws prevailing at the time of payment of premium or receipt of benefits by you/ your nominee.
-- Guaranteed Death Benefit is defined as higher of 11 times the annualised premium, 105% of all premiums paid as on the date of death or Guaranteed Maturity Sum Assured. Please note that here annualised premium includes extra premium, if any,
but does not include loading for modal premium.

I ________________________________________________________ (Name), have explained the terms and conditions and the benefits of the policy to the prospect/policyholder.

Signature of Agent/Specified Person:

Name and ID:

Place:
Date:
Company Seal:

I _____________________________________________________________________________________ (Name), having received the information with respect to the above,have understood the above statement before entering into the
contract. I understand and intend to continue paying the above said premium amount for the complete Premium Payment Term
under the plan are

non guaranteed.

of 10 Years and as per the opted frequency. I also understand that some of the benefits

This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 4% and 8% are used as an illustration.
MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 4 of 5

Policyholders Signature:
Policyholders Name:
Date
MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 5 of 5