Saurabh Kumar Singh

HOUSE NO 505,
POST OFFICEBASANTPUR,
NEAR HANUMAN MANDIR,
BASANTPUR,
BALLIA,
UTTAR PRADESH-277301

MOBILE NUMBER: 8354953469

Email ID: kumarsaurabh1988@gmail.com

Dear Sir/Madam,
This is your life insurance policy. It is a legal document. Please read it carefully. We have highlighted some important points
regarding your policy that you should keep in mind.

Name of your plan : ICICI Pru iProtect Smart Name : Policy Bazaar Insurance Web Aggregator Pvt Ltd
Policy Number : 97774144 Address :Policy Bazar Building Plot no 119 Sector no 44
Your Mobile Number : 8354953469 Gurgaon HARYANA 122001

Email Id : kumarsaurabh1988@gmail.com
Code/License No. : 01308816
Person insured in this policy : Saurabh Kumar Singh
Contact No. : 1860 266 7766
Sum Assured(Insurance Cover Amount) : ` 1,00,00,000
Premium Instalment* : ` 989
Payment Frequency : Every month
You have a period of 15/30 days* to review your policy from the
Next Premium Due Date : May 13, 2021 date you receive it. In this period you can return the policy to us
You need to pay premiums for : 27 years for cancellation. We will refund the premium paid after deduction
of Stamp duty, proportionate risk premium and expenses for
Policy Term : 27 years medical tests if any.
Policy end date : April 13, 2048
*30 days free look period is applicable only for policies sourced through distance
marketing. For complete definition of Distance Marketing, please refer to Part B of
the policy document.

In case of any discrepancies in the above details please inform us

immediately. *Tax and cess(if any) will have to be paid in addition to
premium amount as per prevailing tax laws. The claimant can speak to us on 1860-266-7766 and we will assist
the claimant through the entire process.

In case of any queries or clarifications required, please feel free to contact your advisor or reach us at any of our service centres
mentioned below. We will be happy to assist you.

Warm regards,

Authorised Signatory

ICICI Prudential Life Insurance Co Ltd. Registered Address: 1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai-400025, Reg No:105. Unique Identification Number as specified by IRDAI
105N151V06. Comp/doc/Nov/2012/1096. CIN: L66010MH2000PLC127837 Fax Number : +91-22-42058222
Features of ICICI Pru iProtect Smart
ICICI Pru iProtect Smart is a plan which is designed to provide a life insurance cover
and cover against Terminal Illness. This plan also provides a premium waiver in case
of Permanent Disability due to an accident.
This document has been designed to help you understand your policy better by
explaining some of its features.

What are the benefits of this policy?

The following benefits are available in this policy:

1
Life Insurance Benefit:

In case of death or detection of Terminal illness during the policy term of

27
10 years, i.e. till Apr 2048 , we will pay ` 1,00,00,000/- which is the life
10,00,00,000/-
insurance cover chosen by you. Your insurance amount will be paid as a
lump sum as that is the payout option chosen by you.

Permanent Disability Benefit:

If Permanent Disability occurs due to an accident, the future premiums of

the policy will be waived off and the life cover and other benefits of the
policy will continue till the end of the policy term.

To initiate the process of receiving the benefit amount, you or your nominee can
visit www.iciciprulife.com/insurance-claim.html

What is the premium amount that I need to

2
pay for this plan?
____________________
You have to pay a premium of ` 989/-
10,00,000/- every month/ 6 months/
____________________
year for 27
10 years. Additional tax and cess (if any) will have to be paid
in addition to the premium amount as per prevailing tax laws.
 What happens if I pay premiums for lesser number of

3 years or I decide to close my policy?

If you stop paying premiums or voluntarily decide to close your policy, your
policy benefits will stop.

Terminology
Terminal illness: This is a medical condition in which the person is not likely to live for more than 6 months. This condition has to be
certified by two doctors. For more details refer Part C Section 1.1 of your Policy Document.
Permanent Disability: This is a condition in which the policy holder is not able to permanently perform certain daily activities. For
complete details refer Part C Section 1.2 of your Policy document.

“The values appearing in this feature document are based on the information provided and the type of cover sought by you in the duly filed proposal
form. It is pertinent to note that any change affected by you in the details provided in the proposal form may lead to a change in the benefits or
premium payable under this policy.” COMP/DOC/Jul/2020/107/3944

IRDAI Reg No: 105. CIN: L66010MH2000PLC127837. ICICI Prudential Life Insurance Co. Ltd.Registered Address: 1089,
Appasaheb Marathe Marg, Prabhadevi, Mumbai-400025. UIN 105N151V06. COMP/DOC/Nov/2018/3011/1838.
 Policy Schedule of ICICI Pru iProtect Smart UIN 105N151V06

Soft Copy of Welcome Kit

Non-Linked Non-Par Life Individual pure risk premium product
This Policy is the evidence of a contract between ICICI Prudential Life Insurance Company Limited( Us/We/Company) and the
Policyholder( You) referred below.
We have issued this Policy on the basis of the details provided by You in the Proposal Form submitted along with the required declarations,
personal statement, applicable medical reports, the first premium deposit and any other information and documentation which constitute
evidence of the insurability of the Life Assured for the issuance of the Policy.

We agree to provide the benefits set out in this Policy subject to its terms and conditions.

Name of the Life Assured: Saurabh Kumar Singh

Address: HOUSE NO 505, Post officeBasantpur, Near hanuman Category: Medical
mandir, Basantpur, Ballia, Uttar Pradesh-277301

Date of Birth : January 01, 1988 Age( in years) : 33 Age Admitted : YES

Name of the Policyholder : Saurabh Kumar Singh

Policy Number : 97774144 Benefit Option : Life

Policy Issue Date : April 13, 2021 Policy Term in years : 27
Policy Acceptance Date : April 13, 2021 Date of Maturity : April 13, 2048
Premium payment option : Regular Pay Premium Payment Term in years : 27
Total instalment premium(Rs.) : 989 Periodicity of payment of premium(premium frequency) : Monthly
Due date of last premium payable : March 13, 2048 Sum Assured(Rs.) : 1,00,00,000
Policy sourced by Distance Mode : Y Death Benefit Payout Option : Lump Sum

Option Sum Assured payable

Lump sum(Rs.) 1,00,00,000
Income(Rs.) NA
Increasing Income(Rs.) NA

Appointee(Name)* : NA Nominee(Name) : Ms.Rashmi Singh

Nominee's Relationship with the Life Assured : Wife Nominee age( in years) : 33

*Applicable only if Nominee is less than 18 Years old

Please note :
Applicable taxes would be charged extra, as applicable.
Policy Schedule, terms and conditions of the policy and the endorsements by us, if any, shall form an integral part of this contract and shall be binding on us
and you.
The policy shall stand cancelled by the Company, without any further notice, in the event of dishonour of the first premium deposit.
Please immediately inform us about any change in address or contact details.

Signed for and on behalf of the ICICI Prudential Life Insurance Company Limited, at Head Office, Mumbai on April 13, 2021 (the issuance date).

Digitally signed by ASHISH RAVINDRA RAO

Date: 2021.04.15 06:44:02 IST
Reason: Digitally Signed
Location: Mumbai

Authorised Signatory
(Stamp Duty of Rs.2000 /- (TWO THOUSAND RUPEES) paid by CSD/256/2021/637 dated 20th Feb 2021. )

Please examine the policy and approach Us immediately in case of any discrepancies.
 PREMIUM RECEIPT

Name of Policy Holder Saurabh Kumar Singh

Policy Name ICICI Pru iProtect Smart

Policy Number Receipt Number Date of Receipt

97774144 L4956781 April 08, 2021

Premium Details (`) Payment Details

Premium Installment(A) 989.00 Frequency of Payment Monthly

Goods and Services tax / Cess(B) 178 Cheque / Transaction No 692770331

Premium Amount received(A+B) 1,167 Cheque / Transaction Date NA

Bank Name NA

Balance Premium (`)

The amount indicated as 'balance in deposit' (if any) will be adjusted towards the
Balance in deposit 0 next premium or refunded to you as applicable

Consolidated revenue stamp duty paid: Notification No - Mudrank - V3.00CSD/336/2019 649/19 -15/02/2019

Income Tax Benefits :

Tax benefits on Life Insurance policy would be available u/s 80C, on Pension Policy u/s 80CCC & on Health riders (if any) u/s 80D

Please note :
For premium payments (including top-ups) aggregating Rs.50,000 or more in a year, updating PAN details is mandatory. Option of
submitting Form 60/61 is available in case of no PAN.
The risk of the company under this policy starts with effect from the date of the issuance of this policy April 13,2021 or the date of
encashment of the first premium deposit, whichever is later.
In any case, the policy shall stand cancelled in case of non-encashment of the First Premium Deposit by the Company.
This is an authenticated Receipt/Intimation/Statement of premium. In case of any discrepancies, kindly notify us within 14 working
days through any of our touch points mentioned on page 1 of the policy document.
NRI customers are requested to retain a copy of the instrument/proof of transaction of the payment of premium. Such copy of
instrument/proof of transaction would be required to be produced at the time of any payments request from you. It would help us
in confirming the source/form of receipt of premium , which could aid the process of repatriation at the Authorized dealer's end.
Applicable taxes would be charged extra, as applicable.

Other details :
UIN - Unique Identification Number specified for ICICI Pru iProtect Smart is 105N151V06
 Policy Document - Terms and Conditions of your policy
ICICI Pru iProtect Smart death within 6 months. The terminal illness must be diagnosed and confirmed by
(This is a Non-Linked Non-Par Life Individual pure risk premium product) Medical Practitioners registered with Indian Medical Association and approved by
Us. We reserve the right for independent assessment of the Terminal Illness. Death
PART-B Benefit would be as per the below table:
Definitions Premium Payment Death Benefit
1. Age means age at last birthday. 2. Accident means a sudden, unforeseen and Option
involuntary event caused by external, visible and violent means. 3. Annualized Single Pay Higher of 125% of the single premium or the sum assured
Premium means the premium amount payable in a year chosen by the policyholder, as stated on your policy schedule to be paid on death.
excluding the taxes, rider premiums, underwriting extra premiums and loadings for
Regular Pay and Higher of 7 times the annualized premium or 105% of the
modal premiums, if any. 4. Appointee means the person appointed by You to receive
Limited Pay total premiums received up to the date of death or the
the benefits payable under the Policy till Your Nominee is a minor. 5. Death Benefit
sum assured as stated on your policy schedule to be
means the benefit, which is payable on death or diagnosis of Terminal Illness as
paid on death.
specified in the Policy document. 6. Death Benefit Payout Option is the manner in
which the nominee receives the Death Benefit payable under the Policy. 7. Claimant a. The Policy shall terminate on payment of the benefit and all rights, benefits and
means the person entitled to receive the Policy benefits and includes the You, the interests under the Policy shall stand extinguished. b. The benefit amount may be
nominee, the assignee, the legal heir, the legal representative(s) or the holder(s) of taxable as per the prevailing tax laws.
succession certificate as the case may be. 8. Date of commencement of risk is later of 1.2 Waiver of Premium on Permanent Disability due to accident a. Upon the
Policy Issue Date or Policy Acceptance Date 9. Date of Maturity means the date diagnosis of Permanent Disability (as defined below) of the Life Insured which arises
specified in the Policy Schedule on which the term of the Policy ends. 10. Distance due to an Accident, We shall waive all future premiums payable for all benefits
Marketing means every activity of solicitation (including lead generation) and sale of under the Policy during the remaining Premium Payment Term of the Policy
insurance products through the following modes: (i) voice mode, which includes provided the Policy is in force as on the date of diagnosis of Permanent Disability of
the Life Assured. The Policy will continue for the Death Benefit. b. For the purpose of
telephone-calling (ii) short messaging service (SMS) (iii) electronic mode which
this benefit, “ Permanent Disability” means the inability of the Life Assured to
includes e-mail, internet and interactive television (DTH) (iv) physical mode which perform at least 3 of the following 6 activities of daily work: • Mobility: The ability to
includes direct postal mail and newspaper and magazine inserts and (v) solicitation walk a distance of 200 meters on flat ground. • Bending: The ability to bend or kneel
through any means of communication other than in person. 11. Insured event is the to touch the floor and straighten up again and the ability to get into a standard
event on the happening of which, benefits under Your policy become payable. 12. saloon car, and out again. • Climbing: The ability to climb up a flight of 12 stairs and
Life Assured means the person named in the Policy Schedule on whose life the Policy down again, using the handrail if needed. • Lifting: The ability to pick up an object
has been issued. 13. Limited Pay means premiums need to be paid regularly for a weighing 2kg at table height and hold for 60 seconds before replacing the object on
limited portion of the Policy Term. 14. Medical Practitioner is a person who holds a the table. • Writing: The manual dexterity to write legibly using a pen or pencil, or
valid registration from the Medical Council of any State or Medical Council of India or type using a desktop personal computer keyboard. • Blindness: The permanent
and irreversible loss of sight to the extent that even when tested with the use of
Council for Indian Medicine or for Homeopathy set up by the Government of India or a
visual aids, vision is measured at 3/60 or worse in the better eye using a Snellen eye
State Government and is thereby entitled to practice medicine within its jurisdiction; chart. c. Provided that the disability should have lasted for at least 180 days without
and is acting within the scope and jurisdiction of licence The Medical Practitioner interruption and must be deemed permanent by a Company empanelled Medical
should neither be the insured person(s) himself nor related to the insured person(s) Practitioner. In the event of death of the insured within the above period, the policy
by blood or marriage. 15. Nominee means the person named in the Policy Schedule shall terminate on payment of applicable benefits and all rights, benefits and
who has been nominated by You to receive benefits in respect of this Policy. 16. interests under the policy shall stand extinguished. This Benefit is not applicable for
Policy means the contract of Insurance entered into between You and Us as Single Pay policies.
evidenced by the “Policy document”. 17. Policy Acceptance Date means the date as 1.3 Death Benefit Payout Options The Death Benefit will be payable as per one of
specified in the Policy Schedule, from which the policy was effected. 18. Policy the below options chosen by You at the inception of Your policy and mentioned in
document means this document, the Proposal Form, the Policy Schedule and any Your Policy Schedule. 1. Lump Sum Option– Entire Benefit amount is payable as
lump sum. 2. Income Option- 10% of the benefit amount is payable every year for
additional information/document(s) provided to Us in respect of the Proposal Form,
10 years. This will be payable in equal monthly instalments in advance at the rate of
and any endorsement issued by Us. 19. Policy Issue Date means the date as specified 0.83333% of death benefit amount. The beneficiary can also advance the first year’s
in the Policy Schedule. 20. Policyholder or the Proposer or You or Your means the income as a lump sum. The monthly income will then continue from the
owner of the Policy at any point of time. 21. Policy Term means the period between subsequent month for next 9 years at the rate of 0.80% of death benefit amount. 3.
the Policy Acceptance Date and the Date of Maturity specified in the Policy Schedule. Lump sum and Income – The part of the Death Benefit amount to be paid out as
22. Policy Schedule means the policy schedule and any endorsements attached to lump sum is chosen at inception. The balance Death Benefit amount will be paid out
and forming part of this Policy. 23. Premium means the instalment premium in case of in equal monthly instalments in advance at the rate of 0.8333% per month over 10
Regular Pay and Limited Pay or single premium in case of Single Pay specified in the years. 4. Increasing Income Option– Benefit amount is payable in monthly
Policy Schedule which is payable/has been received under the Policy. 24. Premium instalments for 10 years starting with 10% of the benefit amount per annum in the
Payment Term means the period specified in the Policy Schedule during which first year. The income amount will increase at 10% p.a. simple interest every year
thereafter. For options 2, 3 and 4, You or the nominee as the case may be, will have
Premium is payable. 25. Proposal Form means a form to be completed by You for
an option to take the discounted value of the future payouts anytime during the
availing an insurance policy, and to furnish all Material information required by Us to payout term by informing Us of this decision in writing. The present value will be
assess risk and to decline or to undertake the risk, and in the event of acceptance of derived using the discount rate of 4% p.a.
risk, to determine the rates, advantages, terms and conditions of a cover to be 1.4 Life Stage Protection You can choose to increase the Death Benefit at the key
granted. Explanation: “Material” shall mean and include all important, essential and milestones of marriage and child birth/ adoption of child, provided no claim has
relevant information that enables Us to take an informed decision while underwriting been admitted for any benefits under the policy and the policy is in force. The Death
the risk. 26. Regulator means the authority that has regulatory jurisdiction and Benefit can be increased without any medicals on any one or all of the below events
powers over Us. Currently the Regulator is the Insurance Regulatory and during the term of the Policy. This feature is available to a Life Assured
Development Authority of India (IRDAI). 27. Regular Pay means premiums need to be underwritten as a standard life at the time of inception of the Policy per the Board
paid regularly throughout the Policy term. 28. Revival of the Policy means restoration Approved Underwriting Policy.
of Policy benefits. 29. Revival period means the period of five consecutive years from Event Additional Death Benefit Subject to maximum
the due date of the first unpaid premium and before the termination date of the Policy, (percentage of original additional Death
during which period You are entitled to revive the policy. 30. Single Pay means Sum Assured) Benefit
premium needs to be paid once at the start of the Policy. 31. Sum Assured means the Marriage 50% ` 50,00,000
amount specified in the Policy Schedule. 32. Surrender means complete Birth / Legal adoption of 25% ` 25,00,000
withdrawal/termination of the Policy by You. 33. Total Premiums Paid means the total 1st child
of all premiums received, excluding any extra premium, any rider premium and Birth / Legal adoption of 25% ` 25,00,000
taxes. 34. Unexpired risk premium value means an amount, if any, that becomes 2nd child
payable in case of surrender or discontinuance of premium in single/ limited pay
On exercising the option, You will have to pay an additional premium for the
policies in accordance with the terms and conditions of the Policy. 35. You or Your additional Sum Assured for the outstanding term of the policy based on your then
means the Policyholder of the Policy at any point of time. 36. We or Us or Our or age. Hence the future premium payable by You on exercising this option will be the
Company means ICICI Prudential Life Insurance Company Limited. sum of original premium and additional premium. No fee is chargeable for this
option. This feature is available only with Regular premium payment option. Such
PART- C
increase in sum assured is only applicable to base death benefit. The AD Benefit
1. Benefits available under the policy: will remain unchanged. Premium will be recalculated based on the increased
1.1 Death Benefit We shall pay the Death Benefit as per the Death Benefit Payout Death Sum Assured and outstanding policy term. This is subject to: 1. Minimum
Option stated on Your Policy Schedule upon diagnosis of Terminal Illness or death policy term (which is 5 years) available at the time of the exercising this feature. 2.
of the Life Assured whichever is earlier provided the Policy is in force as on the date The Life Assured being less than 50 years of age at the time of the event. Such
increase needs to be exercised within 6 months of the event and will be effective
of diagnosis of Terminal Illness or the date of death of the Life Assured. A Life
from the next policy anniversary. The additional premium will also be payable from
Assured shall be regarded as “Terminally Ill” only if that Life Assured is diagnosed
next policy anniversary.
as suffering from a condition which, in the opinion of two independent Medical
1.5 You have an option to add Accidental Death(AD) Benefit anytime during the
Practitioners, specializing in treatment of such illness, is highly likely to lead to policy term except in last 5 years, for which the following conditions apply: • It
 can be opted in Regular Pay Policies only • The policy must be in-force at the time of 4. Exclusions
adding the Benefit • There must not have been any claim in the policy till the time of For Waiver of Premium on Permanent Disability the following exclusions shall
opting of AD Benefit • The availability of the AD benefit will be subject to apply: i. We will not be liable to provide the Waiver of Premium on Permanent
underwriting, as per the prevailing board approved underwriting policy • The AD Disability benefit if the Permanent Disability due to accident is directly or indirectly
Benefit will commence from subsequent policy anniversary for the remaining due to or caused, occasioned, accelerated or aggravated by, any one of the
policy term or till age 80, whichever is lower. You will have to pay an additional following: • Attempted suicide or self-inflicted injuries while sane or insane, or
premium corresponding to this Benefit. Life Assured’s then age must be less than or whilst the Life Assured is under the influence of any narcotic substance or drug or
equal to 55 years (age last birthday) • The Benefit once added, cannot be removed. intoxicating liquor except under the direction of a medical practitioner; or •
2. Premium payment: Engaging in aerial flights (including parachuting and skydiving) other than as a fare
i. You are required to pay Premiums on the due dates and for the amount paying passenger or crew on a licensed passenger-carrying commercial aircraft
mentioned in the Policy Schedule. ii. The grace period for payment of premium is operating on a regular scheduled route; or • The Life Assured with criminal intent
15 days for monthly frequency of premium payment and 30 days for other committing any breach of law; or • Due to war, whether declared or not or civil
frequencies of premium payment. In case of occurrence of the covered events commotion; or • Engaging in hazardous sports / pastimes, i.e. taking part in (or
during the grace period, We will pay the benefits as per the terms and conditions of practising for) boxing, caving, climbing, horse racing, jet skiing, martial arts,
the Policy. iii. If any premium instalment is not paid within the grace period then the mountaineering, off piste skiing, pot holing, power boat racing, underwater diving,
Policy shall lapse and all cover under the Policy will cease. iv. You are required to yacht racing or any race, trial or timed motor sport. • PD due to accident must be
pay Premiums for the entire Premium Payment Term. v. If Single Pay option has caused by violent, external and visible means. ii. The accident shall result in bodily
been chosen by You, only one Premium is to be paid and no future Premiums are injury or injuries to the Life Assured independently of any other means. Such injury
payable. vi. We are not under any obligation to remind You about the premium due or injuries shall, within 180 days of the occurrence of the accident, directly and
date, except as required by applicable regulations. vii. The loading based on independently of any other means cause the PD of the Life Assured. In the event of
premium paying modes are mentioned below: PD of the Life Assured after 180 days of the occurrence of the accident, the
Premium frequency Loading as a % of Premium Company shall not be liable to pay this benefit. iii. The Company shall not be liable
to pay this benefit in case PD of the Life Assured occurs after the date of termination
Yearly NA
of the policy.
Half-yearly 1.25% 5. Loan
Monthly 2.50% We will not provide loans under this Policy.
viii. You may pay Premium through any of the following modes: a) Cash b) Cheque 6. Riders
c) Demand Draft d) Pay Order e) Banker’s cheque f) Internet facility as approved by No riders are available under this Policy.
the Company from time to time g) Electronic Clearing System / Direct Debit h) 7. Revival
Credit or Debit cards held in your name ix. Amount and modalities will be subject to A Policy which has lapsed for non-payment of premium within the grace period may
our rules and relevant legislation or regulation x. Any payment made towards first be revived subject to underwriting and the following conditions: a) The application
or renewal premium is deemed to be received by Us only when it is received at any for revival is made within 5 years from the due date of the first unpaid premium and
of Our branch offices or authorized collection points and after an official printed before the termination date of the Policy. Revival will be based on the prevailing
receipt is issued by Us. xi. No person or individual or entity is authorized to collect Board approved underwriting policy. b) You furnish, at your own expense,
cash or self-cheque or bearer cheque on Our behalf. xii. Cheque or demand drafts satisfactory evidence of health as required by Us. c) The arrears of Premiums
must be drawn only in favour of ICICI Prudential Life Insurance Company Limited. together with interest at such rate as We may charge for late payment of premiums
xiii. Please ensure that You mention the application number for the first premium are paid. The interest rate applicable in April 2020 is 7.87% p.a. compounded half
deposit and the policy number for the renewal premiums on the cheque or demand yearly. d) The revival of the Policy may be on terms different from those applicable
draft. xiv. Where Premiums have been remitted otherwise than in cash, the to the Policy before it lapsed for example, extra mortality premiums or charges may
application of the Premiums received will be conditional on the realization of the be applicable subject to our Board approved underwriting policy. e) We reserve the
proceeds of the instrument of payment, including electronic mode. xv. If You right to not revive the Policy. In that case, only the premiums paid towards the
suspend payment of premium for any reason whatsoever, We will not be held revival of the policy shall be refunded without any interest. f) The revival will take
liable. In such an event, benefits, if any, will be available only in accordance with the effect only if it is specifically communicated by Us to You.
Policy terms and conditions. xvi. Premiums need to be paid only for the chosen 8. To whom benefits are payable
premium payment term. Once premiums have been paid for the premium payment Benefits are payable to the Policyholder or to the assignee(s) where an
term, the policy benefits will continue for the term of the policy. endorsement has been recorded in accordance with Section 38 of the Insurance
3. Maturity / Survival Benefit: Laws (Amendment) Act, 2015 and as amended from time to time. In case of death
No benefit will be payable on maturity. At the end of the Policy Term, the Policy will of the Policyholder or assignee(s) as mentioned above, benefits are payable either
automatically terminate and all rights, benefits and interests under the Policy will to the Nominee(s) where a valid nomination has been registered by the Company
stand extinguished. (in accordance with section 39 of the Insurance Laws (Amendment) Act, 2015 and
as amended from time to time), or to the executors, administrators or other legal
PART - D representatives who obtain representation to the estate of the Policyholder or to
1. Free look Period (15 / 30 days refund policy) such person or persons as directed by a court of competent jurisdiction in India,
You have an option to review the Policy following receipt of the Policy Document. If limited at all times to the monies payable under this Policy. We hereby agree to pay
you are not satisfied with the terms and conditions of this Policy, please return the the appropriate benefits under the Policy subject to: a) Our satisfaction of the
Policy Document to Us for cancellation with reasons within i. 15 days from the date benefits having become payable on the happening of an event as per the Policy
you received it, if your Policy is not purchased through Distance Marketing ii. 30 terms and conditions, b) The title of the said person or persons claiming
days from the date you received it, if your Policy is an electronic policy or is payment.
purchased through Distance Marketing On cancellation of the Policy during the
freelook period, We will return the premium paid subject to the following PART-E – Not Applicable
deductions: i. Proportionate risk premium for the period of cover ii. Stamp duty
under the Policy iii. Expenses borne by the Company on medical examination, if any PART-F
The Policy shall terminate on payment of this amount and all rights, benefits and General Conditions
interests under this Policy will stand extinguished. 1. Age: We have calculated the premiums under the Policy on the basis of the Age of
2. Paid-up Value There is no paid-up value under this Policy. the Life Assured as declared by You in the Proposal Form. In case if the age proof of
3. Unexpired risk premium value the Life Assured was not submitted at the time of Proposal, You will be required to
A. Single Pay: i. Surrender means voluntary termination of the Policy by you. ii. The submit such an Age proof of the Life Assured acceptable to Us, and have the Age
Policy will terminate on surrender and all the rights / title and interest under the admitted. If the Age of the life assured has been misstated, We will take one of the
Policy shall stand extinguished. iii. Unexpired risk premium value may be taxable as following actions: a) If the Correct Age of the Life Assured makes him ineligible for
per the prevailing tax laws. iv. The bases for computing Unexpired risk premium this product, We will offer a suitable plan as per Our underwriting norms. If You do
Value factors will be reviewed from time to time and the factors applicable to not wish to opt for the alternative plan or if it is not possible for Us to grant any other
existing business may be revised subject to the prior approval of the IRDAI. v. plan, We will cancel the Policy and refund the premiums paid (without interest)
Unexpired risk premium value will be calculated as given below. Unexpired risk under the Policy after adjustment against the paid benefits. The Policy will
premium value = (Unexpired risk premium value Factor/ 100) * Single Premium terminate on the said payment. b) If the Correct Age of the Life Assured makes him
Unexpired risk premium value factors are given in Annexure I B. Limited Pay: i. eligible for this Policy, revised Premium depending upon the Correct Age will be
Unexpired risk premium value, if any, will be payable if the policy holder voluntarily payable. Difference of premium from inception will be collected with interest, if
terminates the policy during the policy term Or for lapsed policies on earlier of: • age declared is higher and excess premium collected will be refunded without
Death of the Life Assured within the revival period, or • At the end of the revival interest, if age is found to be lower. The provisions of Section 45 of the Insurance
period. Unexpired risk premium value = (Unexpired risk premium value Factor/100) Laws (Amendment) Act, 2015 as amended from time to time shall be applicable.
X Annual Premium Unexpired risk premium value Factors are given in Annexure I ii. 2. Nomination: Nomination under the Policy will be governed by Section 39 of the
The Policy will terminate on payment of this amount and all the rights / title and Insurance Laws (Amendment) Act, 2015 as amended from time to time. Please
interest under the Policy shall stand extinguished. iii. Unexpired risk premium value refer to Annexure lI for details on this section.
may be taxable as per the prevailing tax laws. C. Regular Pay: No unexpired risk 3. Assignment: Assignment of the Policy will be governed by Section 38 of the
premium value is payable for Regular Pay policies. Insurance Laws (Amendment) Act, 2015 as amended from time to time. Please
refer to Annexure IIl for details on this section.
4. Incontestability: Incontestability will be as per Section 45 of the Insurance Laws Insurance Regulatory and Development Authority of India
(Amendment) Act, 2015 as amended from time to time. Please refer to Annexure IV Survey No. 115/1, Financial District, Nanakramguda, Gachibowli,
for details on this section. Hyderabad, Telangana State – 500032
5. Non-Disclosure & Fraud: Non-disclosure and Fraud terms and conditions will be as Insurance Ombudsman: The Central Government has established an office of the
per Section 45 of the Insurance Laws (Amendment) Act, 2015 as amended from Insurance Ombudsman for redressal of grievances with respect to life insurance
time to time. Please refer to Annexure IV for details on this section. The Policy is policies. As per Insurance Ombudsman Rules, 2017, the Ombudsman shall receive
subject to the terms and conditions as mentioned in the Policy document and is and consider complaints or disputes relating to: a. delay in settlement of claims,
governed by the Laws of India. beyond the time specified in the regulations, framed under the Insurance
6. Communication address: Our communication address is: Address: Customer Regulatory and Development Authority of India Act, 1999; b. any partial or total
Service Desk ICICI Prudential Life Insurance Company Limited, Ground Floor & repudiation of claims; c. disputes over premium paid or payable in terms of
Upper Basement, Unit No. 1A & 2A, Raheja Tipco Plaza, Rani Sati Marg, Malad insurance policy; d. misrepresentation of policy terms and conditions at any time
(East), Mumbai- 400097 Maharashtra. Telephone/ Facsimile: 022 67100803 / 805 in the policy document or policy contract; e. legal construction of insurance
E-mail: lifeline@iciciprulife.com We expect You to immediately inform Us about policies in so far as the dispute relates to claim; f. policy servicing related
any change in Your address or contact details. grievances against insurers and their agents and intermediaries; g. issuance of life
7. Electronic transactions: All transactions carried out by You through Internet, insurance policy, general insurance policy including health insurance policy which
electronic, call centres, tele-service operations, computer, automated machines is not in conformity with the proposal form submitted by the proposer; h. non-
network or through other means of communication will be valid and legally issuance of insurance policy after receipt of premium in life insurance and general
insurance including health insurance; and i. any other matter resulting from the
binding on Us as well as You. This will be subject to the relevant guidelines and
violation of provisions of the Insurance Act, 1938 or the regulations, circulars,
terms and conditions as may be specified by Us
guidelines or instructions issued by the IRDAI from time to time or the terms and
8. Jurisdiction: The Policy is subject to the terms and conditions as mentioned in the
conditions of the policy contract, in so far as they relate to issues mentioned at
Policy document and is governed by the laws of India. Indian courts shall have
clauses (a) to (f). Manner in which complaint to be made (1) Any person who has a
exclusive jurisdiction over all differences or disputes arising in relation to this grievance against an insurer, may himself or through his legal heirs, nominee or
Policy. assignee, make a complaint in writing to the Insurance Ombudsman within whose
9. Legislative changes: All benefits payable under the Policy are subject to the tax territorial jurisdiction the branch or office of the insurer complained against or the
laws and other financial enactments as they exist from time to time. The Policy residential address or place of residence of the complainant is located. (2) The
terms and conditions may be altered based on any future legislative or regulatory complaint shall be in writing, duly signed by the complainant or through his legal
changes. heirs, nominee or assignee and shall state clearly the name and address of the
10. Payment of claim: For processing a claim under this Policy, We will require the complainant, the name of the branch or office of the insurer against whom the
following documents (as may be relevant): a) Claimant’s Statement b) Original complaint is made, the facts giving rise to the complaint, supported by documents,
Policy Document c) Death Certificate of the Life Assured issued by the local the nature and extent of the loss caused to the complainant and the relief sought
municipal authority d) Any other documents or information as may be required by from the Insurance Ombudsman. (3) No complaint to the Insurance Ombudsman
the Company for processing of the claim depending on the cause of the death e) shall lie unless— (a) the complainant makes a written representation to the insurer
Cancelled Cheque for processing electronic payment Claim payments are made named in the complaint and— i. either the insurer had rejected the complaint; or ii.
only in Indian currency in accordance with the prevailing Exchange control the complainant had not received any reply within a period of one month after the
regulations and other relevant laws and regulations in India. In case the Claimant is insurer received his representation; or iii. the complainant is not satisfied with the
unable to provide any or all of the above documents, in exceptional circumstances reply given to him by the insurer; (b) The complaint is made within one year— (i)
such as a natural calamity, the Company may at its own discretion conduct an after the order of the insurer rejecting the representation is received; or (ii) after
investigation and may subsequently settle the claim. receipt of decision of the insurer which is not to the satisfaction of the complainant;
11. Suicide: If the Life Assured, whether sane or insane, commits suicide within 12 (iii) after expiry of a period of one month from the date of sending the written
months from the date of commencement of risk of this Policy, We will refund representation to the insurer if the insurer named fails to furnish reply to the
higher of 80% of the total premiums paid including extra premiums, if any till the complainant. (4) The Ombudsman shall be empowered to condone the delay in
such cases as he may consider necessary, after calling for objections of the insurer
date of death or unexpired risk premium value as available on date of death,
against the proposed condonation and after recording reasons for condoning the
provided the policy is in force. In the case of a revived Policy, if the Life Assured,
delay and in case the delay is condoned, the date of condonation of delay shall be
whether sane or insane, commits suicide within 12 months of the date of revival of
deemed to be the date of filing of the complaint, for further proceedings under
the Policy, higher of 80% of the total premiums paid including extra premiums, if these rules. (5) No complaint before the Insurance Ombudsman shall be
any till date of death or unexpired risk premium value as available on date of death maintainable on the same subject matter on which proceedings are pending
will be payable by Us. The Policy will terminate on making such a payment and all before or disposed of by any court or consumer forum or arbitrator. (6) The
rights, benefits and interests under the Policy will stand extinguished. Ombudsman shall not award compensation exceeding more than Rupees Thirty
12. Issue of duplicate policy: We shall issue a duplicate of Policy document, on Lakhs (including relevant expenses, if any). We have given below the details of the
receipt of a written request for the same from You along with the necessary existing offices of the Insurance Ombudsman. We request You to regularly check
documents as may be required by Us and at such charges as may be applicable our website at www.iciciprulife.com or the website of the IRDAI at
from time to time. The current charges for issuance of duplicate policy is Rs. 200. www.irdai.gov.in for updated contact details.
Freelook option is not available on issue of duplicate Policy document.
13. Amendment to policy document Any variations, modifications or amendment of 1. AHMEDABAD: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th
any terms of the Policy document shall be communicated to you in writing. floor, Tilak Marg, Relief Road, Ahmedabad- 380 001. Tel.:- 079 -
25501201/02/05/06. Email: bimalokpal.ahmedabad@ecoi.co.in Jurisdiction:
PART - G Gujarat, Dadra & Nagar Haveli, Daman and Diu.
Grievance Redressal Mechanism & List of Ombudsman 2. BENGALURU: Office of Insurance Ombudsman, Jeevan Soudha Building, PID No.
1. Customer service For any clarification or assistance You may contact Our advisor 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar, 1st Phase, Bengaluru –
or call Our customer service representative (between 10.00 a.m. to 7.00 p.m, 560078. Tel No: 080 - 26652048 / 26652049. Email:
Monday to Saturday; excluding national holidays) on the numbers mentioned on bimalokpal.bengaluru@ecoi.co.inJurisdiction: Karnataka.
the reverse of the Policy folder or on Our website: www.iciciprulife.com. 3. BHOPAL: Office of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor 6,
Alternatively You may communicate with Us at the customer service desk whose Malviya Nagar, Opp Airtel Office, Near New Market, Bhopal - 462 003. Tel.:- 0755-
details are mentioned in the Welcome Letter. For updated contact details, We 2769201, 2769202. Fax : 0755-2769203. Email: bimalokpal.bhopal@ecoi.co.in
request You to regularly check Our website. i. Grievance Redressal Officer: If You Jurisdiction: Madhya Pradesh & Chhattisgarh.
do not receive any resolution from Us or if You are not satisfied with Our resolution, 4. BHUBANESHWAR: Office of the Insurance Ombudsman, 62, Forest Park,
You may get in touch with Our designated grievance redressal officer (GRO) at Bhubaneshwar -751 009. Tel.:- 0674-2596455/2596461. Fax : 0674-2596429 Email:
gro@iciciprulife.com or 1860 266 7766. Address: ICICI Prudential Life Insurance bimalokpal.bhubaneswar@ecoi.co.in Jurisdiction: Orissa.
Company Limited, Ground Floor & Upper Basement, Unit No. 1A & 2A, Raheja Tipco 5. CHANDIGARH: Office of the Insurance Ombudsman, S.C.O. No.101, 102 & 103,
Plaza, Rani Sati Marg, Malad (East), Mumbai-400097. For more details please refer 2nd Floor, Batra Building, Sector 17-D, Chandigarh - 160 017. Tel.:- 0172-
to the “Grievance Redressal” section on www.iciciprulife.com. ii. Grievance 2706468/2706196. Fax : 0172-2708274. Email: bimalokpal.chandigarh@ecoi.co.in
Redressal Committee: If You do not receive any resolution or if You are not satisfied Jurisdiction: Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir, UT of
with the resolution provided by the GRO, You may escalate the matter to Our Chandigarh.
internal grievance redressal committee at the address mentioned below: ICICI
Prudential Life Insurance Co. Ltd. Ground Floor & Upper Basement, Unit No. 1A & 6. CHENNAI: Office of the Insurance Ombudsman, Fathima Akhtar Court, 4th Floor,
2A, RahejaTipco Plaza, Rani Sati Marg, Malad (East),Mumbai- 400097. Maharashtra. 453, Anna Salai, Teynampet, Chennai -600 018. Tel.:- 044-24333668 /24335284. Fax
If you are not satisfied with the response or do not receive a response from us : 044-24333664. Email: bimalokpal.chennai@ecoi.co.in Jurisdiction: Tamil Nadu,
within 15 days, you may approach the Grievance Cell of the Insurance Regulatory UT–Pondicherry Town and Karaikal (which are part of UT of Pondicherry)
and Development Authority of India (IRDAI) on the following contact details: IRDAI 7. DELHI: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Bldg., Asaf
Grievance Call Centre (IGCC) TOLL FREE NO: 155255 (or) 1800 4254 732. Ali Road, New Delhi -110 002. Tel.:- 011-23232481/23213504 Fax : 011-23230858.
Email ID: complaints@irdai.gov.in Email: bimalokpal.delhi@ecoi.co.inJurisdiction: Delhi.
You can also register your complaint online at igms.irda.gov.in 8. ERNAKULAM: Office of the Insurance Ombudsman, 2nd Floor, Pulinat Building,
Address for communication for complaints by fax/paper: Consumer Affairs Opp. Cochin Shipyard, M.G. Road, Ernakulam-682 015. Tel : 0484-
Department 2358759/2359338. Fax : 0484-2359336. Email: bimalokpal.ernakulam@ecoi.co.in
Jurisdiction: Kerala , Lakshadweep, Mahe– a part of Pondicherry.
9. GUWAHATI: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near
PanbazarOverbridge, S.S. Road, Guwahati -781 001. Tel.:- 0361- 2132204/2132205.
Fax : 0361-2732937. Email: bimalokpal.guwahati@ecoi.co.in Jurisdiction: Assam,
Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura.
10. HYDERABAD: Office of the Insurance Ombudsman, 6-2-46, 1st Floor, Moin Court,
Lane opp Salem Function Palace, A.C. Guards, Lakdi-Ka-Pool, Hyderabad -500 004.
Tel : 040-65504123/23312122. Fax: 040-23376599. Email:
bimalokpal.hyderabad@ecoi.co.inJurisdiction: Andhra Pradesh, Telangana, UT of
Yanam& part of the UT of Pondicherry.
11. JAIPUR: Office of Insurance Ombudsman, Jeevan Nidhi - II, Ground floor, Bhawani
Singh Road, Ambedkar circle, Jaipur- 302005. Tel : 0141 -2740363. Email:
bimalokpal.jaipur@ecoi.co.in.Jurisdiction: Rajasthan.
12. KOLKATA: Office of the Insurance Ombudsman, 4th Floor, Hindusthan Building
Annexe, 4, C.R.Avenue, Kolkatta – 700 072. Tel : 033- 22124339/22124340. Fax :
033-22124341. Email: bimalokpal.kolkata@ecoi.co.in Jurisdiction: West Bengal,
Sikkim and Andeman & Nicobar Islands.
13. LUCKNOW: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase
II, Nawal Kishore Road, Hazaratganj, Lucknow - 226 001. Tel: 0522 -2231331/2231330.
Fax : 0522-2231310. Email: bimalokpal.lucknow@ecoi.co.in Jurisdiction: Districts of
Uttar Pradesh: Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad,
Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun,
Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli,
Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar,
Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria,
Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
14. MUMBAI: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe,
S.V. Road, Santacruz(W), Mumbai - 400 054. Tel : 022 -26106960/26106552. Fax :
022-26106052. Email: bimalokpal.mumbai@ecoi.co.in Jurisdiction: Goa and
Mumbai Metropolitan region (excluding Navi Mumbai & Thane)
15. NOIDA: Office of Insurance Ombudsman, Bhagwan Sahai Palace, 4th Floor, Main
Road, Naya Bans, Sector 15, Noida Distt - Gautam Buddh Nagar, U.P - 201 301. Tel:
0120-2514250 / 2514251 / 2514253. Email: bimalokpal.noida@ecoi.co.in Jurisdiction:
State of Uttaranchal and the following Districts of Uttar Pradesh: Agra, Aligarh,
Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura,
Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad,
Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur,
Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
16. PATNA: Office of the Insurance Ombudsman, 1st Floor, Kalpana Arcade Building,
Bazar Samiti Road, Bahadurpur, Patna - 800 006. Tel : 0612-2680952. Email:
bimalokpal.patna@ecoi.co.inJurisdiction: Bihar, Jharkhand.
17. PUNE: Office of Insurance Ombudsman, II Floor, Jeevan Darshan, N C Kelkar Road,
C.T.S No 195 to 198, Narayanpeth, Pune-411030. Tel: 020-41312555. Email:
bimalokpal.pune@ecoi.co.in Jurisdiction: State of Maharashtra, Area of Navi
Mumbai & Thane (excluding Mumbai Metropolitan region).
In case of dispute in respect of interpretation of these terms and conditions and
special provisions/conditions the English version shall stand valid.
YOU ARE REQUESTED TO EXAMINE THIS POLICY DOCUMENT, AND IF ANY
MISTAKE BE FOUND THEREIN, RETURN IT IMMEDIATELY FOR CORRECTION.

Policy Schedule, terms and conditions of the policy and all the endorsements by
the Company, if any, will form an integral part of this contract and will be binding
on the parties.

Annexure I – Unexpired risk premium value factors

1. For Single Pay:
Policy Year \
Policy Term 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 30 30 30 35 35 40 40 40 40 40 40 40 40 40 40 40
2 25 25 25 35 35 35 35 35 35 35 35 35 35 35 40 40
3 15 20 20 30 30 35 35 35 35 35 35 35 35 35 40 40
4 5 15 15 25 30 30 30 35 35 35 35 35 35 35 40 40
5 0 5 5 20 25 30 30 30 30 35 35 35 35 35 40 40
6 0 0 5 15 20 25 25 30 30 35 35 35 35 35 40 40
7 0 0 0 5 15 20 20 25 30 30 35 35 35 35 40 40
8 0 0 0 0 5 15 15 20 25 30 30 35 35 35 40 40
9 0 0 0 0 0 5 10 15 20 25 30 30 35 35 40 40
10 0 0 0 0 0 0 5 10 15 20 25 25 30 35 35 35
11 0 0 0 0 0 0 0 5 10 15 25 25 30 30 35 35
12 0 0 0 0 0 0 0 0 5 10 15 20 25 30 35 35
13 0 0 0 0 0 0 0 0 0 5 10 15 20 25 30 35
14 0 0 0 0 0 0 0 0 0 0 5 5 15 20 25 30
15 0 0 0 0 0 0 0 0 0 0 0 5 10 15 20 25
16 0 0 0 0 0 0 0 0 0 0 0 0 5 10 20 20
17 0 0 0 0 0 0 0 0 0 0 0 0 0 5 10 15
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 10
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Limited Pay Options:
2. (Policy term - 5)
Policy Year \
Benefit Term 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

1 - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - -
4 15 - - - - - - - - - - - - - - -
5 50 25 5 - - - - - - - - - - - - -
6 40 55 35 15 - - - - - - - - - - - -
7 35 45 60 40 20 10 - - - - - - - - - -
8 25 35 50 60 45 30 15 5 - - - - - - - -
9 10 25 40 55 65 50 35 25 15 10 - - - - - -
10 - 10 30 40 55 70 55 40 30 25 15 10 5 - - -
11 - - 15 30 45 60 70 55 45 40 30 25 20 15 15 10
12 - - - 15 30 45 60 70 60 50 40 40 35 30 25 20
13 - - - - 15 35 50 60 75 65 55 50 45 40 35 35
14 - - - - - 15 35 50 65 75 65 60 55 50 45 45
15 - - - - - - 15 35 50 65 75 70 65 60 55 50
16 - - - - - - - 20 35 50 65 80 70 65 65 60
17 - - - - - - - - 20 35 50 65 80 75 70 65
18 - - - - - - - - - 20 35 55 65 80 75 70
19 - - - - - - - - - - 20 40 55 65 80 75
20 - - - - - - - - - - - 20 40 55 65 80
21 - - - - - - - - - - - - 20 40 55 65
22 - - - - - - - - - - - - - 20 40 55
23 - - - - - - - - - - - - - - 20 40
24 - - - - - - - - - - - - - - - 20
25 - - - - - - - - - - - - - - - -

Policy Year \
Benefit Term 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

1 - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - -
6 - - - - - - - - - - - - - - -
7 - - - - - - - - - - - - - - -
8 - - - - - - - - - - - - - - -
9 - - - - - - - - - - - - - - -
10 - - - - - - - - - - - - - - -
11 5 - - - - - - - - - - - - - -
12 15 15 10 10 5 5 - - - - - - - - -
13 30 25 25 20 15 15 10 5 - - - - - - -
14 40 35 35 30 25 25 20 15 10 5 5 - - - -
15 45 45 40 40 35 35 30 25 20 15 15 10 5 5 -
16 55 50 50 50 45 40 35 35 30 25 20 20 15 10 10
17 60 60 55 55 50 50 45 40 35 35 30 25 25 20 15
18 65 65 60 60 55 55 50 45 45 40 35 35 30 25 25
19 70 70 65 65 60 60 55 50 50 45 40 40 35 35 30
20 75 70 70 70 65 65 60 55 50 50 45 45 40 40 35
21 75 75 70 70 65 65 60 60 55 55 50 45 45 40 40
22 65 75 75 70 70 70 65 60 60 55 55 50 50 45 45
23 50 65 75 70 70 70 65 65 60 60 55 55 50 50 45
24 35 50 60 70 70 70 65 65 60 60 55 55 55 50 50
25 20 35 50 60 65 70 65 65 60 60 60 55 55 55 50
26 - 20 35 50 55 65 65 65 60 60 60 55 55 55 50
27 - - 15 35 45 55 65 60 60 60 60 55 55 55 55
28 - - - 15 30 45 55 60 60 60 55 55 55 55 55
29 - - - - 15 30 40 50 55 55 55 55 55 55 55
30 - - - - - 15 30 40 50 55 55 55 55 55 55
31 - - - - - - 15 30 40 45 50 50 50 50 50
32 - - - - - - - 15 25 35 45 50 50 50 50
33 - - - - - - - - 15 25 35 40 50 50 50
34 - - - - - - - - - 10 25 35 40 45 45
35 - - - - - - - - - - 10 25 30 40 45
36 - - - - - - - - - - - 10 20 30 35
37 - - - - - - - - - - - - 10 20 30
38 - - - - - - - - - - - - - 10 20
39 - - - - - - - - - - - - - - 10
40 - - - - - - - - - - - - - - -
Policy Year \
Benefit Term 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
1 - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 - - - - - - - - - - - - - - - - - - - - - - - - - - -
11 - - - - - - - - - - - - - - - - - - - - - - - - - - -
12 - - - - - - - - - - - - - - - - - - - - - - - - - - -
13 - - - - - - - - - - - - - - - - - - - - - - - - - - -
14 - - - - - - - - - - - - - - - - - - - - - - - - - - -
15 5 5 5 5 - - - - - - - - - - - - - - - - - - - - - - -
16 15 15 15 15 - - - - - - - - - - - - - - - - - - - - - - -
17 25 25 25 25 - - - - - - - - - - - - - - - - - - - - - - -
18 30 30 30 30 - 5 5 5 5 5 - - - - - - - - - - - - - - - - -
19 40 40 40 40 10 15 15 10 10 10 - - - - - - - - - - - - - - - - -
20 45 45 45 45 15 20 20 15 15 15 5 5 5 5 5 - - - - - - - - - - - -
21 55 55 55 55 20 25 25 20 20 20 10 10 10 10 10 - - - - - - - - - - - -
22 60 60 60 60 25 35 35 25 25 25 15 15 15 15 15 - - - - - - - - - - - -
23 65 65 65 65 30 40 40 30 30 30 20 20 20 20 20 - - - - - - - - - - - -
24 70 70 70 70 35 45 45 35 35 35 25 25 25 25 25 - - - - - - - - - - - -
25 75 75 75 75 35 50 50 35 35 35 30 30 30 30 30 - - - - - - - - - - - -
26 75 75 75 75 40 50 50 40 40 40 30 30 30 30 30 5 5 5 5 5 - - - - - - -
27 80 80 80 80 45 55 55 40 40 40 35 35 35 35 35 5 5 5 5 5 - - - - - - -
28 80 80 80 80 45 60 60 45 45 45 35 35 35 35 35 10 10 10 10 10 5 5 5 5 5 5 5
29 85 85 85 85 45 60 60 45 45 45 35 35 35 35 35 15 15 15 15 15 10 10 10 10 10 10 10
30 85 85 85 85 50 65 65 45 45 45 40 40 40 40 40 15 15 15 15 15 10 10 10 10 10 10 10
31 90 90 90 90 50 65 65 45 45 45 40 40 40 40 40 20 20 20 20 20 15 15 15 15 15 15 15
32 90 90 90 90 50 70 70 50 50 50 40 40 40 40 40 20 20 20 20 20 15 15 15 15 15 15 15
33 90 90 90 90 50 70 70 50 50 50 40 40 40 40 40 25 25 25 25 25 15 15 15 15 15 15 15
34 90 90 90 90 45 70 70 50 50 50 45 45 45 45 45 25 25 25 25 25 20 20 20 20 20 20 20
35 90 90 90 90 45 70 70 50 50 50 45 45 45 45 45 25 25 25 25 25 20 20 20 20 20 20 20
36 85 85 85 85 45 70 70 45 45 45 45 45 45 45 45 25 25 25 25 25 20 20 20 20 20 20 20
37 80 80 80 80 45 70 70 45 45 45 45 45 45 45 45 25 25 25 25 25 25 25 25 25 25 25 25
38 70 70 70 70 40 75 75 45 45 45 40 40 40 40 40 30 30 30 30 30 25 25 25 25 25 25 25
39 65 65 65 65 40 75 75 45 45 45 40 40 40 40 40 30 30 30 30 30 25 25 25 25 25 25 25
40 55 55 55 55 35 75 75 40 40 40 40 40 40 40 40 30 30 30 30 30 25 25 25 25 25 25 25
41 45 45 45 30 70 70 40 40 40 40 40 40 40 40 30 30 30 30 30 25 25 25 25 25 25 25
42 35 35 25 60 60 40 40 40 40 40 40 40 40 30 30 30 30 30 25 25 25 25 25 25 25
43 25 15 55 55 35 35 35 35 35 35 35 35 30 30 30 30 30 25 25 25 25 25 25 25
44 10 50 50 35 35 35 35 35 35 35 35 30 30 30 30 30 25 25 25 25 25 25 25
45 - - - - 45 45 30 30 30 35 35 35 35 35 30 30 30 30 30 25 25 25 25 25 25 25
46 - - - - - 35 25 25 25 30 30 30 30 30 30 30 30 30 30 25 25 25 25 25 25 25
47 - - - - - 20 20 20 30 30 30 30 30 25 25 25 25 25 25 25 25 25 25 25 25
48 - - - - - 15 15 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25
49 - - - - - 10 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25
50 - - - - - 20 20 20 20 20 25 25 25 25 25 25 25 25 25 25 25 25
51 - - - - 20 20 20 20 25 25 25 25 25 25 25 25 25 25 25 25
52 - - - - 15 15 15 20 20 20 20 20 20 20 20 20 20 20 20
53 - - - - 10 10 20 20 20 20 20 20 20 20 20 20 20 20
54 - - - - 5 20 20 20 20 20 20 20 20 20 20 20 20
55 - - - - - - - - - 15 15 15 15 15 20 20 20 20 20 20 20
56 - - - - 15 15 15 15 20 20 20 20 20 20 20
57 - - - - 10 10 10 15 15 15 15 15 15 15
58 - - - - 10 10 15 15 15 15 15 15 15
59 - - - - 5 15 15 15 15 15 15 15
60 - - - - - - - - - 10 10 10 10 10 10 10
61 - - - - 10 10 10 10 10 10
62 - - - - 10 10 10 10 10
63 - - - - 5 5 5 5
64 - - - - 5 5 5
65 - - - - - 5 5
66 - 5
67
3. 5 pay option:
Policy
Year \ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
Benefit
Term
1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 25 25 25 25 25 30 30 30 30 30 30 30 30 30 30 30 30
3 - 10 10 10 10 10 25 25 25 25 25 35 35 35 35 35 45 45 45 45 45 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 70 70 70 70 70 85 85 85 85 85 100 100 100 100 100 100 100
4 15 50 50 50 50 50 65 65 65 65 65 80 80 80 80 80 90 90 90 90 90 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 120 120 120 120 120 135 135 135 135 135 150 150 150 150 150 150 150
5 50 85 85 85 85 85 105 105 105 105 105 120 120 120 120 120 130 130 130 130 130 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140 145 145 145 145 145 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
6 40 80 80 80 80 80 100 100 100 100 100 115 115 115 115 115 130 130 130 130 130 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140 145 145 145 145 145 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
7 35 70 70 70 70 70 95 95 95 95 95 115 115 115 115 115 125 125 125 125 125 135 135 135 135 135 140 140 140 140 140 140 140 140 140 140 145 145 145 145 145 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
8 25 65 65 65 65 65 90 90 90 90 90 110 110 110 110 110 125 125 125 125 125 135 135 135 135 135 135 135 135 135 135 140 140 140 140 140 145 145 145 145 145 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
9 10 60 60 60 60 60 90 90 90 90 90 110 110 110 110 110 120 120 120 120 120 135 135 135 135 135 135 135 135 135 135 135 135 135 135 135 145 145 145 145 145 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
10 - 50 50 50 50 50 85 85 85 85 85 105 105 105 105 105 120 120 120 120 120 135 135 135 135 135 135 135 135 135 135 135 135 135 135 135 145 145 145 145 145 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
11 - 40 40 40 40 75 75 75 75 75 100 100 100 100 100 120 120 120 120 120 130 130 130 130 130 135 135 135 135 135 135 135 135 135 135 140 140 140 140 140 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
12 - 30 30 30 70 70 70 70 70 100 100 100 100 100 115 115 115 115 115 130 130 130 130 130 135 135 135 135 135 135 135 135 135 135 140 140 140 140 140 165 165 165 165 165 180 180 180 180 180 195 195 195 195 195 195 195
13 - 25 25 65 65 65 65 65 95 95 95 95 95 110 110 110 110 110 130 130 130 130 130 130 130 130 130 130 135 135 135 135 135 140 140 140 140 140 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
14 - 10 60 60 60 60 60 90 90 90 90 90 110 110 110 110 110 125 125 125 125 125 130 130 130 130 130 135 135 135 135 135 140 140 140 140 140 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
15 - - - - - - 50 50 50 50 50 85 85 85 85 85 105 105 105 105 105 125 125 125 125 125 130 130 130 130 130 130 130 130 130 130 140 140 140 140 140 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
16 - - - - - - 40 40 40 40 80 80 80 80 80 105 105 105 105 105 120 120 120 120 120 125 125 125 125 125 130 130 130 130 130 140 140 140 140 140 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
17 - - - - - - 35 35 35 75 75 75 75 75 100 100 100 100 100 120 120 120 120 120 125 125 125 125 125 130 130 130 130 130 140 140 140 140 140 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
18 - - - - - - 25 25 65 65 65 65 65 95 95 95 95 95 115 115 115 115 115 125 125 125 125 125 130 130 130 130 130 135 135 135 135 135 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
19 - - - - - - 10 60 60 60 60 60 90 90 90 90 90 110 110 110 110 110 120 120 120 120 120 125 125 125 125 125 135 135 135 135 135 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
20 - - - - - - - - - - - 50 50 50 50 50 85 85 85 85 85 110 110 110 110 110 120 120 120 120 120 125 125 125 125 125 135 135 135 135 135 160 160 160 160 160 175 175 175 175 175 185 185 185 185 185 185 185
21 - - - - - - - - - - - 45 45 45 45 80 80 80 80 80 105 105 105 105 105 115 115 115 115 115 125 125 125 125 125 135 135 135 135 135 155 155 155 155 155 165 165 165 165 165 180 180 180 180 180 180 180
22 - - - - - - - - - - - 35 35 35 70 70 70 70 70 100 100 100 100 100 115 115 115 115 115 120 120 120 120 120 130 130 130 130 130 155 155 155 155 155 165 165 165 165 165 180 180 180 180 180 180 180
23 - - - - - - - - - - - 25 25 65 65 65 65 65 95 95 95 95 95 110 110 110 110 110 120 120 120 120 120 130 130 130 130 130 155 155 155 155 155 165 165 165 165 165 180 180 180 180 180 180 180
24 - - - - - - - - - - - 10 60 60 60 60 60 90 90 90 90 90 105 105 105 105 105 115 115 115 115 115 130 130 130 130 130 155 155 155 155 155 165 165 165 165 165 180 180 180 180 180 180 180
25 - - - - - - - - - - - - - - - - 50 50 50 50 50 85 85 85 85 85 105 105 105 105 105 115 115 115 115 115 130 130 130 130 130 155 155 155 155 155 165 165 165 165 165 180 180 180 180 180 180 180
26 - - - - - - - - - - - - - - - - 40 40 40 40 80 80 80 80 80 100 100 100 100 100 110 110 110 110 110 125 125 125 125 125 150 150 150 150 150 160 160 160 160 160 170 170 170 170 170 170 170
27 - - - - - - - - - - - - - - - - 30 30 30 70 70 70 70 70 95 95 95 95 95 110 110 110 110 110 125 125 125 125 125 150 150 150 150 150 160 160 160 160 160 170 170 170 170 170 170 170
28 - - - - - - - - - - - - - - - - 20 20 65 65 65 65 65 90 90 90 90 90 105 105 105 105 105 120 120 120 120 120 150 150 150 150 150 160 160 160 160 160 170 170 170 170 170 170 170
29 - - - - - - - - - - - - - - - - 10 55 55 55 55 55 85 85 85 85 85 105 105 105 105 105 120 120 120 120 120 145 145 145 145 145 155 155 155 155 155 160 160 160 160 160 160 160
30 - - - - - - - - - - - - - - - - - - - - - 50 50 50 50 50 80 80 80 80 80 100 100 100 100 100 115 115 115 115 115 145 145 145 145 145 155 155 155 155 155 160 160 160 160 160 160 160
31 - - - - - - - - - - - - - - - - - - - - - 40 40 40 40 75 75 75 75 75 95 95 95 95 95 115 115 115 115 115 145 145 145 145 145 155 155 155 155 155 160 160 160 160 160 160 160
32 - - - - - - - - - - - - - - - - - - - - - 30 30 30 70 70 70 70 70 90 90 90 90 90 110 110 110 110 110 140 140 140 140 140 145 145 145 145 145 155 155 155 155 155 155 155
33 - - - - - - - - - - - - - - - - - - - - - 20 20 60 60 60 60 60 85 85 85 85 85 110 110 110 110 110 140 140 140 140 140 145 145 145 145 145 155 155 155 155 155 155 155
34 - - - - - - - - - - - - - - - - - - - - - 10 55 55 55 55 55 80 80 80 80 80 105 105 105 105 105 135 135 135 135 135 140 140 140 140 140 145 145 145 145 145 145 145
35 - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 45 45 45 75 75 75 75 75 105 105 105 105 105 135 135 135 135 135 140 140 140 140 140 145 145 145 145 145 145 145
36 - - - - - - - - - - - - - - - - - - - - - - - - - - 40 40 40 40 70 70 70 70 70 100 100 100 100 100 130 130 130 130 130 135 135 135 135 135 140 140 140 140 140 140 140
37 - - - - - - - - - - - - - - - - - - - - - - - - - - 30 30 30 65 65 65 65 65 95 95 95 95 95 130 130 130 130 130 135 135 135 135 135 140 140 140 140 140 140 140
38 - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 60 60 60 60 60 90 90 90 90 90 125 125 125 125 125 130 130 130 130 130 135 135 135 135 135 135 135
39 - - - - - - - - - - - - - - - - - - - - - - - - - - 10 55 55 55 55 55 85 85 85 85 85 125 125 125 125 125 130 130 130 130 130 135 135 135 135 135 135 135
40 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 45 45 45 80 80 80 80 80 120 120 120 120 120 125 125 125 125 125 130 130 130 130 130 130 130
41 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 40 40 40 75 75 75 75 75 115 115 115 115 115 120 120 120 120 120 120 120 120 120 120 120 120
42 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 30 30 70 70 70 70 70 110 110 110 110 110 115 115 115 115 115 115 115 115 115 115 115 115
43 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 65 65 65 65 65 110 110 110 110 110 115 115 115 115 115 115 115 115 115 115 115 115
44 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 60 60 60 60 60 105 105 105 105 105 110 110 110 110 110 110 110 110 110 110 110 110
45 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50 50 50 50 50 100 100 100 100 100 105 105 105 105 105 105 105 105 105 105 105 105
46 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 45 45 90 90 90 90 90 95 95 95 95 95 95 95 95 95 95 95 95
47 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 35 85 85 85 85 85 90 90 90 90 90 90 90 90 90 90 90 90
48 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 25 80 80 80 80 80 85 85 85 85 85 90 90 90 90 90 90 90
49 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 70 70 70 70 70 75 75 75 75 75 80 80 80 80 80 80 80
50 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 60 60 60 60 60 65 65 65 65 65 70 70 70 70 70 70 70
51 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50 50 50 50 60 60 60 60 60 65 65 65 65 65 65 65
52 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 40 40 50 50 50 50 50 60 60 60 60 60 60 60
53 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 30 40 40 40 40 40 55 55 55 55 55 55 55
54 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 30 30 30 30 30 45 45 45 45 45 45 45
55 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 25 25 25 25 40 40 40 40 40 40 40
56 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 20 20 35 35 35 35 35 35 35
57 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 20 30 30 30 30 30 30 30
58 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 15 25 25 25 25 25 25 25
59 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 20 20 20 20 20 20 20
60 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 15 15 15 15 15 15
61 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 15 15 15 15 15
62 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 10 10 10 10
63 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 10 10 10
64 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5 5
65 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5
66 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5
67 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4. 7 pay option:
Policy
Year \ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
Benefit
Term
1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 30 30 30 30 30 30 30 30 30 35 35 35 35 35 35 35 35 35 35 35 35
4 - - - - - - 5 5 5 5 5 20 20 20 20 20 25 25 25 25 25 30 30 30 30 30 35 35 35 35 35 45 45 45 45 45 75 75 75 75 75 75 75 75 75 75 100 100 100 100 100 125 125 125 125 125 125 125
5 - 20 20 20 20 20 40 40 40 40 40 55 55 55 55 55 65 65 65 65 65 70 70 70 70 70 75 75 75 75 75 85 85 85 85 85 115 115 115 115 115 120 120 120 120 120 145 145 145 145 145 170 170 170 170 170 170 170
6 15 50 50 50 50 50 70 70 70 70 70 90 90 90 90 90 105 105 105 105 105 110 110 110 110 110 115 115 115 115 115 125 125 125 125 125 160 160 160 160 160 160 160 160 160 160 185 185 185 185 185 205 205 205 205 205 205 205
7 40 80 80 80 80 80 105 105 105 105 105 125 125 125 125 125 140 140 140 140 140 150 150 150 150 150 155 155 155 155 155 170 170 170 170 170 205 205 205 205 205 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 245 245
8 25 70 70 70 70 70 100 100 100 100 100 120 120 120 120 120 140 140 140 140 140 150 150 150 150 150 155 155 155 155 155 170 170 170 170 170 205 205 205 205 205 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 245 245
9 15 65 65 65 65 65 95 95 95 95 95 120 120 120 120 120 135 135 135 135 135 145 145 145 145 145 155 155 155 155 155 170 170 170 170 170 205 205 205 205 205 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 245 245
10 - 55 55 55 55 55 90 90 90 90 90 115 115 115 115 115 135 135 135 135 135 145 145 145 145 145 150 150 150 150 150 170 170 170 170 170 205 205 205 205 205 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 245 245
11 - 45 45 45 45 85 85 85 85 85 110 110 110 110 110 130 130 130 130 130 145 145 145 145 145 150 150 150 150 150 165 165 165 165 165 200 200 200 200 200 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 245 245
12 - 35 35 35 75 75 75 75 75 105 105 105 105 105 130 130 130 130 130 140 140 140 140 140 150 150 150 150 150 165 165 165 165 165 200 200 200 200 200 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 245 245
13 - 25 25 70 70 70 70 70 100 100 100 100 100 125 125 125 125 125 140 140 140 140 140 150 150 150 150 150 165 165 165 165 165 200 200 200 200 200 200 200 200 200 200 215 215 215 215 215 235 235 235 235 235 235 235
14 - 15 65 65 65 65 65 100 100 100 100 100 120 120 120 120 120 135 135 135 135 135 145 145 145 145 145 165 165 165 165 165 200 200 200 200 200 200 200 200 200 200 215 215 215 215 215 235 235 235 235 235 235 235
15 - - - - - - 55 55 55 55 55 90 90 90 90 90 120 120 120 120 120 135 135 135 135 135 145 145 145 145 145 160 160 160 160 160 200 200 200 200 200 200 200 200 200 200 215 215 215 215 215 235 235 235 235 235 235 235
16 - - - - - - 45 45 45 45 85 85 85 85 85 115 115 115 115 115 130 130 130 130 130 145 145 145 145 145 160 160 160 160 160 200 200 200 200 200 200 200 200 200 200 215 215 215 215 215 235 235 235 235 235 235 235
17 - - - - - - 35 35 35 80 80 80 80 80 110 110 110 110 110 130 130 130 130 130 140 140 140 140 140 160 160 160 160 160 195 195 195 195 195 200 200 200 200 200 215 215 215 215 215 235 235 235 235 235 235 235
18 - - - - - - 25 25 75 75 75 75 75 105 105 105 105 105 125 125 125 125 125 140 140 140 140 140 160 160 160 160 160 195 195 195 195 195 200 200 200 200 200 215 215 215 215 215 235 235 235 235 235 235 235
19 - - - - - - 15 65 65 65 65 65 100 100 100 100 100 120 120 120 120 120 135 135 135 135 135 155 155 155 155 155 195 195 195 195 195 200 200 200 200 200 215 215 215 215 215 235 235 235 235 235 235 235
20 - - - - - - - - - - - 55 55 55 55 55 95 95 95 95 95 120 120 120 120 120 135 135 135 135 135 155 155 155 155 155 190 190 190 190 190 195 195 195 195 195 210 210 210 210 210 225 225 225 225 225 225 225
21 - - - - - - - - - - - 45 45 45 45 85 85 85 85 85 115 115 115 115 115 130 130 130 130 130 150 150 150 150 150 190 190 190 190 190 195 195 195 195 195 210 210 210 210 210 225 225 225 225 225 225 225
22 - - - - - - - - - - - 35 35 35 80 80 80 80 80 110 110 110 110 110 125 125 125 125 125 150 150 150 150 150 190 190 190 190 190 195 195 195 195 195 210 210 210 210 210 225 225 225 225 225 225 225
23 - - - - - - - - - - - 25 25 75 75 75 75 75 105 105 105 105 105 125 125 125 125 125 145 145 145 145 145 185 185 185 185 185 195 195 195 195 195 210 210 210 210 210 225 225 225 225 225 225 225
24 - - - - - - - - - - - 15 65 65 65 65 65 100 100 100 100 100 120 120 120 120 120 145 145 145 145 145 185 185 185 185 185 190 190 190 190 190 200 200 200 200 200 215 215 215 215 215 215 215
25 - - - - - - - - - - - - - - - - 55 55 55 55 55 90 90 90 90 90 115 115 115 115 115 140 140 140 140 140 180 180 180 180 180 190 190 190 190 190 200 200 200 200 200 215 215 215 215 215 215 215
26 - - - - - - - - - - - - - - - - 45 45 45 45 85 85 85 85 85 110 110 110 110 110 140 140 140 140 140 180 180 180 180 180 190 190 190 190 190 200 200 200 200 200 215 215 215 215 215 215 215
27 - - - - - - - - - - - - - - - - 35 35 35 80 80 80 80 80 105 105 105 105 105 135 135 135 135 135 175 175 175 175 175 185 185 185 185 185 195 195 195 195 195 205 205 205 205 205 205 205
28 - - - - - - - - - - - - - - - - 25 25 70 70 70 70 70 100 100 100 100 100 130 130 130 130 130 175 175 175 175 175 185 185 185 185 185 195 195 195 195 195 205 205 205 205 205 205 205
29 - - - - - - - - - - - - - - - - 15 65 65 65 65 65 95 95 95 95 95 125 125 125 125 125 170 170 170 170 170 185 185 185 185 185 195 195 195 195 195 205 205 205 205 205 205 205
30 - - - - - - - - - - - - - - - - - - - - 55 55 55 55 55 90 90 90 90 90 120 120 120 120 120 165 165 165 165 165 180 180 180 180 180 185 185 185 185 185 195 195 195 195 195 195 195
31 - - - - - - - - - - - - - - - - - - - - - 45 45 45 45 85 85 85 85 85 115 115 115 115 115 165 165 165 165 165 180 180 180 180 180 185 185 185 185 185 195 195 195 195 195 195 195
32 - - - - - - - - - - - - - - - - - - - - - 35 35 35 75 75 75 75 75 110 110 110 110 110 160 160 160 160 160 175 175 175 175 175 180 180 180 180 180 185 185 185 185 185 185 185
33 - - - - - - - - - - - - - - - - - - - - - 25 25 70 70 70 70 70 105 105 105 105 105 155 155 155 155 155 175 175 175 175 175 180 180 180 180 180 185 185 185 185 185 185 185
34 - - - - - - - - - - - - - - - - - - - - - 10 60 60 60 60 60 100 100 100 100 100 150 150 150 150 150 170 170 170 170 170 175 175 175 175 175 175 175 175 175 175 175 175
35 - - - - - - - - - - - - - - - - - - - - - - - - - - 55 55 55 55 55 95 95 95 95 95 145 145 145 145 145 170 170 170 170 170 175 175 175 175 175 175 175 175 175 175 175 175
36 - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 45 45 90 90 90 90 90 140 140 140 140 140 165 165 165 165 165 165 165 165 165 165 170 170 170 170 170 170 170
37 - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 35 80 80 80 80 80 135 135 135 135 135 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160
38 - - - - - - - - - - - - - - - - - - - - - - - - - - 25 25 75 75 75 75 75 130 130 130 130 130 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160
39 - - - - - - - - - - - - - - - - - - - - - - - - - - 10 65 65 65 65 65 125 125 125 125 125 155 155 155 155 155 155 155 155 155 155 155 155 155 155 155 155 155
40 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 55 55 55 55 55 115 115 115 115 115 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150
41 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 45 45 110 110 110 110 110 145 145 145 145 145 145 145 145 145 145 145 145 145 145 145 145 145
42 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 35 100 100 100 100 100 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140
43 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 25 90 90 90 90 90 135 135 135 135 135 135 135 135 135 135 135 135 135 135 135 135 135
44 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 80 80 80 80 80 130 130 130 130 130 130 130 130 130 130 130 130 130 130 130 130 130
45 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 70 70 70 70 70 120 120 120 120 120 120 120 120 120 120 120 120 120 120 120 120 120
46 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 60 60 60 60 115 115 115 115 115 115 115 115 115 115 115 115 115 115 115 115 115
47 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50 50 50 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110
48 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
49 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90
50 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 80 80 80 80 80 80 80 80 80 80 85 85 85 85 85 85 85
51 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 65 65 65 65 75 75 75 75 75 80 80 80 80 80 80 80
52 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50 50 50 65 65 65 65 65 75 75 75 75 75 75 75
53 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 50 50 50 50 50 70 70 70 70 70 70 70
54 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 40 40 40 40 40 65 65 65 65 65 65 65
55 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 35 35 35 55 55 55 55 55 55 55
56 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 30 30 30 50 50 50 50 50 50 50
57 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 25 25 45 45 45 45 45 45 45
58 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 15 35 35 35 35 35 35 35
59 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 30 30 30 30 30 30 30
60 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 25 25 25 25 25 25
61 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 20 20 20 20
62 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 15 15 15 15
63 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 10 10 10
64 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5 5
65 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5
66 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5
67 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5. 10 pay option:
Policy
Year \ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
Benefit
Term
1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5 5 5 5 15 15 15 15 15 20 20 20 20 20 25 25 25 25 25 25 25 25 25 25 25 25
5 - - - - - - 5 5 5 5 5 20 20 20 20 20 25 25 25 25 25 30 30 30 30 30 40 40 40 40 40 55 55 55 55 55 55 55 55 55 55 65 65 65 65 65 75 75 75 75 75 75 75
6 - 15 15 15 15 15 40 40 40 40 40 50 50 50 50 50 60 60 60 60 60 65 65 65 65 65 80 80 80 80 80 95 95 95 95 95 95 95 95 95 95 105 105 105 105 105 115 115 115 115 115 115 115
7 10 45 45 45 45 45 70 70 70 70 70 85 85 85 85 85 95 95 95 95 95 100 100 100 100 100 115 115 115 115 115 130 130 130 130 130 135 135 135 135 135 150 150 150 150 150 160 160 160 160 160 160 160
8 30 70 70 70 70 70 95 95 95 95 95 115 115 115 115 115 125 125 125 125 125 135 135 135 135 135 150 150 150 150 150 170 170 170 170 170 175 175 175 175 175 190 190 190 190 190 205 205 205 205 205 205 205
9 50 95 95 95 95 95 125 125 125 125 125 145 145 145 145 145 160 160 160 160 160 170 170 170 170 170 185 185 185 185 185 205 205 205 205 205 210 210 210 210 210 225 225 225 225 225 240 240 240 240 240 240 240
10 70 115 115 115 115 115 155 155 155 155 155 180 180 180 180 180 195 195 195 195 195 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 250 250 250 250 250 265 265 265 265 265 280 280 280 280 280 280 280
11 60 105 105 105 105 105 150 150 150 150 150 175 175 175 175 175 195 195 195 195 195 205 205 205 205 205 225 225 225 225 225 245 245 245 245 245 250 250 250 250 250 265 265 265 265 265 280 280 280 280 280 280 280
12 45 100 100 100 100 100 145 145 145 145 145 175 175 175 175 175 190 190 190 190 190 200 200 200 200 200 220 220 220 220 220 245 245 245 245 245 250 250 250 250 250 265 265 265 265 265 280 280 280 280 280 280 280
13 35 90 90 90 90 90 140 140 140 140 140 170 170 170 170 170 185 185 185 185 185 200 200 200 200 200 220 220 220 220 220 240 240 240 240 240 250 250 250 250 250 265 265 265 265 265 280 280 280 280 280 280 280
14 15 80 80 80 80 80 130 130 130 130 130 165 165 165 165 165 185 185 185 185 185 200 200 200 200 200 220 220 220 220 220 240 240 240 240 240 250 250 250 250 250 265 265 265 265 265 280 280 280 280 280 280 280
15 - 70 70 70 70 70 125 125 125 125 125 160 160 160 160 160 180 180 180 180 180 195 195 195 195 195 220 220 220 220 220 240 240 240 240 240 245 245 245 245 245 255 255 255 255 255 265 265 265 265 265 265 265
16 - 60 60 60 60 115 115 115 115 115 155 155 155 155 155 175 175 175 175 175 195 195 195 195 195 215 215 215 215 215 240 240 240 240 240 245 245 245 245 245 255 255 255 255 255 265 265 265 265 265 265 265
17 - 45 45 45 110 110 110 110 110 150 150 150 150 150 175 175 175 175 175 190 190 190 190 190 215 215 215 215 215 235 235 235 235 235 245 245 245 245 245 255 255 255 255 255 265 265 265 265 265 265 265
18 - 35 35 100 100 100 100 100 140 140 140 140 140 170 170 170 170 170 185 185 185 185 185 210 210 210 210 210 235 235 235 235 235 245 245 245 245 245 255 255 255 255 255 265 265 265 265 265 265 265
19 - 15 90 90 90 90 90 135 135 135 135 135 165 165 165 165 165 185 185 185 185 185 210 210 210 210 210 235 235 235 235 235 245 245 245 245 245 255 255 255 255 255 265 265 265 265 265 265 265
20 - - - - - - 75 75 75 75 75 125 125 125 125 125 160 160 160 160 160 180 180 180 180 180 205 205 205 205 205 230 230 230 230 230 240 240 240 240 240 245 245 245 245 245 255 255 255 255 255 255 255
21 - - - - - - 65 65 65 65 120 120 120 120 120 155 155 155 155 155 175 175 175 175 175 205 205 205 205 205 230 230 230 230 230 240 240 240 240 240 245 245 245 245 245 255 255 255 255 255 255 255
22 - - - - - - 50 50 50 110 110 110 110 110 145 145 145 145 145 170 170 170 170 170 200 200 200 200 200 230 230 230 230 230 240 240 240 240 240 245 245 245 245 245 255 255 255 255 255 255 255
23 - - - - - - 35 35 100 100 100 100 100 140 140 140 140 140 165 165 165 165 165 195 195 195 195 195 225 225 225 225 225 240 240 240 240 240 245 245 245 245 245 255 255 255 255 255 255 255
24 - - - - - - 20 90 90 90 90 90 130 130 130 130 130 160 160 160 160 160 195 195 195 195 195 225 225 225 225 225 235 235 235 235 235 240 240 240 240 240 245 245 245 245 245 245 245
25 - - - - - - - - - 75 75 75 75 75 125 125 125 125 125 155 155 155 155 155 190 190 190 190 190 220 220 220 220 220 235 235 235 235 235 240 240 240 240 240 245 245 245 245 245 245 245
26 - - - - - - - - - - 60 60 60 60 115 115 115 115 115 150 150 150 150 150 185 185 185 185 185 215 215 215 215 215 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230
27 - - - - - - - - - - - 50 50 50 105 105 105 105 105 145 145 145 145 145 180 180 180 180 180 215 215 215 215 215 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230
28 - - - - - - - - - - - 35 35 95 95 95 95 95 135 135 135 135 135 175 175 175 175 175 210 210 210 210 210 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230 230
29 - - - - - - - - - - - 15 85 85 85 85 85 130 130 130 130 130 170 170 170 170 170 205 205 205 205 205 225 225 225 225 225 225 225 225 225 225 225 225 225 225 225 225 225
30 - - - - - - - - - - - - - - 75 75 75 75 75 120 120 120 120 120 165 165 165 165 165 200 200 200 200 200 225 225 225 225 225 225 225 225 225 225 225 225 225 225 225 225 225
31 - - - - - - - - - - - - - - - - 60 60 60 60 115 115 115 115 115 160 160 160 160 160 200 200 200 200 200 220 220 220 220 220 220 220 220 220 220 220 220 220 220 220 220 220
32 - - - - - - - - - - - - - - - - 45 45 45 105 105 105 105 105 150 150 150 150 150 195 195 195 195 195 215 215 215 215 215 215 215 215 215 215 215 215 215 215 215 215 215
33 - - - - - - - - - - - - - - - - 30 30 95 95 95 95 95 145 145 145 145 145 190 190 190 190 190 215 215 215 215 215 215 215 215 215 215 215 215 215 215 215 215 215
34 - - - - - - - - - - - - - - - - 15 85 85 85 85 85 135 135 135 135 135 185 185 185 185 185 210 210 210 210 210 210 210 210 210 210 210 210 210 210 210 210 210
35 - - - - - - - - - - - - - - - - - - - - 70 70 70 70 70 130 130 130 130 130 175 175 175 175 175 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205
36 - - - - - - - - - - - - - - - - - - - - - 60 60 60 60 120 120 120 120 120 170 170 170 170 170 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205
37 - - - - - - - - - - - - - - - - - - - - - 45 45 45 110 110 110 110 110 165 165 165 165 165 200 200 200 200 200 200 200 200 200 200 200 200 200 200 200 200 200
38 - - - - - - - - - - - - - - - - - - - - - 30 30 100 100 100 100 100 155 155 155 155 155 195 195 195 195 195 195 195 195 195 195 195 195 195 195 195 195 195
39 - - - - - - - - - - - - - - - - - - - - - 15 90 90 90 90 90 150 150 150 150 150 190 190 190 190 190 190 190 190 190 190 190 190 190 190 190 190 190
40 - - - - - - - - - - - - - - - - - - - - - - - - - - 75 75 75 75 75 140 140 140 140 140 185 185 185 185 185 185 185 185 185 185 185 185 185 185 185 185 185
41 - - - - - - - - - - - - - - - - - - - - - - - - - - 65 65 65 65 130 130 130 130 130 180 180 180 180 180 180 180 180 180 180 180 180 180 180 180 180 180
42 - - - - - - - - - - - - - - - - - - - - - - - - - - 50 50 50 120 120 120 120 120 170 170 170 170 170 170 170 170 170 170 170 170 170 170 170 170 170
43 - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 110 110 110 110 110 165 165 165 165 165 165 165 165 165 165 165 165 165 165 165 165 165
44 - - - - - - - - - - - - - - - - - - - - - - - - - - 20 100 100 100 100 100 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160 160
45 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 85 85 85 85 85 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150
46 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 75 75 75 75 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140 140
47 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 60 60 60 130 130 130 130 130 130 130 130 130 130 130 130 130 130 130 130 130
48 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 40 120 120 120 120 120 120 120 120 120 120 120 120 120 120 120 120 120
49 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110
50 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95
51 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80
52 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 65 65 65 70 70 70 70 70 70 70 70 70 70 70 70
53 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 50 50 50 50 50 60 60 60 60 60 60 60
54 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 35 35 35 35 35 45 45 45 45 45 45 45
55 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 30 30 30 30 40 40 40 40 40 40 40
56 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 25 25 25 35 35 35 35 35 35 35
57 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 20 30 30 30 30 30 30 30
58 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 15 20 20 20 20 20 20 20
59 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 15 15 15 15 15 15 15
60 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 15 15 15 15 15 15
61 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 10 10 10 10 10
62 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 10 10 10 10
63 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5 5 5
64 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5 5
65 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 5
66 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5
67 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6.1 60 – Age at entry option: Age 18-20
Policy Year \
Benefit Term 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
1 - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - - - - - - - - - -
6 - - - - - - - - - - - - - - - - - - - - - - -
7 - - - - - - - - - - - - - - - - - - - - - - -
8 - - - - - - - - - - - - - - - - - - - - - - -
9 - - - - - - - - - - - - - - - - - - - - - - -
10 - - - - - - - - - - - - - - - - - - - - - - -
11 - - - - - - - - - - - - - - - - - - - - - - -
12 - - - - - - - - - - - - - - - - - - - - - - -
13 - - - - - - - - - - - - - - - - - - - - - - -
14 - - - - - - - - - - - - - - - - - - - - - - -
15 - - - - - - - - - - - - - - - - - - - - - - -
16 - - - - - - - - - - - - - - - - - - - - - - -
17 - - - - - - - - - - - - - - - - - - - - - - -
18 - 5 5 5 5 5 5 5 5 5 5 - - - - - - - - - - - -
19 10 15 15 15 15 15 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
20 15 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
21 20 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25
22 25 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35
23 30 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40
24 35 45 45 45 45 45 45 45 45 45 45 45 45 45 45 45 50 50 50 50 50 50 50
25 35 50 50 50 50 50 50 50 50 50 50 55 55 55 55 55 55 55 55 55 55 55 55
26 40 50 50 50 50 50 55 55 55 55 55 60 60 60 60 60 65 65 65 65 65 65 65
27 45 55 55 55 55 55 60 60 60 60 60 65 65 65 65 65 70 70 70 70 70 70 70
28 45 60 60 60 60 60 65 65 65 65 65 70 70 70 70 70 75 75 75 75 75 75 75
29 45 60 60 60 60 60 70 70 70 70 70 75 75 75 75 75 85 85 85 85 85 85 85
30 50 65 65 65 65 65 75 75 75 75 75 80 80 80 80 80 90 90 90 90 90 90 90
31 50 65 65 65 65 65 75 75 75 75 75 85 85 85 85 85 95 95 95 95 95 95 95
32 50 70 70 70 70 70 80 80 80 80 80 90 90 90 90 90 100 100 100 100 100 100 100
33 50 70 70 70 70 70 80 80 80 80 80 95 95 95 95 95 105 105 105 105 105 105 105
34 45 70 70 70 70 70 85 85 85 85 85 100 100 100 100 100 110 110 110 110 110 110 110
35 45 70 70 70 70 70 90 90 90 90 90 105 105 105 105 105 120 120 120 120 120 120 120
36 45 70 70 70 70 70 90 90 90 90 90 105 105 105 105 105 125 125 125 125 125 125 125
37 45 70 70 70 70 70 95 95 95 95 95 110 110 110 110 110 130 130 130 130 130 130 130
38 40 75 75 75 75 75 95 95 95 95 95 115 115 115 115 115 135 135 135 135 135 135 135
39 40 75 75 75 75 75 100 100 100 100 100 120 120 120 120 120 145 145 145 145 145 145 145
40 35 75 75 75 75 75 100 100 100 100 100 125 125 125 125 125 150 150 150 150 150 150 150
41 30 70 70 70 70 70 95 95 95 95 95 120 120 120 120 120 150 150 150 150 150 150 150
42 25 60 60 60 60 60 90 90 90 90 90 120 120 120 120 120 145 145 145 145 145 145 145
43 15 55 55 55 55 55 90 90 90 90 90 115 115 115 115 115 145 145 145 145 145 145 145
44 10 50 50 50 50 50 85 85 85 85 85 115 115 115 115 115 140 140 140 140 140 140 140
45 - 45 45 45 45 45 80 80 80 80 80 110 110 110 110 110 140 140 140 140 140 140 140
46 - 35 35 35 35 75 75 75 75 75 105 105 105 105 105 135 135 135 135 135 135 135
47 - 30 30 30 65 65 65 65 65 100 100 100 100 100 135 135 135 135 135 135 135
48 - 20 20 60 60 60 60 60 95 95 95 95 95 130 130 130 130 130 130 130
49 - 10 55 55 55 55 55 90 90 90 90 90 125 125 125 125 125 125 125
50 - - - - - - 45 45 45 45 45 85 85 85 85 85 125 125 125 125 125 125 125
51 - - - - - - 40 40 40 40 80 80 80 80 80 120 120 120 120 120 120 120
52 - - - - - - 30 30 30 75 75 75 75 75 115 115 115 115 115 115 115
53 - - - - - - 20 20 70 70 70 70 70 110 110 110 110 110 110 110
54 - - - - - - 10 60 60 60 60 60 105 105 105 105 105 105 105
55 - - - - - - - - - 55 55 55 55 55 100 100 100 100 100 100 100
56 - - - - - - - - - - - 45 45 45 45 95 95 95 95 95 95 95
57 - - - - - - - - - - - 35 35 35 90 90 90 90 90 90 90
58 - - - - - - - - - - - 25 25 80 80 80 80 80 80 80
59 - - - - - - - - - - - 15 70 70 70 70 70 70 70
60 - - - - - - - - - - - - - - - 65 65 65 65 65 65 65
61 - - - - - - - - - - - - - - - - 55 55 55 55 55 55
62 - - - - - - - - - - - - - - - - 40 40 40 40 40
63 - - - - - - - - - - - - - - - - 30 30 30 30
64 - - - - - - - - - - - - - - - - 15 15 15
65 - - - - - - - - - - - - - - - - - - 15 15
66 - - - - - - - - - - - - - - - - - - - - - - 15
67 - - - - - - - - - - - - - - - - - - - - - - -
6.2 60 – Age at entry option: Age 21-25
Policy Year \
Benefit Term 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64
1 - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - - - - - - - - - - - -
6 - - - - - - - - - - - - - - - - - - - - - - - - -
7 - - - - - - - - - - - - - - - - - - - - - - - - -
8 - - - - - - - - - - - - - - - - - - - - - - - - -
9 - - - - - - - - - - - - - - - - - - - - - - - - -
10 - - - - - - - - - - - - - - - - - - - - - - - - -
11 - - - - - - - - - - - - - - - - - - - - - - - - -
12 - - - - - - - - - - - - - - - - - - - - - - - - -
13 - - - - - - - - - - - - - - - - - - - - - - - - -
14 - - - - - - - - - - - - - - - - - - - - - - - - -
15 - 5 5 5 5 5 - - - - - - - - - - - - - - - - - - -
16 10 15 15 15 15 15 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 15 25 25 25 25 25 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
18 25 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30
19 30 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 45 45 45 45 45 45 45 45 45
20 35 45 45 45 45 45 50 50 50 50 50 50 50 50 50 50 55 55 55 55 55 55 55 55 55
21 40 55 55 55 55 55 55 55 55 55 55 60 60 60 60 60 65 65 65 65 65 65 65 65 65
22 45 60 60 60 60 60 65 65 65 65 65 65 65 65 65 65 70 70 70 70 70 70 70 70 70
23 45 65 65 65 65 65 70 70 70 70 70 75 75 75 75 75 80 80 80 80 80 80 80 80 80
24 50 70 70 70 70 70 75 75 75 75 75 85 85 85 85 85 90 90 90 90 90 90 90 90 90
25 50 75 75 75 75 75 80 80 80 80 80 90 90 90 90 90 100 100 100 100 100 100 100 100 100
26 50 75 75 75 75 75 85 85 85 85 85 95 95 95 95 95 105 105 105 105 105 105 105 105 105
27 55 80 80 80 80 80 90 90 90 90 90 105 105 105 105 105 115 115 115 115 115 115 115 115 115
28 55 80 80 80 80 80 95 95 95 95 95 110 110 110 110 110 125 125 125 125 125 125 125 125 125
29 55 85 85 85 85 85 100 100 100 100 100 115 115 115 115 115 130 130 130 130 130 130 130 130 130
30 55 85 85 85 85 85 105 105 105 105 105 120 120 120 120 120 140 140 140 140 140 140 140 140 140
31 50 90 90 90 90 90 110 110 110 110 110 130 130 130 130 130 145 145 145 145 145 145 145 145 145
32 50 90 90 90 90 90 115 115 115 115 115 135 135 135 135 135 155 155 155 155 155 155 155 155 155
33 50 90 90 90 90 90 115 115 115 115 115 140 140 140 140 140 165 165 165 165 165 165 165 165 165
34 45 90 90 90 90 90 120 120 120 120 120 145 145 145 145 145 170 170 170 170 170 170 170 170 170
35 45 90 90 90 90 90 125 125 125 125 125 155 155 155 155 155 180 180 180 180 180 180 180 180 180
36 35 85 85 85 85 85 120 120 120 120 120 150 150 150 150 150 180 180 180 180 180 180 180 180 180
37 30 80 80 80 80 80 115 115 115 115 115 145 145 145 145 145 175 175 175 175 175 175 175 175 175
38 20 70 70 70 70 70 110 110 110 110 110 140 140 140 140 140 175 175 175 175 175 175 175 175 175
39 10 65 65 65 65 65 105 105 105 105 105 140 140 140 140 140 170 170 170 170 170 170 170 170 170
40 - 55 55 55 55 55 95 95 95 95 95 135 135 135 135 135 170 170 170 170 170 170 170 170 170
41 - 45 45 45 45 90 90 90 90 90 130 130 130 130 130 165 165 165 165 165 165 165 165 165
42 - 35 35 35 85 85 85 85 85 125 125 125 125 125 160 160 160 160 160 160 160 160 160
43 - 25 25 75 75 75 75 75 120 120 120 120 120 160 160 160 160 160 160 160 160 160
44 - 15 65 65 65 65 65 115 115 115 115 115 155 155 155 155 155 155 155 155 155
45 - - - - 55 55 55 55 55 105 105 105 105 105 150 150 150 150 150 150 150 150 150
46 - - - - - - 50 50 50 50 100 100 100 100 100 145 145 145 145 145 145 145 145 145
47 - - - - - - 35 35 35 90 90 90 90 90 140 140 140 140 140 140 140 140 140
48 - - - - - - 25 25 85 85 85 85 85 135 135 135 135 135 135 135 135 135
49 - - - - - - 15 75 75 75 75 75 130 130 130 130 130 130 130 130 130
50 - - - - - - - - - 65 65 65 65 65 120 120 120 120 120 120 120 120 120
51 - - - - - - - - - - 55 55 55 55 115 115 115 115 115 115 115 115 115
52 - - - - - - - - - - 45 45 45 105 105 105 105 105 105 105 105 105
53 - - - - - - - - - - 30 30 100 100 100 100 100 100 100 100 100
54 - - - - - - - - - - 15 90 90 90 90 90 90 90 90 90
55 - - - - - - - - - - - - - - 75 75 75 75 75 75 75 75 75
56 - - - - - - - - - - - - - - - - 65 65 65 65 65 65 65 65
57 - - - - - - - - - - - - - - - - 50 50 50 50 50 50 50
58 - - - - - - - - - - - - - - - - 35 35 35 35 35 35
59 - - - - - - - - - - - - - - - - 20 20 20 20 20
60 - - - - - - - - - - - - - - - - - - - - 20 20 20 20
61 - - - - - - - - - - - - - - - - - - - - - - 20 20 20
62 - - - - - - - - - - - - - - - - - - - - - - - 20 20
63 - - - - - - - - - - - - - - - - - - - - - - - - 20
64 - - - - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - - - - -
6.3 60 – Age at entry option: Age 26-30
Policy Year \
Benefit Term 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
1 - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - - - - - - - - - - - -
6 - - - - - - - - - - - - - - - - - - - - - - - - -
7 - - - - - - - - - - - - - - - - - - - - - - - - -
8 - - - - - - - - - - - - - - - - - - - - - - - - -
9 - - - - - - - - - - - - - - - - - - - - - - - - -
10 - - - - - - - - - - - - - - - - - - - - - - - - -
11 - - - - - - - - - - - - - - - - - - - - - - - - -
12 - - - - - - - - - - - - - - - - - - - - - - - - -
13 - 10 10 10 10 10 10 10 10 10 10 5 5 5 5 5 5 5 5 5 5 5 5 5 5
14 5 25 25 25 25 25 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
15 15 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35
16 25 45 45 45 45 45 45 45 45 45 45 50 50 50 50 50 50 50 50 50 50 50 50 50 50
17 35 55 55 55 55 55 55 55 55 55 55 60 60 60 60 60 65 65 65 65 65 65 65 65 65
18 40 60 60 60 60 60 65 65 65 65 65 70 70 70 70 70 75 75 75 75 75 75 75 75 75
19 45 70 70 70 70 70 75 75 75 75 75 80 80 80 80 80 90 90 90 90 90 90 90 90 90
20 50 75 75 75 75 75 85 85 85 85 85 90 90 90 90 90 100 100 100 100 100 100 100 100 100
21 55 80 80 80 80 80 90 90 90 90 90 100 100 100 100 100 110 110 110 110 110 110 110 110 110
22 55 85 85 85 85 85 100 100 100 100 100 110 110 110 110 110 125 125 125 125 125 125 125 125 125
23 60 90 90 90 90 90 105 105 105 105 105 120 120 120 120 120 135 135 135 135 135 135 135 135 135
24 60 95 95 95 95 95 115 115 115 115 115 130 130 130 130 130 145 145 145 145 145 145 145 145 145
25 60 100 100 100 100 100 120 120 120 120 120 140 140 140 140 140 155 155 155 155 155 155 155 155 155
26 60 100 100 100 100 100 125 125 125 125 125 145 145 145 145 145 165 165 165 165 165 165 165 165 165
27 60 105 105 105 105 105 130 130 130 130 130 155 155 155 155 155 180 180 180 180 180 180 180 180 180
28 60 105 105 105 105 105 135 135 135 135 135 165 165 165 165 165 190 190 190 190 190 190 190 190 190
29 55 110 110 110 110 110 145 145 145 145 145 170 170 170 170 170 200 200 200 200 200 200 200 200 200
30 55 110 110 110 110 110 150 150 150 150 150 180 180 180 180 180 215 215 215 215 215 215 215 215 215
31 45 105 105 105 105 105 145 145 145 145 145 175 175 175 175 175 210 210 210 210 210 210 210 210 210
32 35 95 95 95 95 95 135 135 135 135 135 175 175 175 175 175 205 205 205 205 205 205 205 205 205
33 25 85 85 85 85 85 130 130 130 130 130 170 170 170 170 170 205 205 205 205 205 205 205 205 205
34 10 75 75 75 75 75 125 125 125 125 125 165 165 165 165 165 200 200 200 200 200 200 200 200 200
35 - 65 65 65 65 65 115 115 115 115 115 160 160 160 160 160 195 195 195 195 195 195 195 195 195
36 - 55 55 55 55 110 110 110 110 110 155 155 155 155 155 195 195 195 195 195 195 195 195 195
37 - 45 45 45 100 100 100 100 100 145 145 145 145 145 190 190 190 190 190 190 190 190 190
38 - 30 30 90 90 90 90 90 140 140 140 140 140 185 185 185 185 185 185 185 185 185
39 - 15 80 80 80 80 80 135 135 135 135 135 180 180 180 180 180 180 180 180 180
40 - - - - 70 70 70 70 70 125 125 125 125 125 175 175 175 175 175 175 175 175 175
41 - - - - - - 55 55 55 55 120 120 120 120 120 170 170 170 170 170 170 170 170 170
42 - - - - - - 45 45 45 110 110 110 110 110 165 165 165 165 165 165 165 165 165
43 - - - - - - 30 30 100 100 100 100 100 160 160 160 160 160 160 160 160 160
44 - - - - - - 15 90 90 90 90 90 150 150 150 150 150 150 150 150 150
45 - - - - - - - - - 80 80 80 80 80 145 145 145 145 145 145 145 145 145
46 - - - - - - - - - - 65 65 65 65 135 135 135 135 135 135 135 135 135
47 - - - - - - - - - - 50 50 50 125 125 125 125 125 125 125 125 125
48 - - - - - - - - - - 35 35 115 115 115 115 115 115 115 115 115
49 - - - - - - - - - - 20 105 105 105 105 105 105 105 105 105
50 - - - - - - - - - - - - - 90 90 90 90 90 90 90 90 90
51 - - - - - - - - - - - - - - - 75 75 75 75 75 75 75 75
52 - - - - - - - - - - - - - - - - 60 60 60 60 60 60 60
53 - - - - - - - - - - - - - - - - 40 40 40 40 40 40
54 - - - - - - - - - - - - - - - - 20 20 20 20 20
55 - - - - - - - - - - - - - - - - - - - - 20 20 20 20
56 - - - - - - - - - - - - - - - - - - - - - 20 20 20
57 - - - - - - - - - - - - - - - - - - - - - - - 20 20
58 - - - - - - - - - - - - - - - - - - - - - - - - 20
59 - - - - - - - - - - - - - - - - - - - - - - - - -
60 - - - - - - - - - - - - - - - - - - - - - - - - -
61 - - - - - - - - - - - - - - - - - - - - - - - - -
62 - - - - - - - - - - - - - - - - - - - - - - - - -
63 - - - - - - - - - - - - - - - - - - - - - - - - -
64 - - - - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - - - - -
6.4 60 – Age at entry option: Age 31-35
Policy Year \
Benefit Term 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
1 - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - - - - - - - - - - - -
6 - - - - - - - - - - - - - - - - - - - - - - - - -
7 - - - - - - - - - - - - - - - - - - - - - - - - -
8 - - - - - - - - - - - - - - - - - - - - - - - - -
9 - - - - - - - - - - - - - - - - - - - - - - - - -
10 - 5 5 5 5 5 - - - - - - - - - - - - - - - - - - -
11 - 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
12 5 30 30 30 30 30 35 35 35 35 35 35 35 35 35 35 40 40 40 40 40 40 40 40 40
13 15 45 45 45 45 45 50 50 50 50 50 50 50 50 50 50 55 55 55 55 55 55 55 55 55
14 25 55 55 55 55 55 60 60 60 60 60 65 65 65 65 65 70 70 70 70 70 70 70 70 70
15 35 65 65 65 65 65 75 75 75 75 75 80 80 80 80 80 90 90 90 90 90 90 90 90 90
16 45 75 75 75 75 75 85 85 85 85 85 95 95 95 95 95 105 105 105 105 105 105 105 105 105
17 50 85 85 85 85 85 100 100 100 100 100 110 110 110 110 110 120 120 120 120 120 120 120 120 120
18 55 95 95 95 95 95 110 110 110 110 110 120 120 120 120 120 135 135 135 135 135 135 135 135 135
19 60 100 100 100 100 100 120 120 120 120 120 135 135 135 135 135 150 150 150 150 150 150 150 150 150
20 65 105 105 105 105 105 125 125 125 125 125 145 145 145 145 145 165 165 165 165 165 165 165 165 165
21 65 110 110 110 110 110 135 135 135 135 135 160 160 160 160 160 180 180 180 180 180 180 180 180 180
22 70 115 115 115 115 115 145 145 145 145 145 170 170 170 170 170 195 195 195 195 195 195 195 195 195
23 70 120 120 120 120 120 155 155 155 155 155 180 180 180 180 180 210 210 210 210 210 210 210 210 210
24 70 125 125 125 125 125 165 165 165 165 165 195 195 195 195 195 225 225 225 225 225 225 225 225 225
25 65 130 130 130 130 130 170 170 170 170 170 205 205 205 205 205 240 240 240 240 240 240 240 240 240
26 55 120 120 120 120 120 165 165 165 165 165 200 200 200 200 200 235 235 235 235 235 235 235 235 235
27 45 110 110 110 110 110 160 160 160 160 160 195 195 195 195 195 235 235 235 235 235 235 235 235 235
28 30 100 100 100 100 100 150 150 150 150 150 190 190 190 190 190 230 230 230 230 230 230 230 230 230
29 15 90 90 90 90 90 140 140 140 140 140 185 185 185 185 185 225 225 225 225 225 225 225 225 225
30 - 75 75 75 75 75 135 135 135 135 135 180 180 180 180 180 220 220 220 220 220 220 220 220 220
31 - 65 65 65 65 125 125 125 125 125 175 175 175 175 175 220 220 220 220 220 220 220 220 220
32 - 50 50 50 115 115 115 115 115 165 165 165 165 165 215 215 215 215 215 215 215 215 215
33 - 35 35 105 105 105 105 105 160 160 160 160 160 210 210 210 210 210 210 210 210 210
34 - 20 90 90 90 90 90 150 150 150 150 150 205 205 205 205 205 205 205 205 205
35 - - - - - 80 80 80 80 80 145 145 145 145 145 200 200 200 200 200 200 200 200 200
36 - - - - - - 65 65 65 65 135 135 135 135 135 190 190 190 190 190 190 190 190 190
37 - - - - - - 50 50 50 125 125 125 125 125 185 185 185 185 185 185 185 185 185
38 - - - - - - 35 35 115 115 115 115 115 180 180 180 180 180 180 180 180 180
39 - - - - - - 20 100 100 100 100 100 170 170 170 170 170 170 170 170 170
40 - - - - - - - - - - 90 90 90 90 90 160 160 160 160 160 160 160 160 160
41 - - - - - - - - - - - 75 75 75 75 155 155 155 155 155 155 155 155 155
42 - - - - - - - - - - - 60 60 60 140 140 140 140 140 140 140 140 140
43 - - - - - - - - - - - 40 40 130 130 130 130 130 130 130 130 130
44 - - - - - - - - - - - 20 115 115 115 115 115 115 115 115 115
45 - - - - - - - - - - - - - - - 105 105 105 105 105 105 105 105 105
46 - - - - - - - - - - - - - - - - 85 85 85 85 85 85 85 85
47 - - - - - - - - - - - - - - - - 70 70 70 70 70 70 70
48 - - - - - - - - - - - - - - - - 50 50 50 50 50 50
49 - - - - - - - - - - - - - - - - 25 25 25 25 25
50 - - - - - - - - - - - - - - - - - - - - 25 25 25 25
51 - - - - - - - - - - - - - - - - - - - - - 25 25 25
52 - - - - - - - - - - - - - - - - - - - - - - - 25 25
53 - - - - - - - - - - - - - - - - - - - - - - - - 25
54 - - - - - - - - - - - - - - - - - - - - - - - - -
55 - - - - - - - - - - - - - - - - - - - - - - - - -
56 - - - - - - - - - - - - - - - - - - - - - - - - -
57 - - - - - - - - - - - - - - - - - - - - - - - - -
58 - - - - - - - - - - - - - - - - - - - - - - - - -
59 - - - - - - - - - - - - - - - - - - - - - - - - -
60 - - - - - - - - - - - - - - - - - - - - - - - - -
61 - - - - - - - - - - - - - - - - - - - - - - - - -
62 - - - - - - - - - - - - - - - - - - - - - - - - -
63 - - - - - - - - - - - - - - - - - - - - - - - - -
64 - - - - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - - - - -
6.5 60 – Age at entry option: Age 36-40
Policy Year \
Benefit Term 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
1 - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - - - - - - - - - - - -
6 - - - - - - - - - - - - - - - - - - - - - - - - -
7 - - - - - - - - - - - - - - - - - - - - - - - - -
8 - 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 10 10 10 10 10 10 10 10 10
9 - 25 25 25 25 25 25 25 25 25 25 30 30 30 30 30 30 30 30 30 30 30 30 30 30
10 - 40 40 40 40 40 45 45 45 45 45 50 50 50 50 50 55 55 55 55 55 55 55 55 55
11 10 55 55 55 55 55 60 60 60 60 60 70 70 70 70 70 75 75 75 75 75 75 75 75 75
12 20 70 70 70 70 70 80 80 80 80 80 90 90 90 90 90 100 100 100 100 100 100 100 100 100
13 35 80 80 80 80 80 95 95 95 95 95 105 105 105 105 105 120 120 120 120 120 120 120 120 120
14 45 90 90 90 90 90 110 110 110 110 110 125 125 125 125 125 140 140 140 140 140 140 140 140 140
15 50 100 100 100 100 100 125 125 125 125 125 140 140 140 140 140 160 160 160 160 160 160 160 160 160
16 60 110 110 110 110 110 135 135 135 135 135 160 160 160 160 160 180 180 180 180 180 180 180 180 180
17 65 120 120 120 120 120 150 150 150 150 150 175 175 175 175 175 195 195 195 195 195 195 195 195 195
18 70 130 130 130 130 130 165 165 165 165 165 190 190 190 190 190 215 215 215 215 215 215 215 215 215
19 75 140 140 140 140 140 175 175 175 175 175 205 205 205 205 205 235 235 235 235 235 235 235 235 235
20 80 145 145 145 145 145 190 190 190 190 190 225 225 225 225 225 255 255 255 255 255 255 255 255 255
21 65 135 135 135 135 135 180 180 180 180 180 220 220 220 220 220 255 255 255 255 255 255 255 255 255
22 55 125 125 125 125 125 175 175 175 175 175 215 215 215 215 215 250 250 250 250 250 250 250 250 250
23 40 115 115 115 115 115 165 165 165 165 165 210 210 210 210 210 245 245 245 245 245 245 245 245 245
24 20 100 100 100 100 100 155 155 155 155 155 200 200 200 200 200 240 240 240 240 240 240 240 240 240
25 - 85 85 85 85 85 145 145 145 145 145 195 195 195 195 195 240 240 240 240 240 240 240 240 240
26 - 70 70 70 70 135 135 135 135 135 190 190 190 190 190 235 235 235 235 235 235 235 235 235
27 - 55 55 55 125 125 125 125 125 180 180 180 180 180 230 230 230 230 230 230 230 230 230
28 - 40 40 115 115 115 115 115 175 175 175 175 175 225 225 225 225 225 225 225 225 225
29 - 20 100 100 100 100 100 165 165 165 165 165 220 220 220 220 220 220 220 220 220
30 - - - - 85 85 85 85 85 155 155 155 155 155 210 210 210 210 210 210 210 210 210
31 - - - - - - 70 70 70 70 145 145 145 145 145 205 205 205 205 205 205 205 205 205
32 - - - - - - 55 55 55 135 135 135 135 135 200 200 200 200 200 200 200 200 200
33 - - - - - - 40 40 125 125 125 125 125 190 190 190 190 190 190 190 190 190
34 - - - - - - 20 110 110 110 110 110 180 180 180 180 180 180 180 180 180
35 - - - - - - - - - 95 95 95 95 95 175 175 175 175 175 175 175 175 175
36 - - - - - - - - - - - 80 80 80 80 165 165 165 165 165 165 165 165 165
37 - - - - - - - - - - - 65 65 65 150 150 150 150 150 150 150 150 150
38 - - - - - - - - - - - 45 45 140 140 140 140 140 140 140 140 140
39 - - - - - - - - - - - 25 125 125 125 125 125 125 125 125 125
40 - - - - - - - - - - - - - - 110 110 110 110 110 110 110 110 110
41 - - - - - - - - - - - - - - - 95 95 95 95 95 95 95 95
42 - - - - - - - - - - - - - - - - 75 75 75 75 75 75 75
43 - - - - - - - - - - - - - - - - 50 50 50 50 50 50
44 - - - - - - - - - - - - - - - - 25 25 25 25 25
45 - - - - - - - - - - - - - - - - - - 25 25 25 25
46 - - - - - - - - - - - - - - - - - - - - - - 25 25 25
47 - - - - - - - - - - - - - - - - - - - - - - - 25 25
48 - - - - - - - - - - - - - - - - - - - - - - - - 25
49 - - - - - - - - - - - - - - - - - - - - - - - - -
50 - - - - - - - - - - - - - - - - - - - - - - - - -
51 - - - - - - - - - - - - - - - - - - - - - - - - -
52 - - - - - - - - - - - - - - - - - - - - - - - - -
53 - - - - - - - - - - - - - - - - - - - - - - - - -
54 - - - - - - - - - - - - - - - - - - - - - - - - -
55 - - - - - - - - - - - - - - - - - - - - - - - - -
56 - - - - - - - - - - - - - - - - - - - - - - - - -
57 - - - - - - - - - - - - - - - - - - - - - - - - -
58 - - - - - - - - - - - - - - - - - - - - - - - - -
59 - - - - - - - - - - - - - - - - - - - - - - - - -
60 - - - - - - - - - - - - - - - - - - - - - - - - -
61 - - - - - - - - - - - - - - - - - - - - - - - - -
62 - - - - - - - - - - - - - - - - - - - - - - - - -
63 - - - - - - - - - - - - - - - - - - - - - - - - -
64 - - - - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - - - - -
6.6 60 – Age at entry option: Age 41-45
Policy Year \
Benefit Term 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44
1 - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - - - - - - - - - - - - - - - - - - - -
6 - 5 5 5 5 5 5 5 5 5 5 10 10 10 10 10 15 15 15 15 15 15 15 15 15
7 - 25 25 25 25 25 30 30 30 30 30 35 35 35 35 35 45 45 45 45 45 45 45 45 45
8 - 45 45 45 45 45 55 55 55 55 55 65 65 65 65 65 70 70 70 70 70 70 70 70 70
9 - 65 65 65 65 65 75 75 75 75 75 90 90 90 90 90 100 100 100 100 100 100 100 100 100
10 15 80 80 80 80 80 100 100 100 100 100 110 110 110 110 110 125 125 125 125 125 125 125 125 125
11 30 95 95 95 95 95 120 120 120 120 120 135 135 135 135 135 150 150 150 150 150 150 150 150 150
12 40 110 110 110 110 110 135 135 135 135 135 160 160 160 160 160 175 175 175 175 175 175 175 175 175
13 55 125 125 125 125 125 155 155 155 155 155 180 180 180 180 180 205 205 205 205 205 205 205 205 205
14 65 140 140 140 140 140 175 175 175 175 175 205 205 205 205 205 230 230 230 230 230 230 230 230 230
15 75 155 155 155 155 155 195 195 195 195 195 225 225 225 225 225 255 255 255 255 255 255 255 255 255
16 65 145 145 145 145 145 185 185 185 185 185 220 220 220 220 220 250 250 250 250 250 250 250 250 250
17 50 130 130 130 130 130 180 180 180 180 180 215 215 215 215 215 250 250 250 250 250 250 250 250 250
18 35 120 120 120 120 120 170 170 170 170 170 210 210 210 210 210 245 245 245 245 245 245 245 245 245
19 20 105 105 105 105 105 160 160 160 160 160 205 205 205 205 205 240 240 240 240 240 240 240 240 240
20 - 90 90 90 90 90 150 150 150 150 150 195 195 195 195 195 235 235 235 235 235 235 235 235 235
21 - 75 75 75 75 140 140 140 140 140 190 190 190 190 190 230 230 230 230 230 230 230 230 230
22 - 60 60 60 130 130 130 130 130 185 185 185 185 185 225 225 225 225 225 225 225 225 225
23 - 40 40 115 115 115 115 115 175 175 175 175 175 220 220 220 220 220 220 220 220 220
24 - 20 105 105 105 105 105 165 165 165 165 165 215 215 215 215 215 215 215 215 215
25 - - - - - 90 90 90 90 90 155 155 155 155 155 210 210 210 210 210 210 210 210 210
26 - - - - - 75 75 75 75 145 145 145 145 145 205 205 205 205 205 205 205 205 205
27 - - - - - 60 60 60 135 135 135 135 135 195 195 195 195 195 195 195 195 195
28 - - - - - 40 40 125 125 125 125 125 190 190 190 190 190 190 190 190 190
29 - - - - - - 20 110 110 110 110 110 180 180 180 180 180 180 180 180 180
30 - - - - - - - - - - 100 100 100 100 100 170 170 170 170 170 170 170 170 170
31 - - - - - - - - - - - 85 85 85 85 165 165 165 165 165 165 165 165 165
32 - - - - - - - - - - - 65 65 65 150 150 150 150 150 150 150 150 150
33 - - - - - - - - - - - 45 45 140 140 140 140 140 140 140 140 140
34 - - - - - - - - - - - 25 125 125 125 125 125 125 125 125 125
35 - - - - - - - - - - - - - - - 110 110 110 110 110 110 110 110 110
36 - - - - - - - - - - - - - - - - 90 90 90 90 90 90 90 90
37 - - - - - - - - - - - - - - - - 75 75 75 75 75 75 75
38 - - - - - - - - - - - - - - - - 50 50 50 50 50 50
39 - - - - - - - - - - - - - - - - 25 25 25 25 25
40 - - - - - - - - - - - - - - - - - - - - - 25 25 25 25
41 - - - - - - - - - - - - - - - - - - - - - - 25 25 25
42 - - - - - - - - - - - - - - - - - - - - - - - 25 25
43 - - - - - - - - - - - - - - - - - - - - - - - - 25
44 - - - - - - - - - - - - - - - - - - - - - - - - -
45 - - - - - - - - - - - - - - - - - - - - - - - - -
46 - - - - - - - - - - - - - - - - - - - - - - - - -
47 - - - - - - - - - - - - - - - - - - - - - - - - -
48 - - - - - - - - - - - - - - - - - - - - - - - - -
49 - - - - - - - - - - - - - - - - - - - - - - - - -
50 - - - - - - - - - - - - - - - - - - - - - - - - -
51 - - - - - - - - - - - - - - - - - - - - - - - - -
52 - - - - - - - - - - - - - - - - - - - - - - - - -
53 - - - - - - - - - - - - - - - - - - - - - - - - -
54 - - - - - - - - - - - - - - - - - - - - - - - - -
55 - - - - - - - - - - - - - - - - - - - - - - - - -
56 - - - - - - - - - - - - - - - - - - - - - - - - -
57 - - - - - - - - - - - - - - - - - - - - - - - - -
58 - - - - - - - - - - - - - - - - - - - - - - - - -
59 - - - - - - - - - - - - - - - - - - - - - - - - -
60 - - - - - - - - - - - - - - - - - - - - - - - - -
61 - - - - - - - - - - - - - - - - - - - - - - - - -
62 - - - - - - - - - - - - - - - - - - - - - - - - -
63 - - - - - - - - - - - - - - - - - - - - - - - - -
64 - - - - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - - - - -
6.7 60 – Age at entry option: Age 46-50
Policy Year \
Benefit Term 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
1 - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - - - - - - - - - - - - - - - - - - - - - -
5 - - - - - - 5 5 5 5 5 20 20 20 20 20 25 25 25 25 25 30 30 30 30
6 - 15 15 15 15 15 40 40 40 40 40 50 50 50 50 50 60 60 60 60 60 65 65 65 65
7 10 45 45 45 45 45 70 70 70 70 70 85 85 85 85 85 95 95 95 95 95 100 100 100 100
8 30 70 70 70 70 70 95 95 95 95 95 115 115 115 115 115 125 125 125 125 125 135 135 135 135
9 50 95 95 95 95 95 125 125 125 125 125 145 145 145 145 145 160 160 160 160 160 170 170 170 170
10 70 115 115 115 115 115 155 155 155 155 155 180 180 180 180 180 195 195 195 195 195 205 205 205 205
11 60 105 105 105 105 105 150 150 150 150 150 175 175 175 175 175 195 195 195 195 195 205 205 205 205
12 45 100 100 100 100 100 145 145 145 145 145 175 175 175 175 175 190 190 190 190 190 200 200 200 200
13 35 90 90 90 90 90 140 140 140 140 140 170 170 170 170 170 185 185 185 185 185 200 200 200 200
14 15 80 80 80 80 80 130 130 130 130 130 165 165 165 165 165 185 185 185 185 185 200 200 200 200
15 - 70 70 70 70 70 125 125 125 125 125 160 160 160 160 160 180 180 180 180 180 195 195 195 195
16 - 60 60 60 60 115 115 115 115 115 155 155 155 155 155 175 175 175 175 175 195 195 195 195
17 - 45 45 45 110 110 110 110 110 150 150 150 150 150 175 175 175 175 175 190 190 190 190
18 - 35 35 100 100 100 100 100 140 140 140 140 140 170 170 170 170 170 185 185 185 185
19 - 15 90 90 90 90 90 135 135 135 135 135 165 165 165 165 165 185 185 185 185
20 - - - - - - 75 75 75 75 75 125 125 125 125 125 160 160 160 160 160 180 180 180 180
21 - - - - - - 65 65 65 65 120 120 120 120 120 155 155 155 155 155 175 175 175 175
22 - - - - - - 50 50 50 110 110 110 110 110 145 145 145 145 145 170 170 170 170
23 - - - - - - 35 35 100 100 100 100 100 140 140 140 140 140 165 165 165 165
24 - - - - - - 20 90 90 90 90 90 130 130 130 130 130 160 160 160 160
25 - - - - - - - - - 75 75 75 75 75 125 125 125 125 125 155 155 155 155
26 - - - - - - - - - - 60 60 60 60 115 115 115 115 115 150 150 150 150
27 - - - - - - - - - - - 50 50 50 105 105 105 105 105 145 145 145 145
28 - - - - - - - - - - - 35 35 95 95 95 95 95 135 135 135 135
29 - - - - - - - - - - - 15 85 85 85 85 85 130 130 130 130
30 - - - - - - - - - - - - - - 75 75 75 75 75 120 120 120 120
31 - - - - - - - - - - - - - - - - 60 60 60 60 115 115 115 115
32 - - - - - - - - - - - - - - - - 45 45 45 105 105 105 105
33 - - - - - - - - - - - - - - - - 30 30 95 95 95 95
34 - - - - - - - - - - - - - - - - 15 85 85 85 85
35 - - - - - - - - - - - - - - - - - - - - 70 70 70 70
36 - - - - - - - - - - - - - - - - - - - - - 60 60 60
37 - - - - - - - - - - - - - - - - - - - - - 45 45
38 - - - - - - - - - - - - - - - - - - - - - 30
39 - - - - - - - - - - - - - - - - - - - - -
40 - - - - - - - - - - - - - - - - - - - - - - - - -
41 - - - - - - - - - - - - - - - - - - - - - - - - -
42 - - - - - - - - - - - - - - - - - - - - - - - - -
43 - - - - - - - - - - - - - - - - - - - - - - - - -
44 - - - - - - - - - - - - - - - - - - - - - - - - -
45 - - - - - - - - - - - - - - - - - - - - - - - - -
46 - - - - - - - - - - - - - - - - - - - - - - - - -
47 - - - - - - - - - - - - - - - - - - - - - - - - -
48 - - - - - - - - - - - - - - - - - - - - - - - - -
49 - - - - - - - - - - - - - - - - - - - - - - - - -
50 - - - - - - - - - - - - - - - - - - - - - - - - -
51 - - - - - - - - - - - - - - - - - - - - - - - - -
52 - - - - - - - - - - - - - - - - - - - - - - - - -
53 - - - - - - - - - - - - - - - - - - - - - - - - -
54 - - - - - - - - - - - - - - - - - - - - - - - - -
55 - - - - - - - - - - - - - - - - - - - - - - - - -
56 - - - - - - - - - - - - - - - - - - - - - - - - -
57 - - - - - - - - - - - - - - - - - - - - - - - - -
58 - - - - - - - - - - - - - - - - - - - - - - - - -
59 - - - - - - - - - - - - - - - - - - - - - - - - -
60 - - - - - - - - - - - - - - - - - - - - - - - - -
61 - - - - - - - - - - - - - - - - - - - - - - - - -
62 - - - - - - - - - - - - - - - - - - - - - - - - -
63 - - - - - - - - - - - - - - - - - - - - - - - - -
64 - - - - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - - - - -
6.8 60 – Age at entry option: Age 51-53
Policy Year \
Benefit Term 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
1 - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - -
3 - - - - - - - - - - - - - - - - - - - - - - -
4 - - - - 5 5 5 5 5 20 20 20 20 20 25 25 25 25 25 30 30 30 30
5 20 20 20 20 40 40 40 40 40 55 55 55 55 55 65 65 65 65 65 70 70 70 70
6 50 50 50 50 70 70 70 70 70 90 90 90 90 90 105 105 105 105 105 110 110 110 110
7 80 80 80 80 105 105 105 105 105 125 125 125 125 125 140 140 140 140 140 150 150 150 150
8 70 70 70 70 100 100 100 100 100 120 120 120 120 120 140 140 140 140 140 150 150 150 150
9 65 65 65 65 95 95 95 95 95 120 120 120 120 120 135 135 135 135 135 145 145 145 145
10 55 55 55 55 90 90 90 90 90 115 115 115 115 115 135 135 135 135 135 145 145 145 145
11 45 45 45 45 85 85 85 85 85 110 110 110 110 110 130 130 130 130 130 145 145 145 145
12 35 35 35 75 75 75 75 75 105 105 105 105 105 130 130 130 130 130 140 140 140 140
13 25 25 70 70 70 70 70 100 100 100 100 100 125 125 125 125 125 140 140 140 140
14 15 65 65 65 65 65 100 100 100 100 100 120 120 120 120 120 135 135 135 135
15 - - - - 55 55 55 55 55 90 90 90 90 90 120 120 120 120 120 135 135 135 135
16 - - - - 45 45 45 45 85 85 85 85 85 115 115 115 115 115 130 130 130 130
17 - - - - 35 35 35 80 80 80 80 80 110 110 110 110 110 130 130 130 130
18 - - - - 25 25 75 75 75 75 75 105 105 105 105 105 125 125 125 125
19 - - - - 15 65 65 65 65 65 100 100 100 100 100 120 120 120 120
20 - - - - - - - - - 55 55 55 55 55 95 95 95 95 95 120 120 120 120
21 - - - - - - - - - 45 45 45 45 85 85 85 85 85 115 115 115 115
22 - - - - - - - - - 35 35 35 80 80 80 80 80 110 110 110 110
23 - - - - - - - - - 25 25 75 75 75 75 75 105 105 105 105
24 - - - - - - - - - 15 65 65 65 65 65 100 100 100 100
25 - - - - - - - - - - - - - - 55 55 55 55 55 90 90 90 90
26 - - - - - - - - - - - - - - 45 45 45 45 85 85 85 85
27 - - - - - - - - - - - - - - 35 35 35 80 80 80 80
28 - - - - - - - - - - - - - - 25 25 70 70 70 70
29 - - - - - - - - - - - - - - 15 65 65 65 65
30 - - - - - - - - - - - - - - - - - - 55 55 55 55
31 - - - - - - - - - - - - - - - - - - - 45 45 45
32 - - - - - - - - - - - - - - - - - - - 35 35
33 - - - - - - - - - - - - - - - - - - - 25
34 - - - - - - - - - - - - - - - - - - -
35 - - - - - - - - - - - - - - - - - - - - - - -
36 - - - - - - - - - - - - - - - - - - - - - - -
37 - - - - - - - - - - - - - - - - - - - - - - -
38 - - - - - - - - - - - - - - - - - - - - - - -
39 - - - - - - - - - - - - - - - - - - - - - - -
40 - - - - - - - - - - - - - - - - - - - - - - -
41 - - - - - - - - - - - - - - - - - - - - - - -
42 - - - - - - - - - - - - - - - - - - - - - - -
43 - - - - - - - - - - - - - - - - - - - - - - -
44 - - - - - - - - - - - - - - - - - - - - - - -
45 - - - - - - - - - - - - - - - - - - - - - - -
46 - - - - - - - - - - - - - - - - - - - - - - -
47 - - - - - - - - - - - - - - - - - - - - - - -
48 - - - - - - - - - - - - - - - - - - - - - - -
49 - - - - - - - - - - - - - - - - - - - - - - -
50 - - - - - - - - - - - - - - - - - - - - - - -
51 - - - - - - - - - - - - - - - - - - - - - - -
52 - - - - - - - - - - - - - - - - - - - - - - -
53 - - - - - - - - - - - - - - - - - - - - - - -
54 - - - - - - - - - - - - - - - - - - - - - - -
55 - - - - - - - - - - - - - - - - - - - - - - -
56 - - - - - - - - - - - - - - - - - - - - - - -
57 - - - - - - - - - - - - - - - - - - - - - - -
58 - - - - - - - - - - - - - - - - - - - - - - -
59 - - - - - - - - - - - - - - - - - - - - - - -
60 - - - - - - - - - - - - - - - - - - - - - - -
61 - - - - - - - - - - - - - - - - - - - - - - -
62 - - - - - - - - - - - - - - - - - - - - - - -
63 - - - - - - - - - - - - - - - - - - - - - - -
64 - - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - - -
6.9 60 – Age at entry option: Age 54-55
Policy Year \
Benefit Term 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - 5
3 - 10 10 10 10 10 25 25 25 25 25 35 35 35 35 35 45 45 45 45 45 50
4 15 50 50 50 50 50 65 65 65 65 65 80 80 80 80 80 90 90 90 90 90 95
5 50 85 85 85 85 85 105 105 105 105 105 120 120 120 120 120 130 130 130 130 130 140
6 40 80 80 80 80 80 100 100 100 100 100 115 115 115 115 115 130 130 130 130 130 140
7 35 70 70 70 70 70 95 95 95 95 95 115 115 115 115 115 125 125 125 125 125 135
8 25 65 65 65 65 65 90 90 90 90 90 110 110 110 110 110 125 125 125 125 125 135
9 10 60 60 60 60 60 90 90 90 90 90 110 110 110 110 110 120 120 120 120 120 135
10 - 50 50 50 50 50 85 85 85 85 85 105 105 105 105 105 120 120 120 120 120 135
11 - 40 40 40 40 75 75 75 75 75 100 100 100 100 100 120 120 120 120 120 130
12 - 30 30 30 70 70 70 70 70 100 100 100 100 100 115 115 115 115 115 130
13 - 25 25 65 65 65 65 65 95 95 95 95 95 110 110 110 110 110 130
14 - 10 60 60 60 60 60 90 90 90 90 90 110 110 110 110 110 125
15 - - - - - - 50 50 50 50 50 85 85 85 85 85 105 105 105 105 105 125
16 - - - - - - 40 40 40 40 80 80 80 80 80 105 105 105 105 105 120
17 - - - - - - 35 35 35 75 75 75 75 75 100 100 100 100 100 120
18 - - - - - - 25 25 65 65 65 65 65 95 95 95 95 95 115
19 - - - - - - 10 60 60 60 60 60 90 90 90 90 90 110
20 - - - - - - - - - - - 50 50 50 50 50 85 85 85 85 85 110
21 - - - - - - - - - - - 45 45 45 45 80 80 80 80 80 105
22 - - - - - - - - - - - 35 35 35 70 70 70 70 70 100
23 - - - - - - - - - - - 25 25 65 65 65 65 65 95
24 - - - - - - - - - - - 10 60 60 60 60 60 90
25 - - - - - - - - - - - - - - - - 50 50 50 50 50 85
26 - - - - - - - - - - - - - - - - 40 40 40 40 80
27 - - - - - - - - - - - - - - - - 30 30 30 70
28 - - - - - - - - - - - - - - - - 20 20 65
29 - - - - - - - - - - - - - - - - 10 55
30 - - - - - - - - - - - - - - - - - - - - - 50
31 - - - - - - - - - - - - - - - - - - - - -
32 - - - - - - - - - - - - - - - - - - - - -
33 - - - - - - - - - - - - - - - - - - - - -
34 - - - - - - - - - - - - - - - - - - - - -
35 - - - - - - - - - - - - - - - - - - - - - -
36 - - - - - - - - - - - - - - - - - - - - - -
37 - - - - - - - - - - - - - - - - - - - - - -
38 - - - - - - - - - - - - - - - - - - - - - -
39 - - - - - - - - - - - - - - - - - - - - - -
40 - - - - - - - - - - - - - - - - - - - - - -
41 - - - - - - - - - - - - - - - - - - - - - -
42 - - - - - - - - - - - - - - - - - - - - - -
43 - - - - - - - - - - - - - - - - - - - - - -
44 - - - - - - - - - - - - - - - - - - - - - -
45 - - - - - - - - - - - - - - - - - - - - - -
46 - - - - - - - - - - - - - - - - - - - - - -
47 - - - - - - - - - - - - - - - - - - - - - -
48 - - - - - - - - - - - - - - - - - - - - - -
49 - - - - - - - - - - - - - - - - - - - - - -
50 - - - - - - - - - - - - - - - - - - - - - -
51 - - - - - - - - - - - - - - - - - - - - - -
52 - - - - - - - - - - - - - - - - - - - - - -
53 - - - - - - - - - - - - - - - - - - - - - -
54 - - - - - - - - - - - - - - - - - - - - - -
55 - - - - - - - - - - - - - - - - - - - - - -
56 - - - - - - - - - - - - - - - - - - - - - -
57 - - - - - - - - - - - - - - - - - - - - - -
58 - - - - - - - - - - - - - - - - - - - - - -
59 - - - - - - - - - - - - - - - - - - - - - -
60 - - - - - - - - - - - - - - - - - - - - - -
61 - - - - - - - - - - - - - - - - - - - - - -
62 - - - - - - - - - - - - - - - - - - - - - -
63 - - - - - - - - - - - - - - - - - - - - - -
64 - - - - - - - - - - - - - - - - - - - - - -
65 - - - - - - - - - - - - - - - - - - - - - -
66 - - - - - - - - - - - - - - - - - - - - - -
67 - - - - - - - - - - - - - - - - - - - - - -
7. Whole Life (60 - age at entry)
Policy Year\
44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81
Benefit Term
1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 15 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 60 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 110 40 40 40 40 40 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 155 80 80 80 80 80 10 10 10 10 10 - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 155 120 120 120 120 120 40 40 40 40 40 - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 155 160 160 160 160 160 75 75 75 75 75 - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 155 200 200 200 200 200 110 110 110 110 110 30 30 30 30 30 - - - - - - - - - - - - - - - - - - - - - -
9 155 240 240 240 240 240 140 140 140 140 140 60 60 60 60 60 - - - - - - - - - - - - - - - - - - - - - -
10 150 280 280 280 280 280 175 175 175 175 175 85 85 85 85 85 15 15 15 15 15 - - - - - - - - - - - - - - - - -
11 150 275 275 275 275 275 205 205 205 205 205 110 110 110 110 110 35 35 35 35 35 - - - - - - - - - - - - - - - - -
12 150 275 275 275 275 275 235 235 235 235 235 135 135 135 135 135 60 60 60 60 60 - - - - - - - - - - - - - - - - -
13 150 275 275 275 275 275 270 270 270 270 270 165 165 165 165 165 80 80 80 80 80 15 15 15 15 15 - - - - - - - - - - - -
14 150 275 275 275 275 275 305 305 305 305 305 190 190 190 190 190 100 100 100 100 100 35 35 35 35 35 - - - - - - - - - - - -
15 150 275 275 275 275 275 335 335 335 335 335 215 215 215 215 215 120 120 120 120 120 50 50 50 50 50 - - - - - - - - - - - -
16 145 270 270 270 270 270 335 335 335 335 335 240 240 240 240 240 140 140 140 140 140 70 70 70 70 70 15 15 15 15 15 - - - - - - -
17 145 270 270 270 270 270 335 335 335 335 335 265 265 265 265 265 160 160 160 160 160 85 85 85 85 85 30 30 30 30 30 - - - - - - -
18 145 270 270 270 270 270 335 335 335 335 335 295 295 295 295 295 180 180 180 180 180 100 100 100 100 100 45 45 45 45 45 5 5 5 5 5 5 5
19 145 270 270 270 270 270 330 330 330 330 330 320 320 320 320 320 205 205 205 205 205 115 115 115 115 115 55 55 55 55 55 15 15 15 15 15 15 15
20 140 265 265 265 265 265 330 330 330 330 330 350 350 350 350 350 225 225 225 225 225 135 135 135 135 135 70 70 70 70 70 25 25 25 25 25 25 25
21 140 265 265 265 265 265 330 330 330 330 330 350 350 350 350 350 245 245 245 245 245 150 150 150 150 150 80 80 80 80 80 35 35 35 35 35 35 35
22 140 265 265 265 265 265 325 325 325 325 325 345 345 345 345 345 265 265 265 265 265 165 165 165 165 165 95 95 95 95 95 45 45 45 45 45 45 45
23 135 260 260 260 260 260 325 325 325 325 325 345 345 345 345 345 290 290 290 290 290 180 180 180 180 180 105 105 105 105 105 55 55 55 55 55 55 55
24 135 260 260 260 260 260 325 325 325 325 325 345 345 345 345 345 310 310 310 310 310 195 195 195 195 195 115 115 115 115 115 65 65 65 65 65 65 65
25 135 255 255 255 255 255 320 320 320 320 320 345 345 345 345 345 335 335 335 335 335 215 215 215 215 215 130 130 130 130 130 70 70 70 70 70 70 70
26 130 255 255 255 255 255 320 320 320 320 320 340 340 340 340 340 335 335 335 335 335 230 230 230 230 230 140 140 140 140 140 80 80 80 80 80 80 80
27 130 250 250 250 250 250 320 320 320 320 320 340 340 340 340 340 330 330 330 330 330 245 245 245 245 245 155 155 155 155 155 90 90 90 90 90 90 90
28 125 250 250 250 250 250 315 315 315 315 315 340 340 340 340 340 330 330 330 330 330 265 265 265 265 265 165 165 165 165 165 100 100 100 100 100 100 100
29 120 245 245 245 245 245 315 315 315 315 315 335 335 335 335 335 330 330 330 330 330 285 285 285 285 285 180 180 180 180 180 110 110 110 110 110 110 110
30 120 240 240 240 240 240 310 310 310 310 310 335 335 335 335 335 330 330 330 330 330 305 305 305 305 305 190 190 190 190 190 115 115 115 115 115 115 115
31 115 235 235 235 235 235 310 310 310 310 310 335 335 335 335 335 325 325 325 325 325 300 300 300 300 300 205 205 205 205 205 125 125 125 125 125 125 125
32 110 230 230 230 230 230 305 305 305 305 305 330 330 330 330 330 325 325 325 325 325 300 300 300 300 300 220 220 220 220 220 135 135 135 135 135 135 135
33 105 225 225 225 225 225 300 300 300 300 300 330 330 330 330 330 325 325 325 325 325 300 300 300 300 300 235 235 235 235 235 145 145 145 145 145 145 145
34 100 220 220 220 220 220 295 295 295 295 295 325 325 325 325 325 320 320 320 320 320 300 300 300 300 300 250 250 250 250 250 155 155 155 155 155 155 155
35 90 215 215 215 215 215 290 290 290 290 290 325 325 325 325 325 320 320 320 320 320 295 295 295 295 295 265 265 265 265 265 165 165 165 165 165 165 165
36 85 205 205 205 205 205 285 285 285 285 285 320 320 320 320 320 320 320 320 320 320 295 295 295 295 295 265 265 265 265 265 175 175 175 175 175 175 175
37 75 195 195 195 195 195 280 280 280 280 280 315 315 315 315 315 315 315 315 315 315 295 295 295 295 295 260 260 260 260 260 185 185 185 185 185 185 185
38 70 190 190 190 190 190 275 275 275 275 275 310 310 310 310 310 315 315 315 315 315 295 295 295 295 295 260 260 260 260 260 200 200 200 200 200 200 200
39 60 175 175 175 175 175 265 265 265 265 265 310 310 310 310 310 310 310 310 310 310 290 290 290 290 290 260 260 260 260 260 210 210 210 210 210 210 210
40 50 165 165 165 165 165 260 260 260 260 260 305 305 305 305 305 310 310 310 310 310 290 290 290 290 290 260 260 260 260 260 220 220 220 220 220 220 220
41 40 155 155 155 155 155 250 250 250 250 250 295 295 295 295 295 305 305 305 305 305 290 290 290 290 290 260 260 260 260 260 220 220 220 220 220 220 220
42 25 140 140 140 140 140 240 240 240 240 240 290 290 290 290 290 300 300 300 300 300 285 285 285 285 285 255 255 255 255 255 220 220 220 220 220 220 220
43 15 125 125 125 125 125 225 225 225 225 225 285 285 285 285 285 300 300 300 300 300 285 285 285 285 285 255 255 255 255 255 220 220 220 220 220 220 220
44 - 110 110 110 110 110 215 215 215 215 215 275 275 275 275 275 295 295 295 295 295 280 280 280 280 280 255 255 255 255 255 220 220 220 220 220 220 220
45 - 90 90 90 90 200 200 200 200 200 270 270 270 270 270 290 290 290 290 290 280 280 280 280 280 250 250 250 250 250 220 220 220 220 220 220 220
46 - 70 70 70 185 185 185 185 185 260 260 260 260 260 285 285 285 285 285 275 275 275 275 275 250 250 250 250 250 215 215 215 215 215 215 215
47 - 50 50 170 170 170 170 170 250 250 250 250 250 280 280 280 280 280 275 275 275 275 275 250 250 250 250 250 215 215 215 215 215 215 215
48 - 25 150 150 150 150 150 235 235 235 235 235 270 270 270 270 270 270 270 270 270 270 245 245 245 245 245 215 215 215 215 215 215 215
49 - - - - 130 130 130 130 130 225 225 225 225 225 265 265 265 265 265 265 265 265 265 265 245 245 245 245 245 215 215 215 215 215 215 215
50 - - - - - 110 110 110 110 210 210 210 210 210 255 255 255 255 255 260 260 260 260 260 245 245 245 245 245 210 210 210 210 210 210 210
51 - - - - - 85 85 85 195 195 195 195 195 245 245 245 245 245 255 255 255 255 255 240 240 240 240 240 210 210 210 210 210 210 210
52 - - - - - - 60 60 175 175 175 175 175 235 235 235 235 235 250 250 250 250 250 240 240 240 240 240 210 210 210 210 210 210 210
53 - - - - - - 30 155 155 155 155 155 225 225 225 225 225 245 245 245 245 245 235 235 235 235 235 210 210 210 210 210 210 210
54 - - - - - - - - - 135 135 135 135 135 215 215 215 215 215 240 240 240 240 240 230 230 230 230 230 205 205 205 205 205 205 205
55 - - - - - - - - - - 115 115 115 115 200 200 200 200 200 230 230 230 230 230 225 225 225 225 225 205 205 205 205 205 205 205
56 - - - - - - - - - - - 90 90 90 185 185 185 185 185 225 225 225 225 225 225 225 225 225 225 200 200 200 200 200 200 200
57 - - - - - - - - - - - 60 60 170 170 170 170 170 215 215 215 215 215 220 220 220 220 220 200 200 200 200 200 200 200
58 - - - - - - - - - - - 30 150 150 150 150 150 205 205 205 205 205 215 215 215 215 215 195 195 195 195 195 195 195
59 - - - - - - - - - - - - - - 130 130 130 130 130 195 195 195 195 195 205 205 205 205 205 195 195 195 195 195 195 195
60 - - - - - - - - - - - - - - - 110 110 110 110 180 180 180 180 180 200 200 200 200 200 190 190 190 190 190 190 190
61 - - - - - - - - - - - - - - - - 85 85 85 165 165 165 165 165 195 195 195 195 195 185 185 185 185 185 185 185
62 - - - - - - - - - - - - - - - - 60 60 150 150 150 150 150 185 185 185 185 185 185 185 185 185 185 185 185
63 - - - - - - - - - - - - - - - - 30 135 135 135 135 135 175 175 175 175 175 180 180 180 180 180 180 180
64 - - - - - - - - - - - - - - - - - - - 115 115 115 115 115 165 165 165 165 165 175 175 175 175 175 175 175
65 - - - - - - - - - - - - - - - - - - - - - 95 95 95 95 155 155 155 155 155 170 170 170 170 170 170 170
66 - - - - - - - - - - - - - - - - - - - - - 75 75 75 145 145 145 145 145 160 160 160 160 160 160 160
67 - - - - - - - - - - - - - - - - - - - - - 50 50 130 130 130 130 130 155 155 155 155 155 155 155
68 - - - - - - - - - - - - - - - - - - - - - 25 115 115 115 115 115 150 150 150 150 150 150 150
69 - - - - - - - - - - - - - - - - - - - - - - - 100 100 100 100 100 140 140 140 140 140 140 140
70 - - - - - - - - - - - - - - - - - - - - - - - - - 85 85 85 85 130 130 130 130 130 130 130
71 - - - - - - - - - - - - - - - - - - - - - - - - - 65 65 65 120 120 120 120 120 120 120
72 - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 110 110 110 110 110 110 110
73 - - - - - - - - - - - - - - - - - - - - - - - - - - 25 100 100 100 100 100 100 100
74 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 85 85 85 85 85 85 85
75 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 70 70 70 70 70 70
76 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 55 55 55 55 55
77 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 40 40 40
78 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 20
79 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20
80 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20
81 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8. Whole Life 10 pay option:
Policy
Year\ 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81
Benefit
Term
1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 20 15 15 15 15 15 5 5 5 5 5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 60 55 55 55 55 55 45 45 45 45 45 40 40 40 40 40 35 35 35 35 35 25 25 25 25 25 15 15 15 15 15 10 10 10 10 10 - - - - - - - - - - - -
5 95 95 95 95 95 95 85 85 85 85 85 80 80 80 80 80 75 75 75 75 75 65 65 65 65 65 60 60 60 60 60 50 50 50 50 50 40 40 40 40 40 30 30 30 30 30 30 30
6 135 130 130 130 130 130 125 125 125 125 125 120 120 120 120 120 115 115 115 115 115 110 110 110 110 110 100 100 100 100 100 90 90 90 90 90 80 80 80 80 80 70 70 70 70 70 70 70
7 170 170 170 170 170 170 165 165 165 165 165 160 160 160 160 160 155 155 155 155 155 150 150 150 150 150 140 140 140 140 140 130 130 130 130 130 115 115 115 115 115 105 105 105 105 105 105 105
8 210 210 210 210 210 210 205 205 205 205 205 200 200 200 200 200 195 195 195 195 195 190 190 190 190 190 180 180 180 180 180 165 165 165 165 165 155 155 155 155 155 145 145 145 145 145 145 145
9 245 245 245 245 245 245 245 245 245 245 245 240 240 240 240 240 235 235 235 235 235 225 225 225 225 225 220 220 220 220 220 205 205 205 205 205 195 195 195 195 195 180 180 180 180 180 180 180
10 280 285 285 285 285 285 280 280 280 280 280 280 280 280 280 280 275 275 275 275 275 265 265 265 265 265 260 260 260 260 260 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
11 280 280 280 280 280 280 280 280 280 280 280 275 275 275 275 275 275 275 275 275 275 265 265 265 265 265 260 260 260 260 260 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
12 275 280 280 280 280 280 280 280 280 280 280 275 275 275 275 275 270 270 270 270 270 265 265 265 265 265 260 260 260 260 260 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
13 270 280 280 280 280 280 280 280 280 280 280 275 275 275 275 275 270 270 270 270 270 265 265 265 265 265 260 260 260 260 260 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
14 265 275 275 275 275 275 275 275 275 275 275 275 275 275 275 275 270 270 270 270 270 265 265 265 265 265 255 255 255 255 255 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
15 265 275 275 275 275 275 275 275 275 275 275 275 275 275 275 275 270 270 270 270 270 265 265 265 265 265 255 255 255 255 255 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
16 260 270 270 270 270 270 275 275 275 275 275 270 270 270 270 270 270 270 270 270 270 265 265 265 265 265 255 255 255 255 255 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
17 255 265 265 265 265 265 270 270 270 270 270 270 270 270 270 270 270 270 270 270 270 265 265 265 265 265 255 255 255 255 255 245 245 245 245 245 235 235 235 235 235 220 220 220 220 220 220 220
18 245 265 265 265 265 265 270 270 270 270 270 270 270 270 270 270 265 265 265 265 265 265 265 265 265 265 255 255 255 255 255 245 245 245 245 245 230 230 230 230 230 220 220 220 220 220 220 220
19 240 260 260 260 260 260 265 265 265 265 265 270 270 270 270 270 265 265 265 265 265 265 265 265 265 265 255 255 255 255 255 245 245 245 245 245 230 230 230 230 230 220 220 220 220 220 220 220
20 230 255 255 255 255 255 265 265 265 265 265 265 265 265 265 265 265 265 265 265 265 260 260 260 260 260 255 255 255 255 255 245 245 245 245 245 230 230 230 230 230 220 220 220 220 220 220 220
21 225 250 250 250 250 250 260 260 260 260 260 265 265 265 265 265 265 265 265 265 265 260 260 260 260 260 255 255 255 255 255 245 245 245 245 245 230 230 230 230 230 220 220 220 220 220 220 220
22 215 245 245 245 245 245 260 260 260 260 260 265 265 265 265 265 265 265 265 265 265 260 260 260 260 260 255 255 255 255 255 245 245 245 245 245 230 230 230 230 230 220 220 220 220 220 220 220
23 205 240 240 240 240 240 255 255 255 255 255 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 255 255 255 255 255 245 245 245 245 245 230 230 230 230 230 220 220 220 220 220 220 220
24 195 235 235 235 235 235 250 250 250 250 250 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 255 255 255 255 255 245 245 245 245 245 230 230 230 230 230 220 220 220 220 220 220 220
25 180 225 225 225 225 225 250 250 250 250 250 255 255 255 255 255 260 260 260 260 260 260 260 260 260 260 250 250 250 250 250 240 240 240 240 240 230 230 230 230 230 220 220 220 220 220 220 220
26 170 220 220 220 220 220 245 245 245 245 245 255 255 255 255 255 255 255 255 255 255 255 255 255 255 255 250 250 250 250 250 240 240 240 240 240 230 230 230 230 230 220 220 220 220 220 220 220
27 155 210 210 210 210 210 240 240 240 240 240 250 250 250 250 250 255 255 255 255 255 255 255 255 255 255 250 250 250 250 250 240 240 240 240 240 230 230 230 230 230 220 220 220 220 220 220 220
28 135 200 200 200 200 200 235 235 235 235 235 250 250 250 250 250 255 255 255 255 255 255 255 255 255 255 250 250 250 250 250 240 240 240 240 240 230 230 230 230 230 220 220 220 220 220 220 220
29 120 190 190 190 190 190 225 225 225 225 225 245 245 245 245 245 250 250 250 250 250 255 255 255 255 255 250 250 250 250 250 240 240 240 240 240 230 230 230 230 230 215 215 215 215 215 215 215
30 100 175 175 175 175 175 220 220 220 220 220 240 240 240 240 240 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 240 240 240 240 240 230 230 230 230 230 215 215 215 215 215 215 215
31 75 165 165 165 165 165 210 210 210 210 210 235 235 235 235 235 245 245 245 245 245 250 250 250 250 250 245 245 245 245 245 240 240 240 240 240 230 230 230 230 230 215 215 215 215 215 215 215
32 55 150 150 150 150 150 205 205 205 205 205 230 230 230 230 230 245 245 245 245 245 250 250 250 250 250 245 245 245 245 245 240 240 240 240 240 230 230 230 230 230 215 215 215 215 215 215 215
33 25 135 135 135 135 135 195 195 195 195 195 225 225 225 225 225 240 240 240 240 240 245 245 245 245 245 245 245 245 245 245 235 235 235 235 235 225 225 225 225 225 215 215 215 215 215 215 215
34 - 115 115 115 115 115 185 185 185 185 185 220 220 220 220 220 240 240 240 240 240 245 245 245 245 245 245 245 245 245 245 235 235 235 235 235 225 225 225 225 225 215 215 215 215 215 215 215
35 - 95 95 95 95 170 170 170 170 170 215 215 215 215 215 235 235 235 235 235 240 240 240 240 240 240 240 240 240 240 235 235 235 235 235 225 225 225 225 225 215 215 215 215 215 215 215
36 - 75 75 75 160 160 160 160 160 205 205 205 205 205 230 230 230 230 230 240 240 240 240 240 240 240 240 240 240 235 235 235 235 235 225 225 225 225 225 215 215 215 215 215 215 215
37 - 50 50 145 145 145 145 145 195 195 195 195 195 225 225 225 225 225 235 235 235 235 235 240 240 240 240 240 235 235 235 235 235 225 225 225 225 225 215 215 215 215 215 215 215
38 - 25 130 130 130 130 130 190 190 190 190 190 220 220 220 220 220 235 235 235 235 235 235 235 235 235 235 230 230 230 230 230 225 225 225 225 225 215 215 215 215 215 215 215
39 - - - - - - 110 110 110 110 110 175 175 175 175 175 215 215 215 215 215 230 230 230 230 230 235 235 235 235 235 230 230 230 230 230 225 225 225 225 225 215 215 215 215 215 215 215
40 - - - - - - 95 95 95 95 165 165 165 165 165 205 205 205 205 205 225 225 225 225 225 235 235 235 235 235 230 230 230 230 230 220 220 220 220 220 215 215 215 215 215 215 215
41 - - - - - - 70 70 70 155 155 155 155 155 200 200 200 200 200 225 225 225 225 225 230 230 230 230 230 230 230 230 230 230 220 220 220 220 220 210 210 210 210 210 210 210
42 - - - - - - 50 50 140 140 140 140 140 190 190 190 190 190 220 220 220 220 220 230 230 230 230 230 225 225 225 225 225 220 220 220 220 220 210 210 210 210 210 210 210
43 - - - - - - 25 125 125 125 125 125 180 180 180 180 180 215 215 215 215 215 225 225 225 225 225 225 225 225 225 225 220 220 220 220 220 210 210 210 210 210 210 210
44 - - - - - - - - - 110 110 110 110 110 170 170 170 170 170 205 205 205 205 205 220 220 220 220 220 225 225 225 225 225 220 220 220 220 220 210 210 210 210 210 210 210
45 - - - - - - - - - - 90 90 90 90 160 160 160 160 160 200 200 200 200 200 220 220 220 220 220 220 220 220 220 220 215 215 215 215 215 210 210 210 210 210 210 210
46 - - - - - - - - - - - 70 70 70 150 150 150 150 150 195 195 195 195 195 215 215 215 215 215 220 220 220 220 220 215 215 215 215 215 210 210 210 210 210 210 210
47 - - - - - - - - - - - 50 50 135 135 135 135 135 185 185 185 185 185 210 210 210 210 210 215 215 215 215 215 215 215 215 215 215 205 205 205 205 205 205 205
48 - - - - - - - - - - - 25 120 120 120 120 120 175 175 175 175 175 205 205 205 205 205 215 215 215 215 215 210 210 210 210 210 205 205 205 205 205 205 205
49 - - - - - - - - - - - - - 105 105 105 105 105 165 165 165 165 165 200 200 200 200 200 210 210 210 210 210 210 210 210 210 210 205 205 205 205 205 205 205
50 - - - - - - - - - - - - - - - 85 85 85 85 155 155 155 155 155 195 195 195 195 195 205 205 205 205 205 210 210 210 210 210 205 205 205 205 205 205 205
51 - - - - - - - - - - - - - - - - 70 70 70 145 145 145 145 145 185 185 185 185 185 205 205 205 205 205 205 205 205 205 205 200 200 200 200 200 200 200
52 - - - - - - - - - - - - - - - - 45 45 130 130 130 130 130 180 180 180 180 180 200 200 200 200 200 205 205 205 205 205 200 200 200 200 200 200 200
53 - - - - - - - - - - - - - - - - 25 120 120 120 120 120 170 170 170 170 170 195 195 195 195 195 200 200 200 200 200 200 200 200 200 200 200 200
54 - - - - - - - - - - - - - - - - - - - 100 100 100 100 100 160 160 160 160 160 190 190 190 190 190 200 200 200 200 200 200 200 200 200 200 200 200
55 - - - - - - - - - - - - - - - - - - - - - 85 85 85 85 150 150 150 150 150 185 185 185 185 185 195 195 195 195 195 195 195 195 195 195 195 195
56 - - - - - - - - - - - - - - - - - - - - - 65 65 65 140 140 140 140 140 175 175 175 175 175 190 190 190 190 190 195 195 195 195 195 195 195
57 - - - - - - - - - - - - - - - - - - - - - 45 45 125 125 125 125 125 170 170 170 170 170 190 190 190 190 190 190 190 190 190 190 190 190
58 - - - - - - - - - - - - - - - - - - - - - 25 115 115 115 115 115 160 160 160 160 160 185 185 185 185 185 190 190 190 190 190 190 190
59 - - - - - - - - - - - - - - - - - - - - - - - 100 100 100 100 100 155 155 155 155 155 180 180 180 180 180 185 185 185 185 185 185 185
60 - - - - - - - - - - - - - - - - - - - - - - - - - 80 80 80 80 145 145 145 145 145 175 175 175 175 175 185 185 185 185 185 185 185
61 - - - - - - - - - - - - - - - - - - - - - - - - - - 65 65 65 130 130 130 130 130 165 165 165 165 165 180 180 180 180 180 180 180
62 - - - - - - - - - - - - - - - - - - - - - - - - - - 45 45 120 120 120 120 120 160 160 160 160 160 175 175 175 175 175 175 175
63 - - - - - - - - - - - - - - - - - - - - - - - - - - 25 105 105 105 105 105 150 150 150 150 150 170 170 170 170 170 170 170
64 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 95 95 95 95 95 145 145 145 145 145 165 165 165 165 165 165 165
65 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 75 75 75 75 135 135 135 135 135 160 160 160 160 160 160 160
66 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 60 60 60 125 125 125 125 125 155 155 155 155 155 155 155
67 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 40 115 115 115 115 115 150 150 150 150 150 150 150
68 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 100 100 100 100 100 140 140 140 140 140 140 140
69 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 85 85 85 85 85 135 135 135 135 135 135 135
70 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 70 70 70 70 125 125 125 125 125 125 125
71 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 55 55 55 115 115 115 115 115 115 115
72 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 40 105 105 105 105 105 105 105
73 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 95 95 95 95 95 95 95
74 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 80 80 80 80 80 80 80
75 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 70 70 70 70 70 70
76 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 55 55 55 55 55
77 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 35 35 35
78 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 20
79 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20
80 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20
81 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Annexure II – Section 39 – Nomination by policyholder become payable to policyholder or nominee(s) in the event of assignee or
Nomination of a life insurance Policy is as below in accordance with Section 39 of transferee dying before the insured OR ii. the insured surviving the term of the
the Insurance Laws (Amendment) Act, 2015 as amended from time to time. The policy Such conditional assignee will not be entitled to obtain a loan on policy or
extant provisions in this regard are as follows: 1. The policyholder of a life insurance surrender the policy. This provision will prevail notwithstanding any law or custom
on his own life may nominate a person or persons to whom money secured by the having force of law which is contrary to the above position. 14. In other cases, the
policy shall be paid in the event of his death. 2. Where the nominee is a minor, the insurer shall, subject to terms and conditions of assignment, recognize the
policyholder may appoint any person to receive the money secured by the policy in transferee or assignee named in the notice as the absolute transferee or assignee
the event of policyholder’s death during the minority of the nominee. The manner and such person a. shall be subject to all liabilities and equities to which the
of appointment to be laid down by the insurer. 3. Nomination can be made at any transferor or assignor was subject to at the date of transfer or assignment and b.
time before the maturity of the policy. 4. Nomination may be incorporated in the
may institute any proceedings in relation to the policy c. obtain loan under the
text of the policy itself or may be endorsed on the policy communicated to the
policy or surrender the policy without obtaining the consent of the transferor or
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 assignor or making him a party to the proceedings Disclaimer: This is a simplified
endorsement or a further endorsement or a will as the case may be. 6. A notice in version of Section 38 of the Insurance Laws (Amendment) Act, 2015 as amended
writing of Change or Cancellation of nomination must be delivered to the insurer for from time to time. The policyholders are advised to refer to The Insurance Laws
the insurer to be liable to such nominee. Otherwise, insurer will not be liable if a (Amendment) Act, 2015 as amended from time to time for complete and accurate
bonafide payment is made to the person named in the text of the policy or in the details
registered records of the insurer. 7. Fee to be paid to the insurer for registering Annexure IV – Section 45 – Policy shall not be called in question on the ground of
change or cancellation of a nomination can be specified by the Authority through mis-statement after three years
Regulations. 8. On receipt of notice with fee, the insurer should grant a written Provisions regarding policy not being called into question in terms of Section 45 of
acknowledgement to the policyholder of having registered a nomination or the Insurance Laws (Amendment) Act, 2015, as amended from time to time are as
cancellation or change there of. 9. A transfer or assignment made in accordance follows: 1. No Policy of Life Insurance shall be called in question on any ground
with Section 38 shall automatically cancel the nomination except in case of whatsoever after expiry of 3 yrs from a) the date of issuance of policy or b) the date
assignment to the insurer or other transferee or assignee for purpose of loan or of commencement of risk or c) the date of revival of policy or d) the date of rider to
against security or its reassignment after repayment. In such case, the nomination the policy whichever is later. 2. On the ground of fraud, a policy of Life Insurance
will not get cancelled to the extent of insurer’s or transferee’s or assignee’s interest may be called in question within 3 years from a) the date of issuance of policy or b)
in the policy. The nomination will get revived on repayment of the loan. 10. The the date of commencement of risk or c) the date of revival of policy or d) the date of
right of any creditor to be paid out of the proceeds of any policy of life insurance rider to the policy whichever is later. For this, the insurer should communicate in
shall not be affected by the nomination. 11. In case of nomination by policyholder writing to the insured or legal representative or nominee or assignees of insured,
whose life is insured, if the nominees die before the policyholder, the proceeds are
as applicable, mentioning the ground and materials on which such decision is
payable to policyholder or his heirs or legal representatives or holder of succession
based. 3. Fraud means any of the following acts committed by insured or by his
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 agent, with the intent to deceive the insurer or to induce the insurer to issue a life
policyholder whose life is insured nominates his a. parents or b. spouse or c. insurance policy: a) The suggestion, as a fact of that which is not true and which the
children or d. spouse and children e. or any of them the nominees are beneficially insured does not believe to be true; b) The active concealment of a fact by the
entitled to the amount payable by the insurer to the policyholder unless it is proved insured having knowledge or belief of the fact; c) Any other act fitted to deceive;
that policyholder could not have conferred such beneficial title on the nominee and d) Any such act or omission as the law specifically declares to be fraudulent. 4.
having regard to the nature of his title. 14. If nominee(s) die after the policyholder Mere silence is not fraud unless, depending on circumstances of the case, it is the
but before his share of the amount secured under the policy is paid, the share of the duty of the insured or his agent keeping silence to speak or silence is in itself
expired nominee(s) shall be payable to the heirs or legal representative of the equivalent to speak. 5. No Insurer shall repudiate a life insurance Policy on the
nominee or holder of succession certificate of such nominee(s). 15. If policyholder ground of Fraud, if the Insured / beneficiary can prove that the misstatement was
dies after maturity but the proceeds and benefit of the policy has not been paid to true to the best of his knowledge and there was no deliberate intention to suppress
him because of his death, his nominee(s) shall be entitled to the proceeds and the fact or that such mis-statement of or suppression of material fact are within the
benefit of the policy. 16. The provisions of Section 39 are not applicable to any life knowledge of the insurer. Onus of disproving is upon the policyholder, if alive, or
insurance policy to which Section 6 of Married Women’s Property Act, 1874 applies beneficiaries. 6. Life insurance Policy can be called in question within 3 years on the
or has at any time applied Where nomination is intended to be made to spouse or ground that any statement of or suppression of a fact material to expectancy of life
children or spouse and children under Section 6 of MWP Act, it should be of the insured was incorrectly made in the proposal or other document basis which
specifically mentioned on the policy. In such a case only, the provisions of Section policy was issued or revived or rider issued. For this, the insurer should
39 will not apply. Disclaimer: This is a simplified version of Section 39 of the communicate in writing to the insured or legal representative or nominee or
Insurance Laws (Amendment) Act, 2015 as amended from time to time. The
assignees of insured, as applicable, mentioning the ground and materials on which
policyholders are advised to refer to The Insurance Laws (Amendment) Act, 2015
decision to repudiate the policy of life insurance is based. 7. In case repudiation is
as amended from time to time for complete and accurate details.
on ground of mis-statement and not on fraud, the premium collected on policy till
Annexure III – Section 38 – Assignment and Transfer of Insurance Policies
the date of repudiation shall be paid to the insured or legal representative or
Assignment or transfer of a policy should be in accordance with Section 38 of the
nominee or assignees of insured, within a period of 90 days from the date of
Insurance Laws (Amendment) Act, 2015 as amended from time to time. The extant
repudiation. 8. Fact shall not be considered material unless it has a direct bearing
provisions in this regard are as follows: 1. This policy may be transferred/assigned,
on the risk undertaken by the insurer. The onus is on insurer to show that if the
wholly or in part, with or without consideration. 2. An Assignment may be effected
insurer had been aware of the said fact, no life insurance policy would have been
in a policy by an endorsement upon the policy itself or by a separate instrument
issued to the insured. 9. The insurer can call for proof of age at any time if he is
under notice to the Insurer. 3. The instrument of assignment should indicate the
entitled to do so and no policy shall be deemed to be called in question merely
fact of transfer or assignment and the reasons for the assignment or transfer,
because the terms of the policy are adjusted on subsequent proof of age of life
antecedents of the assignee and terms on which assignment is made. 4. The
insured. So, this Section will not be applicable for questioning age or adjustment
assignment must be signed by the transferor or assignor or duly authorized agent
based on proof of age submitted subsequently.
and attested by at least one witness. 5. The transfer of 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 acknowledgment 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 or b. not in the interest of the
policyholder or 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
Comm/ IP SMART AN OP-LIFE/ T&C/ 1.0

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
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
 Application Number : OP00324469

Sales details

LOB/Agent Code : 01308816 Agent/AFSM Name : POLICY BAZAAR INSURANCE WEB AGGREGATOR PVT LTD

Channel Code : W2 Bank : PBZO

Branch : 0WEB Source : WADS

IN UNIT-LINKED INSURANCE POLICIES(ULIPs), THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICY HOLDER.
IMPORTANT GUIDELINES:
1) Insurance is contract of utmost good faith between the Insurer and the Insured. The Proposer and the Life to be Assured are required to disclose all facts in response to the question in this
application form. 2) Any cancellation/alteration is to be signed by the Proposer/Life to be Assured as applicable. 3) For adding nominee(s) or assignee to the policy please refer to the
servicing forms available on the website.
I/We understand the importance of disclosing all material information and confirm that I/we shall share details which are true and correct, failing which the company reserves the right to
cancel the policy and/or repudiate any claims under the policy and initiate appropriate action.

Proposer / Life Assured Basic Details

Full Name : SAURABH KUMAR SINGH Father's Name: RAJ NARAYAN SINGH

Mother's Name: MAYA DEVI Gender : MALE

Date Of Birth : Jan 01,1988 Marital status : MARRIED

Proposer/Policy Owner Electronic Insurance Account(eiA)

Do you have an Electronic Insurance Account?: NO Insurance Repository : CENTRAL INSURANCE REPOSITORY LIMITED (CDSL GROUP)

Do you wish to convert your ICICI Prudential policies into electronic policies : NO

Proposer / Life Assured Personal Details

Relationship With The Life Assured : SELF Education : GRADUATE

Occupation : SALARIED Organization Type: PVT LTD

Name Of Organization : OTHERS - JINDAL STEEL AND POWER LTD Annual Income : INR 15,00,000
(Politically Exposed Persons (PEPs) are individuals who have been entrusted with Prominent public functions in a foreign country,
Politically Exposed : NO Example, Heads of the State or Governments, Senior Politicians, Senior Government/Judicial/Military officials, Senior Executives
of State Owned Corporations, important political party officials, etc - including the family Members and close relatives).

Contact Details

Mailing Address : HOUSE NO 505, POST OFFICEBASANTPUR, BASANTPUR, NEAR HANUMAN MANDIR, BALLIA- 277301, UTTAR PRADESH, INDIA

Email ID : KUMARSAURABH1988@GMAIL.COM Mobile Number : 8354953469

Permanent Address : HOUSE NO 505, POST OFFICEBASANTPUR, BASANTPUR, NEAR HANUMAN MANDIR, BALLIA- 277301, UTTAR PRADESH, INDIA

Nationality : INDIAN Resident Status : RESIDENT INDIAN

Previous Policy Details

Details of Life Insurance/Mediclaim/Health/Personal Accident policies of the Life to be Assured held/applied with ICICI Prudential Life Insurance Company Limited/other companies. (Have any

such proposals on your life / application for reinstatement ever been accepted with extra premium, postponement, decline, withdrawal, non completion, been offered on modified terms.) : No

Policy Number / Base Sum Assured (in

Company Name Proposal Date Policy decision
Application Number Rs)

If The Life To Be Assured Is A Student/Housewife, Please Provide Insurance Details Of Parents/Husband/Siblings : . NO

Nominee Details
 Full Name : RASHMI SINGH Gender : FEMALE

Date Of Birth : Apr 01,1988 Relationship with Life Assured/Proposer : WIFE

Proposer / Life Assured KYC Details

IT Proof : PANCARD - CJBPS7067P Source Of Funds : SALARY

Address Proof : VOTERS ID CARD Income Proof : INCOME TAX RETURN

ID Proof : PAN CARD ID Number : CJBPS7067P

Objective Of Taking This Policy : PROTECTION Age Proof : GOVERNMENT EMPLOYEE ID

Is The Premium Paid By A Person Other Than Proposer : 1

Health Details of Life Assured

Suppressing facts or giving wrong information will adversely impact payment of your claim.

Height : 6 feet 2 inches

Weight : 85(Kgs)

Do You Consume Or Have Ever Consumed Tobacco? : NO

Do You Consume Or Have Ever Consumed Alcohol? : NO

Do You Consume Or Have Ever Consumed Narcotics? : NO

Is your occupation associated with any specific hazard or do you take part in activities or have hobbies that could be dangerous in any way ? (eg - occupation - Chemical factory, mines,

explosives, radiation, corrosive chemicals j - aviation other than as a fare paying passenger, diving, mountaineering, any form of racing, etc ) : NO

Are you employed in the armed, para military or police forces ?(If yes, please provide Rank, Department/Division, Date of last medical & category after medical exam)? : NO

Family details of the life assured(include parents/sibling) Are any of your family members suffering from /have suffered from/have died of heart disease,Diabetes Mellitus, cancer or any

other hereditary/familial disorder, before 55 years of age.if yes please provide details below? : NO

Have you lost weight of 10 kgs or more in the last six months? : NO

Do you have any congenital defect/abnormality/physical deformity/handicap? : NO

Have you undergone or been advised to undergo any tests/investigations or any surgery or hospitalized for observation or treatment in the past? : NO

Did you have any ailment/injury/accident requiring treatment/medication for more than a week or have you availed leave for more than 5 days on medical grounds in the last two years? : N

Hypertension/High BP/high cholesterol : NO Chest Pain/Heart Attack/any other heart disease or problem : NO

Undergone angioplasty,bypass surgery,heart surgery : NO Diabetes/High Blood Sugar/Sugar in Urine : NO

Asthma,Tuberculosis or any other respiratory disorder : NO Nervous disorders/stroke/paralysis/epilepsy : NO

Any GastroIntestinal disorders like Pancreatitis,Colitis etc. : NO Liver disorders/Jaundice/Hepatitis B or C : NO

Genitourinary disorders related to kidney,prostate,urinary system : NO Cancer, Tumor, Growth or Cyst of any Kind : NO

HIV infection AIDS or positive test for HIV : NO Any blood disorders like Anaemeia, Thalassemia etc : NO

Psychiatric or mental disorders : NO Any other disorder not mentioned above : NO

Have you ever suffered/are suffering from or have undergone investigations or treatment for any gynecological complications such as disorders of cervix,uterus,ovaries,breast, breast

lump,cyst etc? : NO

Are you pregnant at present? : NO

Product Details

Product Name : ICICI PRULIFE IPROTECT SMART Policy Term (in yrs) : 27

Premium Payment Term(in Yrs) : 27 Guaranteed Maturity Benefit/Guaranteed Surrender Benefit/Sum Assured on Maturity (in INR)

: N.A.

Sum Assured/Modal Income (in INR) : 1,00,00,000 Lumpsum Percentage : 0

Income Percentage : 0 Modal Premium (in INR) : 989

Mode : MONTHLY

Benefit Option : Life Death Benefit Option : Lump-Sum

Premium Deposit
 Mode Of Deposit : NET BANKING Amount : 1,167

Bank : ICIB

Note 1. Cheque/DD should be drawn in favour of "ICICI Prudential Life Insurance Co. Ltd." only. Please mention application no. and name of the proposer behind the cheque/DD. 2. In the event of non-realization of first premium deposit, the policy, if issued, shall be
treated as cancelled/void from inception. 3. Incase of non-acceptance/withdrawal of this application for insurance, the company shall return the first premium deposit without any interest and after deducting the expenses incurred on the medical test/examination. 4.
Please note that a copy of PAN card of Form60/61 as applicable shall be required for premium payment in cash of Rs. 50,000/- or more. You are requested to pay cash only at the authorized collection point and not to advisor or employee. The company will not be
responsible for any loss in this regard. 5. Please submit a cash authority letter along with the cash if you are depositing the cash through a third party. 6. Payments made through credit cards can be accepted only if the card is issued in the name of the relevant
proposer/policy holder.

Payout Mode
Mode selected would be used by the company to makepayout(s) to the proposer. Payout would be in accordance and subject to the terms and conditions of the policy.

Account Type : NA Bank Name : NA

Branch : NA Account Number : NA

MICR Code : NA IFSC Code : NA

Do you wish to set the preference month for renewal premium as November: NA

Note 1. Please provide a cancelled copy of your cheque if any of the above payout option is selected. 2. In case of non credit to my bank account with or without assigning any reasons there of or if the transaction is delayed or not effected at all for reasons of
incomplete/incorrect information, I would not hold ICICI Prudential Life Insurance Co. Ltd. responsible. 3. Further, the company reserves the right to use any alternative payout option in spite of opting for Direct Credit option.

Declaration & Authorization

I/We declare that I/we have answered the questions in the proposal form and have duly signed it after understanding its contents. I/ We have fully understood the nature of the questions

including health related questions and the importance of disclosing all material information while answering such questions. I/We declare that the answers given by me/us to all the questions

in the proposal form and the information given to ICICI Prudential Life Insurance Co. Ltd. as to the state of health and habits of the life/lives to be assured are true and complete in every

respect and that I/we have not withheld any material information or suppressed any material fact. I/ We have made no statement to the Insurance Advisor, Medical Examiner or any other

person associated with the Company which in any way modifies the answer given by me/ us in this application form. I/We undertake to notify the Company of any change in the information

given by me/ us in the proposal form with respect to the Life/ Lives to be Assured subsequent to the signing of this proposal form and before the receipt of the policy document. I/We also

understand that the terms and conditions including the premium and the benefits payable under the Policy are subject to variation/ taxes/ duties/ charges in accordance to applicable laws.

I/We confirm that all premiums will be paid from bonafide sources.

I/We hereby authorize ICICI Prudential Life Insurance Co. Ltd. to assess the health status and conduct screening/confirmation/telephonic verification/reconfirmation of the life/lives to be

assured including the health status through medical examinations which may include Laboratory tests, Cardiology, Radiological investigations and other medical tests including blood tests to

detect bacterial/viral/fungal infections if required by the Company. I/We hereby give my/our consent to undergo HIV1/2 test. I/We am/are aware that this test is only for screening purpose and

not confirmatory for HIV/AIDS. I/We hereby authorize ICICI Prudential Life Insurance Co. Ltd. to send all service related communications to the contact details registered with the Company.

The Company reserves the right to accept, decline or offer alternate terms on my/our proposal for Life/Health Insurance. In order to enable the Company to assess the risk under this

proposal and any time thereafter, I/we hereby, authorize the past and present employer(s)/business associates/medical practitioner(s)/hospital and medical source/any life and non-life

insurance Company to provide the records of employment/business or other details as may be considered relevant.I/we agree and authorize the Company, for the purpose of processing of

this Proposal or servicing of the resulting policy, to verify/share my our/documents/other information provided herein on confidential basis within ICICI group and/or third party agencies. This

application form shall be a part of the life insurance policy contract, in case of its acceptance by the Company.

I/We understand that in case of fraud or misstatement by me/us, the policy shall be treated by the Company in accordance with Section 45 of the Insurance Laws (Amendment) Act, 1938 as

amended from time to time.

I hereby consent to receiving information from Central KYC registry through SMS or email on the above registered number or email address.

Date : Apr 8, 2021

Authenticated via OTP shared for OP00324469 on 04/12/2021 08:22:17

Place : UTTAR PRADESH

The Insurance Laws (Amendment) Act, 2015

Section 41 Prohibition of rebates: (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance in respect

of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person

taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: Provided that

acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of

premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent

employed by the insurer. (2) Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.

Section 45 Policy not to be called in question on ground of mis statement after three years: (1) No policy of life insurance shall be called in question on any ground whatsoever after the

expiry of three years from the date of the policy, i.e., from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to

the policy, whichever is later. (2) A policy of life insurance may be called in question at anytime within three years from the date of issuance of the policy or the date of commencement of risk

or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud: Provided that the insurer shall have to communicate in writing to the insured

or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision is based. Explanation I. For the purposes of this sub-section, the

expression 'fraud' means any of the following acts committed by the 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 specially declares to be fraudulent. Explanation II. Mere silence as to facts likely to affect the assessment of the

risk by the insurer is notfraud, unless the circumstances of the case are such that regard being had to them, it is the duty of the insured or his agent, keeping silence to speak, or unless his

silence is, in itself, equivalent to speak. (3) Notwithstanding anything contained in sub-section (2), no insurer shall repudiate a life insurance policy on the ground of fraud if the insured can

prove that the mis-statement of or suppression of a material fact was true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis

-statement of or suppression of a material fact are within the knowledge of the insurer. Provided that in case of fraud, the onus of disproving lies upon the beneficiaries, in case the

policyholder is not alive. Explanation. - A person who solicits and negotiates a contract of insurance shall be deemed for the purpose of the formation of the contract, to be the agent of the

insurer. (4) A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival

of the policy or the date of the rider to the policy, whichever is later, on the ground that any statement of or suppression of a fact material to the expectancy of the life of the insured was

incorrectly made in the proposal or other document on the basis of which the policy was issued or revived or rider issued: Provided that the insurer shall have to communicate in writing to the

insured or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision to repudiate the policy of life insurance is based: Provided

further that in case of repudiation of the policy on the ground of mis-statement or suppression of a material fact, and not on the ground of fraud, the premiums collected on the policy till the

date of repudiation shall be paid to the insured or the legal representatives or nominees or assignees of the insured within a period of ninety days from the date of such repudiation.

Explanation - For the purposes of this sub-section, the mis-statement of or suppression of fact shall not be considered material unless it has a direct bearing on the risk undertaken by the

insurer, the onus is on the insurer to show that had the insurer been aware of the said fact no life insurance policy would have been issued to the insured. (5) Nothing in this section shall

prevent the insurer from calling for proof of age at anytime 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 that the age of the life insured was incorrectly stated in the proposal."
 Benefit Illustration for iProtect Smart

Name/Buyer : Mr. SAURABH KUMAR SINGH Application Number : OP00324469

Date Of Birth(Age) : 01-Jan-1988 (33 Years) Gender : Male
Smoker/Non-Smoker : Non-Smoker
Product Features
Name of the Product(Unique : ICICI Pru iProtect Smart(105N151V06) Tag Line: : Non-Linked Non-Par Life
Identification No.) Individual pure risk
premium product
Sum Assured on Death/Terminal : Rs. 10,000,000 Policy Term : 27 years
Illness
Premium Payment Option : Regular Pay Premium Frequency : Monthly
Premium Payment Term : 27 years Benefit Option : Life
Payout option : Lump-Sum Accidental Death(AD) Benefit : 0 years
Period
Accidental Death(AD) Benefit : Rs. 0 Critical Illness(CI) Benefit : Rs. 0
Payout Term :- Accelerated Critical Illness : 0 years
(ACI) Benefit period
Sales Channel : Web Aggregator Waiver of Premium on : All future premiums
Permanent Disability(PD) due payable in the policy
to accident

Benefit Death/Terminal Accidental Death Critical Illness Total

Illness and Waiver of Benefit Benefit
Premium on PD
Tax Benefit 80C 80C 80D
Instalment Premium Rs. 989 Rs. 0 Rs. 0 Rs. 989
Applicable Taxes Rs. 179 Rs. 0 Rs. 0 Rs. 179
Total Premium Rs. 1168 Rs. 0 Rs. 0 Rs. 1168
Total installment Rs. 2336
premium payable
Total Annual Premium Rs. 11868 Rs. 0 Rs. 0 Rs. 11868
Surrender:
No surrenders are allowed in case of Regular Pay and
Limited Pay.
In case of One Pay, Surrender Value will be calculated as :
Surrender Value = Surrender Value Factor X Single
Premium

Disclaimers

1. For Smoker profiles, the premium calculated above is inclusive of an additional premium applicable for smokers.
2. The premium calculated above is based on the data provided by you.
3. The above information must be read in conjunction with the sales brochure and policy document.
4. The above illustration is applicable to a standard life from medical, life style and occupation point of view.
5. ICICI Pru iProtect Smart is only the name of the policy and does not in any way indicate the quality of the policy, its future
prospects or returns.
6. In the event of Critical Illness(CI), the Death Benefit is accelerated to the extent of Critical Illness(CI) Benefit paid. Please
refer to the policy terms & conditions for complete details.
7. Surrenders are not allowed in case of Regular Pay and Limited Pay policies
8. The Policyholder shall be required to pay Applicable Taxes or any other taxes as per prevailing tax laws. Tax laws are
subject to amendments from time to time.
9. Tax benefits would be available as per the prevailing Income Tax laws.

Type1
I ___________________________(Name), having received the information I ___________________________(Name), have explained the
with respect to the above,have understood the above illustration before above illustration and the terms and conditions of this product to
entering into the contract. the Policyholder.

Policyholder's Signature :___________________________ Marketing official's Signature :

Place : Company Seal :
Date : Place :
Date :
ICICI Prudential Life Insurance Company Limited.
1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400025
www.iciciprulife.com