Duplicate

PART A
Welcome to Max Life Insurance
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Date 26-Sep-2016
To MR. PRASHANT CHOUDHARY
C-9/9518
VASANT KUNJ IMPORTANT
NEAR VASANT KUNJ S O,VASANT KUNJ Premium Payment Term (in years) 15
NEW DELHI 110070 Total Premium Payable (Inclusive of 2,94,578.32
DELHI Service Tax and Rider premium) Annual
G. O. Name: BY634
Policy Maturity Date 09-Sep-2041
Policy no.: 127896132
Guaranteed Monthly Income 47,165.00
Telephone: 8222831111,9810944777
Email id: PRASHANT800800@GMAIL.COM

-----------------------------------------------------------------------------------------------------------------------------------------------------------
Welcome Dear MR. PRASHANT CHOUDHARY,
Thank you for opting for Max Life Monthly Income Advantage Plan.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
What to do On examination of the policy, if you notice any mistake or error, proceed as follows:
in case of 1. Contact our customer helpdesk or your agent immediately at the details mentioned below.
errors 2. Return the policy to us for rectifying the same.

-----------------------------------------------------------------------------------------------------------------------------------------------------------
Free Look In case you are not satisfied with the policy, you have the option to cancel it by returning the original copy with a written
Cancellation request, stating the objections/reasons for such disagreement, to us within the free look period of fifteen (15) days, or
thirty (30) days (for policies sourced through distance marketing modes) of receiving the document.
Result: Upon return, the policy will terminate forthwith and all rights, benefits and interests under the policy will cease immediately. We will
refund only the premiums received by us after deducting the proportionate risk premium for the period of cover, charges of stamp duty paid and
the expenses incurred on medical examination of the Life Insured, if any.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Long term We are committed to giving you honest advice and offering you long-term savings, protection and retirement solutions
protection backed by the highest standards of customer service. We will be delighted to offer you any assistance or clarification
you may require about your policy or claim-related services at the address mentioned below. We look forward to being
your partner for life.
Yours Sincerely,
Max Life Insurance Co. Ltd.

Rajesh Sud
Executive Vice Chairman & Managing Director
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Agent YES BANK LIMITED ROHTAK ROAD (609925)
Name:
Ph. no.: 8950333308,
Address: House No 15 Board No 1, Block No 10, Andhi Nagar, Rohtak 124001
-----------------------------------------------------------------------------------------------------------------------------------------------------------
"Visit http://www.maxlifeinsurance.com/customer-service/download_policy_pack.aspx to download the soft copy of the policy pack"
NB13
Max Life Insurance Company Limited
Plot No. 90A, Sector 18, Gurgaon, 122015, Haryana, India
Customer Helpline: 1800 200 4003 Fax 2389268 (From Delhi and Other cities: 0124)
Regd Office: Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India
Visit us at: www.maxlifeinsurance.com E-mail: goldcircle@maxlifeinsurance.com
IRDAI Registration No: 104 Corporate Identity Number: U74899DL2000PLC106723

1 of 36
2 of 36
 Key Feature Document for Max Life Monthly
Income Advantage Plan
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Introduction This document is the summary of important points in your policy. You must read this to understand your
policy better.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Your policy details The table below gives an overview of the details of this policy:

Policyholder/ Life Insured MR. PRASHANT CHOUDHARY Policy No.: (please use this for 127896132
Name: any communication with us)
Date of Commencement: 09-SEP-16 Premium Payment Date: 9th of Sep Every Year
(date when the policy starts)
ECS Draw Date: 01st of Sep Every Year Policy Term:(period of 25
coverage- in years)
Premium Payment Term: 15 Maturity Date: 09-Sep-2041
(period for which premium is to
be paid- in years)
Premium Amount : ` 2,89,156.63 Premium Payment Mode: Annual
(applicable taxes extra)
Sum Assured: `56,59,750.00 Death Benefit: `56,59,750.00
(minimum amount payable on
the death of the life insured)
Monthly Income Benefit: ` 47,165.00

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

Policy Benefits
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
If the life insured lives If the life insured lives, and we have received all the premiums due, we will pay you the following:

• a monthly income benefit of 1/12th of 10% of the sum assured for 10 consecutive years at each
monthly anniversary, as follows:
If the premium payment term for your policy Then the monthly income payout will start
is... from the beginning of...
12 years the 13th year
15 years the 16th year

• additionally on the maturity date i.e. on the expiry of 10 years from the end of premium payment
term, we will pay:
- accrued compound reversionary bonus, if any,

- terminal bonus, if any.

Note:

Accrued compound reversionary bonus is the compounded sum total of all reversionary bonus that may be declared every
year after completion of the second policy year. It is guaranteed, once declared.

Terminal bonus is an additional bonus paid only once on any of the events that happen earlier: death, surrender or maturity..
It accrues only if the policy has been in force for at least 5 complete years.

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Continued on next page

3 of 36
Policy Benefits, Continued
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
If the life insured expires If the life insured expires during the policy term and we have received all the premiums due, we will:

• pay the death benefit which will be highest of the following:

■ 11 times the total premium paid in a year
■ 105% of all the premiums we have received till the date of death of the life insured
■ sum assured

• waive off all the future premiums and continue with the policy as is.

• the monthly income and maturity benefits (including accrued compound reversionary bonus, if any
& terminal bonus, if any) will be paid to the beneficiary as and when due.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

A. Managing Your Policy – Frequently asked questions

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
What you need to do You need to

• pay premiums on time for the entire premium payment term. There are various easy and
convenient payment options for you to choose from. To know more about payment options log on
to www.maxlifeinsurance.com.
• read the details of the policy document, including the proposal form, to ensure the accuracy of
information. For any error you observe, contact us for correction.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
How can you manage Register your policy at www.maxlifeinsurance.com to get easy access to the following self-service
your policy? options:
• Access policy statements, receipts and premium due information.

• Update your contact details.

• Change the premium payment mode to any of these - annual, semi-annual, quarterly or monthly
modes.
• Pay renewal premiums online.
Note: For any support you can reach us at 1800 200 4003 or goldcircle@maxlifeinsurance.com
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
What happens if you To ensure continuous life insurance cover, please pay your premium on time.
delay your premium If for any reason, you are unable to pay by the due date, you have a grace period within which you
payment? can pay without any late fee or interest.

Note: During the grace period, the insurance cover continues. If the life insured dies during this period, we will pay the
death benefit after deducting the unpaid due premium, if any.

If you are unable to pay the premium by the end of grace period
Where your policy has... Then your...
not acquired a surrender value policy shall lapse and no benefit will be payable.
acquired a surrender value policy will be in reduced paid up mode.
Note: The insurance cover will be reduced proportionately in the
ratio of the premiums received to the total premiums payable.

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

How can you revive You may revive your policy within two years from the due date of the first unpaid premium, once you
your policy?
• pay all due premiums, and

• produce evidence of insurability of the life insured.

However, if a reduced paid up policy is not revived within two years, then it will continue to be under
reduced paid up mode.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Continued on next page

4 of 36
A. Managing Your Policy – Frequently asked questions, Continued
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Do you have an option If your policy does not meet your objective, you may contact us to understand the policy benefits. If you
to cancel the policy? still feel the need to cancel your policy, you have an option to cancel it within the free look period of
fifteen days from the day you receive the policy documents.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Increasing the policy You can buy any of the applicable rider(s) (add-on benefit that you buy with your policy to increase
cover coverage), at a nominal increase in the premium, and enhance your policy cover as per your needs.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

B. Taxes and Others - Frequently asked questions

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Tax benefits You may be entitled to certain tax benefits on the premiums you pay and the benefits you will receive
under the policy as per the tax laws prevailing at that time. Consult your tax advisor for further details.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Will any benefit payouts Your policy will attract a Tax Deduction at Source (TDS) if
be subject to Tax
Deduction at Source (TDS)?
• the death benefit is less than ten times the total premium you pay in a year anytime during the
policy term, and
• the benefit payable in a policy year is equal to or greater than ` 1 lakh.

If applicable, you will pay TDS on the benefit amount as follows:

If you have... Then you pay TDS at the rate of...
shared your PAN with us 2%.
not shared your PAN with us 20%.
Note: To ensure TDS is applied correctly, do share your PAN with us timely. These rates are not applicable to NRI's
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Are there any exclusions All risks and benefits under this policy shall cease and no benefits will be payable under this policy, in
under the policy? the event of death of the life insured due to suicide within twelve months from the date of start of the
policy or the date of revival of your policy. In such an event:
If your policy has... Then we pay...
not acquired a surrender value total premiums received.
acquired a surrender value the higher of the surrender value or total
premiums received.

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
Disclaimers Please read the following carefully:

• The actual returns of the policy may be different from what is shown in the benefit illustration,
enclosed in the policy document as:
- the benefit illustration represents the guaranteed benefits, and

- the non-guaranteed benefits are shown at investment returns of 4% and 8% p.a.

• Bonuses are not guaranteed and they depend on many factors including our investments, claims,
costs, and customer retention.
• The aim of this document is to summarize the key features of your policy and does not replace the
policy, in any way. In case of any discrepancy between the policy contract and this document, the
terms and conditions of the policy contract shall prevail.
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
"If this Key Feature Document has been issued in any language in addition to English, the English version shall prevail in
case of any inconsistency between the two languages."

5 of 36
 eSDl ykbQ eaFkyh bUde ,MokaVst+ Iyku ds fy, izeq[k fo'ks"krk
nLrksot+
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
ifjp; ;g nLrkost+ ¼MkWD;qesaV½ vkidh ikWfylh ds egRoiw.kZ fcUnqvksa dk lkjka'k gSA ikWfylh dks csgrj le>us ds
fy, bls t+:j i<+ ysaA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
vkidh ikWfylh ds fooj.k bl ikWfylh ds fooj.kksa dh :ijs[kk dh ,d rkfydk uhps nh xbZ gS%
ikWfylh/kkjd@chfer thou dk MR. PRASHANT CHOUDHARY ikWfylh la-: (gels fdlh laokn esa 127896132
uke:
Ñi;k ;g la[;k crk,¡s)
ykxw gksus dh frfFk: 09-SEP-16 izhfe;e Hkqxrku dh frfFk: 9th of Sep Every Year
(ikWfylh dh vkjafHkd frfFk)
bZ lh ,l ls fudklh dh frfFk: 01st of Sep Every Year ikWfylh dh vof/k:(dojst dh 25
vof/k & o"kZ)
izhfe;e Hkqxrku dh vof/k: 15 ifjiDork dh frfFk: 09-Sep-2041
(ftl vof/k rd izhfe;e nsuk gS
& o"kZ)
izhfe;e dh jkf'k : ` 2,89,156.63 izhfe;e Hkqxrku dk ek/;e: Annual
(dj vfrfjDr ykxw)
chfer jkf'k: ` 56,59,750.00 e`R;q laca/kh ykHk: ` 56,59,750.00
(chfer thou dh e`R;q ij ns;
U;wure jkf'k)
ekfld vk; ykHk: ` 47,165.00

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

ikWfylh ds ykHk
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

;fn chfer O;fDr ;fn chfer O;fDr thfor jgrk gS vkSj mlus gekjs lHkh fu;r izhfe;e dk Hkqxrku dj fn;k gks rks ge
thfor jgrk gS fuEufyf[kr ykHk nsaxs%
• ekfld vk; ykHk & chfer jkf'k ds 10 izfr'kr dk 1@12ok¡ Hkkx] yxkrkj 10 o"kks± rd izR;sd eaFkyh
,fuolZjh ijA fooj.k uhps fn;k x;k gS%
;fn vkidh ikWfylh ds izhfe;e Hkqxrku dh rks vkidh ekfld vk; ds Hkqxrku ls 'kq:
vof/k gS gksxh%
12 o"kZ 13 osa o"kZ ds 'kq: gksus ij
15 o"kZ 16 osa o"kZ ds 'kq: gksus ij
• blds vfrfjDr ifjiDork dh frfFk] vFkkZr~] izhfe;e Hkqxrku dh vof/k ds var ls 10 o"kks± dh lekfIr
ij ge Hkqxrku djsaxs%
- ,ØwM dEikmaM fjo'kZujh cksul] ;fn gks] vkSj
- lekiu cksul] ;fn gksA
uksV%

,ØwM dEikmaM fjo'kZujh cksul lHkh fjo'kZujh cksul dk dqy pØo`f) jkf'k gSA fjo'kZujh cksul nwljs ikWfylh
o"kZ ds lekiu ds ckn gj o"kZ ?kksf"kr fd;k tk ldrk gSA ?kks"k.kk gks tkus ds ckn bldh xkjaVh gksrh gSA
VfeZuy cksul & e`R;q] leiZ.k ;k ifjiDork esa tks igys gks] mlds ckn dsoy ,d ckj fn;k tkrk gSA ;g
ikWfylh ds de ls de 5 laiw.kZ o"kZ ykxw jgus ij gh tqM+rk gSA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

vxys i`"B ij tkjh

6 of 36
ikWfylh ds ykHk, tkjh
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
;fn chfer O;fDr dh ;fn chfer O;fDr dh e`R;q gks tkrh gS vkSj mlus gekjs lHkh fu;r izhfe;e dk Hkqxrku dj fn;k gks rks
e`R;q gks tkrh gS
ge fuEufyf[kr ykHk nsaxs%
• e`R;q laca/kh ykHk nsaxs] tks buesa lcls vf/kd gksxk%
■ fdlh o"kZ dqy izhfe;e Hkqxrku dk 11 xquk
■ chfer O;fDr dh e`R;q dh frfFk rd gesa izkIr dqy izhfe;e dk 105 izfr'kr
■ chfer jkf'k

• Hkkoh lHkh izhfe;e ekQ dj nsaxs vkSj ikWfylh igys dh rjg tkjh jgsxhA
• ykHk ds gdnkj dks ekfld vk; vkSj ifjiDork ykHk ¼,ØwM dEikmaM fjo'kZujh cksul] ;fn gks vkSj VfeZuy
cksul] ;fn gks½ fn, tk,axs tc vkSj tSls ns; gksaxsA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

A. vkidk ikWfylh çca/ku & vDlj iwNs tkus okys iz'u

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
vkidks D;k djuk gS vki%
• izhfe;e Hkqxrku dh iwjh vof/k esa fu;r le; ls izhfe;e dk Hkqxrku djsaA Hkqxrku ds dbZ vklku vkSj
lqfo/kktud fodYi gSa ftuls viuk euilan fodYi pqusaA Hkqxrku ds fodYiksa dh vf/kd tkudkjh ds
fy, www.maxlifeinsurance.com ij ykWx&bu djsaA
• lko/kkuh ls izLrko i= lfgr ikWfylh MkWD;qesaV~l ds fooj.k dks i<+sa rkfd lVhd tkudkjh feysA ;fn
dksbZ =qfV ut+j vk, lq/kkj ds fy, gels laidZ djsaA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
vki dSls djsa vius vkiuh ikWfylh dks www.maxlifeinsurance.com ij jftLVj djsa vkSj vklkuh ls ik,¡ lsYQ+&lfoZl ds
ikWfylh dk izca/ku\
uhps fy[ks fodYi%
• ikWfylh LVsVesaV] jlhn vkSj izhfe;e dh fu;r frfFk dh tkudkjh ns[ksaA

• vkils laidZ ds fooj.k viMsV djsaA

• izhfe;e Hkqxrku dh i)fr cnysa & okf"kZd] Nekgh] frekgh ;k ekfldA
• fjU;qvy izhfe;e dk vkWuykbu Hkqxrku djsaA
/;ku nsa : fdlh Hkh çdkj dh lgk;rk ds fy, vki gels 1800 200 4003 ;k
goldcircle@maxlifeinsurance.com ij laidZ dj ldrs gSaA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
izhfe;e Hkqxrku esa thou chek doj fujarj jgs blfy, Ñi;k izhfe;r dk le; ls Hkqxrku djsaA
foyac djus ls D;k gksxk\
;fn fdlh dkj.k ls vki fu;r frfFk rd Hkqxrku ugha dj ikrs rks ge xzsl ihfj;M nsrs gSa ftlesa vki
fcuk foyac 'kqYd ;k C;kt Hkqxrku dj ldrs gSaA

uksV: xzsl ihfj;M esa chek doj ykxw jgrk gSA ;fn chfer O;fDr dh bl vof/k esa e`R;q gksrh gS rks ge
izhfe;e dh cdk;k jkf'k] ;fn gks] dkV dj e`R;q laca/kh ykHk nsaxsA

;fn vki xzsl ihfj;M dh lekfIr ds ckn Hkh izhfe;e ugha ns ikrs gSa%
tc vkidh ikWfylh dk--- rks vkidh---
dksbZ Hkh leiZ.k ewY; u gks ikWfylh ySIl dj tk,xh vkSj vkidks dksbZ ykHk ugha fn;k tk,xkA
dqN leiZ.k ewY; gks ikWfylh ?kVs gq, Hkqxrku dj fn;s x;s eksM esa gksxhA
uksV: dqy ns; izhfe;e dh rqyuk esa izkIr izhfe;e ds vuqikr esa chek
doj de dj fn;k tk,xkA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

vxys i`"B ij tkjh

7 of 36
A. vkidk ikWfylh çca/ku & vDlj iwNs tkus okys iz'u, tkjh
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
ikWfylh dks fQj ls vkius ftl igys izhfe;e dk Hkqxrku ugha fd;k mldh fu;r frfFk ls nks o"kks± ds vanj vkidh ikWfylh
dSls ’kq: djsa\
nksckjk ’kq: dh tk ldrh gS ;fn vki%
• cdk;k lHkh izhfe;e dk Hkqxrku dj nsa] vkSj

• ;g izke.k nsa fd chfer O;fDr dk chek fd;k tk ldrk gSA

gkyk¡fd] ;fn ?kVh pqdrk iwath okyh ikWfylh nks o"kks± ds vanj iqu% ’kq: ugha dh tkrh gS rks ;g ?kVh pqdrk
iwath okyh ikWfylh ds :i esa jgsxhA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
D;k vkidks ikWfylh ;fn vkidh ikWfylh vkidk y{; ugha iwjk dj ldrh rks ikWfylh ds ykHk tkuus ds fy, vki gels laidZ
jí djus dk fodYi gS\
dj ldrs gSaA fQj Hkh vkidks yxs fd ikWfylh jí djuk lgh jgsxk rks vkids ikWfylh nLrkost+ izkIr djus
dh frfFk ls 15 fnu ds Ýh yqd ihfj;M ds vanj bls jí dj ldrs gSaA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
ikWfylh dk doj c<+kuk vki FkksM+k izhfe;e c<+kdj vkids fy, ykxw jkbMj ¼ikWfylh dk dojst c<+kus ds fy, mlds lkFk [kjhnk
x;k vfrfjDr ykHk½ ys ldrs gSaA blls vkidh t+:jr ds fglkc ls vkidh ikWfylh dk doj c<+ tk,xkA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -

B. dj vkSj vU; & vDlj iwNs tkus okys iz'u

- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
dj laca/kh ykHk vki tks izhfe;e nsrs gSa vkSj ikWfylh ds rgr tks ykHk feysa gSa mu ij dj laca/kh NwV ysus dk vkidks
vf/kdkj gS tks ml le; ds ykxw dj dkuwuksa ds vuqlkj fn, tkrs gSaA vf/kd tkudkjh vius dj
lykgdkj ls ysaA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
D;k fdlh ykHk ds Hkqxrkuksa ij vkidh ikWfylh ij VhMh,l ¼lzksr ij dj½ yxsxk ;fn
VhMh,l ¼lzksr ij dj½ yxsxk\
• ;fn ikWfylh vof/k esa fdlh le; e`R;q laca/kh ykHk lky esa vkids fn, dqy izhfe;e ls de gS] vkSj

• ;fn fdlh ikWfylh vof/k esa ns; ykHk ` 1 yk[k #- ds cjkcj ;k mlls vf/kd gSA

;fn ;g ykxw gks] rks vkidh ykHk jkf'k ij fuEuor~ VhMh,l dVsxk%
;fn vki--- rks vkids fy, VhMh,l dh nj gksxh---
gesa viuk iSu nsrs gSa 2%.
gesa viuk iSu ugha nsrs gSa 20%.
uksV: ;g lqfuf'pr djus ds fy, fd lgh VhMh,l dVs Ñi;k gesa le; ls viuk iSu uacj nsaA ;s njsa
,uvkjvkbZ ij ykxw ugha gSaA
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
D;k dqN ,slk gS tks bl ikWfylh ds varxZr lHkh tksf[ke vkSj ykHk #d tk,axs vkSj bl ikWfylh ds rgr dksbZ ykHk ugha fn;k
ikWfylh ds nk;js esa ugha gSa\
tk,xk ;fn chfer O;fDr dh e`R;q ikWfylh dh vkjafHkd frfFk ;k ikWfylh ds iquthZou dh frfFk ls cgj
eghuksa ds vanj vkRegR;k ds dkj.k gksrh gSA bl fLFkfr esa%
;fn vkidh ikWfylh dk---- rks ge Hkqxrku djsaxs---
dksbZ leiZ.k ewY; ugha gS dqy izhfe;e izkIr
dqN leiZ.k ewY; gS leiZ.k ewY; ;k dqy izhfe;e izkIr esa tks vf/kd gks
- -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
fMLDysej Ñi;k fuEufyf[kr rF;ksa dks lko/kkuh ls i<+sa%
• ikWfylh ls okLrfod vk; ikWfylh nLrkost+ ds mnkgj.k esa fn[kk, x, ykHk ls vyx gks ldrk gS D;ksafd%
- ykHk ds mnkgj.k esa xkjaVhM ykHk fn[kk, x, gSa] vkSj
- xSj&xkjaVhM ykHk fuos'k ij 4% vkSj 8% izfr o"kZ Øe'k% dh vkenuh ds :i esa fn[kk, x, gSaA
• cksul dh xkjaVh ugha gS vkSj ;s dbZ dkjdksa ij fuHkZj djrs gSa] tSls] fuos'k] Dyse] ykxr] vkSj xzkgd
dks cuk, j[kukA
• bl nLrkost+ dk mís'; vkidh ikWfylh dh eq[; fo'ks"krkvksa dk lkjka'k nsuk gS vkSj ;g fdlh izdkj
ls ikWfylh dk LFkku ugha ys ldrk gSA ;fn ikWfylh djkj vkSj bl nLrkost+ esa dksbZ fHkUurk gks rks
ikWfylh djkj ds fu;e vkSj 'krs± ykxw gksaxhA

8 of 36
POLICY PREAMBLE
MAX LIFE INSURANCE COMPANY LIMITED
Regd. Office: Max House, 1, Dr. Jha Marg, Okhla, New Delhi -110020

Max Life Monthly Income Advantage Plan

A Non-Linked Participating Savings Insurance Plan

UIN [104N091V01]

Max Life Insurance Company Limited has entered into this contract of insurance on the basis of the information
given in the Proposal Form together with the Premium deposit, statements, reports or other documents and
declarations received from or on behalf of the proposer for effecting a life insurance contract on the life of the
person named in the Schedule.

We agree to pay the benefits under the Policy on the happening of the insured event, while the Policy is in force
subject to the terms and conditions stated herein.

Max Life Insurance Company Limited

"Visit http://www.maxlifeinsurance.com/customer-service/download_policy_pack.aspx to download the soft copy

of the policy pack"

9 of 36
 POLICY SCHEDULE

Policy - Max Life Monthly Income Advantage Plan Type of Policy - A Non-Linked Participating Savings
Insurance Plan
UIN - 104N091V01 Office - Yes Bank Rohtak Road
Policy No./ Proposal No.:127896132 Client ID: 5006963815
Date of Proposal: 09-Sep-2016
Policyholder/Proposer : Age Admitted: Yes
MR. PRASHANT CHOUDHARY
Gender: Male
PAN: AOIPC7563G
Tel No./Mobile No.: / 8222831111,9810944777
Identification Source & I.D No.:
Email: PRASHANT800800@GMAIL.COM
Relationship with Life Insured: Same Person
Date of Birth: 18-Aug-1991
Address:
C-9/9518
VASANT KUNJ NEAR VASANT KUNJ S O,VASANT KUNJ
NEW DELHI 110070
DELHI

Life Insured: Age Admitted: Yes

MR. PRASHANT CHOUDHARY
Gender: Male
Identification Source & ID No.:

Date of Birth: 18-Aug-1991

Age: 25
Nominee(s): Appointee (if Nominee is minor) :
MRS.MILLIE .
Relationship of Nominee(s) with Policyholder:
Spouse
Date of Birth:
16-Jun-1991
Date of Commencement: 09-SEP-16 Premium Payment mode: Annual
Premium Payment Method: Two-stage autopay Bill Draw Date: 01ST
Bank Name:
Bank Account Number: 063499000003850
Agent's name/Broker's name: YES BANK LIMITED ROHTAK Agent's code / Broker's code: 609925
ROAD
Broker's License No.:
Email: CA0125
Address:
House No 15 Board No 1, Block No 10, Andhi Nagar Mobile / Landline Telephone Number: 8950333308,
Rohtak 124001

10 of 36
 List of Maturity Date Insured Event Sum Assured Monthly Policy Term Premium Premium Annual Extra Premium Annualised
Coverage (INR) Income Payment B
Payment Premium Premium
Benefit Term (INR)
payable Mode A C(A+B) c
for 10 (INR) (INR)
consecutive
years after
completion
of Premium
Payment
Term
(INR)
BASE POLICY
Max Life 09-SEP-41 Death of 56,59,750.00 47,165.00 25 15 Annual 2,89,156.63 NA 2,89,156.63
Monthly Income Life Insured
Advantage Plan

11 of 36
PART B payment mode - (1); ii) for semi-annual Premium payment mode
DEFINITIONS - (0.520); iii) for quarterly Premium payment mode - (0.265); iv)
for monthly Premium payment mode - (0.090);
The words and phrases listed below will have the meaning attributed to
19. "Nominee" means a person nominated by You in accordance
them wherever they appear in the Policy unless the context otherwise
with Clause 7 of Part F, to receive the benefits under the Policy
requires.
and whose name is mentioned in the Schedule;
1. "Act" means the Insurance Act, 1938, as amended from time to
20. "Participating" means participating in the Actuarial Valuation
time;
Surplus of the participating life policyholders' fund;
2. "Actuarial Valuation Surplus" means the surplus arising in
21. "Policy" means the contract of insurance entered into between
the Participating life policyholders' fund, established by Us
You and Us as evidenced by this document, the Proposal
for Participating life insurance policies and calculated by the
Form, the Schedule and any additional information/document(s)
Appointed Actuary in accordance with the standards or guidance
provided to Us in respect of the Proposal Form along with any
issued by the Institute of Actuaries of India and the Insurance
written instructions from You subject to Our acceptance of the
Regulatory and Development Authority (Distribution of Surplus)
same and any endorsement issued by Us;
Regulations, 2002, as amended from time to time;
22. "Policy Anniversary" means the annual anniversary of the Date
3. "Age" means Life Insured's age on last birthday as on the Date
of Commencement;
of Commencement or on the previous Policy Anniversary, as the
case may be; 23. "Policy Term" means the term of this Policy as specified in the
Schedule;
4. "Annual Premium" means an amount specified in the Schedule,
which is payable under annual Premium payment mode, 24. "Policy Year" means a period of 12 (Twelve) months
excluding Extra Premium, if any and excluding service tax or any commencing from the Date of Commencement and every Policy
other taxes, cesses or levies, if any; Anniversary thereafter;
5. "Annualised Premium" means the sum total of Annual Premium 25. "Premium" means an amount specified in the Schedule, payable
and Extra Premium, if any, as specified in the Schedule; by You, by the due dates to secure the benefits under the Policy,
excluding service tax or any other taxes, cesses or levies, if any;
6 "Claimant" means You (in case of maturity), Nominee(s) (if
valid nomination is effected), assignee(s) or their heirs, legal 26. "Premium Payment Term" means the term specified in the
representatives or holders of a succession certificates in case Schedule, during which the Premiums are payable by You;
Nominee(s) or assignee(s) is/are not alive at the time of claim; 27. "Proposal Form" means the form filled in and completed by You
7. "Date of Commencement" means the date as specified in the for the purpose of obtaining insurance coverage under the Policy;
Schedule, on which the insurance coverage under the Policy 28. "Reduced Paid Up Death Benefit" means an amount equal to
commences; the Death Benefit multiplied by the resultant of the total Premiums
8. "Death Benefit" means an amount which will be highest of the received by Us less Extra Premium (if any) divided by the total
following: Premiums payable by You excluding Extra Premium (if any);
i. 11 (Eleven) times the Annualised Premium; 29. "Reduced Paid Up Mode" means the Policy with reduced paid
up benefits as specified under Clause 3 of Part C;
105% (One Hundred Five percent) of all the Premiums
ii. 30. "Reduced Paid Up Sum Assured" means an amount equal to
received from You till the date of death of the Life Insured;
the Sum Assured multiplied by the resultant of the total Premiums
iii. Guaranteed Sum Assured payable on Maturity Date; or
received by Us less Extra Premium (if any) divided by total
iv. Sum Assured. Premiums payable by You excluding Extra Premium (if any);
9. "Extra Premium" means an additional amount mentioned in the 31. "Reversionary Bonus" means the bonus(es) payable by Us in
Schedule and charged by Us, as per Our Underwriting policy, accordance with Clause 4.2 of Part C, if declared by Us;
which is determined on the basis of disclosures made by You 32. "Revival Period" means a period of 2 (Two) years from the due
in the Proposal Form or any other information received by Us date of the first unpaid Premium;
including medical examination report of the Life Insured;
33. "Rider" means benefits, which are in addition to basic benefits
10. "Force Majeure Event" means an event by which performance under the Policy;
of any of Our obligations are prevented or hindered as a
34. "Schedule" means the policy schedule and any endorsements
consequence of any act of God, State, strike, lock-out, legislation
attached to and forming part of the Policy and if any updated
or restriction by any government or other authority or any
Schedule is issued, then, the Schedule latest in time;
circumstance beyond Our control;
35. "Special Surrender Value" means the special surrender value
11. "Grace Period" means a period of 15 (Fifteen) days from the due
computed in accordance with Clause 1.6 of Part D;
date of the unpaid Premium under monthly Premium payment
mode and 30 (Thirty) days from the due date of unpaid Premium 36. "Special Surrender Value Factors" are factors determined by
for all other Premium payment modes; Us in consultation with and approved by the IRDAI to compute
the Special Surrender Value which can be revised by Us on the
12. "Guaranteed Sum Assured payable on Maturity Date" means
basis of Our experience from time to time in consultation with and
'zero' or 'nil' benefit payable under this Policy as all the
approval of the IRDAI;
guaranteed benefits are paid in form of regular monthly income
after completion of Premium Payment Term; 37. "Sum Assured" means an absolute assured amount as specified
in the Schedule, which is payable on the death of the Life Insured;
13. "Guaranteed Surrender Value" means the minimum surrender
value computed in accordance with Clause 1 of Part D, which is 38. "Surrender Value" means an amount payable on surrender of
guaranteed by Us; this Policy, which will be the higher of the Guaranteed Surrender
Value or the Special Surrender Value;
14 "IRDAI" means the Insurance Regulatory and Development
Authority of India; 39. "Terminal Bonus" means a bonus determined by Us as a
percentage applied on the sum of Sum Assured and accrued
15. "Lapsed Policy" means a Policy which has not acquired the
Reversionary Bonus (if any);
Surrender Value and where the due Premium has not been
received till the expiry of the Grace Period; 40. "Underwriting Policy" means our then prevailing underwriting
policy approved by Our board of directors;
16. "Life Insured" means the person named in the Schedule, who is
also the policyholder, on whose life the Policy is effected; 41. "We", "Us" or "Our" means Max Life Insurance Company
Limited; and
17. "Maturity Date" means the date specified in the Schedule, on
which the Policy Term expires; 42. "You" or "Your" means the policyholder as named in the
Schedule.
18. "Modal Factor" means the applicable factor specified in the
Schedule, which is used by Us for determining the Premium. The
Modal Factors for this Policy are as follows: i) for annual Premium
12 of 36
 PART C
POLICY FEATURES, BENEFITS AND PREMIUM PAYMENT 3.2. If this Policy is under Reduced Paid Up Mode, then, the
1. ELIGIBILITY benefits payable shall be as follows:
1.1. The Policy has been written on a single life basis. 3.2.1. Reduced Death Benefit
1.2 The minimum Age of the Life Insured on the Date of In the event of the death of the Life Insured during
Commencement should be 18 (Eighteen) years. Policy Term, then, We will pay the following benefits:
1.3 The maximum Age of the Life Insured on the Date of 3.2.1.1. Reduced Paid Up Death Benefit;
Commencement cannot exceed: 3.2.1.2. Reduced monthly income benefit, as and
1.3.1. 55 (Fifty Five) years for the Policy where the Policy when due; and
Term is 22 (Twenty Two) years; and 3.2.1.3. Reduced maturity benefit, as and when due.
1.3.2. 50 (Fifty) years for the Policy where the Policy Term is 3.2.2. Reduced Monthly Income Benefit
of 25 (Twenty Five) years. 3.2.2.1. On completion of the Premium Payment
1.4 The maximum Age of the Life Insured on the Maturity Date Term as chosen by You, We will pay the
cannot exceed: th
monthly income benefit equal to 1/12
1.4.1. 77 (Seventy Seven) years for the Policy where the (one twelfth) of 10% (Ten percent) of the
Policy Term is 22 (Twenty Two) years; and Reduced Paid Up Sum Assured for 10 (Ten)
1.4.2. 75 (Seventy Five) years for the Policy where the Policy consecutive years (i.e. 120 months) on each
Term is 25 (Twenty Five) years. monthly anniversary i.e. on the date specific
to Policy Anniversary date.
2. BENEFITS
3.2.2.2. The monthly income payout will start
2.1. Death Benefit th
from beginning of 145 policy month (i.e.
2.1.1. If Life Insured dies during the Policy Term provided th
beginning of 13 Policy Year) for Policy
the Policy is in force and not under lapsed or Reduced
with Premium Payment Term of 12 (Twelve)
Paid Up Mode, We will pay the following benefits: st
years and 181 policy month (i.e. beginning
2.1.1.1. Death Benefit; and th
of 16 Policy Year) for Policy with Premium
2.1.1.2. Policy Continuance Benefit.
Payment Term of 15 (Fifteen) years.
"Policy Continuance Benefit" means waiver of all
3.2.2.3. The risk coverage as per Clause 3.2.1 will
future Premiums, if any, coinciding or following the
continue during the reduced monthly income
date of death of the Life Insured. The Policy will
benefit payout period of 10 (Ten) years.
continue as is, the monthly income benefit and
maturity benefit shall be payable to the Claimant, as 3.2.3. Reduced Maturity Benefit
and when due. The Policy will continue to participate 3.2.3.1. If the Life Insured is alive on the Maturity
in the future bonuses and the benefits will continue to Date, then, We will pay bonuses (if any)
be applicable. All future benefits shall be paid to the accrued before the conversion of the Policy
Claimant, as and when due, as if the Life Insured was to Reduced Paid Up Mode.
alive and had paid the Premiums to Us.
4. BONUSES
2.2. Monthly Income Benefit 4.1. Bonus(es) may be declared by Us depending upon the
2.2.1. On completion of the Premium Payment Term as surplus generated in the participating fund over the Policy
chosen by You, irrespective of the fact whether the Term. You shall be eligible to receive the following Bonus(es),
Life Insured is alive or not, We will pay the monthly if any, on Maturity Date or on surrender of this Policy,
th whichever is earlier:
income benefit equal to 1/12 (One twelfth) of 10%
(Ten percent) of Sum Assured for 10 (Ten) consecutive 4.1.1. Reversionary Bonus; and
years (i.e. 120 months) at each monthly anniversary 4.1.2. Terminal Bonus.
i.e. on the date specific to Policy Anniversary date.

13 of 36
4.2. Reversionary Bonus
2.2.2. The monthly income benefit payout will start from
th th 4.2.1. Under this Policy, We may declare a Reversionary
beginning of 145 policy month (i.e. beginning of 13
Bonus, based on Our Actuarial Valuation Surplus.
Policy Year) for Policy with Premium Payment Term
A compound Reversionary Bonus rate will be
st
of 12 (Twelve) years and 181 policy month (i.e. determined each year by Us and shall be applied
 5.2. You have an option to change the Premium payment mode 1.5.1.2. Guaranteed surrender value of the accrued
by submitting a written request to Us. Any change in the compound Reversionary Bonuses, if any.
Premium payment mode will result in a change in the
Premium amount basis the applicable Modal Factors. A Policy 22 years 25 years
change in Premium payment mode will be effective only on Term
the Policy Anniversary following the receipt of such request. Year Guaranteed Guaranteed Guaranteed Guaranteed
5.3. You can pay Premium at any of Our offices or through Our of Surrender Surrender Surrender Surrender
website www.maxlifeinsurance.com or by any other means, Surrender Value Value Value Value
as informed by Us. Any Premium paid by You will be deemed factor for factor for factor for factor
to have been received by Us only after the same has been Policy Reversionary Policy for
realized and credited to Our bank account. Provided Bonus Provided Reversionary
due Provided due Bonus
5.4. The Premium payment receipt will be issued in Your name,
Premiums due Premiums Provided
which will be subject to realization of cheque or any other
for first 3 Premiums for first due
instrument/ medium.
years for first 3 years Premiums
6. GRACE PERIOD have been 3 years have been for first
6.1. The Premium is due and payable by the due date specified received have been received 3 years
in the Schedule. If the Premium is not paid by the due date, and received and have been
You may pay the same during the Grace Period without any applied and applied received
interest/ late fee. by Us applied by Us and
by Us applied
6.2. During the Grace Period, if the due Premium is not paid and
by Us
the Life Insured dies, then, We will pay the death benefit after
deducting the due Premium from the benefits payable under 1 0% 0% 0% 0%
the Policy. 2 0% 0% 0% 0%
7. LAPSATION OF POLICY 3 30% 12% 30% 8%
7.1. If You discontinue the payment of Premium before paying
4 50% 13% 50% 9%
Premiums for the first 3 (Three) Policy Years, then, the Policy
will lapse on the expiry of the Grace Period and no benefits 5 50% 15% 50% 10%
under the Policy will be payable. 6 50% 16% 50% 12%
PART D 7 50% 18% 50% 13%
POLICY SERVICING CONDITIONS 8 53% 20% 52% 15%
1. SURRENDER 9 56% 23% 55% 16%
1.1. This Policy shall acquire a Surrender Value provided all the 10 59% 26% 57% 18%
due Premiums for the first 3 (Three) Policy Years have been
received and applied by Us on or after the due dates. 11 61% 29% 59% 20%

1.2. You may request in writing to surrender this Policy at any 12 64% 32% 62% 23%
time only if the Policy has acquired the Surrender Value. On 13 67% 36% 64% 26%
receipt of such request, this Policy shall terminate and the
14 70% 40% 66% 29%
Surrender Value (if any) prevailing on the date of request for
the surrender of this Policy, shall be payable by Us. If the 15 73% 45% 69% 32%
Policy has not acquired the Surrender Value, then, no benefit 16 76% 51% 71% 36%
or money is payable by Us.
17 79% 57% 74% 40%
1.3. In the event of death of the Life Insured (who is also the
Policyholder) during the Policy Term, the Policy cannot be 18 81% 64% 76% 45%
surrendered and the Policy shall continue till the end of the 19 84% 71% 78% 51%
Policy Term. The Policy will continue as is, the monthly income
20 87% 80% 81% 57%
and maturity benefits shall be payable to the Claimant, as and
when due. The Policy will continue to participate in the future 21 90% 89% 83% 64%
bonuses and the benefits will continue to be applicable. All 22 90% 100% 85% 71%
future benefits shall be paid to the Claimant, as and when due,
as if the Life Insured was alive and had paid the Premiums, 23 NA NA 88% 80%
as and when due. 24 NA NA 90% 89%
1.4. The Surrender Value payable will be subject to the condition 25 NA NA 90% 100%
that there are no statutory or other restrictions to the contrary.
Upon surrender of this Policy, this Policy will terminate and no 1.5.2. The guaranteed surrender value of accrued compound
benefits under this Policy shall be payable. Reversionary Bonuses, if any, will be calculated by
1.5. Guaranteed Surrender Value Us by multiplying the accrued compound Reversionary
Bonuses with the guaranteed surrender value factors
1.5.1. The Guaranteed Surrender Value will be determined of Reversionary Bonuses, as stated above.
in the Policy Year in which the surrender is effected.
The Guranteed Surrender Value will be sum total of the 1.6. Special Surrender Value
following: 1.6.1. Special Surrender Value will be determined by Us
1.5.1.1. Higher of: from time to time in consultation with the IRDAI and
in accordance with the prior approval of the IRDAI
1.5.1.1.1. Guaranteed Surrender Value factors obtained by Us. This Special Surrender Value will
(as specified in the table below) always be greater than or equal to the Guaranteed
multiplied by {Total Premiums Surrender Value. The Special Surrender Value is not
received excluding Extra Premium guaranteed.
(if any) and applied by Us on or after
1.6.2. Special Surrender Value will be sum total of
the due dates} less monthly income
benefit already paid, if any; or 1.6.2.1. Reduced Paid Up Sum Assured multiplied by
1.5.1.1.2. 0 (zero); and Special Surrender Value Factor;
1.6.2.2. surrender value of accrued compound
Reversionary Bonus, if any; and
14 of 36
 1.6.2.3. surrender value of Terminal Bonus, if any. No. of days between
2. LOANS date of revival and Late payment fee (in INR)
date of lapse of Policy
2.1. You are not entitled to any loans under this Policy.
30-60 100
3. REVIVAL OF POLICY
61-180 250
3.1. A Lapsed Policy or a Policy under Reduced Paid Up Mode
can be revived as per Underwriting Policy, within the Revival 250 plus interest on
Period: >180 due Premium @8% p.a.
compounded annually
3.1.1. on receipt of Your written request to revive the Policy by
Us; PART F
3.1.2. if You produce an evidence of insurability of Life Insured GENERAL TERMS AND CONDITIONS
at Your own cost which is acceptable to Us; and 1. TAXES
3.1.3. on payment of all overdue Premiums (along with the
1.1. All Premiums are subject to applicable taxes, cesses, levies
service tax or any other taxes, cesses or levies, if any)
including service tax and education cess which will entirely be
to Us with late fee and/or interest at such rate as may
borne by You and will always be paid by You along with the
be determined by Us from time to time.
payment of Premium. If any imposition (tax or otherwise)
3.2. The revival of the Lapsed Policy or a Policy under Reduced is levied by any statutory or administrative body under the
Paid Up Mode will take effect only after We have approved Policy, We reserve the right to claim the same from You.
the same in accordance with Our Underwriting Policy and Alternatively, We have the right to deduct the amount from the
communicated Our decision to You in writing. In view of benefits payable by Us under the Policy.
our Underwriting Policy, We may waive any of the above
1.2. Tax benefits and liabilities under the Policy are subject
conditions for revival of the Policy. All accrued bonus(es)
to prevailing tax laws. Tax laws and the benefits arising
and original benefits including death, monthly income and
thereunder are subject to change. You are advised to seek an
maturity benefits which were originally payable will be
opinion of Your tax advisor in relation to the tax benefits and
restored on such revival. However, no interest shall be
liabilities applicable to You.
payable by Us on such restoration.
3.3. If a Lapsed Policy is not revived within the Revival Period, 2. CLAIM PROCEDURE
this Policy will terminate without value, on the expiry of the 2.1. For processing a claim request under this Policy, We will
Revival Period. require all of the following documents:
3.4. If a Policy under Reduced Paid Up Mode is not revived within 2.1.1. Claimant's statement in the prescribed form;
the Revival Period then, it will continue to be under Reduced 2.1.2. original Policy document;
Paid Up Mode for the remaining part of the Policy Term.
2.1.3. a copy of police complaint/ first information report (only
3.5. The Policy cannot be revived beyond the Policy Term. in the case of death by accident of the Life Insured);
4. PAYMENT OF BENEFITS 2.1.4. a copy of duly certified post mortem report (only in the
4.1. The benefits under this Policy will be payable only on case of death by accident of the Life Insured);
submission of satisfactory proof to Us. The benefits under 2.1.5. death certificate issued by the local/municipal authority
this Policy will be payable to the Claimant. (only in the case of death of the Life Insured);
4.2. Once the benefits under this Policy are paid to the Claimant, 2.1.6. identity proof of the Claimant including Nominee(s)
the same will constitute a valid discharge of Our liability bearing their photographs and signatures (only in the
under this Policy. case of the death of the Life Insured); and
5. TERMINATION OF POLICY 2.1.7. any other documents or information required by Us for
5.1. This Policy will terminate upon the happening of any of the assessing and approving the claim request.
following events: 2.2. A Claimant can download the claim request documents from
5.1.1. on the date on which We receive free look cancellation Our website www.maxlifeinsurance.com or can obtain the
request; same from any of Our branches.
5.1.2. the date of intimation of repudiation of the death claim 2.3. We reserve the right to scrutinize the documents submitted
by Us in accordance with the provisions of this Policy; by the Claimant and/or investigate the cause of death of the
Life Insured and deny the claim partially or completely on the
5.1.3. on the expiry of the Revival Period, if the Lapsed
basis of Our scrutiny of the documents or investigation, as
Policy has not been revived. However, if a Policy
the case may be. We shall pay the benefits under this Policy
under Reduced Paid Up Mode is not revived within
subject to Our satisfaction:
the Revival Period then, it will not terminate and will
continue to be under Reduced Paid Up Mode for the 2.3.1. that the benefits have become payable as per the terms
remaining part of the Policy Term; and conditions of this Policy; and
5.1.4. on the date of surrender of this Policy; or 2.3.2. of the bonafides and credentials of the Claimant.
5.1.5. on the Maturity Date. 2.4. Subject to Our sole discretion and satisfaction, in exceptional
circumstances such as on happening of a Force Majeure
Event, We may decide to waive all or any of the requirements
PART E set out in Clause 2.1 of Part F.
POLICY CHARGES 3. DECLARATION OF THE CORRECT AGE
1. APPLICABLE FEES/ CHARGES UNDER THE POLICY
3.1. Declaration of the correct Age and/ or gender of the
1.1. This Policy is a non-linked participating savings insurance Life Insured is important for Our underwriting process and
plan. calculation of Premiums payable under the Policy. If the Age
1.2. If the Policy is a Lapsed Policy or is under Reduced Paid Up and/or gender declared in the Proposal Form is found to be
Mode, then, the same can be revived as per Underwriting incorrect at any time during the Policy Term or at the time
Policy, within the Revival Period. For revival of such a Policy, of claim, We may revise the Premium with interest and/or
we may charge the following late fee and/or interest on the applicable benefits payable under the Policy in accordance
due Premiums depending upon the number of days between with the Premium and benefits that would have been payable,
the date of revival and lapse of Policy: if the correct Age and/ or gender would have made the Life
Insured eligible to be covered under the Policy on the Date of

15 of 36
 Commencement subject to Section 45 of the Insurance Act, will resume Our obligations under the Policy after the Force
1938 as amended from time to time. Majeure Event ceases to exist.
4. FRAUD, MISREPRESENATION AND FORFEITURE 15. COMMUNICATION AND NOTICES
4.1. Fraud, misrepresentation and forfeiture would be dealt with 15.1. All notices meant for Us should be in writing and delivered to
in accordance with provisions of Section 45 of the Insurance Our address as mentioned in Part G or such other address
Act, 1938, as amended from time to time. [A leaflet containing as We may notify from time to time. You should mention
the simplified version of the provisions of the above section is the correct Policy number in all communications including
enclosed in Annexure - (1) for reference] communications with respect to Premium remittances made
5. SUICIDE EXCLUSION by You.
15.2. All notices meant for You will be in writing and will be sent
5.1. Notwithstanding anything stated herein, if the Life Insured
by Us to Your address as shown in the Schedule or as
dies due to suicide, whether sane or insane, within 12
communicated by You and registered with Us. We may
(Twelve) months from the Date of Commencement or from
send You notices by post, courier, hand delivery, fax or
the date of revival of this Policy, then, this Policy will terminate
e-mail/electronic mode or by any other means as determined
and We shall only pay the following to the Claimant:
by Us. If You change Your address, or if the address of the
5.1.1. higher of the Surrender Value or total Premiums Nominee changes, You must notify Us immediately.
received by Us, if the Policy has acquired a Surrender
15.3. For any updates, please visit Our website
Value; or
www.maxlifeinsurance.com.
5.1.2. total Premiums received by Us, if the Policy has not
16. GOVERNING LAW AND JURISDICTION
acquired a Surrender Value.
16.1. The Policy will be governed by and enforced in accordance
6. TRAVEL AND OCCUPATION
with the laws of India. The competent courts in India will have
6.1. There are no restrictions on travel or occupation under this exclusive jurisdiction in all matters and causes arising out of
Policy. the Policy.
7. NOMINATION PART G
7.1. Nomination is allowed as per Section 39 of the Insurance GRIEVANCE REDRESSAL MECHANISM AND OMBUDSMAN
Act, 1938 as amended from time to time. [A leaflet containing DETAILS
the simplified version of the provisions of the above section is enclosed
1. DISPUTE REDRESSAL PROCESS UNDER THE POLICY
in Annexure - (2) for reference]
1.1. All consumer grievances and/or queries may be first
8. ASSIGNMENT
addressed to Your agent or Our customer helpdesk as
8.1. Assignment is allowed as per Section 38 of the Insurance mentioned below:
Act, 1938 as amended from time to time. [A leaflet containing Max Life Insurance Company Limited
the simplified version of the provisions of the above section is enclosed Plot No. 90A, Sector 18, Gurgaon, 122015, Haryana, India
in Annexure - (3) for reference] Toll Free No. - 1800 200 4003
9. POLICY CURRENCY Email: goldcircle@maxlifeinsurance.com
9.1. This Policy is denominated in Indian Rupees. Any 1.2. If Our response is not satisfactory or there is no response
benefit/claim payments under the Policy will be made in within 15 (Fifteen) days:
Indian Rupees by Us or in any other currency in accordance 1.2.1. the complainant or his legal heirs may file a written
with the applicable guidelines issued by the Reserve Bank complaint with full details of the complaint and the
of India from time to time. complainant's contact information to the following
10. ELECTRONIC TRANSACTIONS official for resolution:
10.1. You will comply with all the terms and conditions Head Operations and Customer Services
with respect to all transactions effected by or through Max Life Insurance Company Limited
facilities for conducting remote transactions including the Plot No. 90A, Sector 18,
internet, world wide web, electronic data interchange, Gurgaon, 122015, Haryana, India,
call centre, tele-service operations or by other means of Toll Free No. - 1800 200 4003
telecommunication established by Us or on Our behalf, for Email: manager.services@maxlifeinsurance.com;
and in respect of the Policy or services, which will constitute 1.2.2. the complainant or his legal heirs may approach the
legally binding and valid transactions when executed in Grievance Cell of the IRDAI on the following contact
adherence to and in compliance with the terms and details:
conditions for such facilities. IRDAI Grievance Call Centre (IGCC)
11. DUPLICATE POLICY Toll Free No:155255 or 1800 4254 732
Email: complaints@irda.gov.in
11.1. In case of loss of this Policy document, You may contact our
nearest branch office to know the requirements for issuance 1.2.3. You can also register Your complaint online at
of a duplicate Policy. The duplicate Policy shall be issued by http://www.igms.irda.gov.in.
Us without any charge. 1.2.4. You can also register Your complaint through fax/paper
by submitting Your complaint to:
12. AMENDMENT
Consumer Affairs Department
12.1. No amendments to the Policy will be effective, unless such
Insurance Regulatory and Development Authority of
amendments are expressly approved in writing by Us and/or
India
by the IRDAI wherever applicable.
9th floor, United India Towers, Basheerbagh
13. REGULATORY AND JUDICIAL INTERVENTION Hyderabad - 500 029, Andhra Pradesh
13.1. If any competent regulatory body or judicial body imposes Fax No: 91- 40 - 6678 9768
any condition on the Policy for any reason, We are bound to 1.3. If You are not satisfied with the redressal or there is no
follow the same which may include suspension of all benefits response within a period of 1 (One) month, the complainant
and obligations under the Policy. or his legal heirs may approach Insurance Ombudsman at the
14. FORCE MAJEURE address mentioned in Annexure A or on the IRDAI website
www.irda.gov.in, if the grievance pertains to:
14.1. The performance of the Policy may be wholly or partially
suspended during the continuance of such Force Majeure 1.3.1. any partial or total repudiation of a claim by Us;
Event under an intimation to or approval of the IRDAI. We 1.3.2. any dispute on the legal construction of the Policy in so
far as such dispute relates to a claim;
16 of 36
 1.3.3. delay in settlement of a claim;
1.3.4. any dispute with regard to the Premium paid or payable
in terms of the Policy; or
1.3.5. non issuance of any insurance document after receipt
of the Premium.
1.4. As per Rule 13(3) of the Redressal of Public Grievances
Rules 1998, a complaint to the Insurance Ombudsman can be
made only within a period of 1 (One) year after Our rejection
of the representation or the date of Our final reply on the
representation of the complainant, provided the complaint is
not on the same matter, for which any proceedings before any
court, or consumer forum or arbitrator is pending.

ENDORSEMENT

Total stamp value : `1132

17 of 36
 Annexure 1
Section 45 - Policy shall not be called in question on the ground of mis-statement after three years
Provisions regarding policy not being called into question in terms of Section 45 of the Insurance Act, 1938, as amended from time to time
are as follows:
1. No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3 yrs from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
2. On the ground of fraud, a policy of Life Insurance may be called in question within 3 years from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
For this, the insurer should communicate in writing to the insured or legal representative or nominee or assignees of insured, as applicable,
mentioning the ground and materials on which such decision is based.
3. Fraud means any of the following acts committed by insured or by his agent, with the intent to deceive the insurer or to induce the insurer
to issue a life insurance policy:
a. The suggestion, as a fact of that which is not true and which the insured does not believe to be true;
b. The active concealment of a fact by the insured having knowledge or belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be fraudulent.
4. Mere silence is not fraud unless, depending on circumstances of the case, it is the duty of the insured or his agent keeping silence to speak
or silence is in itself equivalent to speak.
5. No Insurer shall repudiate a life insurance policy on the ground of fraud, if the insured / beneficiary can prove that the misstatement was true to
the best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of material
fact are within the knowledge of the insurer. Onus of disproving is upon the policyholder, if alive, or beneficiaries.
6. Life insurance Policy can be called in question within 3 years on the ground that any statement of or suppression of a fact material to expectancy
of life of the insured was incorrectly made in the proposal or other document basis which policy was issued or revived or rider issued. For this,
the insurer should communicate in writing to the insured or legal representative or nominee or assignees of insured, as applicable, mentioning
the ground and materials on which decision to repudiate the policy of life insurance is based.
7. In case repudiation is on ground of mis-statement and not on fraud, the premium collected on policy till the date of repudiation shall be paid
to the insured or legal representative or nominee or assignees of insured, within a period of 90 days from the date of repudiation.
8. Fact shall not be considered material unless it has a direct bearing on the risk undertaken by the insurer. The onus is on insurer to show that
if the insurer had been aware of the said fact, no life insurance policy would have been issued to the insured.
9. The insurer can call for proof of age at any time if he is entitled to do so and no policy shall be deemed to be called in question merely because
the terms of the policy are adjusted on subsequent proof of age of life insured. So, this Section will not be applicable for questioning age or
adjustment based on proof of age submitted subsequently.
[Disclaimer: This is only a simplified version prepared for general information. You are advised to refer to the Insurance Act 1938
as amended from time to time for complete and accurate details.]

18 of 36
 Annexure 2
Section 39 - Nomination by Policyholder
Nomination of a life insurance policy is as below in accordance with Section 39 of the Insurance Act, 1938 as amended from time to time.
The extant provisions in this regard are as follows:
1. The policyholder of a life insurance policy on his own life may nominate a person or persons to whom money secured by the policy shall
be paid in the event of his death.
2. Where the nominee is a minor, the policyholder may appoint any person to receive the money secured by the policy in the event of policyholder's
death during the minority of the nominee. The manner of appointment is to be laid down by the insurer.
3. Nomination can be made at any time before the maturity of the policy.
4. Nomination may be incorporated in the text of the policy itself or may be endorsed on the policy communicated to the insurer and can be
registered by the insurer in the records relating to the policy.
5. Nomination can be cancelled or changed at any time before policy matures, by an endorsement or a further endorsement or a will as the
case may be.
6. A notice in writing of change or cancellation of nomination must be delivered to the insurer for the insurer to be liable to such nominee.
Otherwise, insurer will not be liable if a bonafide payment is made to the person named in the text of the policy or in the registered records
of the insurer.
7. Fee to be paid to the insurer for registering change or cancellation of a nomination can be specified by the Authority through Regulations.
8. On receipt of notice with fee, the insurer should grant a written acknowledgement to the policyholder of having registered a nomination or
cancellation or change thereof.
9. A transfer or assignment made in accordance with Section 38 shall automatically cancel the nomination except in case of assignment to
the insurer or other transferee or assignee for purpose of loan or against security or its reassignment after repayment. In such case, the
nomination will get affected to the extent of insurer's or transferee's or assignee's interest in the policy. The nomination will get revived on
repayment of the loan.
10. The right of any creditor to be paid out of the proceeds of any policy of life insurance shall not be affected by the nomination.
11. In case of nomination by policyholder whose life is insured, if the nominees die before the policyholder, the proceeds are payable to policyholder
or his heirs or legal representatives or holder of succession certificate.
12. In case nominee(s) survive the person whose life is insured, the amount secured by the policy shall be paid to such survivor(s).
13. Where the policyholder whose life is insured nominates his
a. parents or
b. spouse or
c. children or
d. spouse and children
e. or any of them
the nominees are beneficially entitled to the amount payable by the insurer to the policyholder unless it is proved that policyholder could
not have conferred such beneficial title on the nominee having regard to the nature of his title.
14. If nominee(s) die after the policyholder but before his share of the amount secured under the policy is paid, the share of the expired nominee(s)
shall be payable to the heirs or legal representative of the nominee or holder of succession certificate of such nominee(s).
15. The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance policies maturing for payment after the commencement
of Insurance Laws (Amendment) Act 2015.
16. If policyholder dies after maturity but the proceeds and benefit of the policy has not been paid to him because of his death, his nominee(s)
shall be entitled to the proceeds and benefit of the policy.
17. The provisions of Section 39 are not applicable to any life insurance policy to which Section 6 of Married Women's Property Act, 1874 applies
or has at any time applied except where before or after Insurance Act, 1938 as amended from time to time, a nomination is made in favour
of spouse or children or spouse and children whether or not on the face of the policy it is mentioned that it is made under Section 39.
Where nomination is intended to be made to spouse or children or spouse and children under Section 6 of MWP Act, it should be specifically
mentioned on the policy. In such a case only, the provisions of Section 39 will not apply.
[Disclaimer: This is only a simplified version prepared for general information. You are advised to refer to the Insurance Act 1938
as amended from time to time for complete and accurate details.]

19 of 36
 Annexure 3
Section 38 - Assignment and Transfer of Insurance Policies
Assignment or transfer of a policy should be in accordance with Section 38 of the Insurance Act, 1938 as amended from time to time. The
extant provisions in this regard are as follows:
1. The policy may be transferred/assigned, wholly or in part, with or without consideration.
2. An Assignment may be effected in a policy by an endorsement upon the policy itself or by a separate instrument under notice to the Insurer.
3. The instrument of assignment should indicate the fact of transfer or assignment and the reasons for the assignment or transfer, antecedents
of the assignee and terms on which assignment is made.
4. The assignment must be signed by the transferor or assignor or duly authorized agent and attested by at least one witness.
5. The transfer or assignment shall not be operative as against an insurer until a notice in writing of the transfer or assignment and either the
said endorsement or instrument itself or copy there of certified to be correct by both transferor and transferee or their duly authorised agents
have been delivered to the insurer.
6. Fee to be paid for assignment or transfer can be specified by the Authority through Regulations.
7. On receipt of notice with fee, the insurer should Grant a written acknowledgement of receipt of notice. Such notice shall be conclusive evidence
against the insurer of duly receiving the notice.
8. If the insurer maintains one or more places of business, such notices shall be delivered only at the place where the policy is being serviced.
9. The insurer may accept or decline to act upon any transfer or assignment or endorsement, if it has sufficient reasons to believe that it is
a. not bonafide;
b. not in the interest of the policyholder;
c. not in public interest; or
d. is for the purpose of trading of the insurance policy.
10. Before refusing to act upon endorsement, the insurer should record the reasons in writing and communicate the same in writing to policyholder
within 30 days from the date of policyholder giving a notice of transfer or assignment.
11. In case of refusal to act upon the endorsement by the insurer, any person aggrieved by the refusal may prefer a claim to IRDAI within 30
days of receipt of the refusal letter from the insurer.
12. The priority of claims of persons interested in an insurance policy would depend on the date on which the notices of assignment or transfer
is delivered to the insurer; where there are more than one instruments of transfer or assignment, the priority will depend on dates of delivery
of such notices. Any dispute in this regard as to priority should be referred to the Authority.
13. Every assignment or transfer shall be deemed to be absolute assignment or transfer and the assignee or transferee shall be deemed to be
absolute assignee or transferee, except
a. where assignment or transfer is subject to terms and conditions of transfer or assignment OR
b. where the transfer or assignment is made upon condition that
i. the proceeds under the policy shall become payable to policyholder or nominee(s) in the event of assignee or transferee dying before
the insured; or
ii. the insured surviving the term of the policy.
Such conditional assignee will not be entitled to obtain a loan on policy or surrender the policy. This provision will prevail notwithstanding any
law or custom having force of law which is contrary to the above position.
14. In other cases, the insurer shall, subject to terms and conditions of assignment, recognize the transferee or assignee named in the notice
as the absolute transferee or assignee and such person
a. shall be subject to all liabilities and equities to which the transferor or assignor was subject to at the date of transfer or assignment;
b. may institute any proceedings in relation to the policy; and
c. obtain loan under the policy or surrender the policy without obtaining the consent of the transferor or assignor or making him a party to
the proceedings
15. Any rights and remedies of an assignee or transferee of a life insurance policy under an assignment or transfer effected before
commencement of the Insurance Laws (Amendment) Act, 2015 shall not be affected by this section.
[Disclaimer: This is only a simplified version prepared for general information. You are advised to refer to the Insurance Act, 1938
as amended from time to time for complete and accurate details.]

20 of 36
 Annexure A1
List of Insurance Ombudsman
CONTACT DETAILS JURISDICTION
Office of the Insurance Ombudsman, State of Gujarat and Union Territories of Dadra & Nagar
2nd Floor, Ambica House, Ashram Rd, Haveli and Daman and Diu.
AHMEDABAD-380 014.
Tel.:- 079-27545441/27546840 Fax : 079-27546142
Email: bimalokpal.ahmedabad@gbic.co.in
Office of the Insurance Ombudsman, State of Karnataka
th
24 Main Road, Jeevan Soudha Bldg.,
JP Nagar, 1st Phase, Ground Floor
BENGALURU - 560025.
Tel No: 080-26652049/26652048
Email: bimalokpal.bengaluru@gbic.co.in
Office of the Insurance Ombudsman, States of Madhya Pradesh and Chattisgarh.
2nd Floor, Janak Vihar Complex, 6, Malviya Nagar,
BHOPAL-462 003.
Tel.:- 0755-2769201/9202 Fax : 0755-2769203
Email: bimalokpal.bhopal@gbic.co.in
Office of the Insurance Ombudsman, State of Orissa.
62, Forest Park,
BHUBANESHWAR-751 009.
Tel.:- 0674-2596455/2596003 Fax : 0674-2596429
Email: bimalokpal.bhubaneswar@gbic.co.in
Office of the Insurance Ombudsman, States of Punjab, Haryana, Himachal Pradesh, Jammu &
SCO No.101-103,2nd Floor, Batra Building, Sector 17-D, Kashmir and Union territory of Chandigarh.
CHANDIGARH-160 017.
Tel.:- 0172-2706468/2772101 Fax : 0172-2708274
Email: bimalokpal.chandigarh@gbic.co.in
Office of the Insurance Ombudsman, State of Tamil Nadu and Union Territories - Pondicherry
Fathima Akhtar Court, 4th Floor, 453 (old 312), Town and Karaikal (which are part of Union Territory of
Anna Salai, Teynampet, Pondicherry).
CHENNAI-600 018.
Tel.:- 044-24333668 /24335284 Fax : 044-24333664
Email: bimalokpal.chennai@gbic.co.in
Office of the Insurance Ombudsman, States of Delhi
2/2 A, Universal Insurance Bldg.,Asaf Ali Road,
NEW DELHI-110 002.
Tel.:- 011-23234057/23232037 Fax : 011-23230858
Email: bimalokpal.delhi@gbic.co.in
Office of the Insurance Ombudsman, States of Assam, Meghalaya, Manipur, Mizoram, Arunachal
"Jeevan Nivesh", 5th Floor, S.S. Road, Pradesh, Nagaland and Tripura.
GUWAHATI-781 001 .
Tel.:- 0361-2132204/5 Fax : 0361-2732937
Email: bimalokpal.guwahati@gbic.co.in
Office of the Insurance Ombudsman, States of Andhra Pradesh and Union Territory of Yanam - a
6-2-46, 1st Floor, Moin Court, A.C. Guards, part of the Union Territory of Pondicherry.
Lakdi-Ka-Pool,
HYDERABAD-500 004.
Tel : 040-65504123/23312122 Fax: 040-23376599
Email: bimalokpal.hyderabad@gbic.co.in
Office of the Insurance Ombudsman, State of Kerala and Union Territory of (a) Lakshadweep (b)
2nd Floor, CC 27/2603, Pulinat Bldg., M.G. Road, Mahe-a part of Union Territory of Pondicherry.
ERNAKULAM-682 015.
Tel : 0484-2358759/2359338 Fax : 0484-2359336
Email: bimalokpal.ernakulam@gbic.co.in

21 of 36
Office of the Insurance Ombudsman, State of Rajasthan
Ground Floor, Jeevan Nidhi II, Bhawani Singh Road,
JAIPUR - 302005.
Tel: 0141-2740363
Email: bimalokpal.jaipur@gbic.co.in
Office of the Insurance Ombudsman, States of West Bengal, Bihar, Sikkim, Jharkhand and Union
Hindustan Building. Annexe, 4th Floor, C.R.Avenue, Territories of Andaman and Nicobar Islands.
KOLKATA - 700072
Tel No: 033-22124339/22124346 Fax: 22124341
Email: bimalokpal.kolkata@gbic.co.in
Office of the Insurance Ombudsman, States of Uttar Pradesh and Uttaranchal.
Jeevan Bhawan, Phase-2,
6th Floor, Nawal Kishore Road,Hazaratganj,
LUCKNOW-226 001.
Tel : 0522 -2231331/2231330 Fax : 0522-2231310
Email: bimalokpal.lucknow@gbic.co.in
Office of the Insurance Ombudsman, State of Goa and Mumbai Metropolitan Region excluding Navi
3rd Floor, Jeevan Seva Annexe,S.V. Road, Santacruz(W), Mumbai and Thane.
MUMBAI-400 054.
Tel : 022-26106960/26106552 Fax : 022-26106052
Email: bimalokpal.mumbai@gbic.co.in
Office of the Insurance Ombudsman, State of Maharashtra including Navi Mumbai and Thane and
3rd Floor, Jeevan Darshan, N.C. Kelkar Road, Narayanpet excluding Mumbai Metropolitan Region.
PUNE - 411030.
Tel.: 020-41312555
Email: Bimalokpal.pune@gbic.co.in
Office of the Insurance Ombudsman, State of Uttaranchal and the following Districts of Uttar
4th Floor, Bhagwan Sahai Palace, Pradesh:Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun,
Main Road, Naya Bans, Sector-15, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut,
NOIDA - 201301. Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
Tel: 0120-2514250/51/53 Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad,
Email: bimalokpal.noida@gbic.co.in Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
Office of the Insurance Ombudsman, Bihar, Jharkhand.
1st Floor, Kalpana Arcade Building,
Bazar Samiti Road, Bahadurpur,
PATNA - 800006
Tel No: 0612-2680952
Email id : bimalokpal.patna@gbic.co.in.

OFFICE OF THE GOVERNING BODY OF INSURANCE COUNCIL

Secretary General
3rd Floor, Jeevan Seva Annexe,
S.V. Road, Santacruz(W),
MUMBAI - 400 021
Tel : 022-26106245
Fax : 022-26106949
Email- inscoun@gmail.com
Web: www.gbic.co.in

22 of 36
23 of 36
24 of 36
25 of 36
26 of 36
27 of 36
28 of 36
29 of 36
30 of 36
31 of 36
32 of 36
 INSURANCE PREMIUM RECEIPT
Policy Number: 127896132 Date: 26-Sep-2016
Name: Mr. Prashant Choudhary Base Life Insured: MR. PRASHANT CHOUDHARY
Address: C-9/9518 Receipt Number: 127896132 /2016-17/01
VASANT KUNJ NEAR VASANT KUNJ S Your Agent Advisor: Yes Bank Limited Rohtak Road
O,VASANT KUNJ Agent Code 609925
New Delhi - 110070
Your Agent Phone No 8950333308
Delhi
General Office Yes Bank Rohtak Road
Telephone: 8222831111,9810944777,

Dear Mr. Prashant Choudhary,

Thank you for choosing Max Life Insurance. This is to acknowledge receipt of your premium as per details below.
Should you need any further assistance, please call our Customer Help Line - 1800 200 4003 (Toll free from any network). You can
also email at goldcircle@maxlifeinsurance.com

Yours Sincerely,
for Max Life Insurance Co. Ltd. Affix
Re1
revenue
stamp
Authorized Signatory

SUMMARY OF POLICY INFORMATION

Plan Premium paid For Due Date Frequency Effective Date
inclusive of of Coverage
Service Tax # ***
Max Life Monthly Income Advantage Plan 3,00,000.00 09-Sep-2016 Annual 09-Sep-2016
Total 3,00,000.00
Minimum Guaranteed Death Benefit / Death Benefit of base plan and term rider (if any) : RS 56,59,750.00

Next Premium Due on - 09-SEP-2017

Note: || # Subject to realisation of monies. Commencement of risk shall be effective from the date of acceptance of risk. || *** Premium paid towards covering
life of specified person would be eligible for deduction under provisions of Section 80C / 80CCC / 80D of Income Tax 1961, as per applicability and subject to
levies under prevailing Tax Laws. || Service tax and Education cess would be applicable on the premium as per prevailing service tax rate. || We request you
to please consult with your tax consultant for more information.

PRM20 V1.5 24052005

Max Life Insurance Company Limited
Plot No. 90A, Sector 18, Gurgaon, 122015, Haryana, India
Customer Helpline: 1800 200 4003 Fax 2389268 (From Delhi and Other cities: 0124)
Regd Office: Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India
Visit us at: www.maxlifeinsurance.com E-mail: goldcircle@maxlifeinsurance.com
Service Tax Regn. No. AACCM3201EST001
E.&O.E

33 of 36
34 of 36
35 of 36
36 of 36