Quotation Number 70003573761 Quotation Date 13 - Sep - 2021

PNB MetLife India Insurance Co. Ltd.

Benefit Illustration for Mera Mediclaim Plan (UIN No. :117Y102V01)
Individual, Non-linked, Non-Participating, Pure risk Premium, Combi Insurance Plan

Personal details
Name of Life Javed Ansari Date of Birth of Life 15 Aug Age of Life 36
assured/Proposer Assured/Proposer 1985 Assured
Gender of the Life Male Age of
Assured/Proposer Date of Birth of Oldest 26 Jan Oldest 60
This benefit illustration is intended to show year-wise premiums payable member covered 1961 member
and benefits under the policy. covered
GST Rate (Life) 18%
GST Rate (Health) 18%
Your Policy Details
Benefit Details Life Cover details Health Plan details
Plan Option Lumpsum Floater Cover
Return of Premiums No Not Applicable
Optional cover
No Claims Bonus Super Premium Yes
Unlimited Automatic Recharge Yes
Personal accident cover (in Lakhs) Yes
Air ambulance cover No
NA
International Second Opinion No
Everyday Care No
OPD Care Yes
Double Sum Insured For Accidental Hospitalization No
Policy Sum Assured/Insured
Base cover 25,00,000 500,000
Optional cover: Personal Accident Cover 5,00,000
NA
Optional cover: OPD Care 5,000
Monthly Income 0
Total monthly income (payable over 10 years) 0 Not Applicable
Lump sum benefit on death / Terminal Illness (100 times of monthly income) 0
Number of lives covered 1 2
Adults 1 2
Children (only below age 25 years) Not Applicable 0
Policy Term(Years) 15 Renewable for life
Premium Payment Term (Years) 15 1
Premium Payment Frequency Annual Annual
Optional cover Details Premium (Without GST + applicable cess) (Rs.)
No Claims Bonus Super Premium 5,283
Unlimited Automatic Recharge 3,962
Personal accident cover 365

PNB MetLife India Ins ura nce Compa ny Limited, Regis tered office: Unit No 701,702 a nd 703, 7th Floor, Wes t Wing ,Ra heja Towers , 26/27 M G Roa d, Ba nga lore- 560001,
Ka rna ta ka .
Ca ll us Toll-free a t 1-800-425-6969, Ema il: india s ervice@pnbmetlife.co.in or write to us : 1s t Floor, Techniplex -1, Techniplex Complex, Off Veer Sa va rka r Flyover,
Gorega on (Wes t), Mumba i - 400062, Ma ha ra s htra . Phone: +91-22-41790000, Fa x: +91-22-41790203. IRDA of India Regis tra tion Number: 117, CI No.: U66010KA2001PLC028883,
Webs ite: www.pnbmetlife.com

Reg Office – Ca re Hea lth Ins ura nce Limited (formerly known a s Religa re Hea lth Ins ura nce Compa ny Limited),
5th Floor, 19, Cha wla Hous e, Nehru Pla ce, New Delhi-110019| CIN - U66000DL2007PLC161503.
Corres pondence Addres s - Ca re Hea lth Ins ura nce Limited (formerly known a s Religa re Hea lth Ins ura nce Compa ny Limited),
Unit no 604 - 607,6th Floor, Tower C, Unitech Cyber Pa rk, Sector 39,Gurga on – 122001
Ca ll :1800-102-4488 | 1800-102-6655 E-ma il : cus tomerfirs t@ca reins ura nce .com Webs ite : www.ca reins ura nce .com
 Optional cover Details Premium (Without GST + applicable cess) (Rs.)
Air ambulance cover -
International Second Opinion -
Everyday Care -
OPD Care 4,056
Double Sum Insured For Accidental Hospitalization -
Premium Details Premium Amount (Rs.)
Life (Base) 6,950
Health (Base) 26,416
Health (Optional) 13,667
Total Premium (Without GST + applicable cess) (Rs.) 47,033
Combi Discount 3,527
Net Premium (Without GST + applicable cess) (Rs.) 43,505
Goods and Services tax (Rs.) 7,831
Net Premium (With GST + applicable cess) (Rs.) 51,336
'# Life Premium shown above is the Annualized premium, where Annualised Premium excludes underwriting extra premium, frequency
loadings on premium, if any, and applicable GST (service tax and applicable cess)

PNB MetLife India Ins ura nce Compa ny Limited, Regis tered office: Unit No 701,702 a nd 703, 7th Floor, Wes t Wing ,Ra heja Towers , 26/27 M G Roa d, Ba nga lore- 560001,
Ka rna ta ka .
Ca ll us Toll-free a t 1-800-425-6969, Ema il: india s ervice@pnbmetlife.co.in or write to us : 1s t Floor, Techniplex -1, Techniplex Complex, Off Veer Sa va rka r Flyover,
Gorega on (Wes t), Mumba i - 400062, Ma ha ra s htra . Phone: +91-22-41790000, Fa x: +91-22-41790203. IRDA of India Regis tra tion Number: 117, CI No.: U66010KA2001PLC028883,
Webs ite: www.pnbmetlife.com

Reg Office – Ca re Hea lth Ins ura nce Limited (formerly known a s Religa re Hea lth Ins ura nce Compa ny Limited),
5th Floor, 19, Cha wla Hous e, Nehru Pla ce, New Delhi-110019| CIN - U66000DL2007PLC161503.
Corres pondence Addres s - Ca re Hea lth Ins ura nce Limited (formerly known a s Religa re Hea lth Ins ura nce Compa ny Limited),
Unit no 604 - 607,6th Floor, Tower C, Unitech Cyber Pa rk, Sector 39,Gurga on – 122001
Ca ll :1800-102-4488 | 1800-102-6655 E-ma il : cus tomerfirs t@ca reins ura nce .com Webs ite : www.ca reins ura nce .com
 Notes to the benefit illustration:
- This illustra on has been produced by PNB MetLife India Insurance Co. Ltd. and Care Health Insurance Limited (formerly known as
Religare Health Insurance Company Limited) to help you understand the benefits of your Mera Mediclaim Plan.This must be
read in conjunction with the product brochure, which describes all Features, Charges, Terms, Conditions & Exclusions.
- The illustrated benefits are applicable for standard life/lives provided all premiums are paid when due.
- Family Floater policy will have same basic Sum Insured for all members (See brochure for floater policy details)
- This premium illustra on is subject to the underwri ng decision of the Company. The actual premium or sum insured amount may
change upon the assessment of the risk of the life assured/ life insured.
- This illustra on explains the benefits and features of the proposed policy and is not a contract or a representa on of any guarantee
or warranty.
- *Applicable Goods and services tax + applicable cess is levied as per applicable tax laws from me to me and the same is
subject to changes in the tax laws in future and the policy proceeds would be affected to that extent.
- This illustra on is valid only as long as the age remains the same or for a period of thirty days from the date of this illustra on,
whichever is earlier.
- In case of any conflict between this benefit illustration and your policy document, the latter shall prevail.
- The main objec ve of the illustra on is that you are able to understand the features of the product and the nature of benefits under
different circumstances with some level of quantification.
- Neither the Company nor any of its Advisor/ Financial Planning Consultants are authorised to offer any tax related advice. The tax
benefits under various sec ons shall be available as per Income Tax Act, 1961, and are subject to any amendments made thereto
from time to time.
- If you buy this Combi product, discount of 7.5% on annual premiums paid towards both Life & Health will be offered as compared to
the individual policy purchased under Life & Health. At any me during the validity of the policy, if you decide to opt out of the
insurance coverage of one of the Insurer, the discount being offered under the Combi-Product shall not be available.
- The values in the illustration below have been rounded off to the nearest rupee wherever applicable.

Policyholder’s/ Prospect’s Declaration

I _______________________________________________have been taken through the illustra on for Mera Mediclaim Plan
comprising of PNB MetLife Mera Jeevan Suraksha Plan and
Care Plan. The Financial Advisor/Specified Person/Authorized Person of Broker/IMF has explained to me the premiums payable and
benefits under the product. I having received the informa on with respect to the above and have fully understood the above
statement before entering into the contract.

Signature of the Policyholder/ Prospect ______________________________________

For PNB MetLife India Insurance Company Limited (FA/FPC/SP/Authorised Person/IMF as applicable)

I cer fy that this illustra on has been fully explained to the Policyholder / Prospect. Further, I have also explained to the Policyholder
/ Prospect that the actual returns/benefits under the product may be different from what has been illustrated..

Signature of the FA(Agency)/FPC (Partner)/SP (CA)/Authorized Person(Broker)/Insurance Marke ng Firm(IMF):

Seal:
_____________________________________________________________ Date of Signature: ___________________
_______________________________________

Name of FA(Agency)/FPC (Partner)/SP (CA)/Authorized Person(Broker)/Insurance Marketing Firm(IMF):

Channel:
___________________________________________________________________________________________________
________________________________________

Code of FA(Agency)/FPC (Partner)/SP (CA)/Authorized Person(Broker)/Insurance Marketing Firm(IMF):

___________________________________________________________________________________________________

PNB MetLife India Ins ura nce Compa ny Limited, Regis tered office: Unit No 701,702 a nd 703, 7th Floor, Wes t Wing ,Ra heja Towers , 26/27 M G Roa d, Ba nga lore- 560001,
Ka rna ta ka .
Ca ll us Toll-free a t 1-800-425-6969, Ema il: india s ervice@pnbmetlife.co.in or write to us : 1s t Floor, Techniplex -1, Techniplex Complex, Off Veer Sa va rka r Flyover,
Gorega on (Wes t), Mumba i - 400062, Ma ha ra s htra . Phone: +91-22-41790000, Fa x: +91-22-41790203. IRDA of India Regis tra tion Number: 117, CI No.: U66010KA2001PLC028883,
Webs ite: www.pnbmetlife.com

Reg Office – Ca re Hea lth Ins ura nce Limited (formerly known a s Religa re Hea lth Ins ura nce Compa ny Limited),
5th Floor, 19, Cha wla Hous e, Nehru Pla ce, New Delhi-110019| CIN - U66000DL2007PLC161503.
Corres pondence Addres s - Ca re Hea lth Ins ura nce Limited (formerly known a s Religa re Hea lth Ins ura nce Compa ny Limited),
Unit no 604 - 607,6th Floor, Tower C, Unitech Cyber Pa rk, Sector 39,Gurga on – 122001
Ca ll :1800-102-4488 | 1800-102-6655 E-ma il : cus tomerfirs t@ca reins ura nce .com Webs ite : www.ca reins ura nce .com