1910508839-BI

Bajaj Allianz Life

Income Assure
A Guaranteed Monthly Income
Life Insurance Plan

Key Features of the plan

Aim of the policy Bajaj Allianz Life Income Assure is a non-linked, participating, limited premium payment, monthly income endowment plan.
Survival Benefit - Provided the life assured is alive at the end of the premium payment term, the Guaranteed Monthly Income (GMI)+
(irrespective of the variant chosen) will be paid every month for 144 months, starting from the end of premium payment term.
In case of death of the life assured during the installment period of the Survival Benefit, the GMI will be stopped immediately. Any GMI paid
during the period from the date of death to the date of intimation will be deducted from the death benefit.
+
The GMI has to be selected at the inception of the policy and is fixed throughout the term of the policy.
Maturity Benefit - Provided the policy is in-force and the life assured is alive, vested bonus plus terminal bonus, if any, will be paid.
Death Benefit – Provided all due premiums are paid, then, in case of unfortunate death of the life assured during the policy term, the death
benefit will be higher of:
• Sum Assured on Death# plus vested bonus plus terminal bonus, if any, or
• 105% of the total premium** paid
Income Assure
• Vested bonus plus terminal bonus, if any, will be paid • Death benefit will be paid as a lump sum
Benefits under immediately
• The policy will terminate on the date of death of the life assured
the policy • The sum assured on death will be paid to the nominee as
monthly income, over the next 144 equated monthly
installments (over the next 12 years), and the first installment
will start from date of death
• The nominee will not have the option of taking the installments
in lump sum
• All risk cover under the policy will cease as on the date of death
of the life assured
• The policy will terminate on payment of the 144th monthly
installment
#
Sum Assured on Death is higher of (i) sum assured (ii) 10 times of Annualised Premium*.
*Annualised Premium is exclusive of extra premium, rider premium, loadings for modal premiums, Goods and Service Tax, if any. **Total
Premium is exclusive of extra premium, rider premium, Goods and Service Tax, if any. Goods and Service Tax will be collected over and above the
premium under the policy.
Premiums at regular intervals are payable for the entire premium payment term as chosen by you. The premium payment term chosen by
Premium payment
you is the basis on which Benefit Illustration has been drawn and shall also be mentioned in the Policy Schedule.
1.Bajaj Allianz Accidental Death Benefit Rider UIN: 116B034V01
2.Bajaj Allianz Accidental Permanent Total/ Partial Disability Benefit Rider UIN: 116B036V01
Riders Available 3.Bajaj Allianz Critical Illness Benefit Rider UIN: 116B035V01
4.Bajaj Allianz Family Income Benefit Rider UIN: 116B037V01
5.Bajaj Allianz Waiver of Premium Benefit Rider UIN: 116B031V01
Please refer to respective product/ rider sales literature or visit Company website or consult your “Insurance Consultant” for more details and
eligibility conditions.

Bajaj Allianz Life Insurance Co. Ltd.,

G.E. Plaza, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver1.1 : English
 If at least 2 years’ premium for premium payment term less than 10 years or at least 3 years’ premium for premium payment term of 10
years and above are not paid, then,
• policy will lapse at the expiry of the grace period
• no benefits under the plan will be paid.
If at least 2 years’ premiums for premium payment term less than 10 years or at least 3 years’ premiums for premium payment term of 10
years and above are paid, , then your policy will be converted to a paid-up policy at the expiry of the grace period.
• The Sum Assured and the Sum Assured on Death under the policy will be reduced to the paid-up Sum Assured and paid-up Sum Assured
on Death respectively.
• The vested bonuses as on the paid-up date shall remain attached to the policy. A paid-up policy will not accrue any further bonus.
• The Maturity Benefit under a paid-up policy will be the vested bonuses attached in the policy till the policy became a paid-up policy.
• The Survival Benefit under a paid-up policy will be the paid-up GMI i.e. paid-up Sum Assured divided by 144 months and is payable every
month starting from the end of premium payment term as long as the life assured is alive, till the end of the policy term. If paid-up GMI is
less than ` 400 per month, then, the benefit will be paid annually which will be equal to paid-up Sum Assured in 12 yearly installments
over the next 12 years.
Non- payment • The Death Benefit under a paid-up policy will be the paid-up Sum Assured on Death plus vested bonus plus terminal bonus, if any,
of premium attached in the policy till the policy became a paid-up policy, subject to a minimum of 105% of total premium** paid. The Death Benefit
will be paid as per the life cover variant chosen at inception.
o In case ‘Assure’ variant was chosen at inception, the paid-up sum assured on death plus vested bonuses, if any will be paid to the
nominee as a lump-sum as on date of death.
o In case ‘Income’ variant was chosen at inception, the vested bonus, plus terminal bonus, if any, will be paid immediately and the
paid-up sum assured on death will be paid to the nominee as monthly income, over the next 144 equated monthly installments
(over the next 12 years). The first installment will start from date of death. If the monthly income is less than ` 400 per month, then
the benefit will be paid annually in 12 yearly installments over the next 12 years
o The paid-up GMI paid during the period from the date of death to the date of intimation will be recovered from the monthly
income/s.
• You may revive a lapsed/ paid-up policy during the revival period of 2 years from the due date of first unpaid premium, subject to the
revival conditions mentioned under the plan

Although it is not advisable to surrender your policy unless there is an extreme urgency, you will have the option to surrender your policy
Surrender anytime, provided at least 2 full years’ premiums in full have been paid for premium payment term less than 10 years or at least 3 years’
premiums in full for premium payment term of 10 years and above.
The surrender value shall be higher of the Guaranteed Surrender Value (GSV) and the Special Surrender Value (SSV).
Revival You may revive your lapsed/ paid-up policy during the revival period of 2 years from the due date of first unpaid premium, subject to the
revival conditions under the policy
Termination The policy will terminate on the earlier occurrence of either of the following events:
• on payment of surrender value
• on the maturity date
• on the expiry of the revival period of 2 years from the date of first unpaid premium, in case of a lapsed policy
• on date of death of the life assured in case of ‘Assure’
• on payment of the 144th installment in case of ‘Income’, however the risk cover under the policy will terminate on date of death
You will have the option to review the terms and conditions of the policy and if you disagree to any of the terms & conditions, you will have an
Free Look option to return the policy within 15 days [30 days in case this policy is issued under the provisions of IRDAI Guidelines on Distance Marketing
Cancellation of Insurance Products] stating the reasons for your objections.

Contact us Regd. Office Address: G.E. Plaza, Airport Road, Yerawada, Pune - 411006., IRDAI Reg No.: 116, Visit us: www.bajajallianzlife.com,
BALIC CIN : U66010PN2001PLC015959, Mail us : customercare@bajajallianz.co.in, Call on : Toll free no. 1800 209 7272, Fax No: 020-66026789,

Do’s and Don’ts

• Do fill the proposal form very carefully and personally in CAPITAL letters in blue ink only
• Do provide true and complete information
• Do provide correct contact number, address and email ID, and update in case of any change, so that you can receive
necessary communication
• Do sign on all the documents provided by you (Self Attestation)
Do’s • Do provide your recent passport photograph
• Do draw cheque/ DD, in favour of “Bajaj Allianz Life Insurance Co. Ltd.”
• Do read the policy bond carefully upon receipt of the same.
• Do contact us if you do not receive the policy bond or any other communication from the Company within 30 days.
• Do read the enclosed Benefit Illustration carefully before signing
• Do register for Auto Debit Instructions/ ECS to ensure timely payments of your premium on due dates.

• Do not sign any blank proposal form

• Do not leave any column blank in the proposal form
• Do not conceal any facts as this could lead to dispute at the time of a claim
Don’ts
• Do not miss or delay your premium payment
• Do not rely on any commitments of any additional benefits made by anyone apart from what has been highlighted
herein above.

Disclaimer
This document contains the highlights of the product Bajaj Allianz Life Income Assure UIN: 116N139V01 and is subject to the terms and conditions as contained in
the policy document. The terms and conditions as contained in the policy document shall govern the contractual relationship and shall be binding. For details on
any of the matters highlighted herein above, please refer to policy document upon receipt of the same by you. The standard terms and conditions of the product is
also available on the Company website (at www.bajajallianzlife.com)

Bajaj Allianz Life Insurance Co. Ltd.,

G.E. Plaza, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver1.1 : English
 Bajaj Allianz Life Insurance Company Ltd.
BAJAJ ALLIANZ INCOME ASSURE - INCOME
PREMIUM QUOTATION CUM BENEFIT ILLUSTRATION
(All monetary amounts are expressed in Indian Rupees & all Ages & Terms are expressed in Years)

Personal Details
Life Assured Name s s Life Assured Age 31
Gender Male

Policy Details
Mode Yearly Premium Paying Term 12
Pincode 760003 Branch State ODISHA
Sum Assured 720000 Guaranteed Monthly Income 5000

Premium / Benefit Details

TYPE POLICY TERM SUM ASSURED MODAL PREMIUM
INCOME ASSURE Main Benefit Income [UIN: 116N139V01] 24 720000 53481.60
High Sum Assured Rebate (HSAR) Less : 834.00
Base Policy Premium Net of HSAR 52647.60
RIDER COVER COVERAGE TERM RIDER SUM ASSURED MODAL PREMIUM
Accidental Death Benefit [UIN: 116B034V01] 24 720000 568.80
Total Premium before Goods & Service Tax 53216.40

Premium Payable
MODE -> YEARLY MONTHLY
MODAL PREMIUM PAYABLE DURING FIRST POLICY YEAR
Modal Premium before Goods & Service Tax 53216.40 4789.48
Goods & Service Tax @ 4.5 % 2394.74 215.53
Modal Premium (including GST) * 55612 5006
MODAL PREMIUM PAYABLE DURING SECOND & SUBSEQUENT YEARS
Modal Premium before Goods & Service Tax 53216.40 4789.48
Goods & Service Tax @ 2.25 % 1197.36 107.76
Modal Premium (including GST) * 54414 4898
*It includes CGST,SGST/UTGST,IGST & State Cess as applicable. Taxes and tax rates are subject to change

Case: Investment Return 8% # ##

Polic Life Annualized Cumulative Accrued Survival Death Benefit Maturity Maturity Guaranteed Special Surrender
y Assure Premium Premium (Excl Compound Benefit ^! Benefit Benefit Surrender Surrender Value
Year d Age (Excl of GST) of GST) Reversionar Under Paid- Value (GSV) Value (SSV) Receivable
y Bonus Up Policy **
EOY EOY EOY EOT EOY EOY
1 31 53216 53216 22320 0 742320* 0 0 0 0 0
2 32 53216 106433 45332 0 765332* 0 0 0 0 0
3 33 53216 159649 69057 0 789057* 0 69057 58212 86462 87377
4 34 53216 212866 93518 0 813518* 0 93518 121265 121717 122823
5 35 53216 266082 118737 0 838737* 0 118737 153701 160635 161883
6 36 53216 319298 144738 0 864738* 0 144738 187257 203514 204858
7 37 53216 372515 171545 0 891545* 0 171545 222104 250672 252070
8 38 53216 425731 199183 0 919183* 0 199183 258435 302449 303865
9 39 53216 478948 227677 0 947677* 0 227677 296473 359218 360618
10 40 53216 532164 257055 0 977055* 0 257055 336475 421381 422736
11 41 53216 585380 287344 0 1007344* 0 287344 407694 489381 490666
12 42 53216 638597 318572 0 1038572* 0 0 455192 563705 564899
13 43 0 638597 350767 60000 1070767* 0 0 443738 580356 581443
14 44 0 638597 383961 60000 1103961* 0 0 435749 597294 598262
15 45 0 638597 418184 60000 1138184* 0 0 431767 614506 615346
16 46 0 638597 453468 60000 1173468* 0 0 452008 631984 632692
17 47 0 638597 489845 60000 1209845* 0 0 455026 649710 650286

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place

 18 48 0 638597 527350 60000 1247350* 0 0 464262 667668 668116
19 49 0 638597 566018 60000 1286018* 0 0 480707 685833 686161
20 50 0 638597 605885 60000 1325885* 0 0 505518 704168 704389
21 51 0 638597 646987 60000 1366987* 0 0 540048 722629 722759
22 52 0 638597 689364 60000 1409364* 0 0 585887 741159 741219
23 53 0 638597 733054 60000 1453054* 0 0 644903 759681 759696
24 54 0 638597 778099 60000 1498099* 778099

Case: Investment Return 4% # ##

Polic Life Annualized Cumulative Accrued Survival Death Benefit Maturity Maturity Guaranteed Special Surrender
y Assure Premium Premium (Excl Compound Benefit ^! Benefit Benefit Surrender Surrender Value
Year d Age (Excl of GST) of GST) Reversionar Under Paid- Value (GSV) Value (SSV) Receivable
y Bonus Up Policy **
EOY EOY EOY EOT EOY EOY
1 31 53216 53216 3600 0 723600* 0 0 0 0 0
2 32 53216 106433 7218 0 727218* 0 0 0 0 0
3 33 53216 159649 10854 0 730854* 0 10854 49085 66257 67171
4 34 53216 212866 14508 0 734508* 0 14508 107773 92883 108879
5 35 53216 266082 18181 0 738181* 0 18181 135000 122060 136248
6 36 53216 319298 21872 0 741872* 0 21872 162373 153973 163716
7 37 53216 372515 25581 0 745581* 0 25581 189909 188819 191307
8 38 53216 425731 29309 0 749309* 0 29309 217631 226802 228218
9 39 53216 478948 33056 0 753056* 0 33056 245561 268149 269549
10 40 53216 532164 36821 0 756821* 0 36821 273729 313100 314455
11 41 53216 585380 40605 0 760605* 0 40605 331120 361920 363205
12 42 53216 638597 44408 0 764408* 0 0 362490 414897 416091
13 43 0 638597 48230 60000 768230* 0 0 332248 407815 408902
14 44 0 638597 52071 60000 772071* 0 0 302396 398388 399355
15 45 0 638597 55932 60000 775932* 0 0 272989 386330 387170
16 46 0 638597 59811 60000 779811* 0 0 263677 371328 372035
17 47 0 638597 63710 60000 783710* 0 0 232354 353026 353602
18 48 0 638597 67629 60000 787629* 0 0 201689 331028 331476
19 49 0 638597 71567 60000 791567* 0 0 171777 304886 305215
20 50 0 638597 75525 60000 795525* 0 0 142725 274092 274313
21 51 0 638597 79502 60000 799502* 0 0 114658 238070 238201
22 52 0 638597 83500 60000 803500* 0 0 87720 196162 196222
23 53 0 638597 87517 60000 807517* 0 0 62078 147612 147628
24 54 0 638597 91555 60000 811555* 91555
EOY: End Of Policy Year
EOT: End Of Policy Term
~ Survival Benefit will be paid in monthly installments (unless each installment is less than Rs.400/-). As such, the displayed values of Income Benefit are the sums
of monthly benefits paid over the course of the corresponding years.
^! 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 Plan-Variant 'INCOME', the vested bonus & terminal bonus, if any, will be paid immediately. The amount of (death benefit minus the vested bonus &
terminal bonus, if any) will be paid in 144 equated monthly installments starting from date of settlement of the death benefit as income to the nominee.
# 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 Paid up, the Survival Benefit will also be payable which is equal to paid up GMI(paid up GMI is GMI multiplied by no. of premiums paid divided by no. of premiums
payable) and will be paid in monthly installments (over the next 12 years). If the paid up GMI (Paid-up SA / 144) is less than Rs. 400 per month, then, the benefit will
be paid annually, which will be equal to paid-up Sum Assured in 12 yearly installments over the next 12 years.
## 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.
** 'Surrender Value Receivable' includes Base Policy Surrender Value and Rider Surrender Value, if any.

Notes & Disclaimers:

1.The above information should be read in conjunction with the Sales Literature.
2.Further clarification can be sought by contacting company's sales representative or by sending an e-mail to life@bajajallianz.co.in.
3.Income Benefit: Starting from the end of PPT, Guaranteed Monthly Income (GMI) shall be receivable every month till either the Life Assured dies, surrenders the
Policy or the Policy matures.
4.The company may declare a rate of Compound Reversionary Bonus. This rate will be expressed as a percentage of the Sum Assured . This percentage will be
applied on the Sum Assured plus already attached reversionary bonuses under the policy to determine the amount of reversionary bonus to be added to the policy at
that year end. An interim bonus may also be declared. Furthermore, if the policy has completed ten (10) years and all due premiums have been paid, the company
may declare a terminal bonus (applied on the guaranteed maturity benefit), if any.

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place

The compound reversionary bonus, interim bonus and terminal bonus may vary with the policy term chosen by the policyholder.
5.The illustrated figures of 'Surrender Value Receivable' include the respective 'Base Policy Surrender Value' and 'Rider Surrender Value'.
6.The investment returns illustrated above are only for the illustrative purpose as mandated by the IRDA and do not in any way indicate the upper and lower limits of
investment return.
7.Goods & Service Tax would be payable as per applicable tax laws.
8.Premiums payable and benefits receivable would be eligible for tax benefits, as per the then existing tax laws.
9.Investment return shown at 8% & 4% are not guaranteed and are for illustrative purpose only.
Insurance is a subject matter of solicitation.

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

I declare that I have read the terms and conditions and understood the above Benefit Illustration.

Signature of Proposer:

Date: Place:

I have explained the benefit illustration to the proposer.

Signature of Sales Representative

Date: Place:

Bajaj Allianz Life Insurance Company Limited

GE Plaza, Airport Road, Yerawada, Pune - 411 006
Tel: (020) 66026777. Fax: (020) 66026789
Email: life@bajajallianz.co.in
www.bajajallianz.com

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place