Duplicate

PART A
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Date 21-Jun-2023 Contact number: 9897848677, --
To Sher Singh Branch Code: EBRL1
139/A/B Ananda Super City
Dohra Road
Bareilly
Bareilly 243006
Uttar Pradesh India

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Welcome Dear Sher Singh,
Thank you for choosing us as your life insurance partner. We are committed to financially protect you and your loved ones because
for them
We request you to go through the enclosed policy contract for Max Life Smart Wealth Advantage Growth Par Plan (A
Non-Linked Participating Individual Life Insurance Savings Plan) with Policy number 144887924.
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What to do in On examination of the Policy, if you notice any mistake or error, proceed as follows:
case of errors 1. Contact our customer helpdesk or your agent immediately at the details mentioned below.
2. Return the Policy to Us for rectifying the same.

Cancelling the In case You disagree with any of the terms and conditions of the Policy, you have the option to return the Policy for cancellation
Policy with a written request to Us, stating the reasons for objection, within the Freelook period of 15 days from the date of receiving the
policy document for review of the terms and conditions.

Result: Upon return, the Policy will terminate forthwith and all rights, benefits and interests under the Policy will cease
immediately. You will be entitled for refund of the Premiums received by us after deducting the proportionate risk Premium for the
period of cover, stamp duty paid and the expenses incurred on medical examination of the Life Insured, if any

Long term We are committed to giving you honest advice and offering you long-term savings, protection and retirement solutions backed by
protection the highest standards of customer service. We will be delighted to offer you any assistance or clarification you may require about
your Policy or claim-related services at the address mentioned below.

We value your association with us and assure you the best of our service, always.

Yours Sincerely,
Max Life Insurance Company Limited

R Krishnakumar
Executive Vice President - Head of Operations

Digitally signed by DS MAX LIFE INSURANCE COMPANY LIMITED 1

Date: 2024.01.19 14:12:01 IST
Reason: Max Life Insurance
Location: 90C, Gurugram

Agent's / Intermediary/ Relationship Manager/ Seller name & Code:

RISHABH SARIN (909174),
Contact Number: 8077624761,
Address: Max Life Insurance Co. Ltd., 2nd Floor,Main Commercial, Plot No.
54, Civil Lines, Ayub Khan Chauraha, Chaupla Road, Bareilly 243001,
NB13
Max Life Insurance Company Limited
Plot No. 90 C, Sector 18, Udyog Vihar, Gurugram-122015, Haryana, India
Phone 4219090 Fax 4159397 (From Delhi and Other cities: 0124) Customer Helpline: 1860 120 5577
Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144 533
Visit Us at: www.maxlifeinsurance.com E-mail: service.helpdesk@maxlifeinsurance.com
IRDAI Registration No: 104 Corporate Identity Number: U74899PB2000PLC045626 .

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 POLICY PREAMBLE

MAX LIFE INSURANCE COMPANY LIMITED

Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144533

Max Life Smart Wealth Advantage Growth Par Plan

A Non-Linked Participating Individual Life Insurance Savings Plan

UIN [104N135V01]

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

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

Max Life Insurance Company Limited

Place of Issuance :Gurugram, Haryana

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POLICY SCHEDULE

Policy: Max Life Smart Wealth Advantage Growth Par Plan Type of Policy: A Non-Linked Participating Individual Life
Insurance Savings Plan
UIN: 104N135V01 Office: Max Life Agency Distribution Bareilly 1
Policy No./ Proposal No.: 144887924 Client ID: 1833083345

Date of Proposal: 13-Jun-2023

Policyholder/Proposer : Sher Singh Age Admitted: Yes

PAN: ARQPS3623N Date of Birth: 15-Aug-1974

Identification Source & ID No.: NA Gender: Male

Relationship with Life Insured: Same Person Contact No.: / 9897848677

Email: SSSBHARTI1508@GMAIL.COM

Address(For all communication purposes):

139/A/B Ananda Super City Dohra Road Bareilly
Bareilly 243006 Uttar Pradesh India

Life Insured: Sher Singh Age Admitted: Yes

Identification Source & ID No.: NA Date of Birth: 15-Aug-1974

Address(For all communication purposes): 139/A/B Ananda Age: 48 years

Super City
Dohra Road Bareilly Gender: Male
Bareilly 243006
Uttar Pradesh India

Nominee(s):
Nominee (s) Relationship Date of Age Gender % Appointee Name Gender Age Relationship
Name of Nominee(s) Birth share (if Nominee with Nominee
with Of Nominee is minor)
Policyholder
Kumari Seema Wife 01-Jul-1986 36 Female 100 NA NA

Plan Details
Date of Commencement of
Policy Terms(in years) 37 12-Jun-2023
Risk/Inception of Policy
Premium Payment Term(in
12 Date of Issuance of Policy 21-Jun-2023
years)
Premium Payment Mode Semi-Annual Maturity Date 12-Jun-2060
Age of Life Insured at
Plan Variant Balanced Income Maturity 85
Date (in years)
Sum Assured on Death as on
Policy Continuance Benefit No the Date of Commencement of 5,56,118.00
Risk
Existing Customer/Staff/
Transgender lives Discount
Yes Sum Assured on Maturity 6,12,240.00
(available for first policy year
only)
Save the Date Option No Additional Maturity Benefit NA
Premium Offset Option No Death Multiple 10.9
Survival Benefit Details
Date on which Survival Benefit Frequency of Survival Benefit
12-Jun-2024 Annual
is payable* Chosen

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 Rider Details
Max Life Critical Illness
Rider Name
And Disability Rider
UIN 104B033V01
Rider Sum Assured 3,00,000.00
Rider Term (in
17
Years)
Rider Premium
Payment 12
Term (in Years)
Rider Premium with
3,195.55
GST
*The Survival Benefit would be paid on this date if the option for accrual is not in force (as per Clause 6 of Part C).
Premium Details
Premium (including
Underwriting Extra Premium)
along with applicable taxes,
Annualised Premium 49,999.60 cesses and levies payable as 26,647.29
per premium payment mode
selected
(INR)
Due Date when Premium is
12th of Jun & Dec every year;
Underwriting Extra Premium NA payable/Date when the last
12-Dec-2034
premium is payable
Total Premium (including
GST** and any other taxes,
2,250.00 Rider Premium, if any) for the 29,842.84
cesses & levies
selected variant

Premium Payment Method: ECS Payment Date: 12TH

Bank Name: ZILA SAHKARI BANK LTD
Bank Account Number: 000400320002935
Bank Account Details for Payouts: Bank Name: ZILA SAHKARI BANK LTD
Bank Account Number: 000400320002935
Intermediary Registration No.: MAX909174 Agent / Intermediary / Relationship Manager name: RISHABH
SARIN
Seller code : 909174 Email: rishabh.sarin@maxlifeinsurance.com
Address:
Max Life Insurance Co. Ltd., 2nd Floor,Main Commercial, Plot No.
54, Civil Lines, Ayub Khan Chauraha, Chaupla Road
Bareilly 243001
Contact No.: 8077624761,

Details of Sales Personnel (for direct sales only): Agent's code/ INTERMEDIARY code: 909174
Agent / Intermediary/ Relationship Manager name: RISHABH Email: rishabh.sarin@maxlifeinsurance.com
SARIN

**GST includes IGST, SGST, CGST, UGST (whichever is applicable) and applicable cesses.

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PART B 25. "Modal Factor" means the applicable factor specified in the Schedule, which
DEFINITIONS is used by Us for determining the Premium. The Modal Factors for this Policy
The words and phrases listed below will have the meaning attributed to them wherever are as follows: i) for annual Premium payment mode - (1); ii) for semi-annual
they appear in the Policy unless the context otherwise requires. Premium payment mode - (0.510); iii) for quarterly Premium payment mode
1. "Accident" means sudden, unforeseen and involuntary event caused by - (0.260); iv) for monthly Premium payment mode - (0.087);
external, visible and violent means; 26. "Nomination" is the process of nominating a person(s) in accordance with
2. "Accidental Death" means death which is caused by an Accident provided such provisions of Section 39 of the Insurance Act, 1938 as amended from time to
death was caused directly by such Accident and independent of any physical or time;
mental illness within 180 days of the date of Accident; 27. "Nominee" means the person named in the Policy Schedule who has been
3. "Additional Accidental Death Benefit Term" shall mean the period, starting nominated by You (only if You are the Life Insured), in accordance with Section
from the end of Premium Payment Term and lasting till the end of Policy Term 39 of the Insurance Act, 1938 as amended from time to time to receive benefits
or attainment of maximum maturity age of 80 years applicable for additional in respect of this Policy;
Accidental Death benefit, whichever is earlier; 28. "Policy" means the contract of insurance entered into between You and Us as
4. "Additional Accidental Sum Assured on Death" means an assured additional evidenced by this document, the Proposal Form, the Schedule and any additional
amount which is guaranteed to become payable on the death of the Life Insured information/document(s) provided to Us in respect of the Proposal Form along
due to Accident in accordance with the terms and conditions of the Policy. with any written instructions from You subject to Our acceptance of the same
Additional Accidental Sum Assured on Death shall be equal to 50% of Sum and any endorsement issued by Us;
Assured on Death. The maximum Additional Accidental Sum Assured on Death 29. "Policy Anniversary" means the annual anniversary of the Date of
under the Policy shall not exceed Rs. 1 crore; Commencement of Risk;
5. "Additional Maturity Benefit" is an additional maturity benefit equal to 10% 30. "Policy Continuance Benefit" means the benefit as specified in Clause 1.1.5 of
of Sum Assured on Maturity where the Life Insured is a female, payable in Part C. This option can be chosen only at the Date of Commencement of Risk by
accordance with the terms and conditions of the Policy. the Policyholder and only if the Policyholder and Life Insured are same person
6. "Age" means Life Insured's age on last birthday as on the Date of and once opted cannot be opted out of during the Policy Term. This benefit is
Commencement of Risk or on the previous Policy Anniversary, as the case may not available in case the Life Insured is minor as on the Date of Commencement
be; of Risk;
7. "Annualised Premium" is the amount specified in the Schedule and means 31. "Policy Term" means the term of this Policy as specified in the Schedule during
the Premium amount payable during a Policy Year chosen by You, excluding which the Policy coverage continues;
Underwriting Extra Premiums, loadings for modal premiums, Rider Premiums 32. "Policy Year" means a period of 12 (Twelve) months commencing from the
and applicable taxes cesses and levies, if any; Date of Commencement of Risk and every Policy Anniversary thereafter;
8. "Appointee" means the person named by You (as applicable and registered with 33. "Premium" means an amount specified in the Schedule, payable by You to Us,
Us in the Schedule) who is authorised to receive and hold in trust the benefits by the due dates to secure the benefits under the Policy, excluding applicable
under this Policy on behalf of the Nominee/(s), if the Nominee/(s) is/are less taxes, cesses and levies, if any;
than Age 18 on the date of payment of such benefit(s); 34. "Premium Payment Term" means the term specified in the Schedule, during
9. "Assignee" is the person to whom the rights and benefits are transferred by which the Premiums are payable by You;
virtue of an Assignment; 35. "Proposal Form" means the form filled in and completed by You for the
10. "Assignment" is the process of transferring the rights and benefits to an purpose of obtaining insurance coverage under the Policy;
Assignee, in accordance with the provisions of Section 38 of Insurance Act, 36. "Proposer" is a person, who proposes a life insurance proposal;
1938, as amended from time to time; 37. "Reduced Paid Up Factor" means the ratio of total period for which Premiums
11. "Cash Bonus" means a non-guaranteed bonus expressed as a percentage of have already been paid under the Policy to the maximum period for which
Annualised Premium, as declared from time to time and payable in accordance Premiums were originally payable under the Policy;
with the Survival Benefit option chosen by You; 38. "Reduced Paid Up Mode" means the Policy with reduced paid up benefits as
12. "Claimant" means You (if You are not the Life Insured), Nominee(s) (if specified under Clause 3 of Part C;
valid nomination is effected), Assignee(s) or their heirs, legal representatives or 39. "Reduced Paid Up Guaranteed Income" means an amount equal to
holders of a succession certificates in case You or Nominee(s) or Assignee(s) Guaranteed Income amount (as well as enhanced Guaranteed Income in case of
is/are not alive at the time of claim, as the case may be; Lifelong Income Variant) multiplied by Reduced Paid Up Factor;
13. "Date of Commencement of Risk" means the date as specified in the Schedule, 40. "Reduced Paid Up Sum Assured on Death" means an amount equal to the
on which the insurance coverage / risk under the Policy commences; Sum Assured on Death multiplied by Reduced Paid Up Factor;
14. "Death Multiple" means the applicable death multiple specified in the 41. "Reduced Paid Up Sum Assured on Maturity" means an amount equal to the
Schedule; Sum Assured on Maturity multiplied by Reduced Paid Up Factor;
15. "Freelook" means a period during which, subject to the Clause 6 Part D of the 42. "Revival" means restoration of the Policy, which was discontinued due to
Policy, You have an option to return the original Policy to Us by stating the non-payment of Premium, by Us with all the benefits stated in the Policy, upon
objections/reasons for disagreement in writing; the receipt of all the due Premiums and other charges / revival interest rate as
16. "Grace Period" means the time granted by Us from the due date for the provided in Clause 3 of Part D of the Policy;
payment of Premium, without any penalty or late fee or interest, during which 43. "Revival Period" means a period of 5 (Five) consecutive years from the due
time the Policy is considered to be in force with risk cover without any date of the first unpaid Premium, during which period You are entitled to revive
interruption, as per the terms and conditions of the Policy. The grace period is the Policy which was discontinued due to the non-payment of Premium;
a period of 15 (Fifteen) days from the due date of the first unpaid Premium for 44. "Rider" means optional benefits which are in addition to basic benefits under
monthly Premium payment mode and 30 (Thirty) days from the due date of the the Policy;
first unpaid Premium for annual, semi-annual or quarterly premium payment 45. "Rider Premium" means the premium amount payable in respect of a Rider
modes; applicable under the Policy and is the amount specified in the Schedule;
17. "Guaranteed Income" means a fixed income, calculated as a fixed percentage 46. "Schedule" means the policy schedule and any endorsements attached to and
of Annualised Premium, payable as per the frequency chosen by You, subject forming part of the Policy and if any updated Schedule is issued, then, the
to provisions of Clause 1.2 of Part C; Schedule latest in time;
18. "Guaranteed Surrender Value" means the Surrender Value computed in 47. "Special Surrender Value" means the amount computed in accordance with
accordance with Clause 1.6 of Part D, which is guaranteed by Us; Clause 1.7 of Part D;
19. "Injury" means accidental physical bodily harm excluding any Illness or 48. "Sum Assured on Death" means an assured amount, which is guaranteed to
disease, solely and directly caused by an external, violent, visible and evident become payable on death of the Life Insured in accordance with Clause 1.1 of
means which is verified and certified by a Medical Practitioner; Part C. Sum Assured on Death shall be the higher of:
20. "IRDAI" means the Insurance Regulatory and Development Authority of India; i. 10 times the (Annualised Premium plus Underwriting Extra Premium, if
21. "Lapsed Policy" means a Policy which has not acquired the Surrender Value any); or
and where due Premium has not been received for at least the first two ii. Death Multiple x (Annualised Premium plus Underwriting Extra Premium,
consecutive Policy Years; if any)
22. "Life Insured" means the person named in the Schedule, on whose life the 49. "Sum Assured on Maturity" means the amount which is guaranteed to become
Policy is effected; payable on maturity of the Policy, in accordance with the terms and conditions of
23. "Maturity Date" means the date specified in the Schedule, on which the Policy the Policy and is equal to Annualised Premium multiplied by Premium Payment
Term expires; Term;
24. "Medical Practitioner" means a person who holds a valid registration from 50. "Surrender Value" means an amount payable on surrender of this Policy, in
the Medical Council of any state or Medical Council of India or Council for accordance with Clause 1 of Part D;
Indian Medicine or for Homeopathy set up by the Government of India or 51. "Survival Benefit" means the benefit (including Cash Bonus, if declared and
a State Government and is thereby entitled to practice medicine within its Guaranteed Income) payable as per the terms and conditions of this Policy as
jurisdiction and is acting within its scope and jurisdiction of license, provided per the Survival Benefit Variant chosen by You, until death of the Life Insured
such Medical Practitioner shall not include Your spouse, father (including or end of the Policy Term, whichever is earlier. One of the following Survival
step father), mother (including step mother), son (including step son), son's Benefit variant may be chosen by You:
wife, daughter, daughter's husband, brother (including step brother/s) or sister i. "Insta Income Variant" as specified in Clause 1.2.1 of Part C
(including step sister/s) or the Life Insured or You or employed by You/the Life ii. "Balanced Income Variant" as specified in Clause 1.2.2 of Part C
Insured. iii. "Future Income Variant" as specified in Clause 1.2.3 of Part C
iv. "Lifelong Income Variant" as specified in Clause 1.2.4 of Part C

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52. "Terminal Bonus" means the bonus payable by Us in accordance with Clause a) Cash Bonus, if declared, payable after the end of the Premium
4.2 of Part C. Payment Term plus one (1) year and will continue until the
53. "Total Premiums Paid" means the total of all Premiums received under the end of Policy Term or death of Life Insured (in case Policy
Policy, excluding Underwriting Extra Premium, loadings for modal premiums, Continuance Benefit is not opted), whichever is earlier; and
Rider Premium and applicable taxes, cesses or levies (if any). b) Guaranteed Income, shall be payable after the end of the
54. "Underwriting Extra Premium" means an additional amount mentioned in the Premium Payment Term plus one (1) Policy Year, and will
Schedule and charged by Us, as per Underwriting Policy, which is determined continue till 25 Policy Years or the end of Policy Term or
on the basis of disclosures made by You in the Proposal Form or any other death of Life Insured (in case Policy Continuance Benefit is
information received by Us including medical examination report of the Life not opted), whichever is earlier.
Insured, if any; 1.2.4. In case You have chosen Lifelong Income Variant, We will pay the
55. "Underwriting Policy" means the underwriting policy approved by Our board following Survival Benefit:
of directors; a) Cash Bonus, if declared, payable from the 1st (First) Policy
56. "We", "Us" or "Our" means Max Life Insurance Company Limited; and Year till end of Policy Term or death of Life Insured (in case
57. "You" or "Your" or "Policyholder" means the policyholder as named in the Policy Continuance Benefit is not opted), whichever is earlier;
Schedule. b) Guaranteed Income, shall be payable after the end of the
Premium Payment Term plus one (1) Policy Year, and will
PART C continue till the Life Insured attains age 65 or death of Life
POLICY FEATURES, BENEFITS AND PREMIUM PAYMENT Insured (in case Policy Continuance Benefit is not opted),
1. BENEFITS whichever is earlier; and
1.1. Death Benefit c) Enhanced Guaranteed Income, which is equal to four times the
1.1.1. If the Policy is in force and is not a Lapsed Policy or in Reduced Paid Guaranteed Income shall be payable from the end of the next
Up Mode, then, upon death of the Life Insured, during the Policy Policy Anniversary after Life Insured attains age 65 years and
Term, We will pay the Death Benefit which shall be higher of either: payable till the end of Policy Term or death of Life Insured
a. Sum Assured on Death, plus Terminal Bonus (if declared); (in case Policy Continuance Benefit is not opted), whichever
or is earlier.
b. 105% of (Total Premiums Paid plus Underwriting Extra 1.2.5. Cash Bonus, if declared and Guaranteed Income shall be payable
Premiums plus loadings for modal premiums) as on the date in arrears i.e. end of chosen payout frequency. Pay-out frequency
of death of Life Insured options available are annual, semi-annual, quarterly and monthly.
1.1.2 In case You have opted for Policy Continuance Benefit, no Terminal The frequency of payment of Survival Benefits may be changed in
Bonus shall be payable at the time of death. accordance with Clause 5 of Part C below. You also have an option
1.1.3 Any Survival Benefit paid after the date of death of the Life Insured, to accumulate Cash Bonus (if declared) and Guaranteed Income
will be reduced from the Death Benefit payable. However, in case available to earn investment return.
You have opted for Policy Continuance Benefit, Survival Benefit 1.3 Maturity Benefit
paid will not be reduced. 1.3.1. Subject to Clause 1.1.5 of Part C, on survival of the Life Insured
1.1.4. Survival Benefit, which have accrued but not paid before the date on the Maturity Date, if the insurance cover under this Policy is in
of death, shall be paid in addition to the Death Benefit payable. force and the Policy is not under Reduced Paid Up Mode, We will
1.1.5.Policy Continuance Benefit: pay the sum total of the following in lumpsum to the Claimant:
a) If You have opted for "Policy Continuance Benefit", then on a) Sum Assured on Maturity;
death of the Life Insured any time during the Policy Term, b) Terminal Bonus, if declared; and
death benefit (excluding Terminal Bonus) as per Clause 1.1.1 c) Additional Maturity Benefit, if applicable
of Part C shall be paid immediately as a lump sum amount 1.3.2. Any accrued Survival Benefits, if not already paid shall be paid in
and the applicable future Survival Benefits (including Cash addition to above.
Bonus (if declared), Guaranteed Income) and maturity benefit 2. SETTLEMENT OPTION
(including, Additional Maturity Benefit, if applicable) shall be 2.1. When receiving the maturity benefit, You can opt the settlement option.
paid to the Claimant as and when due as would have been The option can be taken 15 days prior to the Maturity Date. There are
payable to You, had You been alive, without payment of any two options for receiving the maturity benefit: lump sum or regular
future Premiums. monthly/annual income for 5, 10, 15, or 20 years. The terms of the
b) If You have opted for Policy Continuance Benefit, after death settlement option will depend on investment conditions at the time of
of the Life Insured, the Claimant will not have an option to settlement. For details, You may contact Us.
surrender the Policy. 2.2. During the income phase, the remaining payouts can be commuted at any
1.1.6. Death due to Accident during the Additional Accidental Death time, with the present value of all future payouts discounted at the rate
Benefit Term after the end of Premium Payment Term applicable at the time of exercising the settlement option.
If the Life Insured dies due to Accident during the Additional 2.3. Once the settlement option is exercised, the declared discount rate becomes
Accidental Death Benefit Term after the end of Premium Payment guaranteed and applies to any future commutation of remaining payouts.
Term, provided the Policy is in force, on the date of death of the Life 2.4. If the Life Insured dies during the settlement period, the Claimant has the
Insured, We will pay Additional Accidental Sum Assured on Death option to receive the income as and when due or may choose to commute
in addition to the applicable death benefit payable under Clause the outstanding income .
1.1.1 to 1.1.5 above. If the Life Insured is minor as on the Date of 3. REDUCED PAID UP BENEFITS
Commencement of Risk, additional Accidental Death benefit will 3.1. If this Policy has acquired a Surrender Value, then, in the event of
not be available under the Policy. non-payment of the due Premiums, on the expiry of Grace Period, this
1.2. Survival Benefit Policy will not lapse and will continue with reduced paid-up benefits as
During the Policy Term while the Life Insured is alive, Survival Benefit specified below. If this Policy is under Reduced Paid Up Mode, the benefits
payable shall depend on the Survival Benefit variant chosen by You and payable shall be as follows:
shall be payable on the date as specified in the Schedule. The same shall Event during
be as under: Benefits Payable
Policy Term
1.2.1. In case You have chosen Insta Income Variant, We will pay the On death of Life In the event of the death of the Life Insured during
following Survival Benefit: Insured Policy Term, We will pay the higher of:
a) Cash Bonus, if declared, payable from the 1st (First) Policy a. Reduced Paid Up Sum Assured on Death
Year till end of Policy Term or death of Life Insured (in case b. 105% of (Total Premiums Paid plus Underwriting
Policy Continuance Benefit is not opted), whichever is earlier; Extra Premiums plus loadings for modal
and, premiums), as on the date of death of Life Insured
b) Guaranteed Income, payable from 1st (First) Policy Year till
On death of
the end of 25 Policy Years or till the end of Policy Term or
Life Insured i. Reduced Paid Up Sum Assured on Death and
death of Life Insured (in case Policy Continuance Benefit is
(in case Policy ii. Benefits mentioned below to be paid on maturity
not opted), whichever is earlier
Continuance and survival of Life Insured.
1.2.2. In case You have chosen Balanced Income Variant, We will pay the
Benefit is opted)
following Survival Benefit:
On death of Life On death of the Life Insured due to Accident during the
a) Cash Bonus, if declared, payable from the 1st (First) Policy
Insured due to Additional Accidental Death Benefit Term, We will pay
Year till end of Policy Term or death of Life Insured (in case
accident an additional Accidental Death benefit equal to 50% of
Policy Continuance Benefit is not opted), whichever is earlier;
Reduced Paid Up Sum Assured on Death (subject to
and,
maximum of Rs. 1 crore) to Claimant, provided the Life
b) Guaranteed Income) payable from end of Premium Payment
Insured is not minor.
Term plus one (1) Policy Year till the end of Policy Term or
death of Life Insured (in case Policy Continuance Benefit is On maturity If the Life Insured is alive on the Maturity Date, We will
not opted), whichever is earlier. pay the Reduced Paid Up Sum Assured on Maturity.
1.2.3. In case You have chosen Future Income Variant, We will pay the Additional Maturity Benefit, if applicable, shall be
following Survival Benefit: reduced accordingly.

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 On Survival of i. During the Premium Payment Term: Nil payable, the balance amount shall be paid to You. However, if the Survival
the Life Insured ii. After the Premium Payment Term: Reduced Paid Benefit payable is insufficient to adjust the due Premium, the balance due
Up Guaranteed Income. Premium shall be payable by You.
On surrender It will be determined using the methodology and 8.2. Premium offset option can be availed only with Insta Income Variant,
Special Surrender Value scales as mentioned in Clause Balanced Income Variant and Life Long Income Variant.
1 of Part D. 8.3. Premium offset option may be opted at inception or anytime during
3.2. In case the option of accrual of Survival Benefits has been chosen by You, Premium Payment Term. However, any change will be effective from
accrued Survival Benefit, if any and if not already paid, shall be paid on subsequent Premium due date provided the request is received at least 15
death of Life Insured or on Maturity Date. days before the Premium due date. Once opted, You may choose to opt out
4. BONUSES for this option before the next Premium due date.
Bonus(es) may be declared by Us depending upon the surplus generated 9. GRACE PERIOD
in the participating fund over the Policy Term. The bonus under this 9.1. The Premium is due and payable by the due date specified in the Schedule.
Policy will be distributed as follows: If the Premium is not paid by the due date, You may pay the same during
4.1. Cash Bonus the Grace Period without any penalty or late fees or interest.
4.1.1. The bonus, if declared, shall be declared by default in the form of 9.2. The insurance coverage continues during the Grace Period. However, if the
Cash Bonus and be payable in arrears in accordance with clause 1.2 overdue Premium is not paid even in the Grace Period and the Life Insured
in Part C. dies, We will pay the Death Benefit under this Policy after deducting the
4.1.2. Cash Bonus, if declared, shall be paid on Policy Anniversary as due Premium (if any) till the date of death.
a default frequency of payment. You may choose to receive Cash
Bonus payouts (if declared) in Semi-Annual, Quarterly or Monthly PART D
Mode. POLICY SERVICING CONDITIONS
4.2. Terminal Bonus 1. SURRENDER
4.2.1. We will pay an additional 1 (One) time Terminal Bonus, if declared, 1.1. This Policy shall acquire Surrender Value if all the due Premiums for the
on the earlier of the death of the Life Insured or on the survival of first 2 (Two) Policy Years have been received in full and applied by Us.You
the Life Insured till the Maturity Date or on surrender of this Policy, may request in writing to surrender the Policy at any time but You will get
provided this Policy has been in force for at least 2 (Two) complete the Surrender Value only if the Policy has acquired the Surrender Value.
Policy Years from the Date of Commencement of Risk and all the On receipt of such request, the Surrender Value prevailing on the date of
due Premiums are paid. request for the surrender of this Policy shall be payable by Us and thereafter
4.2.2. In case Policy Continuance Benefit has been chosen by You, then, no other benefit under this Policy shall be payable and the Policy shall
Terminal Bonus, if declared, shall be payable only on Maturity Date terminate. If the Policy has not acquired Surrender Value, no amount shall
or on surrender (in accordance with Clause 1 of Part D) and not be payable by Us.
payable at the time of death of Life Insured. 1.2. The Surrender Value payable will be subject to the condition that there are
5. OPTION TO CHANGE FREQUENCY FOR PAYMENT OF SURVIVAL no statutory or other restrictions to the contrary.
BENEFITS 1.3. The Surrender Value will be equal to the higher of Guaranteed Surrender
5.1. You may choose to receive the applicable Survival Benefits at a monthly Value or Special Surrender Value.
or quarterly or semi-annual or annual frequency, in arrears. Such Survival 1.4. Once You have surrendered the Policy, the same cannot be reinstated.
Benefits shall be calculated by multiplying the annual Survival Benefit 1.5. If option for accrual of Survival Benefits has been chosen, any accrued
with the factors: 0.08 for monthly frequency, 0.24 for quarterly frequency, Survival Benefit, if not already paid, shall be paid in addition to the
0.48 for semi-annual frequency and 1 for annual frequency. The payment applicable Surrender Value.
frequency for Cash Bonus, if declared and Guaranteed Income cannot be 1.6. Guaranteed Surrender Value
different. 1.6.1. Subject to Clause 1.1 of Part D, the Guaranteed Surrender Value will
5.2. You can choose the payment frequency of Survival Benefits at inception be determined in the Policy Year in which the surrender is effected
or change it at least 30 days before the Policy Anniversary, which will and shall be higher of:
take effect on the next anniversary. If the Policyholder dies and Survival a. Guaranteed Surrender Value factors (as specified in the Table
Benefits are payable, the Claimant can also change the payment frequency. 1 below) multiplied by sum of Total Premiums Paid, less
6. ACCRUAL OF SURVIVAL BENEFITS applicable Survival Benefits, if any, till the date of surrender;
6.1. You may choose to accrue Survival Benefits or cancel this option anytime or
during the Policy Term by submitting a written request to Us 30 days before b. Zero
the Policy Anniversary and the same will be effective from the next Policy Table 1 - Guaranteed Surrender Value factors
Anniversary. Any change so effected, will be applicable for a minimum of Surrender Guaranteed Surrender Guaranteed
1 (one) Policy Year. during Surrender during Surrender
6.2. Interest rate equal to the Repo rate published by RBI on its website will Policy Year Value factors Policy Year Value factors
apply on the Survival Benefits so accrued and this rate will be reviewed 1 0.00% 8 55.71%
annually. The RBI Repo rate' for the financial year ending on 31st March 2 30.00% 9 61.43%
every year will be considered. As the interest rate will be reviewed at the 3 35.00% 10 67.14%
beginning of each financial year, any change in this interest rate will be 4 50.00% 11 72.86%
applicable from 1st May to 30th April. 5 50.00% 12 78.57%
6.3. You may withdraw the Survival Benefits so accrued in full or in part during
6 50.00% 13 84.29%
the Policy Term. The balance amount, if any, will keep accumulating and
accrued Survival Benefits, if any, will be payable upon termination of the 7 50.00% 14 and above 90.00%
Policy due to death of the Life Insured or maturity or surrender of this 1.7. Special Surrender Value:
Policy. 1.7.1. Your Policy also acquires a Special Surrender Value. Before making
6.4. If You choose to accrue the Survival Benefit, only annual frequency a request for Surrender, You may approach Us to know about the
of payment of Survival Benefits shall be applicable. Once this option Surrender Value in respect of your Policy
is withdrawn, You may choose the frequency for payment of Survival 1.7.2. It may be noted that the Special Surrender Value factors and the
Benefit, as per Clause 5.1 of Part C. basis for calculating the Special Surrender Value factors under the
6.5. Under this option, the entire Cash Bonus, if declared and Guaranteed Policy may be revised by Us, subject to prior approval from IRDAI.
Income (if applicable) together will be accrued and partial accrual will not 2. LOANS
be allowed. 2.1. Once this Policy has acquired the Surrender Value, You will be eligible for
7. PREMIUMS grant of loans from Us during the Premium Payment Term.
7.1. You can pay the Premium annually, semi-annually, quarterly or on monthly 2.2. The minimum amount of loan which can be granted under this Policy
basis, as per the Premium payment mode chosen by You. You have an is INR 10,000 (Rupees Ten Thousand). and the maximum amount of
option to change the Premium payment mode by submitting a written loan shall not exceed 80% (Eighty percent) of the Surrender Value
request to Us, provided the limits of minimum premium for the chosen payable under this Policy, subject to such terms and conditions as may be
Premium payment mode are adhered to. Any change in the Premium determined by Us from time to time.
payment mode will result in a change in the Premium amount basis the 2.3. Upon grant of a loan under this Policy, this Policy shall automatically
applicable Modal Factors. A change in Premium payment mode will be be assigned in Our favour, till the time the entire loan amount including
effective only on the Policy Anniversary following the receipt of such interest, any fees or dues towards such loan has been repaid to Us. On
request. repayment of the entire loan and accumulated interest to Us, this Policy
7.2. You can pay Premium at any of Our offices or through Our website will be reassigned to You.
www.maxlifeinsurance.com or by any other means, as informed by Us. 2.4. All benefits payable under the Policy shall be first adjusted against
Any Premium paid by You will be deemed to have been received by Us outstanding loan and interest accrued thereon, prior to being paid to You.
only after the same has been realized and credited to Our bank account. For clarity, it may be noted that any such adjustment will be done firstly
8. PREMIUM OFFSET OPTION to repay any accrued loan interest and the balance, if any, will be adjusted
8.1. The Survival Benefit may be utilized to adjust the Premium, provided the towards the principle loan outstanding amount.
chosen Survival Benefit payment mode and timing matches with that of 2.5. The loan interest rate shall be equal to applicable 'RBI Bank Rate' plus
the Premium payment. If the Survival Benefit exceeds the due Premium 3.0%(currently 9.75% per annum), compounded annually and is effective

7 of 44
 wef 1st July 2023 based on 'RBI Bank Rate' of 6.75% per annum prevailing to revive the Policy and the applicable terms and conditions for
as at 31st March 2023. The 'RBI Bank Rate' for the financial year ending utilizing this revival scheme;
31st March (every year) will be considered for determining the loan interest 3.6.3. Special Revival Schemes: We may also introduce special revival
rate and the same shall be made effective w.e.f. 01st July every year. The schemes from time to time which are available for a particular
loan interest rate will be revised only if the 'RBI Bank Rate' changes by period. Please contact Us for details on whether such revival scheme
1% or more from the 'RBI Bank Rate' used to determine the prevailing is available and, if You are eligible for the same, the total amount
loan interest rate (reviewed on 31st March of a year). For further details required to be paid by You to revive the Policy and the applicable
and the loan interest rate applicable as on date, please refer to our website terms and conditions for utilizing such revival scheme.
www.maxlifeinsurance.com. 3.7. We may, from time to time, at Our sole discretion, introduce new
2.6. In case the outstanding loan amount including accumulated interest on such revival schemes or modify or terminate existing revival schemes.
loan exceeds 95% of the Surrender Value or the remaining Policy Term is Please contact Us for details on 1860 120 5577 or visit Our website
6 months (whichever is earlier), We will send You a communication for www.maxlifeinsurance.com.
repayment of loan along with the accrued interest. 4. PAYMENT OF BENEFITS
2.7. Except for policies where all due Premiums have been paid, if the loan The benefits under this Policy will be payable only on submission of satisfactory
amount outstanding including the accumulated interest on such loan proof to Us. Once the benefits under this Policy are paid to You/the Claimant
exceeds the Surrender Value, this Policy will terminate. At the end of the as the case may be, the same will constitute a valid discharge of Our liability
Policy Term, in case of non-repayment of loan, the excess of Surrender under this Policy.
Value over the loan amount along with accrued interest shall be returned 5. TERMINATION OF POLICY
to You. This Policy will terminate upon the happening of any of these events: (1) on the
3. REVIVAL OF POLICY date of Freelook cancellation; (2) the date of death of the Life Insured (if You
3.1. A Lapsed Policy or a Policy under Reduced Paid Up Mode can be revived have not opted for Policy Continuance Benefit); (3) on the expiry of the Revival
as per Underwriting Policy, within the Revival Period on Your written Period, if the Lapsed Policy has not been revived; (4) on the date of payment of
request to Us along with evidence of insurability (in form of declaration of Surrender Value; (5) on the date of payment of the maturity benefit; (6) on the
health condition and/or relevant medical reports) of Life Insured at Your date of payment of dues as per suicide clause (Clause 5 of Part-F); or (7) if the
own cost and payment of all overdue Premiums (along with the applicable outstanding loan and accumulated interest exceeds the Surrender Value payable.
taxes, cesses and levies, if any) to Us with interest at a rate as may be 6. FREELOOK CANCELLATION
determined by Us from time to time (in the manner described herein below) "Freelook" means a period (as mentioned in the forwarding letter appended in
as on the date of Revival. Currently the applicable revival interest rate is the beginning of this Policy), to review the terms and conditions of the Policy,
as below: where if You disagree with any of such terms and conditions, You have the
No. of days Currently option to return the Policy stating the reasons for objection. Upon return, the
between date of Revival Interest Applicable Policy will terminate forthwith and all rights, benefits and interests under the
Revival and date Rate basis Revival Policy will cease immediately. You shall be entitled to a refund of the Premium
of lapse of Policy Interest Rate* received by Us after deducting the proportionate risk premium for the period of
0-60 Nil 0.00% cover, stamp duty paid and the expenses incurred by Us on medical examination
RBI Bank Rate of the Life Insured, if any.
+ 1%per annum 7. LAPSATION OF POLICY
61-180 7.75% If You discontinue the payment of Premium before paying due Premiums for
compounded annually
on due Premiums at least the first 2 (Two) consecutive Policy Years, the Policy will become a
Lapsed Policy on the expiry of the Grace Period and no benefit under the Policy
RBI Bank Rate +
shall be payable.
3% per annum.
>180 9.75% 8. SAVE THE DATE OPTION
compounded annually
8.1. The Survival Benefit is payable on the date of policy anniversary by default
on due Premiums
during the income period.
8.2. You have an option to receive the survival benefit on any date other than
*Note: The current applicable revival interest rate effective w.e.f. the policy anniversary. This option is available to You only in case the
1st July 2023 and is based on RBI Bank rate of 6.75% per annum Survival Benefit payment frequency is annual. This option is available to
prevailing as at 31st March 2023 The 'RBI Bank Rate' for the You only at inception and no change will be allowed during the Policy
financial year ending 31st March (every year) will be considered Term. We will pay the pro-rated Survival Benefit in first and last year of
for determining the revival interest rate and the same shall be the Survival Benefit period in case the chosen Survival Benefit payment
made effective w.e.f. 01st July every year. The revival interest rate date is different from the Policy Anniversary date.
is revised only if the 'RBI Bank Rate' changes by 1% or more 8.3. This option is not available in case premium offset has been opted.
from the 'RBI Bank Rate' used to determine the prevailing revival 9. RISK COVERAGE FOR MINOR AND VESTING ON ATTAINING
interest rate (reviewed on every 31st March). For further details MAJORITY
and the revival interest rate applicable as on date, please refer to Risk coverage for minors will start from the Date of Commencement of Risk.
our website www.maxlifeinsurance.com. Any change in the basis of In case the Life Insured is a minor, the Policy will automatically vest in him/her
determination of the above revival interest rate shall be with prior on his/her attaining the Age of majority. However, the Life Insured on attaining
approval of IRDAI. the Age of majority, will be required to provide all the requisite information
3.2. The Revival of the Lapsed Policy or a Policy under Reduced Paid Up (including his address, contact details, bank account details, etc.) and other
Mode will take effect only after We have approved the same in accordance documents as specified by Us to enable Us to pay the benefits under this Policy.
with Our Underwriting Policy and communicated Our decision to You in
writing. All original benefits such as Survival Benefits, Death Benefit and PART E
maturity benefit which were originally payable will be restored on such POLICY CHARGES
Revival. However, no interest shall be payable by Us on such restoration. APPLICABLE FEES/ CHARGES UNDER THE POLICY
3.3. If a Lapsed Policy is not revived within the Revival Period, this Policy will This Policy is a non-linked participating individual life insurance savings plan and
immediately and automatically terminate without value, on the expiry of therefore, Part E is not applicable to this Policy.
the Revival Period.
3.4 If a Policy under Reduced Paid Up Mode is not revived within the Revival PART F
Period, the Policy under Reduced Paid Up Mode cannot be revived and GENERAL TERMS AND CONDITIONS
will continue to be under Reduced Paid Up Mode for the remaining part 1. TAXES
of the Policy Term. 1.1. All Premiums are subject to applicable taxes, cesses, and levies, if any
3.5 For the avoidance of doubt, the Policy cannot be revived beyond the Policy which will entirely be borne by You and will always be paid by You along
Term. with the payment of Premium. If any imposition (tax, penalty or otherwise)
3.6 In addition to the revival provisions stated above, You may also be eligible is levied by any statutory or administrative body, We reserve the right to
to avail of one or more of the following revival schemes to revive Your claim the same from You. Alternatively, We have the right to deduct the
Policy amount from the benefits payable by Us under the Policy.
3.6.1. Reduction in the Sum Assured: You may be eligible to revive Your 1.2. Tax benefits may be available as per the prevailing tax laws. Tax laws
Policy by reducing the Sum Assured. Please contact Us for details and the benefits arising thereunder are subject to change. You are advised
on whether You are eligible for this revival scheme and, if so, the to seek an opinion of Your tax advisor in relation to the tax benefits and
extent to which the Sum Assured can be reduced, the total amount liabilities applicable to You.
required to be paid by You to revive the Policy and the applicable 1.3. The prevailing tax laws will be applicable on the payouts and accrued
terms and conditions for utilizing this revival scheme; benefits.
3.6.2. Change in the Premium Payment Term: You may be eligible to 2. CLAIM PROCEDURE
revive Your Policy by changing the Premium Payment Term. Please 2.1. For processing a claim request under this Policy, We will require all of the
contact Us for details on whether You are eligible for this revival following documents:
scheme and if so, the extent to which the Premium Payment Term 2.1.1. Death Claim documents: (a) Claimant's statement in the
can be changed, the total amount required to be paid by You prescribed form; (b) original Policy document; (c) copy of police
complaint/ first information report (in the case of death by accident

8 of 44
 or suicidal death of the Life Insured); (d) all medical/ hospital ix. Nuclear Contamination; the radio-active, explosive or hazardous nature of
records, in case of hospitalisation, (including diagnostic records) nuclear fuel materials or property contaminated by nuclear fuel materials
(e) copy of duly certified post mortem report (in the case of or accident arising from such nature
death by accident or suicidal death of the Life Insured); (f) copy 7. TRAVEL AND OCCUPATION
of death certificate issued by the local/municipal authority duly There are no restrictions on travel or occupation under this Policy.
attested by the Claimant; (g) self-attested copy of identity proof 8. NOMINATION
of the Claimants bearing their photographs and signatures; (h) Nomination is allowed as per Section 39 of the Insurance Act, 1938 as amended
bank account details of Claimant; and (i) any other document or from time to time. [A leaflet containing the simplified version of the provisions
information required by Us for assessing and approving the claim of the above section is enclosed in Annexure - 2 for reference]
request. 9. ASSIGNMENT
2.1.2. Maturity benefit claim documents: (a) NEFT Form (if not provided Assignment is allowed as per Section 38 of the Insurance Act, 1938 as amended
earlier); (b) cancelled cheque or copy of passbook with pre-printed from time to time. [A leaflet containing the simplified version of the provisions
name and bank account number, for payout through NEFT (if not of the above section is enclosed in Annexure - 3 for reference]
provided earlier); (c) self-attested copy of identity proof of the 10. POLICY CURRENCY
Claimants bearing their photographs and signatures This Policy is denominated in Indian Rupees. Any benefit/claim payments under
2.1.3. Survival Benefit documents: (a) NEFT Form (if not provided the Policy will be made in Indian Rupees by Us or in any other currency in
earlier); (b) cancelled cheque or copy of passbook with pre-printed accordance with the applicable guidelines issued by the Reserve Bank of India
name and bank account number, for payout through NEFT (if not from time to time.
provided earlier); (c) any other document or information required 11. ELECTRONIC TRANSACTIONS
by Us. You will comply with all the terms and conditions with respect to all transactions
2.2. A Claimant can download the claim request documents from Our website effected by or through facilities for conducting remote transactions including the
www.maxlifeinsurance.com or can obtain the same from any of Our internet, world wide web, electronic data interchange, call center, tele-service
branches or offices. operations or by other means of telecommunication established by Us or on Our
2.3. Subject to provisions of Section 45 of the Insurance Act, 1938 as amended behalf, for and in respect of the Policy or services, which will constitute legally
from time to time, We shall pay the benefits under this Policy subject to binding and valid transactions when executed in adherence to and in compliance
Our satisfaction: with the terms and conditions for such facilities.
2.3.1. that the benefits have become payable as per the terms and 12. AMENDMENT
conditions of this Policy; and No amendments to the Policy will be effective, unless such amendments are
2.3.2. of the bonafides and credentials of the Claimant. expressly approved in writing by Us and/or by the IRDAI wherever applicable.
2.4. Subject to Our sole discretion and satisfaction, in exceptional 13. REGULATORY AND JUDICIAL INTERVENTION
circumstances such as on happening of a force majeure event, We may If any competent regulatory body or judicial body imposes any condition on the
decide to waive all or any of the requirements set out in this Clause. Policy for any reason, We are bound to follow the same.
3. DECLARATION OF THE CORRECT AGE 14. COMMUNICATION AND NOTICES
Declaration of the correct Age and/ or gender of the Life Insured is important for 14.1. All notices meant for Us should be in writing and delivered to Our address
Our underwriting process and calculation of Premiums payable under the Policy. as mentioned in Part G or such other address as We may notify from time to
If the Age and/or gender declared in the Proposal Form is found to be incorrect time. You should mention the correct Policy number in all communications
at any time during the Policy Term or at the time of claim, We may exercise Our including communications with respect to Premium remittances made by
rights under Section 45 of the Insurance Act, 1938 as amended from time to time You.
or revise the Premium with interest and/or applicable benefits payable under 14.2. All notices meant for You will be in writing and will be sent by Us
the Policy in accordance with the Premium and benefits that would have been to Your address as shown in the Schedule or as communicated by You
payable, if the correct Age and/ or gender would have made the Life Insured and registered with Us. We may send You notices by post, courier,
eligible to be covered under the Policy on the Date of Commencement of Risk. hand delivery, fax or e-mail/electronic mode or by any other means as
4. FRAUD, MIS-STATEMENT AND FORFEITURE determined by Us. If You change Your address, or if the address of the
Fraud, mis-statement and forfeiture would be dealt with in accordance with Nominee changes, You must notify Us immediately. Failure in timely
provisions of Section 45 of the Insurance Act, 1938 as amended from time to notification of change of address could result in a delay in processing of
time. [A leaflet containing the simplified version of the provisions of the above benefits payable under the Policy.
section is enclosed in Annexure - 1 for reference] 14.3. For any updates, please visit Our website www.maxlifeinsurance.com.
5. SUICIDE EXCLUSION 15. GOVERNING LAW AND JURISDICTION
Notwithstanding anything stated herein, if the Life Insured commits suicide, The Policy will be governed by and enforced in accordance with the laws of
within 12 (Twelve) months from the Date of Commencement of Risk or from India. The competent courts in India will have exclusive jurisdiction in all
the date of Revival of this Policy, as applicable, all risks and benefits under this matters and causes arising out of the Policy.
Policy shall cease and the Policy shall terminate immediately and We shall only 16. ISSUANCE OF DUPLICATE POLICY
pay the following to the Claimant, provided that the Policy is in force: You may request for a duplicate copy of the Policy to Us along with relevant
5.1. Higher of (a) the Surrender Value as on the date of death or (b) the sum documents. Additional charges, not exceeding Rs.250/- may be applicable for
of Total Premiums Paid, loadings for modal premiums and Underwriting issuance of the duplicate Policy.
Extra Premium, if any, paid till the date of death, if the Policy has acquired
a Surrender Value; or PART G
5.2. Total Premiums Paid plus loadings for modal premiums and Underwriting GRIEVANCE REDRESSAL MECHANISM AND OMBUDSMAN DETAILS
Extra Premium, if any, received by Us, if the Policy has not acquired a .DISPUTE REDRESSAL PROCESS UNDER THE POLICY
Surrender Value. 1.1. All consumer grievances and/or queries may be first addressed to Your
6. EXCLUSIONS APPLICABLE TO ADDITIONAL ACCIDENTAL agent or Our customer helpdesk as mentioned below:
DEATH BENEFIT: a. Max Life Insurance Company Limited, Plot No. 90 C,
No benefits under additional Accidental Death benefit will be payable if Sector 18, Udyog Vihar, Gurugram-122015, Haryana, India,
death occurs from, or is caused by, either directly or indirectly, voluntarily or Helpline No.- 1860 120 5577 or (0124) 4219090, Email:
involuntarily due to or caused, occasioned, accelerated or aggravated by, any service.helpdesk@maxlifeinsurance.com, Or
one of the following: b. To any office of Max Life Insurance Company Limited.
i. Intentional self-inflicted injury, attempted suicide, while sane or insane; 1.2 . If Our response is not satisfactory or there is no response within 15 (Fifteen)
ii. Life Insured being under the influence of drugs, alcohol, narcotics or days:
psychotropic substances unless taken in accordance with the lawful 1.2.1. the complainant may file a written complaint with full details of the
directions and prescription of a doctor; complaint and the complainant's contact information to the following
iii. War, invasion, hostilities (whether war be declared or not), armed official for resolution:
or unarmed truce, civil war, mutiny, rebellion, revolution, insurrection, Grievance Redressal Officer,
military or usurped power, riot or civil commotion, strikes; Max Life Insurance Company Limited
iv. Taking part in any naval, military or air force operation during peace time Plot No. 90 C, Sector 18, Udyog Vihar,
or during service in any police, paramilitary or any similar organisation; Gurugram-122015, Haryana, India
v. Participation by the Life Insured in any flying activity, except as a bona Helpline No - 1860 120 5577 or (0124) 4219090
fide, fare-paying passenger of a recognized airline or Pilots and cabin crew Email - manager.services@maxlifeinsurance.com
of a commercial airline, on regular routes and on a scheduled timetable; 1.2.2. the complainant may approach the Grievance Cell of the IRDAI on
vi. Participation by the Life Insured in a criminal or unlawful act with illegal the following contact details:
or criminal intent; IRDAI Grievance Call Centre (IGCC)
vii. Any injury incurred before the Date of Commencement of Risk under the Toll Free No:155255 or 1800 4254 732
Policy; Email ID: complaints@irdai.gov.in
viii. Engaging in or taking part in professional sport(s) or any hazardous 1.2.3. the complainant can also register Your complaint online at
pursuits, including but not limited to, diving or riding or any kind of http://www.igms.irdai.gov.in/
race; underwater activities involving the use of breathing apparatus or not;
martial arts; hunting; mountaineering; parachuting; bungee-jumping;

9 of 44
 1.2.4. the complainant can also register Your complaint through fax/paper
by submitting Your complaint to:
Consumer Affairs Department
Insurance Regulatory and Development Authority of India
Sy No. 115/1, Financial District,
Nanakramguda,Gachibowli, Hyderabad - 500032
Ph: (040) 20204000
1.3. If the complainant are not satisfied with the redressal or there is no
response within a period of 1 (One) month, or within 1 year after
rejection of complaint by Us, the complainant may approach Insurance
Ombudsman at the address mentioned in Annexure A or on the IRDAI
website www.irdai.gov.in or on Council of Insurance Ombudsmen website
at www.cioins.co.in, if the grievance pertains to:
1.3.1 delay in settlement of a claim beyond the time specified in
the regulations, framed under the Insurance Regulatory and
Development Authority of India Act, 1999;
1.3.2. any partial or total repudiation of a claim by Us;
1.3.3. dispute over Premium paid or payable in terms of the Policy; or
1.3.4. misrepresentation of Policy terms and conditions at any time in the
Policy document or Policy contract;
1.3.5. legal construction of the Policy in so far as such dispute relates to
claim;
1.3.6 Policy servicing by Us, Our agents or intermediaries;
1.3.7. issuance of insurance Policy, which is not in conformity with the
Proposal Form submitted by You;
1.3.8. non issuance of any insurance document after receipt of the Premium.
1.3.9. Any other matter resulting from non-observance of or non-adherence
to the provisions of any regulations made by the IRDAI with regard
to protection of policyholders' interests or otherwise, or of any
circulars, guidelines or instructions issued by the IRDAI or of the
terms and conditions of the Policy contract, in so far as they relate to
issues mentioned in this para 1.3 above.
As per Rule 14 of the Insurance Ombudsman Rules, 2017, a complaint to
the Insurance Ombudsman can be made only within a period of 1 (One)
year after receipt of Our rejection of the representation or after receipt of
Our decision which is not to Your satisfaction or if We fail to furnish reply
after expiry of a period of one month from the date of receipt of the written
representation of the complainant, provided the complaint is not on the same
matter, for which any proceedings before any court, or consumer forum or
arbitrator is pending.

ENDORSEMENT

STAMP DUTY AMOUNT : `141.4

Paid by e-Stamps Certificate no. 145/Issue Date: 02-06-2023/Vide Treasury

(E-CHALLAN) GRN NO.103172818 for Rs. 50000000

R Krishnakumar
Authorized Signatory

10 of 44
 Annexure 1 the nature of his title. 14. If nominee(s) die after the policyholder but before his
Section 45 - Policy shall not be called in question on the ground of share of the amount secured under the policy is paid, the share of the expired
mis-statement after three years nominee(s) shall be payable to the heirs or legal representative of the nominee
Provisions regarding policy not being called into question in terms of Section 45 or holder of succession certificate of such nominee(s). 15.The provisions of
of the Insurance Act, 1938, as amended from time to time are as follows: 1. No sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance policies
Policy of Life Insurance shall be called in question on any ground whatsoever maturing for payment after the commencement of Insurance Laws (Amendment)
after expiry of 3 yrs from a. the date of issuance of policy or b. the date of Act 2015.16.If policyholder dies after maturity but the proceeds and benefit of
commencement of risk or c. the date of revival of policy or d. the date of rider the policy has not been paid to him because of his death, his nominee(s) shall be
to the policy, whichever is later. 2.On the ground of fraud, a policy of Life entitled to the proceeds and benefit of the policy.17.The provisions of Section
Insurance may be called in question within 3 years from a. the date of issuance 39 are not applicable to any life insurance policy to which Section 6 of Married
of policy or b. the date of commencement of risk or c. the date of revival of Women's Property Act, 1874 applies or has at any time applied except where
policy or d. the date of rider to the policy, whichever is later. For this, the before or after Insurance Act, 1938 as amended from time to time, a nomination
insurer should communicate in writing to the insured or legal representative is made in favour of spouse or children or spouse and children whether or not
or nominee or assignees of insured, as applicable, mentioning the ground and on the face of the policy it is mentioned that it is made under Section 39. Where
materials on which such decision is based. 3. Fraud means any of the following nomination is intended to be made to spouse or children or spouse and children
acts committed by insured or by his agent, with the intent to deceive the insurer under Section 6 of MWP Act, it should be specifically mentioned on the policy.
or to induce the insurer to issue a life insurance policy: a. The suggestion, as In such a case only, the provisions of Section 39 will not apply.
a fact of that which is not true and which the insured does not believe to be [Disclaimer: This is only a simplified version prepared for general
true; b. The active concealment of a fact by the insured having knowledge or information. You are advised to refer to the Insurance Act 1938 as amended
belief of the fact; c. Any other act fitted to deceive; and d. Any such act or from time to time for complete and accurate details.]
omission as the law specifically declares to be fraudulent. 4.Mere silence is Annexure 3
not fraud unless, depending on circumstances of the case, it is the duty of the Section 38 - Assignment and Transfer of Insurance Policies
insured or his agent keeping silence to speak or silence is in itself equivalent Assignment or transfer of a policy should be in accordance with Section 38 of
to speak. 5. No Insurer shall repudiate a life insurance policy on the ground the Insurance Act, 1938 as amended from time to time. The extant provisions
of fraud, if the insured / beneficiary can prove that the misstatement was true in this regard are as follows:1.This policy may be transferred/assigned, wholly
to the best of his knowledge and there was no deliberate intention to suppress or in part, with or without consideration.2.An Assignment may be effected in a
the fact or that such mis-statement of or suppression of material fact are within policy by an endorsement upon the policy itself or by a separate instrument under
the knowledge of the insurer. Onus of disproving is upon the policyholder, if notice to the Insurer.3.The instrument of assignment should indicate the fact of
alive, or beneficiaries. 6.Life insurance Policy can be called in question within transfer or assignment and the reasons for the assignment or transfer, antecedents
3 years on the ground that any statement of or suppression of a fact material to of the assignee and terms on which assignment is made.4.The assignment must
expectancy of life of the insured was incorrectly made in the proposal or other be signed by the transferor or assignor or duly authorized agent and attested by at
document basis which policy was issued or revived or rider issued. For this, least one witness.5.The transfer or assignment shall not be operative as against
the insurer should communicate in writing to the insured or legal representative an insurer until a notice in writing of the transfer or assignment and either the
or nominee or assignees of insured, as applicable, mentioning the ground and said endorsement or instrument itself or copy there of certified to be correct by
materials on which decision to repudiate the policy of life insurance is based.7.In both transferor and transferee or their duly authorised agents have been delivered
case repudiation is on ground of mis-statement and not on fraud, the premium to the insurer.6.Fee to be paid for assignment or transfer can be specified by
collected on policy till the date of repudiation shall be paid to the insured or legal the Authority through Regulations.7.On receipt of notice with fee, the insurer
representative or nominee or assignees of insured, within a period of 90 days should Grant a written acknowledgement of receipt of notice. Such notice shall
from the date of repudiation.8.Fact shall not be considered material unless it has be conclusive evidence against the insurer of duly receiving the notice.8.If the
a direct bearing on the risk undertaken by the insurer. The onus is on insurer to insurer maintains one or more places of business, such notices shall be delivered
show that if the insurer had been aware of the said fact, no life insurance policy only at the place where the policy is being serviced.9.The insurer may accept
would have been issued to the insured. 9. The insurer can call for proof of age at or decline to act upon any transfer or assignment or endorsement, if it has
any time if he is entitled to do so and no policy shall be deemed to be called in sufficient reasons to believe that it is a. not bonafide; b. not in the interest of
question merely because the terms of the policy are adjusted on subsequent proof the policyholder; c. not in public interest; or d.is for the purpose of trading of
of age of life insured. So, this Section will not be applicable for questioning age the insurance policy.10.Before refusing to act upon endorsement, the insurer
or adjustment based on proof of age submitted subsequently. should record the reasons in writing and communicate the same in writing
[Disclaimer: This is only a simplified version prepared for general to policyholder within 30 days from the date of policyholder giving a notice
information. You are advised to refer to the Insurance Act 1938 as amended of transfer or assignment.11.In case of refusal to act upon the endorsement
from time to time for complete and accurate details.] by the insurer, any person aggrieved by the refusal may prefer a claim to
Annexure 2 IRDAI within 30 days of receipt of the refusal letter from the insurer.12.The
Section 39 - Nomination by Policyholder priority of claims of persons interested in an insurance policy would depend
Nomination of a life insurance policy is as below in accordance with Section 39 on the date on which the notices of assignment or transfer is delivered to the
of the Insurance Act, 1938 as amended from time to time. The extant provisions insurer; where there are more than one instruments of transfer or assignment,
in this regard are as follows: 1. The policyholder of a life insurance policy on the priority will depend on dates of delivery of such notices. Any dispute in this
his own life may nominate a person or persons to whom money secured by the regard as to priority should be referred to the Authority.13.Every assignment or
policy shall be paid in the event of his death. 2. Where the nominee is a minor, transfer shall be deemed to be absolute assignment or transfer and the assignee
the policyholder may appoint any person to receive the money secured by the or transferee shall be deemed to be absolute assignee or transferee, except a.
policy in the event of policyholder's death during the minority of the nominee. where assignment or transfer is subject to terms and conditions of transfer or
The manner of appointment is to be laid down by the insurer. 3. Nomination assignment OR b. where the transfer or assignment is made upon condition
can be made at any time before the maturity of the policy. 4. Nomination may that i. the proceeds under the policy shall become payable to policyholder or
be incorporated in the text of the policy itself or may be endorsed on the policy nominee(s) in the event of assignee or transferee dying before the insured; or
communicated to the insurer and can be registered by the insurer in the records ii. the insured surviving the term of the policy. Such conditional assignee will
relating to the policy. 5. Nomination can be cancelled or changed at any time not be entitled to obtain a loan on policy or surrender the policy. This provision
before policy matures, by an endorsement or a further endorsement or a will as will prevail notwithstanding any law or custom having force of law which is
the case may be. 6. A notice in writing of change or cancellation of nomination contrary to the above position.14In other cases, the insurer shall, subject to terms
must be delivered to the insurer for the insurer to be liable to such nominee. and conditions of assignment, recognize the transferee or assignee named in the
Otherwise, insurer will not be liable if a bonafide payment is made to the person notice as the absolute transferee or assignee and such persona shall be subject
named in the text of the policy or in the registered records of the insurer. 7. Fee to to all liabilities and equities to which the transferor or assignor was subject to at
be paid to the insurer for registering change or cancellation of a nomination can the date of transfer or assignment; b. may institute any proceedings in relation
be specified by the Authority through Regulations. 8. On receipt of notice with to the policy; and c. obtain loan under the policy or surrender the policy without
fee, the insurer should grant a written acknowledgement to the policyholder of obtaining the consent of the transferor or assignor or making him a party to the
having registered a nomination or cancellation or change thereof. 9. A transfer proceedings15.Any rights and remedies of an assignee or transferee of a life
or assignment made in accordance with Section 38 shall automatically cancel insurance policy under an assignment or transfer effected before commencement
the nomination except in case of assignment to the insurer or other transferee of the Insurance Laws (Amendment) Act, 2015 shall not be affected by this
or assignee for purpose of loan or against security or its reassignment after section.
repayment. In such case, the nomination will get affected to the extent of [Disclaimer: This is only a simplified version prepared for general
insurer's or transferee's or assignee's interest in the policy. The nomination will information. You are advised to refer to the Insurance Act, 1938 as amended
get revived on repayment of the loan.10.The right of any creditor to be paid from time to time for complete and accurate details.]
out of the proceeds of any policy of life insurance shall not be affected by the
nomination.11.In case of nomination by policyholder whose life is insured, if the
nominees die before the policyholder, the proceeds are payable to policyholder
or his heirs or legal representatives or holder of succession certificate.12.In case
nominee(s) survive the person whose life is insured, the amount secured by the
policy shall be paid to such survivor(s). 13. Where the policyholder whose life
is insured nominates his a. parents or b. spouse or c. children or d. spouse and
children e. or any of them, the nominees are beneficially entitled to the amount
payable by the insurer to the policyholder unless it is proved that policyholder
could not have conferred such beneficial title on the nominee having regard to

11 of 44
PART A

Welcome to Max Life Insurance

--------------------------------------------------------------------------------------------------------------------------------------------------
Date 21-Jun-2023
To Mr. Sher Singh
139/A/B Ananda Super City
Dohra Road
Bareilly
Bareilly 243006
Uttar Pradesh India

Branch: EBRL1
Policy no.: 144887924
Telephone: 9897848677, --
Email id: SSSBHARTI1508@GMAIL.COM
--------------------------------------------------------------------------------------------------------------------------------------------------
Welcome Dear Mr. Sher Singh,
Thank you for opting for Max Life Critical Illness and Disability Rider (Non-Linked Non-Participating Individual Pure
Risk Premium Health Insurance Rider). We request you to go through the enclosed Rider.
--------------------------------------------------------------------------------------------------------------------------------------------------
What to do in On examination of the Rider (enclosed herewith), if you notice any mistake or error, proceed as follows:
case of errors 1. Contact our customer helpdesk or your agent immediately at the details mentioned below.
2. Return the Rider to us for rectifying the same.
--------------------------------------------------------------------------------------------------------------------------------------------------
Cancelling the In case You are not satisfied with the Rider, You have the option to cancel it by returning the original copy with a written
Rider request, stating the objections/ reasons for such disagreement, to us within 15 days , from the date of receiving the Rider
document.

Result: Upon return, the Rider shall terminate forthwith and all rights, benefits and interests under the Rider shall cease
immediately. We will only refund the Rider Premiums received by Us, after deducting the proportionate risk Rider premium
for the period of cover, charges of stamp duty paid and the expenses incurred on medical examination of the Life Insured,
if any.
--------------------------------------------------------------------------------------------------------------------------------------------------
Long term We are committed to giving you honest advice and offering you long-term savings, protection and retirement solutions
protection backed by the highest standards of customer service. We will be delighted to offer you any assistance or clarification you
may require about your Rider or claim-related services at the address mentioned below. We look forward to being your
partner for life.

Yours Sincerely,

Max Life Insurance Co. Ltd.

R Krishnakumar
Executive Vice President - Head of Operations

AGENT/ INTERMEDIARY/ RELATIONSHIP MANAGER NAME : RISHABH

SARIN (909174), PH NO.: 8077624761, ADDRESS: Max Life Insurance Co. Ltd.,
2nd Floor,Main Commercial, Plot No. 54, Civil Lines, Ayub Khan Chauraha,
Chaupla Road, Bareilly-243001,

Max Life Insurance Company Limited

Plot No. 90 C, Sector 18, Udyog Vihar, Gurugram-122015, Haryana, India
Phone 4219090 Fax 4159397 (From Delhi and Other cities: 0124) Customer Helpline: 1860 120 5577
Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144 533
Visit Us at: www.maxlifeinsurance.com E-mail: service.helpdesk@maxlifeinsurance.com
IRDAI Registration No: 104
Corporate Identity Number: U74899PB2000PLC045626

12 of 44
 RIDER PREAMBLE

MAX LIFE INSURANCE COMPANY LIMITED

Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144533

Max Life Critical Illness and Disability Rider

(Non-Linked Non-Participating Individual Pure Risk Premium Health Insurance Rider)
UIN: 104B033V01

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

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

Max Life Insurance Company Limited

Place of Issuance: Gurugram, Haryana

13 of 44
 CUSTOMER INFORMATION SHEET- Max Life Critical Illness and Disability Rider (Non-Linked
Non-Participating Individual Pure Risk Premium Health Insurance Rider) Unique Identification No. [104B033V01]

Sl. Refer to Policy

Title Description
No. Clause Number
1 Product Name Max Life Critical Illness and Disability Rider Rider document
In case, anytime during the Rider Term, after completion of the Waiting Period, the Life Insured is Diagnosed with: Part C - Clause 1.A

1. Any of the Major Critical Illness, as per the Variant chosen by You (i.e. Gold Variant, Gold Plus Variant, Platinum Variant
or Platinum Plus Variant) and upon the Life Insured surviving through the Survival Period, we shall pay the applicable
Rider Sum Assured.
2. A Minor Critical Illness, as per the Variant chosen by You (i.e. Gold Variant, Gold Plus Variant, Platinum Variant or
Platinum Plus Variant) and upon the Life Insured surviving through the Survival Period, we will pay 25% of the Rider
What am I Sum Assured Or Rs.5 lacs, whichever is lower. In case of Gold or Gold Plus Variant, a Minor Critical Illness claim for
2 Angioplasty only shall be allowed. Whereas, in case of Platinum or Platinum Plus Variant, maximum of three claims
covered for
towards five different Minor Critical Illness conditions can be made. There shall be cooling off period of one year between
the date of the Diagnosis of two Minor Critical Illness.
Note: Multiple claims against the same Critical Illness are not allowed.
(Refer to Rider terms and conditions for list of Critical Illnesses covered)
And/ Or
3. Total and Permanent Disability, as per the Variant chosen by You (i.e. Gold Plus Variant, Platinum Plus Variant and Total
or Permanent Disability Variant) we shall pay the applicable Rider Sum Assured.
(Refer to Rider terms and conditions for list of Total and Permanent Disability covered)
Critical Illnesses Exclusions: In addition of the exclusions covered in the Rider contract and against each Critical Illness, Part C - Clause
following key exclusions shall be applicable if the covered Critical Illness results directly or indirectly from any one of the 1.A.viii.c
following clauses. For all such exclusions, the Claimant will not be entitled to any benefit under this Rider:
1. Any illness, sickness or disease other than those specified as Critical Illnesses under this Policy.
2. Any Pre-Existing Diseases. However, coverage under the Rider after the expiry of 48 months for any Pre-Existing Disease
is subject to the same being declared at the time of application and accepted by Us.
3. Any Critical Illness directly or indirectly caused due to treatment for, alcoholism, drug or substance abuse or any
addictive condition and consequences thereof.
4. Narcotics used by the Life Insured unless taken as prescribed by a Medical Practitioner.
5. Any Critical Illness directly or indirectly caused due to intentional self-injury, suicide or attempted suicide, whether the
person is medically sane or insane.
6. Any Critical Illness directly or indirectly, caused by or arising from or attributable to a foreign invasion, act of foreign
enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of
any country during war or at peace time), civil war, public defense, rebellion, revolution, insurrection, military or usurped
power.
7. Any Critical Illness caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or
hazardous form) or from any nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack.
8. Working in underground mines, tunneling or involving electrical installations with high tension supply, or as race jockeys
or circus personnel.
9. Congenital External Anomalies, inherited disorders or any complications or conditions arising therefrom including any
developmental conditions of the Insured.
10. Any Critical Illness directly or indirectly caused by any treatment necessitated due to participation as a professional in
hazardous or adventure sport, including but not limited to, para jumping, rock climbing, mountaineering, rafting, motor
racing, horse racing or scuba diving, hand gliding, sky diving, deep sea diving and selfie accident.
11. Participation by the Life Insured in any flying activity, except as a bona fide, fare paying passenger of a recognized airline
on regular routes and on a scheduled timetable.
12. Any Critical Illness directly or indirectly, caused by Medical treatment traceable to childbirth (including complicated
deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy. Any Critical Illness due to
miscarriages (unless due to an accident) and lawful medical termination of pregnancy during the policy period.
13. Any Critical Illness directly or indirectly, caused by any unproven/ experimental treatment, service and supplies for or
What are in connection with any treatment. Unproven/ experimental treatments are treatments, procedures or supplies that lack
the major significant medical documentation to support their effectiveness.
3 14. Any Critical Illness based on certification/Diagnosis/treatment from persons not registered as Medical Practitioners, or
exclusions
in the Rider from a Medical Practitioner who is practicing outside the discipline that he/she is licensed for.
15. Any Critical Illness directly or indirectly, caused due to any treatment, including surgical management, to change
characteristics of the body to those of opposite sex.
16. Any Critical Illness directly or indirectly, caused due to cosmetic or plastic surgery or any treatment to change the
appearance unless for reconstruction following an Accident, Burn(s), or Cancer or as part of medically necessary treatment
to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be
certified by the attending Medical Practitioner.
17. Any Critical Illness directly or indirectly, caused due to surgical treatment of obesity that does not fulfil all the below
conditions:
a. Surgery to be conducted is upon the advice of the Doctor
b. The Surgery / Procedure conducted should be supported by clinical protocols
c. The Life Insured is 18 years of age or older and
d. Body Mass Index (BMI):
• greater than or equal to 40 or
• greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
i. Obesity related cardiomyopathy
ii. Coronary heart disease
iii. Severe sleep apnea
iv. Uncontrolled Type 2 Diabetes despite optimal therapy
18. Any Critical Illness directly or indirectly, caused due to treatments received in health hydros, nature cure clinics, spas or
similar establishments or private beds registered as a nursing home attached to such establishments or where admission
is arranged wholly or partly for domestic reason.
19. Any Critical Illness directly or indirectly, caused by treatment directly arising from or consequent upon any Life Insured
committing or attempting to commit a breach of law with criminal intent.
20. In the event of the death of the Life Insured within the stipulated Survival Period as set out above.
21. Any Critical Illness directly or indirectly, caused sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproductive services including artificial insemination and advanced reproductive technologies such as IVF,
ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization

(LEGAL DISCLAIMER NOTE): The information must be read in conjunction with the product brochure and policy document. In case of any conflict between CIS and the policy
document the terms and conditions mentioned in the policy document shall prevail.

14 of 44
 Total and Permanent Disability Exclusions: In addition of the exclusions covered in the Rider contract and against each Part C - Clause 1.B.ii
Critical Illness, following key exclusions shall be applicable if the covered Total and Permanent Disability results directly
or indirectly from any one of the following clauses. For all such exclusions, the Claimant will not be entitled to any benefit
under this Rider:

1. No benefit towards Total and Permanent Disability benefit shall be payable if any Total and Permanent Disability occurs
within the Waiting Period. In such case this Rider will terminate and We will refund the Rider Premium paid
corresponding to the Rider benefit. However, no Waiting Period will be applicable in case of any Total and Permanent
Disability occurring solely due to an Accident.
2. Any Pre-Existing Diseases. However, coverage under the Rider after the expiry of 48 months for any Pre-Existing Disease
is subject to the same being declared at the time of application and accepted by Us.
3. Any disability directly or indirectly caused due to treatment for, alcoholism, drug or substance abuse or any addictive
condition and consequences thereof.
4. Narcotics used by the Life Insured unless taken as prescribed by a Medical Practitioner.
5. Any disability directly or indirectly caused due to intentional self-injury, suicide or attempted suicide, whether the person
is medically sane or insane.
6. Any disability directly or indirectly, caused by or arising from or attributable to a foreign invasion, act of foreign enemies,
hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country
during war or at peace time), civil war, public defense, rebellion, revolution, insurrection, military or usurped power.
7. Service in any military, air-force, naval, paramilitary or similar organization.
8. Any disability caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous
form) or from any nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack.
9. Working in underground mines, tunneling or involving electrical installations with high tension supply, or as race jockeys
or circus personnel.
10. Congenital External Anomalies, inherited disorders or any complications or conditions arising therefrom including any
developmental conditions of the Insured.
11. Any disability directly or indirectly caused by any treatment necessitated due to participation as a professional in hazardous
or adventure sport, including but not limited to, para jumping rock climbing, mountaineering, rafting, motor racing, horse
racing or scuba diving, hand gliding, sky diving, deep sea diving and selfie accidents.
12. Participation by the Life Insured in any flying activity, except as a bona fide, fare-paying passenger of a recognized airline
on regular routes and on a scheduled timetable.
13. Any disability directly or indirectly, caused by medical treatment traceable to childbirth (including complicated deliveries
and caesarean sections incurred during hospitalization) except ectopic pregnancy. Any disability due to miscarriages (unless
due to an accident) and lawful medical termination of pregnancy during the policy period.
14. Any disability directly or indirectly, caused by any unproven/ experimental treatment, service and supplies for or in
connection with any treatment. Unproven/ experimental treatments are treatments, procedures or supplies that lack
significant medical documentation to support their effectiveness.
15. Any disability based on certification/Diagnosis/treatment from persons not registered as Medical Practitioners, or from a
Medical Practitioner who is practicing outside the discipline that he/ she is licensed for.
16. Any disability directly or indirectly, caused due to any treatment, including surgical management, to change characteristics
of the body to those of opposite sex.
17. Any disability directly or indirectly, caused due to cosmetic or plastic surgery or any treatment to change the appearance
unless for reconstruction following an Accident, Burn(s), or Cancer or as part of medically necessary treatment to remove
a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
18. Any disability directly or indirectly, caused due to surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Doctor
b. The surgery / procedure conducted should be supported by clinical protocols
c. The Life Insured is 18 years of age or older and
d. Body Mass Index (BMI):
• greater than or equal to 40 or
• greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
i. Obesity related cardiomyopathy
ii. Coronary heart disease
iii. Severe sleep apnea
iv. Uncontrolled Type 2 Diabetes despite optimal therapy
19. Any disability directly or indirectly, caused due to treatments received in health hydros, nature cure clinics, spas or similar
establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged
wholly or partly for domestic reason.
20. Any disability directly or indirectly, caused by treatment directly arising from or consequent upon any Life Insured
committing or attempting to commit a breach of law with criminal intent.
21. In the event of the death of the Life Insured within a period of 6 (Six) consecutive months from the date of Diagnosis
or Accident.
22. Any disability directly or indirectly, caused by sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproductive services including artificial insemination and advanced reproductive technologies such as IVF,
ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
Waiting Period: A 90 (Ninety) days from the Date of Issuance of Rider / Revival, in case of a Major Critical Illness / Total Part B - Clause 47
and Permanent Disability claim and 180 (One Hundred Eighty) days from the Date of Issuance of Rider / Revival, in case
Waiting
4 of Minor Critical Illness claim
Period
Survival Period: Benefits under this Rider will be payable only if the Insured survives for a period of 14 (Fourteen) days from Part B - Clause 41
the date of Diagnosis of a Critical Illness.
Applicable Rider Sum assured to be paid upon Diagnosis of the Critical Illness or Total and Permanent Disability. Part C - Clause 1
Payment
5 No benefit is payable on Death of Life Insured. Part C - Clause 2
Basis
No maturity benefit is payable under this Rider. Part C - Clause 3

6 Loss Sharing Not applicable -

The Premium and Rider Sum Assured under this Rider are guaranteed only for a period of 10 years from the Date of Part C - Clause 4.6
Renewal Commencement of Risk Under Rider and may be revised thereafter by Us by seeking prior approval from IRDAI. In cases
7
Conditions where revision is done after the end of Rider Premium Payment Term, Rider Sum Assured shall be adjusted to allow for the
revision in the Premium and that such revision may be upwards or downwards.

Renewal To promote good health and wellbeing of the Life Insured, a wellness program is offered to the Life Insured for the first 5 Part C - Clause 1.C
8 years of Rider Term wherein wherein discount on renewal premium for first five Rider Years, is provided basis number of and Clause 4.5
Benefits
Healthy Weeks accumulated.
(LEGAL DISCLAIMER NOTE): The information must be read in conjunction with the product brochure and policy document. In case of any conflict between CIS and the policy
document the terms and conditions mentioned in the policy document shall prevail.

15 of 44
 9 Cancellation Freelook cancellation, death of the Life Insured, Critical Illness occurring within Waiting Period, payment of Rider Sum Part D - Clause 6
Assured, on expiration, cancellation or termination or surrender of the Rider or Base Policy
10 Claims Claim form and required documents to be submitted Part F - Clause 4

Policy Refer Base Policy terms for details: you may register your complaints Part G
Servicing/ 1. contact Your agent;
11 2. Write to https://www.maxlifeinsurance.com or call Grievance Redressal Officer at - (0124) 4219090.
Grievances/
Complaints 3. IRDAI http://www.igms.irda.gov.in/
4. Insurance Ombudsman http://ecoi.co.in/ombudsman.html
Freelook: 15 (Fifteen) days (30 days if the Rider is obtained through distance marketing modes) Part D - Clause 6
Grace Period: You are provided with a Grace Period, as provided to you under the Base policy. Part B - Clause 17
Part C - Clause 6
Insured's
12 Revival: You can revive a Lapsed Rider only if the Base Policy has been revived. Part D - Clause 3
Rights
Surrender: You may surrender the Rider any time, however You will be eligible to get the Exit Value only if Part D - Clause 1
1. you have paid full annualised premium for the first two Rider Years; and
2. You have opted for a limited Premium payment variant of this Rider
Disclosures: You are required to make true and accurate disclosures to the questions asked in the proposal form. Part F - Clause 5
Insured's Non/ Inaccurate disclosure may result in claim not being paid.
13
Obligations Payment of premium: You are required to pay the due Premium under the Rider, as per the schedule, in order to get benefit
under the Rider.

(LEGAL DISCLAIMER NOTE): The information must be read in conjunction with the product brochure and policy document. In case of any conflict between CIS and the policy
document the terms and conditions mentioned in the policy document shall prevail.

16 of 44
 RIDER SCHEDULE

Base Policy Name - Max Life Smart Wealth Advantage Growth Par Type of Base Policy - A Non-Linked Participating Individual Life
Plan Insurance Savings Plan
Policy UIN - 104N135V01 Office - Max Life Agency Distribution Bareilly 1
Rider Name - Max Life Critical Illness and Disability Rider Type of Rider - Non-Linked Non-Participating Individual Pure Risk
Premium Health Insurance Rider
Rider UIN - 104B033V01
Policy No./ Proposal No.: 144887924 Client ID: 1833083345
Date of Proposal: 13-Jun-2023
Policyholder/ Proposer : Mr. Sher Singh Gender: Male
PAN: ARQPS3623N
Identification Source & I.D No.: NA Tel No./Mobile No.: / 9897848677

Relationship with Life Insured: Same Person

Email: SSSBHARTI1508@GMAIL.COM
Date of Birth: 15-Aug-1974
Address(For all communication purposes): 139/A/B Ananda
Super City
Dohra Road Bareilly
Bareilly 243006
Uttar Pradesh India
Life Insured: Mr. Sher Singh Gender: Male
Date of Birth: 15-Aug-1974
Age: 48 Years
Address: 139/A/B Ananda Super City
Dohra Road Bareilly
Bareilly 243006
Uttar Pradesh India
Nominee(s): Guardian (if Nominee is minor):
Nominee (s)Name Relationship Date of Birth Age: % N.A.
of Nominee(s) of Nominee: share
with
Policyholder:
Kumari Seema Wife 01-Jul-1986 36 100

Date of Commencement of Risk under Rider: 12-Jun-2023 Premium payment mode: Semi-Annual
Date of Issuance of Rider: 12-Jun-2023 Coverage Variant chosen: Platinum Plus Variant
Premium Payment Method: ECS Bill Draw Date: 12TH
Bank Account Number: 000400320002935
Agent/ Intermediary/ Relationship Manager name: RISHABH Agent's code/ Intermediary code: 909174
SARIN Agent's/ Intermediary License No.: MAX909174
Email: rishabh.sarin@maxlifeinsurance.com Mobile/Landline Telephone Number: 8077624761,
Address:Max Life Insurance Co. Ltd., 2nd Floor,Main Commercial,
Plot No. 54, Civil Lines, Ayub Khan Chauraha, Chaupla Road
Bareilly 243001

Details of Sales Personnel (for direct sales only): Agent's code/ INTERMEDIARY code: 909174
Agent/ Intermediary/ Relationship Manager name: RISHABH Email: rishabh.sarin@maxlifeinsurance.com
SARIN

17 of 44
 List of Maturity Date Insured Event Rider Sum Rider Term Rider Annualised Underwriting GST** and Modal Factors Total Rider Due Date
Coverage Assured Premium Premium* Extra Premium any other taxes, D Premium along when Rider
(INR) Payment A B cesses & levies with applicable Premium is
Term (INR) (INR) C taxes, cesses and payable/Date
(INR) levies payable when the Last
as per Premium Premium
payment is payable
mode selected
E=
[(A+B+C)*D]
(INR)

Max Life 12th of Jun &

Critical 12-JUN-2040 As per Section 3,00,000.00 17 12 NA 955.80 .51 3,195.55 Dec Every Year;
Illness and 1 of Part C 5,310.00
Disability Rider 12-Dec-2034

* The Premium and Rider Sum Assured under this Rider are guaranteed only for a period of 10 years from the Date of Commencement of Risk Under Rider and may be revised thereafter by Us
by seeking prior approval from IRDAI (Please refer to Clause 4.6 of Part C of this Rider). Note that in cases where revision is done after the end of Rider Premium Payment Term, Rider Sum
Assured shall be adjusted to allow for the revision in the Premium.

**GST includes IGST, SGST, CGST, UGST (whichever is applicable) and applicable cesses.

18 of 44
PART - B or Council for Indian Medicine or for homeopathy set up by the Government of
DEFINITIONS APPLICABLE TO YOUR RIDER India or by a State Government and is thereby entitled to practice medicine within
The words and phrases listed below will have the meanings attributed to them wherever its jurisdiction; and is acting within the scope and jurisdiction of license, provided
they appear in this Rider unless the context otherwise requires. The terms used in this such Medical Practitioner is not You, the Life Insured covered under this Policy or
Rider but not defined will derive their meaning from the Policy. a spouse, Your lineal relative and/or of the Life Insured or a Medical Practitioner
1. "Accident" or "Accidental" means a sudden, unforeseen and involuntary event employed by You/the Life Insured;
caused by external, visible and violent means; 25. "Modal Factor" means the applicable factor as specified in the Base Policy, which
2. "Accidental Injury" means bodily injury of the Life Insured caused solely, directly is used to determine the Premium, as per the frequency of premium opted by You;
and independently of any other intervening causes from an Accident. 26. "Nominee" means nominee nominated by You (only if You are the Life Insured)
3. "Activities of Daily Living" means and includes the following: under the Base Policy, in accordance with Section 39 of Insurance Act, 1938 as
i. Washing: the ability to wash in the bath or shower (including getting into and amended from time to time, to receive the benefits under the Rider and whose name
out of the bath or shower) or wash satisfactorily by other means is mentioned in the Schedule;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as 27. "Platinum Variant" means coverage variant under this Rider, to be chosen by You
appropriate, any braces, artificial limbs or other surgical appliances at the Date of Commencement of Risk under Rider, wherein the benefit shall be
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair payable in the event the Life Insured is Dignosed with any of the 64 Critical Illnesses
and vice versa (5 Minor Critical Illness, 59 Major Critical Illness) as mentioned in Clause 1 of
iv. Mobility: the ability to move indoors from room to room on level surfaces Part-C, to this Rider;
v. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder 28. "Platinum Plus Variant" means a coverage variant under this Rider, to be chosen
functions so as to maintain a satisfactory level of personal hygiene by You at the Date of Commencement of Risk under Rider, wherein the benefit shall
vi Feeding: the ability to feed oneself once food has been prepared and made be payable in the event of earlier of the Life Insured suffers Total and Permanent
available; Disability or is Dignosed with any of the 64 Critical Illnesses (5 Minor Critical
4. "Age" means the Life Insured's age on last birthday as on the Date of Illness, 59 Major Critical Illness) as mentioned in Clause 1 of Part-C, to this Rider;
Commencement of Risk under Rider or on the previous Policy Anniversary, as the 29. "Pre-existing diseases" means any condition, ailment or injury, disease, Critical
case may be; Illness / disability
5. "Annualised Premium" is the amount specified in the Schedule, and means Rider a.) That is/are Diagnosed by a Medical Practitioner within 48 months prior to the
Premium amount payable in a Policy Year chosen by You, excluding Underwriting Date of Commencement of Risk under Rider or its reinstatement; or
Extra Premium, loadings for modal premiums and applicable taxes, cesses or levies, b.) For which medical advice or treatment was recommended by, or received from
if any; a Medical Practitioner within 48 months Prior to the Date of Commencement of
6. "Base Policy" means the policy to which this Rider is attached and forms part of; Risk under Rider, or its reinstatement;
7. "Claimant" means You, Nominee(s) (if valid nomination is effected), assignee(s) 30. "Regular Premium Payment Variant" means where the Rider Premium Payment
or their heirs, legal representatives or holders of a succession certificates in case Term is same as Policy Term;
Nominee(s) or assignee(s) is/are not alive at the time of claim; 31. "Revival" means restoration by Us of the Rider, which was discontinued due to
8. "Critical Illness" means the first time Diagnosis of the Life Insured with any of the non-payment of Rider Premium, with all the benefits stated in the Rider, upon the
illnesses or the first performance of any of the certain medical procedures/surgeries, receipt of all the due Rider Premiums and other charges / late fee as provided in
as enlisted in Clause 1 of Part-C to this Rider, by a Medical Practitioner in respect of Clause 3 of Part D of the Rider;
the Life Insured, during his lifetime. The same has been divided into two categories, 32. "Revival Period" means a such period, as specified under Base Policy, from the
i.e: due date of the first unpaid Rider Premium, during which period You are entitled to
i. "Minor Critical Illness" which includes those Critical Illnesses mentioned at revive the Rider which was discontinued due to the non-payment of Rider Premium;
serial number 1-5 in Clause 1 of Part-C; and; 33. "Rider" means this rider contract containing these terms and conditions;
ii. "Major Critical Illness" which includes those Critical Illnesses mentioned at 34. "Rider Anniversary" means the annual anniversary of the Date of Commencement
serial number 6-64 in Clause 1 of Part-C; of Risk under Rider;
9. "Date of Commencement of Risk under Rider" means the date as specified in the 35. "Rider Premium" means an amount specified in the Schedule, payable by You,
Schedule, on which the coverage under this Rider commences; by the due dates to secure the benefits under the Rider, excluding applicable taxes,
10. "Date of Issuance of Rider" means the date as specified in the Schedule, on which cesses and levies, if any;
this Rider has been issued; 36. "Rider Premium Payment Term" means the term as specified in the Schedule
11. "Diagnosis" or "Diagnosed" means the definitive diagnosis made by a Medical during which the Rider Premium under the Rider is to be paid by You;
Practitioner during Rider Term, based upon radiological, clinical, and histological or 37. "Rider Sum Assured" means the maximum amount of benefit payable under this
laboratory evidence acceptable to Us provided the same is acceptable and concurred Rider, as specified in the schedule. The Rider Sum Assured shall in no case exceed
by Our appointed Medical Practitioner. In the event of any doubt regarding the the sum assured under the Base Policy;
appropriateness or correctness of the Diagnosis, We will have the right to call for 38. "Rider Term" means the term of this Rider as specified in the Schedule;
an examination of the Life Insured and/or the evidence used in arriving at such 39. "Rider Year" means a period of 12 (Twelve) months commencing from the Date
Diagnosis, by an independent expert selected by Us. The opinion of such an expert of Commencement of Risk under Rider and every Rider Anniversary thereafter;
as to such Diagnosis shall be binding on both You and Us; 40. "Schedule" means the policy schedule and any endorsements attached to and
12. "Exit Value" means an amount payable on surrender of this Rider in accordance forming part of the Rider and if any updated Schedule is issued, then, the Schedule
with Clause 1 of Part D; latest in time;
13. "Force Majeure Event" means an event by which performance of any of Our 41. "Survival Period" means a period of 14 (Fourteen) days from the date of Diagnosis
obligations are prevented or hindered as a consequence of any act of God, State, of a Critical Illness, and fulfillment of the conditions covered under the definition of
strike, lock-out, legislation, pandemic, epidemic or restriction by any government the Critical Illness during which the Life Insured shall survive after being Diagnosed
or other authority or any circumstance beyond Our control, owing to which, the with the Critical Illness before any Critical Illness benefit be paid. In case of Total
performance of this Policy shall be wholly or partially suspended during the and Permanent Disability, the applicable survival period shall be 6 months from the
continuance of such Force Majeure Event; date of Diagnosis or Accident, as per the clause 42 of Part B;
14. "Freelook" means a period during which, subject to the Clause 6 Part D of the 42. "Total and Permanent Disability" means occurrence of any of the following
Policy, You have an option to return the original Policy to Us by stating the conditions as a result of accidental bodily injury, sickness or disease whereby the
objections/reasons for such disagreement in writing; Life Insured:
15. "Gold Variant" means coverage variant under this Rider, to be chosen by You at the a) Has the inability to perform at least 3 of the Activities of Daily Living, either
Date of Commencement of Risk under Rider, wherein the benefit shall be payable in with or without the use of mechanical equipment, special devices or other aids
the event the Life Insured is Diganosed with 22 Critical Illnesses (1 Minor Critical and adaptations in use for disabled persons for a continuous period of at least
Illness, 21 Major Critical Illness) as enlisted at Serial no. 1 and 6 to 26 in Clause 1 6 months:
of Part-C to this Rider; Or
16. "Gold Plus Variant" means a coverage variant under this Rider, to be chosen by b) Suffers physical impairment causing:
You at the Date of Commencement of Risk under Rider, wherein the benefit shall be i. Total and irrecoverable loss of sight of both eyes. The blindness must be
payable in the event of earlier of the following events (a) Life Insured suffers Total confirmed by a Medical Practitioner; or
and Permanent Disability or (b) Life Insured is Diganosed with any of the 22 Critical ii. Loss of use or loss by severance of two or more limbs at or above wrists or
Illnesses (1 Minor Critical Illness, 21 Major Critical Illness) as enlisted at Serial no. ankles; or
1 and 6 to 26 in Clause 1 of Part-C to this Rider; iii. The total and irrecoverable loss of sight of one eye and loss of use or loss by
17. "Grace Period" means a period as defined under the Base Policy; severance of one limb at or above wrist or ankle.
18. "Healthy Week" means a week wherein Life Insured have completed minimum The above disability must have lasted, without interruption, for at least 6 (six)
50,000 steps in a week subject to maximum 15,000 steps per day; consecutive months from the date of Diagnosis or Accident and must, in the
19. "IRDAI" means the Insurance Regulatory and Development Authority of India; opinion of a qualified Medical Practitioner appointed by Us, be deemed permanent;
20. "Lapsed Rider" means a Rider where the due Premium has not been received within 43. "Total and Permanent Disability Variant" means a coverage variant under the
the Grace Period; Rider, to be chosen by You at the Date of Commencement of Risk under Rider,
21. "Life Insured" means the person named in the Schedule, on whose life the Rider wherein the Rider Sum Assured shall be payable in the event the Life Insured suffers
is affected; Total and Permanent Disability;
22. "Limited Premium Payment Variant" means a variant under this Rider, wherein 44. "Total Rider Premiums Paid" means the total of all Rider Premiums received under
the Rider Premium Payment Term is less than the Rider Term; the Rider, excluding Underwriting Extra Premium, loadings for modal premiums and
23. "Maturity Date" means the date specified in the Schedule, on which the Rider Term applicable taxes, cesses or levies, if any;
expires; 45. "Underwriting Extra Premium" means an additional amount mentioned in the
24. "Medical Practitioner" means a person who holds a valid registration from the Schedule and charged by Us, as per Underwriting Policy, which is determined on
Medical Council of any State or Medical Council of India or any other such body

19 of 44
 the basis of disclosures made by You in the Proposal Form or any other information or invaded (in the sense of infiltrating and / or
received by Us including medical examination report of the Life Insured; actively destroying) the surrounding tissues or
46. "Underwriting Policy" means an underwriting policy approved by Our board of stroma in any of the following covered organ
directors; groups, and subject to any classification stated:
47. "Waiting Period" means a period of 90 (Ninety) days from the Date of Issuance of i. Breast, where the tumor is classified as Tis
Rider / Revival of this Rider in case of Major Critical Illness/ Total and Permanent according to the TNM Staging method
Disability claim or 180 (One Hundred Eighty) from the Date of Issuance of Rider ii. Corpus uteri, vagina, vulva or fallopian
/ Revival of this Rider in case of a Minor Critical Illness claim; tubes where the tumor is classified
48. "We", "Us" or "Our" means Max Life Insurance Company Limited; and; as Tis according to the TNM Staging
49. "You", "Your" or "Policyholder" means the policyholder as named in the method or FIGO (staging method of the
Schedule, who is the policyholder under the Base Policy. Federation Internationale de Gynecologie et
d'Obstetrique) Stage 0
PART - C iii. Cervix uteri, classified as cervical
intraepithelial neoplasia grade III (CIN III)
RIDER FEATURES, BENEFITS & RIDER PREMIUM PAYMENT
or as Tis according to the TNM staging
CONDITIONS
method or FIGO Stage 0
1. RIDER BENEFITS
iv. Ovary -include borderline ovarian tumors
The following benefits shall be payable upon happening of any insured event, subject
with intact capsule, no tumor on the ovarian
to the conditions mentioned herein: surface, classified as T1aN0M0, T1bN0M0
A. Critical Illness benefit (Applicable only for Gold Variant, Gold Plus Variant, (TNM Staging) or FIGO 1A, FIGO 1B
Platinium Variant and Platinum Plus Variant) v. Colon and rectum; penis; testis; lung; liver;
i) Subject to the Rider and the Base Policy being in force and Life Insured stomach, nasopharynx and oesophagus
surviving through the Survival Period, basis the coverage variant (Gold vi. Urinary tract, for the purpose of in-situ
Variant, Gold Plus Variant, Platinium Variant and Platinum Plus Variant) cancers of the bladder, stage Ta of papillary
chosen by You, in case the Life Insured is Diagnosed with a Major Critical Carcinoma is included.
Illness after completion of the Waiting Period during the Rider Term, We The Diagnosis of the Carcinoma in situ must
shall, on receipt of a written request from the Claimant, pay the applicable always be supported by a histopathological
Rider Sum Assured as per the terms stated hereinbelow. However, in case report. Further more, the Diagnosis of
of Diagnosis of a Minor Critical Illness, We will pay the lower of 25% of the Carcinoma in-situ must always be positively
Rider Sum Assured Or Rs.5 lacs, upon the Life Insured surviving through Diagnosed upon the basis of a microscopic
the Survival Period. examination of the fixed tissue, supported by a
ii) We will admit only one valid Major Critical Illness claim and make payment biopsy result. Clinical Diagnosis does not meet
under this Rider only once during the lifetime of the Life Insured and this standard.
thereafter this Rider shall terminate and no further claim in respect of Pre-malignant lesion and Carcinoma in Situ of
any Critical Illness or Total and Permanent Disability shall be entertained. any organ, unless listed above, are excluded.
However, in case of the claim being in respect of a Minor Critical Illness, b. Specified Early Stage Cancers - Specified
We will pay lower of 25% Rider Sum Assured or Rs.5 lacs and the Rider Early Cancers shall mean first ever
cover will continue with the Rider Sum Assured reduced by the claim presence of one of the following malignant
amount already paid for a Minor Critical Illness(es). It is clarified that the conditions:
Rider Premium will not reduce if Minor Critical Illness claim has been paid i. Prostate Cancer that is histologically
out under this Rider. described using the TNM Classification
iii) In case of Gold Variant or Gold Plus Variant, only the claim for Angioplasty as T1N0M0 or Prostate cancers
under Minor Critical Illness conditions shall be allowed. In case of described using another equivalent
Platinium Variant and Platinum Plus Variant, maximum of three claims classification.
towards five different Minor Critical Illness conditions can be made under ii. Thyroid Cancer that is histologically
this Rider. However, in case of Platinium Variant and Platinum Plus Variant described using the TNM Classification
for multiple Minor Critical Illness claims, the cooling off period of one as T1N0M0.
year must have elapsed between the date of the Diagnosis of two (2) Minor iii. Tumors of the Urinary Bladder
Critical Illness. It is clarified that no cooling off period is applicable in case histologically classified as T1N0M0
of the Major Critical Illness claim. (TNM Classification).
iv) For any Critical Illness claim to be valid under this Rider, the incidence of iv. Chronic Lymphocytic Leukaemia
the Critical Illness must be the first occurrence in the lifetime of the Life (CLL) RAI Stage 1 or 2. CLL RAI Stage
Insured and conform to Survival Period. 0 or lower is excluded.
v) Multiple claims against the same Critical Illness are not allowed. v. Malignant melanoma that has not
vi) Apart from the exclusions specified in Clause 1.A.viii.c (exclusions caused invasion beyond the epidermis.
applicable to this Rider) of Part C, there are other exclusions for Critical vi. Hodgkin's lymphoma Stage I by
Illness as mentioned in Clause 1.A.viii.a and 1.A.viii.b of Part C. For any the Cotswold's classification staging
such exclusions, the Claimant will not be entitled to any Critical Illness system.
benefits under this Rider. vii. The Diagnosis must be based
vii) It is clarifed that the Life Insured must survive through the Survival Period on histopathological features and
and no claim shall be payable under this Rider, in case the Life Insured confirmed by a Pathologist.
dies within the Survival Period, If the Life Insured is Diagnosed with a Pre - malignant lesions and conditions, unless
Critical Illness during the Rider Term, the claim would be payable even if listed above, are excluded.
the Survival Period is beyond Rider Term, subject to Life Insured surviving The receipt of a transplant of small bowel with
through the Survival Period. Small Bowel
3. its own blood supply via a laparotomy resulting
viii) Definitions of Critical Illnesses and exclusions applicable for the Transplant
from intestinal failure.
Critical Illness benefit:
a) The actual undergoing of surgical repair
a. Subject to applicable exclusions and Waiting Period, the Critical Illness
of an intracranial aneurysm or surgical
benefit would be paid only if the Diagnosed Critical Illness condition
removal of an arterio-venous malformation
falls within the definition as laid down below for each Critical Illness.
via craniotomy. The surgical intervention
must be certified to be absolutely necessary
SI Name of Details Brain Aneurysm by a specialist in the relevant field.
no the Illness Surgery or Endovascular repair or procedures are not
4.
MINOR CRITICAL ILLNESS Cerebral Shunt covered, or
Coronary Angioplasty is defined as Insertion b) The actual undergoing of surgical
percutaneous coronary intervention by way of implantation of a shunt from the ventricles
balloon angioplasty with or without stenting of the brain to relieve raised pressure in
for treatment of the narrowing or blockage of the cerebrospinal fluid. The need of a shunt
minimum 50 % of one or more major coronary must be certified to be absolutely necessary
arteries. The intervention must be determined by a specialist in the relevant field.
to be medically necessary by a cardiologist and The occurrence of osteoporosis with fractures
1. Angioplasty must be confirmed by a specialist in the relevant
supported by a coronary angiogram (CAG).
Coronary arteries herein refer to left main stem, medical field and all of the following conditions
left anterior descending, circumflex and right are met:
coronary artery. i. At least fracture of neck of femur or two
Diagnostic angiography or investigation Severe (2) vertebral body fractures, due to or in the
5.
procedures without Angioplasty/stent insertion Osteoporosis presence of Osteoporosis; and
are excluded. ii. Bone mineral density measured in at
Carcinoma in-situ (CiS) - Carcinoma-in-Situ least two (2) sites by dual-energy x-ray
Carcinoma densitometry (DEXA) or quantitative
shall mean first ever histologically proven,
2. in-situ / Early CT scanning is consistent with severe
localized pre-invasion lesion where cancer cells
Stage Cancer Osteoporosis (T-score of less than -2.5)
have not yet penetrated the basement membrane

20 of 44
 Actual undergoing of internal fixation or i. No response to external stimuli
replacement of fractured bone is required. continuously for at least 96 hours;
Coverage for Osteoporosis with Fracture will ii. Life support measures are necessary to
automatically cease after the Life Insured sustain life; and
attains seventy (70) years of age. iii. Permanent neurological deficit which must
MAJOR CRITICAL ILLNESS be assessed at least 30 days after the onset
A malignant tumor characterised by the of the coma.
uncontrolled growth & spread of malignant
cells with invasion & destruction of normal The condition has to be confirmed by a
tissues. This Diagnosis must be supported specialist Medical Practitioner. Coma resulting
by histological evidence of malignancy. The from alcohol or drug abuse is excluded.
term cancer includes leukemia, lymphoma and End stage renal disease presenting as chronic
sarcoma. irreversible failure of both kidneys to function,
The following are excluded - Kidney Failure as a result of which either regular renal
a. All tumors which are histologically 11. Requiring dialysis (haemodialysis or peritoneal dialysis) is
described as carcinoma in situ, benign, Regular Dialysis instituted or renal transplantation is carried out.
pre-malignant, borderline malignant, low Diagnosis has to be confirmed by a specialist
malignant potential, neoplasm of unknown Medical Practitioner.
behavior, or non-invasive, including but not Any cerebrovascular incident producing
limited to: Carcinoma in situ of breasts, permanent neurological sequelae. This includes
Cervical dysplasia CIN-1, CIN -2 and infarction of brain tissue, thrombosis in
CIN-3. an intracranial vessel, haemorrhage and
b. Any non-melanoma skin carcinoma unless embolisation from an extracranial source.
Cancer of there is evidence of metastases to lymph Diagnosis has to be confirmed by a specialist
6. Specified nodes or beyond; Medical Practitioner and evidenced by typical
Stroke resulting
Severity c. Malignant melanoma that has not caused clinical symptoms as well as typical findings
12. in permanent
invasion beyond the epidermis; in CT Scan or MRI of the brain. Evidence
symptoms
d. All tumors of the prostate unless of permanent neurological deficit lasting for at
histologically classified as having a least 3 months has to be produced.
Gleason score greater than 6 or having The following are excluded:
progressed to at least clinical TNM a. Transient ischemic attacks (TIA)
classification T2N0M0 b. Traumatic injury of the brain
e. All Thyroid cancers histologically classified c. Vascular disease affecting only the eye or
as T1N0M0 (TNM Classification) or below; optic nerve or vestibular functions.
f. Chronic lymphocytic leukaemia less than The actual undergoing of a transplant of:
RAI stage 3 i. One of the following human organs: heart,
g. Non-invasive papillary cancer of the lung, liver, kidney, pancreas, that resulted
bladder histologically described as from irreversible end-stage failure of the
TaN0M0 or of a lesser classification, relevant organ, or
h. All Gastro-Intestinal Stromal Tumors Major Organ ii. Human bone marrow using haematopoietic
histologically classified as T1N0M0 (TNM 13. /Bone Marrow stem cells. The undergoing of a transplant
Classification) or below and with mitotic Transplant has to be confirmed by a specialist Medical
count of less than or equal to 5/50 HPFs; Practitioner.
The first occurrence of heart attack or The following are excluded:
myocardial infarction, which means the death i. Other stem-cell transplants
of a portion of the heart muscle as a result of ii. Where only Islets of Langerhans are
inadequate blood supply to the relevant area. transplanted
The Diagnosis for Myocardial Infarction should Total and irreversible loss of use of two or more
be evidenced by all of the following criteria: limbs as a result of injury or disease of the brain
i. A history of typical clinical symptoms Permanent
or spinal cord. A specialist Medical Practitioner
consistent with the Diagnosis of acute 14. Paralysis
must be of the opinion that the paralysis will be
myocardial infarction (for e.g. typical chest of Limbs
Myocardial permanent with no hope of recovery and must
pain) be present for more than 3 months.
Infarction (First
ii. New characteristic electrocardiogram Motor neuron disease Diagnosed by a specialist
7. Heart Attack
changes Medical Practitioner as spinal muscular atrophy,
of Specific
iii. Elevation of infarction specific enzymes, progressive bulbar palsy, amyotrophic lateral
Severity)
Troponins or other specific biochemical sclerosis or primary lateral sclerosis. There must
markers. Motor Neuron
be progressive degeneration of corticospinal
The following are excluded: Disease with
15. tracts and anterior horn cells or bulbar efferent
i. Other acute Coronary Syndromes Permanent
neurons. There must be current significant and
ii. Any type of angina pectoris Symptoms
permanent functional neurological impairment
iii. A rise in cardiac biomarkers or Troponin with objective evidence of motor dysfunction
T or I in absence of overt ischemic heart that has persisted for a continuous period of at
disease OR following an intra-arterial least 3 months.
cardiac procedure
The unequivocal Diagnosis of definite multiple
The actual undergoing of heart surgery to
sclerosis confirmed and evidenced by all of the
correct blockage or narrowing in one or
following:
more coronary artery(s), by coronary artery
i. investigations including typical MRI
bypass grafting done via a sternotomy (cutting Multiple
findings which unequivocally confirm the
through the breast bone) or minimally invasive Sclerosis with
16. Diagnosis to be multiple sclerosis and
Open Chest keyhole coronary artery bypass procedures. The Persisting
8. ii. there must be current clinical impairment of
CABG Diagnosis must be supported by a coronary Symptoms
motor or sensory function, which must have
angiography and the realization of surgery has
persisted for a continuous period of at least
to be confirmed by a cardiologist
6 months.
The following are excluded:
Neurological damage due to SLE is excluded.
Angioplasty and/or any other intra-arterial
Benign brain tumor is defined as a life threatening,
procedures
non-cancerous tumor in the brain, cranial nerves
The actual undergoing of open-heart valve
or meninges within the skull. The presence of the
surgery to replace or repair one or more
underlying tumor must be confirmed by imaging
heart valves, as a consequence of defects
studies such as CT scan or MRI.
in, abnormalities of, or disease-affected
Open Heart This brain tumor must result in at least one of the
cardiac valve(s). The Diagnosis of the
Replacement following and must be confirmed by the relevant
9. valve abnormality must be supported by
or Repair of Benign medical specialist:
an echocardiography and the realization 17.
Heart Valves Brain Tumor i. Permanent Neurological deficit with
of surgery has to be confirmed by a
persisting clinical symptoms for a continuous
specialist Medical Practitioner. Catheter based
period of at least 90 consecutive days or
techniques including but not limited to, balloon
ii. Undergone surgical resection or radiation
valvotomy/valvuloplasty are excluded.
therapy to treat the brain tumor.
A state of unconsciousness with no reaction or The following conditions are excluded:
Coma of
response to external stimuli or internal needs. a. Cysts, Granulomas, malformations in the
10. specified
This Diagnosis must be supported by evidence arteries or veins of the brain, hematomas,
Severity
of all of the following:

21 of 44
 abscesses, pituitary tumors, tumors of skull i. Class III: Marked limitation of physical
bones and tumors of the spinal cord. activity. Comfortable at rest, but less than
Total, permanent and irreversible loss of all ordinary activity causes symptoms.
vision in both eyes as a result of illness or ii. Class IV: Unable to engage in any physical
accident. activity without discomfort. Symptoms may
The Blindness is evidenced by: be present even at rest.
a. corrected visual acuity being 3/60 or less in Pulmonary hypertension associated with lung
18. Blindness both eyes or; disease, chronic hypoventilation, pulmonary
b. the field of vision being less than 10 degrees thromboembolic disease, drugs and toxins,
in both eyes. diseases of the left side of the heart, congenital
The Diagnosis of blindness must be confirmed heart disease and any secondary cause are
and must not be correctable by aids or surgical specifically excluded.
procedure There must be third-degree burns with scarring
Total and irreversible loss of hearing in both ears that cover at least 20% of the body's surface
as a result of illness or accident. This Diagnosis Third Degree area. The Diagnosis must confirm the total
26.
must be supported by pure tone audiogram test Burns area involved using standardized, clinically
19. Deafness and certified by an Ear, Nose and Throat (ENT) accepted, body surface area charts covering
specialist. Total means "the loss of hearing to 20% of the body surface area
the extent that the loss is greater than 90decibels Alzheimer's (presenile dementia) disease
across all frequencies of hearing" in both ears. is a progressive degenerative disease of
End stage lung disease, causing chronic the brain, characterised by diffuse atrophy
respiratory failure, as confirmed and evidenced throughout the cerebral cortex with distinctive
by all of the following: histopathological changes. It affects the
i. FEV1 test results consistently less than 1 brain, causing symptoms like memory loss,
litre measured on 3 occasions 3 months confusion, communication problems, and
apart; and general impairment of mental function, which
End Stage gradually worsens leading to changes in
20. ii. Requiring continuous permanent
Lung Failure personality.
supplementary oxygen therapy for
hypoxemia; and Deterioration or loss of intellectual capacity, as
iii. Arterial blood gas analysis with partial confirmed by clinical evaluation and imaging
oxygen pressures of 55mmHg or less (PaO2 tests, arising from Alzheimer's disease, resulting
< 55 mmHg); and in progressive significant reduction in mental
iv. Dyspnea at rest. and social functioning, requiring the continuous
Permanent and irreversible failure of liver Alzheimer's supervision of the Life Insured. The Diagnosis
27.
function that has resulted in all three of the Disease must be supported by the clinical confirmation
following: of a Neurologist and supported by our appointed
End Stage i. permanent jaundice; and Medical Practitioner.
21. The disease must result in a permanent inability
Liver Failure ii. ascites; and
iii. hepatic encephalopathy. to perform three or more of the Activities of
Liver failure secondary to drug or alcohol Daily Living with Loss of Independent Living
abuse is excluded. or must require the need of supervision and
Total and irrecoverable loss of the ability permanent presence of care staff due to the
to speak as a result of injury or disease to disease. This must be medically documented for
the vocal cords. The inability to speak must a period of at least 90 days
22. Loss of speech be established for a continuous period of 12 The following conditions are however not
months. This Diagnosis must be supported by covered:
medical evidence furnished by an Ear, Nose, • non-organic diseases such as neurosis;
Throat (ENT) specialist. • alcohol related brain damage; and
• any other type of irreversible organic
The physical separation of two or more limbs, at
disorder/dementia
or above the wrist or ankle level limbs as a result
The unequivocal Diagnosis of progressive,
of injury or disease. This will include medically
degenerative idiopathic Parkinson's disease by a
necessary amputation necessitated by injury or
23. Loss of Limbs Neurologist acceptable to us.
disease. The separation has to be permanent
The Diagnosis must be supported by all of the
without any chance of surgical correction. Loss
following conditions:
of Limbs resulting directly or indirectly from
self-inflicted injury, alcohol or drug abuse is • the disease cannot be controlled with
excluded. medication;
Parkinson's • signs of progressive impairment; and
Accidental Injury of Head, resulting in 28.
disease • inability of the Life Insured to perform at least
permanent Neurological deficit to be assessed
3 of the Activities of Daily Living (either with
no sooner than 3 months from the date of the
or without the use of mechanical equipment,
accident. This Diagnosis must be supported by
special devices or other aids and adaptations
unequivocal findings on Magnetic Resonance
in use for disabled persons) for a continuous
Imaging, Computerized Tomography, or other
period of at least 6 months:
reliable imaging techniques. The accident must
Parkinson's disease secondary to drug and/or
be caused solely and directly by accidental,
alcohol abuse is excluded.
violent, external and visible means and
Major Head independently of all other causes. The actual undergoing of major Surgery
24. to repair or correct aneurysm, narrowing,
Trauma The Accidental Injury of head must result
in an inability to perform at least three (3) obstruction or dissection of the Aorta through
of the Activities of Daily Living either with surgical opening of the chest or abdomen. For
or without the use of mechanical equipment, the purpose of this cover the definition of
special devices or other aids and adaptations "Aorta" shall mean the thoracic and abdominal
in use for disabled persons. For the purpose aorta but not its branches.
of this benefit, the word "permanent" shall You understand and agree that we will not
Aorta Graft
29. cover:
mean beyond the scope of recovery with current Surgery
• Surgery performed using only minimally
medical knowledge and technology.
invasive or intra-arterial techniques.
Spinal cord injury is excluded
• Angioplasty and all other intra-arterial,
An unequivocal diagnosis of Primary catheter based techniques, "keyhole" or laser
(Idiopathic) Pulmonary Hypertension by a procedures.
Cardiologist or specialist in respiratory Aorta graft surgery benefit covers Surgery to the
medicine with evidence of right ventricular aorta wherein part of it is removed and replaced
enlargement and the pulmonary artery pressure with a graft.
Primary above 30 mm of Hg on Cardiac Cauterization.
Diabetic neuropathy and vasculitis resulting in
(Idiopathic) There must be permanent irreversible physical
25. Amputation the amputation of both feet at or above ankle
Pulmonary impairment to the degree of at least Class IV of
of feet due to as advised by a Medical Practitioner who is a
Hypertension the New York Heart Association Classification 30.
complications specialist as the only means to maintain life.
(NYHA) of cardiac impairment.
from Diabetes Amputation of toe or toes, or any other causes
The NYHA Classification of Cardiac
for amputation shall not be covered.
Impairment are as follows:
Apallic Apallic Syndrome or Persistent vegetative state
Syndrome (PVS) or unresponsive wakefulness syndrome
31.
or Persistent (UWS) is a Universal necrosis of the brain

22 of 44
 cortex with the brainstem remaining intact. The pain and/or permanent impairment of function.
Diagnosis must be confirmed by a Neurologist The condition must be confirmed by pancreatic
Vegetative acceptable to Us and the patient should be function tests and radiographic and imaging
State (PVS) documented to be in a vegetative state for a evidence.
minimum of at least one month in order to be Relapsing Pancreatitis caused directly or
classified as UWS, PVS, Apallic Syndrome. indirectly, wholly or partly, by alcohol is
Chronic persistent bone marrow failure excluded.
which results in anaemia, neutropenia and Creutzfeldt-Jacob disease is an incurable
thrombocytopenia requiring treatment with at brain infection that causes rapidly progressive
least one of the following: deterioration of mental function and movement.
a. Blood product transfusion. A Medical Practitioner, who is a neurologist,
Creutzfeldt-
b. Marrow stimulating agents. must make a definite Diagnosis of
38. Jacob Disease
c. Immunosuppressive agents; or Creutzfeldt-Jacob disease based on clinical
(CJD)
d. Bone marrow transplantation. assessment, EEG and imaging. There must
The Diagnosis must be confirmed by be objective neurological abnormalities on
a haematologist using relevant laboratory examination along with severe progressive
Aplastic investigations including Bone Marrow Biopsy dementia.
32.
Anaemia resulting in bone marrow cellularity of less than Crohn's Disease is a chronic, transmural
25% which is evidenced by any two of the inflammatory disorder of the bowel. To be
following: considered as severe, there must be evidence
a. Absolute neutrophil count of less than of continued inflammation in spite of optimal
500/mm3 or less therapy, with all of the following having
b. Platelets count less than 20,000/mm3 or less occurred:
c. Reticulocyte count of less than 20,000/mm3 • Stricture formation causing intestinal
or less obstruction requiring admission to hospital,
Severe Crohn's
Temporary or reversible Aplastic Anaemia is 39. and
Disease
excluded. • Fistula formation between loops of bowel,
Bacterial infection resulting in severe and
inflammation of the membranes of the • At least one bowel segment resection.
brain or spinal cord resulting in significant, The Diagnosis must be made by a
irreversible and permanent neurological deficit. Medical Practitioner who is a specialist
The neurological deficit must persist for at least Gastroenterologist and be proven histologically
Bacterial on a pathology report and/or the results of
33. 6 weeks resulting in permanent inability to
Meningitis sigmoidoscopy or colonoscopy.
perform three or more of the Activities of Daily
Living. This Diagnosis must be confirmed by: A condition where the inner lining of the aorta
a. The presence of bacterial infection in (intima layer) is interrupted so that blood enters
cerebrospinal fluid by lumbar puncture; and the wall of the aorta and separates its layers.
b. A consultant neurologist. For the purpose of this definition, aorta shall
The actual undergoing of surgery to mean the thoracic and abdominal aorta but not
Dissecting Aortic
the brain under general anaesthesia during 40. its branches. The Diagnosis must be made by
Aneurysm
which a craniotomy is performed. Keyhole a Medical Practitioner who is a specialist with
surgery is included however, minimally computed tomography (CT) scan, magnetic
invasive treatment where no surgical resonance imaging (MRI), magnetic resonance
incision is performed to expose the target, angiograph (MRA) or angiogram. Emergency
such as irradiation by gamma knife or surgical repair is required.
34. Brain Surgery Development of severe pulmonary
endovascular neuroradiological interventions
such as embolizations, thrombolysis and hypertension and shunt reversal resulting from
stereotactic biopsy are all excluded. Brain heart condition. The Diagnosis must be made by
surgery as a result of an Accident is also a Medical Practitioner who is a specialist with
excluded. The procedure must be considered echocardiography and cardiac catheterisation
Eisenmenger's
medically necessary by a Medical Practitioner 41. and supported by the following criteria:
Syndrome
who is a qualified specialist. • Mean pulmonary artery pressure > 40 mm Hg
An impaired function of the heart muscle, • Pulmonary vascular resistance > 3mm/L/min
unequivocally Diagnosed as Cardiomyopathy (Wood units); and
by a Medical Practitioner who is a cardiologist, Normal pulmonary wedge pressure < 15 mm
and which results in permanent physical Hg.
impairment to the degree of New York Heart Massive swelling in the tissues of the body
Association (NYHA) Classification Class IV, or as a result of destroyed regional lymphatic
its equivalent, for at least six (6) months based circulation by chronic filariasis infection. The
on the following classification criteria: unequivocal Diagnosis of elephantiasis must be
• NYHA Class IV - inability to carry out confirmed by a Medical Practitioner who is
35. Cardiomyopathy an activity without discomfort. Symptoms a specialist physician. There must be clinical
of congestive cardiac failure are present evidence of permanent massive swelling of legs,
even at rest. With any increase in physical 42. Elephantiasis arms, scrotum, vulva, or breasts. There must
activity, discomfort will be experienced. also be laboratory confirmation of microfilariae
The Diagnosis of Cardiomyopathy has to be infection.
supported by echocardiographic findings of Swelling or lymphedema caused by infection
compromised ventricular performance. with a sexually transmitted disease, trauma,
Irrespective of the above, Cardiomyopathy post-operative scarring, congestive heart
directly related to alcohol or drug abuse is failure, or congenital lymphatic system
excluded. abnormalities is excluded.
An autoimmune disorder causing a gradual Severe inflammation of brain substance
destruction of the adrenal gland resulting in (cerebral hemisphere, brainstem or cerebellum)
the need for lifelong glucocorticoid and mineral caused by viral infection and resulting in
corticoid replacement therapy. The disorder permanent neurological deficit. This Diagnosis
must be confirmed by a Medical Practitioner must be certified by a Medical Practitioner who
43. Encephalitis
who is a specialist in endocrinology through one is a consultant neurologist and the permanent
Chronic Adrenal neurological deficit must be documented for at
of the following:
Insufficiency least 6 weeks. The permanent deficit should
36. • ACTH simulation tests
(Addison's result in permanent inability to perform three or
• Insulin-induced hypoglycemia test
Disease) more of the Activities of Daily Living.
• Plasma ACTH level measurement
• Plasma Renin Activity (PRA) level A sub-massive to massive necrosis of the liver
measurement. by the Hepatitis virus, leading precipitously to
Only autoimmune cause of primary adrenal liver failure. This Diagnosis must be supported
insufficiency is included. All other causes of by all of the following:
adrenal insufficiency are excluded. Fulminant i. Rapid decreasing of liver size
44.
An unequivocal Diagnosis of chronic relapsing Viral Hepatitis ii. Necrosis involving entire lobules, leaving
pancreatitis made by a Medical Practitioner only a collapsed reticular framework
Chronic iii. Rapid deterioration of liver function tests
who is a specialist in gastroenterology and
Relapsing iv. Deepening jaundice; and
37. confirmed as a continuing inflammatory disease
Pancreatitis v. Hepatic encephalopathy.
of the pancreas characterised by irreversible
morphological change and typically causing

23 of 44
 Acute Hepatitis infection or carrier status alone Medullary Cystic Disease where the following
does not meet the diagnostic criteria. criteria are met:
• the presence in the kidney of multiple cysts
The total and permanent loss of the use of one in the renal medulla accompanied by the
side of the body through paralysis persisting presence of tubular atrophy and interstitial
for a period of at least 6 weeks and with fibrosis
45. Hemiplegia Medullary
no foreseeable possibility of recovery caused 50. • clinical manifestations of anaemia, polyuria,
Cystic Disease
by illness or injury. Self-inflicted injuries are and progressive deterioration in kidney
excluded. function; and
A. Infection with the Human Immunodeficiency • the Diagnosis of Medullary Cystic Disease is
Virus (HIV) through a blood transfusion, confirmed by renal biopsy.
provided that all of the following conditions are Isolated or benign kidney cysts are specifically
met: excluded from this benefit.
• The blood transfusion was medically A group of hereditary degenerative diseases of
necessary or given as part of a medical muscle characterised by weakness and atrophy
treatment of muscle. The Diagnosis of muscular dystrophy
• The blood transfusion was received in India must be unequivocal and made by a Medical
Muscular
after the Policy Date, Date of endorsement or 51. Practitioner who is a consultant neurologist. The
Dystrophy
Date of reinstatement, whichever is the later condition must result in the inability of the Life
• The source of the infection is established to Insured to perform (whether aided or unaided)
be from the Institution that provided the blood at least 3 of the Activities of Daily Living for a
transfusion and the Institution is able to trace continuous period of at least 6 months.
the origin of the HIV tainted blood; and An acquired autoimmune disorder of
• The Life Insured does not suffer from neuromuscular transmission leading to
Thalassaemia Major or Haemophilia. fluctuating muscle weakness and fatigability,
B. Infection with the Human Immunodeficiency where all of the following criteria are met:
Virus (HIV) which resulted from an Accident • Presence of permanent muscle weakness
occurring after the Policy Date, date categorized as Class IV or V according to the
of endorsement or date of reinstatement, Myasthenia Gravis Foundation of America
HIV due
whichever is the later whilst the Life Insured Clinical Classification (given below); and
to Blood
was carrying out the normal professional duties • The Diagnosis of Myasthenia Gravis and
46. transfusion and
of his or her occupation in India, provided categorization are confirmed by a Medical
occupationally
that all of the following are proven to Our Practitioner who is a neurologist.
acquired HIV Myasthenia
satisfaction: 52. Myasthenia Gravis Foundation of America
• Proof that the Accident involved a definite Gravis
Clinical Classification:
source of the HIV infected fluids; and Class I: Any eye muscle weakness, possible
• Proof of sero-conversion from HIV negative ptosis, no other evidence of muscle weakness
to HIV positive occurring during the elsewhere.
180 days after the documented Accident. Class II: Eye muscle weakness of any severity,
This proof must include a negative HIV mild weakness of other muscles.
antibody test conducted within 5 days of the Class III: Eye muscle weakness of any severity,
Accident; moderate weakness of other muscles.
This benefit is only payable when the Class IV: Eye muscle weakness of any severity,
occupation of the Life Insured is a Medical severe weakness of other muscles.
Practitioner, housemen, medical student, Class V: Intubation needed to maintain airway.
registered nurse, medical laboratory technician, A disorder which can cause fibrous tissue to
dentist (surgeon and nurse) or paramedical replace the normal bone marrow and results in
worker, working in medical centre or clinic anaemia, low levels of white blood cells and
in India. This benefit will not apply under platelets and enlargement of the spleen. The
either section A or B where a cure has become condition must have progressed to the point that
available prior to the infection. "Cure" means 53. Myelofibrosis it is permanent, and the severity is such that
any treatment that renders the HIV inactive or the Life Insured requires a blood transfusion at
non-infectious. least monthly. The Diagnosis of myelofibrosis
Inflammation of the inner lining of the heart must be supported by bone marrow biopsy and
caused by infectious organisms, where all of the confirmed by a Medical Practitioner who is a
following criteria are met: specialist.
• Positive result of the blood culture proving Necrotizing fasciitis is a progressive, rapidly
presence of the infectious organism(s); spreading, infection located in the deep fascia
• Presence of at least moderate heart valve causing necrosis of the subcutaneous tissues. An
incompetence (meaning regurgitant fraction unequivocal Diagnosis of necrotizing fasciitis
Infective of 20% or above) or moderate heart valve must be made by a Medical Practitioner who
47.
Endocarditis stenosis (resulting in heart valve area of Necrotising is a specialist and the Diagnosis must be
30% or less of normal value) attributable to 54.
Fasciitis supported with laboratory evidence of the
Infective Endocarditis; and presence of bacteria that is a known cause
• The Diagnosis of Infective Endocarditis and of necrotising fasciitis. There must also be
the severity of valvular impairment are widespread destruction of muscle and other soft
confirmed by a Medical Practitioner who is a tissues that results in a total and permanent loss
cardiologist. or function of the affected body part.
The narrowing of the lumen of at least one
Inability to perform at least three (3) of coronary artery by a minimum of 75% and of
the Activities of Daily Living (either with two others by a minimum of 60%, as proven by
or without the use of mechanical equipment, coronary angiography, regardless of whether or
special devices or other aids or adaptations in Other Serious
not any form of coronary artery intervention or
use for disabled persons) for a continuous period 55. Coronary
surgery has been performed.
of at least six (6) months and leading to a Artery Disease
Loss of Coronary arteries herein refer to left main
permanent inability to perform the same. For the stem, left anterior descending, circumflex and
Independent
48. purpose of this definition, the word "permanent" right coronary artery (but not including their
Existence (cover
shall mean beyond the hope of recovery with branches).
up to age 74)
current medical knowledge and technology. The
Presence of a neuroendocrine tumour of the
Diagnosis of Loss of Independent Existence
adrenal or extra-chromaffin tissue that secretes
must be confirmed by a Medical Practitioner.
excess catecholamines requiring the actual
Only Life Insured with Age between 18 and 74 Pheochromo-
56. undergoing of surgery to remove the tumour.
on first Diagnosis is eligible to receive a benefit cytoma
The Diagnosis of Pheochromocytoma must be
under this illness.
confirmed by a Medical Practitioner who is an
Total, permanent and irrecoverable loss of sight endocrinologist.
of one eye and loss by severance of one limb at
The occurrence of Poliomyelitis where the
or above the elbow or knee.
Loss of One following conditions are met:
The loss of sight of one eye must be clinically
49. Limb and i. Poliovirus is identified as the cause,
One Eye confirmed by a Medical Practitioner who is an
57. Poliomyelitis ii. Paralysis of the limb muscles or respiratory
eye specialist and must not be correctable by
muscles must be present and persist for at
aides or surgical procedures.
least 3 months.

24 of 44
 A systemic collagen-vascular disease causing (ii) All investigations to confirm the Diagnosis of claimed Critical
progressive diffuse fibrosis in the skin, blood Illness condition should have been done before the death of the Life
vessels and visceral organs. This Diagnosis Insured and Waiting Period should have expired.
must be unequivocally supported by biopsy and (iii) Satisfaction of the respective claimed Critical Illness condition's
serological evidence and the disorder must have definition & exclusion as detailed in Clause 1.A.viii.a of Part C.
Progressive reached systemic proportions to involve the c. Other exclusions to Critical Illness benefit:
58.
Scleroderma heart, lungs or kidneys. We shall not be liable to make any payment under this Rider if the covered
The following are excluded: Critical Illness of the Life Insured results directly or indirectly caused by,
i. Localised scleroderma (linear scleroderma based on, arising out of or howsoever attributable to from any one of the
or morphea); following clauses:
ii. Eosinophilic fasciitis; and 1. Any illness, sickness or disease other than those specified as Critical
iii. CREST syndrome. Illnesses under this Rider.
Confirmed by a Medical Practitioner who is a 2. Any Pre-Existing Diseases. However, coverage under the Rider after
specialist in neurology of a definite Diagnosis the expiry of 48 months for any Pre-Existing Disease is subject to the
Progressive same being declared at the time of application and accepted by Us.
of progressive supranuclear palsy. There must
59. Supranuclear 3. Any Critical Illness directly or indirectly caused due to treatment for,
be permanent clinical impairment of motor
Palsy alcoholism, drug or substance abuse or any addictive condition and
function, eye movement disorder and postural
instability. consequences thereof.
Unequivocal Diagnosis of systemic immune 4. Narcotics used by the Life Insured unless taken as prescribed by a
disorder of rheumatoid arthritis where all of the Medical Practitioner.
following criteria are met: 5. Any Critical Illness directly or indirectly caused due to intentional
• Diagnostic criteria of the American College self-injury, suicide or attempted suicide, whether the person is
of Rheumatology for Rheumatoid Arthritis; medically sane or insane.
Severe • Permanent inability to perform at least two 6. Any Critical Illness directly or indirectly, caused by or arising from
60. Rheumatoid (2) of the Activities of Daily Living; or attributable to a foreign invasion, act of foreign enemies, hostilities,
Arthritis • Widespread joint destruction and major warlike operations (whether war be declared or not or while performing
clinical deformity of three (3) or more of the duties in the armed forces of any country during war or at peace time),
following joint areas: hands, wrists, elbows, civil war, public defense, rebellion, revolution, insurrection, military or
knees, hips, ankle, cervical spine or feet; and usurped power.
• The foregoing conditions have been present 7. Any Critical Illness caused by ionizing radiation or contamination by
for at least six (6) months. radioactivity from any nuclear fuel (explosive or hazardous form) or
Acute fulminant ulcerative colitis with life from any nuclear waste from the combustion of nuclear fuel, nuclear,
threatening electrolyte disturbances. chemical or biological attack.
All of the following criteria must be met: 8. Working in underground mines, tunneling or involving electrical
• the entire colon is affected, with severe installations with high tension supply, or as race jockeys or circus
Severe bloody diarrhoea; and personnel.
61. Ulcerative • the necessary treatment is total colectomy 9. Congenital External Anomalies, inherited disorders or any
Colitis and ileostomy; and complications or conditions arising there from including any
• the Diagnosis must be based on developmental conditions of the Insured.
histopathological features and confirmed by 10. Any Critical Illness directly or indirectly caused by any treatment
a Medical Practitioner who is a specialist in necessitated due to participation as a professional in hazardous or
gastroenterology. adventure sport, including but not limited to, para jumping, rock
climbing, mountaineering, rafting, motor racing, horse racing or scuba
A multi-system autoimmune disorder
diving, hand gliding, sky diving, deep sea diving and selfie accident.
characterised by the development of
11. Participation by the Life Insured in any flying activity, except as a bona
autoantibodies directed against various
fide, fare paying passenger of a recognized airline on regular routes and
self-antigens. In respect of this Policy, systemic
on a scheduled timetable.
lupus erythematosus will be restricted to those
12. Any Critical Illness directly or indirectly, caused by Medical treatment
forms of systemic lupus erythematosus which
traceable to childbirth (including complicated deliveries and caesarean
involve the kidneys (Class III to Class V Lupus
sections incurred during hospitalization) except ectopic pregnancy. Any
Nephritis, established by renal biopsy, and in
Critical Illness due to miscarriages (unless due to an accident) and
accordance with the WHO Classification). The
lawful medical termination of pregnancy during the Rider Term.
Systemic Lupus final Diagnosis must be confirmed by a Medical
13. Any Critical Illness directly or indirectly, caused by any
Erythematosus Practitioner specialising in Rheumatology and
62. unproven/ experimental treatment, service and supplies for or in
with Lupus Immunology.
connection with any treatment. Unproven/ experimental treatments
Nephritis The WHO Classification of Lupus Nephritis:
are treatments, procedures or supplies that lack significant medical
Class I Minimal Change Lupus
documentation to support their effectiveness.
Glomerulonephritis
14. Any Critical Illness based on certification/Diagnosis/treatment from
Class II Mesangial Lupus Glomerulonephritis
persons not registered as Medical Practitioners, or from a Medical
Class III Focal Segmental Proliferative Lupus
Practitioner who is practicing outside the discipline that he/she is
Glomerulonephritis
licensed for.
Class IV Diffuse Proliferative Lupus
15. Any Critical Illness directly or indirectly, caused due to any treatment,
Glomerulonephritis
including surgical management, to change characteristics of the body
Class V Membranous Lupus
to those of opposite sex.
Glomerulonephritis
16. Any Critical Illness directly or indirectly, caused due to cosmetic or
The conclusive Diagnosis of an illness, which plastic surgery or any treatment to change the appearance unless for
in the opinion of a Medical Practitioner who reconstruction following an Accident, Burn(s), or Cancer or as part of
is an attending Consultant and agreed by our medically necessary treatment to remove a direct and immediate health
63. Terminal Illness appointed Medical Practitioner, life expectancy risk to the insured. For this to be considered a medical necessity, it must
is no greater than twelve (12) months from the be certified by the attending Medical Practitioner.
date of notification of claim, regardless of any 17. Any Critical Illness directly or indirectly, caused due to surgical
treatment that might be undertaken. treatment of obesity that does not fulfil all the below conditions:
Meningitis caused by tubercle bacilli, resulting a. Surgery to be conducted is upon the advice of the Doctor
Tuberculosis in permanent neurological deficit. Such a b. The Surgery / Procedure conducted should be supported by clinical
64.
Meningitis Diagnosis must be confirmed by a Medical protocols
Practitioner who is a specialist in neurology. c. The Life Insured is 18 years of age or older and
d. Body Mass Index (BMI):
b. Exclusions to Critical Illness benefit • greater than or equal to 40 or
The following exclusions shall be applicable to the benefits under Gold • greater than or equal to 35 in conjunction with any of
Variant/Gold Plus / Platinum Variant/ / Platinum Plus Variant under this the following severe co-morbidities following failure of less
Rider: invasive methods of weight loss:
No benefit shall be payable if any Major Critical Illness is Diagnosed i. Obesity related cardiomyopathy
a. within the Waiting Period. In such case this Rider will terminate and We ii. Coronary heart disease
will refund the Rider Premium paid corresponding to the Rider benefit. iii. Severe Sleep apnoea
However, no Waiting Period will be applicable in case of any Critical iv. Uncontrolled Type 2 Diabetes despite optimal therapy
Illness occurring solely due to an Accident. 18. Any Critical Illness directly or indirectly, caused due to treatments
b. No Critical Illness benefit shall be payable in respect of any Critical received in health hydros, nature cure clinics, spas or similar
Illness that was Diagnosed before the Date of Commencement of Risk establishments or private beds registered as a nursing home attached to
under Rider. such establishments or where admission is arranged wholly or partly
c. Any valid claim under this Rider is payable only subject to fulfilling all for domestic reason.
of the following criteria: 19. Any Critical Illness directly or indirectly, caused by treatment directly
(i) Completion of Survival Period from the date of Diagnosis. arising from or consequent upon any Life Insured committing or
attempting to commit a breach of law with criminal intent.

25 of 44
 20. In the event of the death of the Life Insured within the stipulated d. Body Mass Index (BMI):
Survival Period as set out above. • greater than or equal to 40 or
21. Any Critical Illness directly or indirectly, caused sterility and infertility. • greater than or equal to 35 in conjunction with any of the
This includes: following severe co-morbidities following failure of less invasive
a. Any type of contraception, sterilization methods of weight loss:
b. Assisted Reproductive services including artificial insemination i. Obesity related cardiomyopathy
and advanced reproductive technologies such as IVF, ZIFT, GIFT, ii. Coronary heart disease
ICSI iii. Severe sleep apnea
c. Gestational Surrogacy iv. Uncontrolled type 2 Diabetes despite optimal therapy
d. Reversal of sterilization 19. Any disability directly or indirectly, caused due to treatments received
in health hydros, nature cure clinics, spas or similar establishments
B. Total and Permanent Disability benefit (Applicable only if You have chosen or private beds registered as a nursing home attached to such
either Gold Plus Variant, Platinum Plus Variant or Total and Permanent establishments or where admission is arranged wholly or partly for
Disability Variant) domestic reason.
i) Rider Sum Assured (or remaining Rider Sum Assured, as applicable) shall 20. Any disability directly or indirectly, caused by treatment directly arising
be payable on a valid Total and Permanent Disability claim during the Rider from or consequent upon any Life Insured committing or attempting to
Term, subject to Rider benefit being in force. Upon payment of the Total and commit a breach of law with criminal intent.
Permanent Disability claim, the Rider shall terminate and no further benefit 21. In the event of the death of the Life Insured within a period of 6 (Six)
shall be paid under the Rider. consecutive months from the date of Diagnosis or Accident.
ii) Exclusions: We shall not be liable to make any payment under this Rider 22. Any disability directly or indirectly, caused by sterility and infertility.
towards the Total and Permanent benefit, directly or indirectly caused by, This includes:
based on, arising out of or howsoever attributable to any of the following: a. Any type of contraception, sterilization
1. No benefit towards Total and Permanent Disability benefit shall be b. Assisted Reproductive services including artificial insemination and
payable if any Total and Permanent Disability occurs within the Waiting advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
Period. In such case this Rider will terminate and We will refund the c. Gestational Surrogacy
Rider Premium paid corresponding to the Rider benefit. However, no d. Reversal of sterilization
Waiting Period will be applicable in case of any Total and Permanent If any of the exclusions stated above is/are found at the underwriting stage,
Disability occurring solely due to an Accident. then the Rider will not be offered. However, if any exclusion is accepted as
2. Any Pre-Existing Diseases. However, coverage under the Rider after the substandard as per board approved Underwriting Policy, then the claim will
expiry of 48 months for any Pre-Existing Disease is subject to the same not be rejected on ground of that exclusion.
being declared at the time of application and accepted by Us. C. Max Fit Program (available with all variants other than Total and Permanent
3. Any disability directly or indirectly caused due to treatment for Disability Variant)
alcoholism, drug or substance abuse or any addictive condition and i. To promote good health and wellbeing of the Life Insured under the Rider,
consequences thereof. a wellness program is offered to the Life Insured wherein a subscription to
4. Narcotics used by the Life Insured unless taken as prescribed by a a mobile application (which can be downloaded from Google Play Store
Medical Practitioner. or Apple Store, on compatible mobile devices) will be available to the
5. Any disability directly or indirectly caused due to intentional self-injury, Life Insured only for the first 5 years of Rider Term from the Date of
suicide or attempted suicide, whether the person is medically sane or Commencement of Risk under Rider calculation of Healthy Weeks should
insane. start from the Date of Commencement of Risk under Rider. Through this
6. Any disability directly or indirectly, caused by or arising from or mobile application the Life Insured will be able to record the number of
attributable to a foreign invasion, act of foreign enemies, hostilities, steps taken per week and by accumulating Healthy Weeks as provided in the
warlike operations (whether war be declared or not or while performing mobile application, You will be eligible for a discount on renewal premium
duties in the armed forces of any country during war or at peace time), as per table in Clause 4.5 of Part C of the Rider.
civil war, public defense, rebellion, revolution, insurrection, military or ii. This benefit will not be available in case the Rider is in lapse status and in
usurped power. case of reinstatement of Rider beyond the first 5 years of Rider Term from
7. Service in any military, air-force, naval, paramilitary or similar the Date of Commencement of Risk under Rider. In case of reinstatement
organization. of the Rider within the first 5 years of Rider Term from the Date of
8. Any disability caused by ionizing radiation or contamination by Commencement of Risk under Rider, the benefit will be available till the
radioactivity from any nuclear fuel (explosive or hazardous form) or end of first 5 years of Rider Term from the Date of Commencement of Risk
from any nuclear waste from the combustion of nuclear fuel, nuclear, under Rider.
chemical or biological attack. iii. It is entirely for You and/or Life Insured to decide whether to obtain this
9. Working in underground mines, tunneling or involving electrical benefit or not. The benefit is intended to improve well-being and habits of the
installations with high tension supply, or as race jockeys or circus Life Insured, by working towards personalized health goals. These benefits
personnel. or advice provided in the mobile application are not based on medical advice
10. Congenital external anomalies, inherited disorders or any complications and are not meant to substitute the Life Insured's visit to/ consultation with
or conditions arising therefrom including any developmental conditions an independent Medical Practitioner. For any change that the Life Insured
of the Insured. makes to his lifestyle, on the advice of the health coach in the mobile
11. Any disability directly or indirectly caused by any treatment necessitated application, Max Life or any of its service provider shall in no manner be
due to participation as a professional in hazardous or adventure liable for any harm or injury, whether bodily or otherwise, that may occur
sport, including but not limited to, para jumping rock climbing, as a result of such lifestyle changes. The Life Insured must seek immediate
mountaineering, rafting, motor racing, horse racing or scuba diving, medical advice if there is any adverse effect or discomfort on making any
hand gliding, sky diving, deep sea diving and selfie accidents. lifestyle changes.
12. Participation by the Life Insured in any flying activity, except as a bona iv. Ihe data received by Us from the Life Insured shall be treated as confidential
fide, fare-paying passenger of a recognized airline on regular routes and and shall be used only for the purpose of calculating the Healthy Weeks in
on a scheduled timetable. the mobile application.
13. Any disability directly or indirectly, caused by medical treatment 2. DEATH BENEFIT
traceable to childbirth (including complicated deliveries and caesarean No Death benefit is payable under this Rider.
sections incurred during hospitalization) except ectopic pregnancy. Any 3. MATURITY BENEFIT
disability due to miscarriages (unless due to an accident) and lawful No maturity benefit is payable under this Rider.
medical termination of pregnancy during the Rider Term. 4. PREMIUM
14. Any disability directly or indirectly, caused by any 4.1. You can pay the Premiums annually, semi-annually, quarterly or on monthly
unproven/ experimental treatment, service and supplies for or in basis, as per the Rider Premium payment mode chosen by You, provided that
connection with any treatment. Unproven/ experimental treatments the Rider Premium payment mode under this Rider shall always be same as the
are treatments, procedures or supplies that lack significant medical Premium payment mode of the Base Policy and can only be changed with the
documentation to support their effectiveness. change of Premium payment mode in the Base Policy.
15. Any disability based on certification/Diagnosis/treatment from persons 4.2. Any change in the Rider Premium payment mode will result in a change in the
not registered as Medical Practitioners, or from a Medical Practitioner Rider Premium amount based on the applicable Modal Factors.
who is practicing outside the discipline that he/ she is licensed for. 4.3. You can pay Rider Premium at any of Our offices or through Our website
16. Any disability directly or indirectly, caused due to any treatment, www.maxlifeinsurance.com or by any other means, as informed by Us. Any
including surgical management, to change characteristics of the body to Premium paid by You will be deemed to have been received by Us only after the
those of opposite sex. same has been realized and credited to Our bank account.
Any disability directly or indirectly, caused due to cosmetic or 4.4. The Rider Premium payment receipt will be issued in Your name, which will be
17. plastic surgery or any treatment to change the appearance unless for subject to realization of cheque or any other instrument/medium.
reconstruction following an Accident, burn(s), or cancer or as part of 4.5. Max Fit Program discount (Applicable in all variants other than Total and
medically necessary treatment to remove a direct and immediate health Permanent Disability Variant)
risk to the insured. For this to be considered a medical necessity, it must i) Subject to Clause 1.C of part C, the Life Insured shall be entitled for
be certified by the attending Medical Practitioner. a discount only on the next renewal premium (Annualised Premium) by
18. Any disability directly or indirectly, caused due to surgical treatment of accumulating Healthy Weeks in a Rider Year as per table given below:
obesity that does not fulfil all the below conditions: a. For Regular Premium Payment Variant:
a. Surgery to be conducted is upon the advice of the Doctor
b. The surgery / procedure conducted should be supported by clinical
protocols
c. The Life Insured has to be 18 years of age or older and

26 of 44
 No. of Healthy c. Fully terminate the Rider and take the applicable Exit Value
Weeks accumulated (if any).
Discount as % of
(During the first 11 months
renewal Premium If none of the above option is exercised by You or the
from Rider Anniversary or Date
(For Regular Pay Variant) revised/differential Rider Premium is not paid, default option
of Commencement of Risk
under Rider, as the case may be) (b) will be applicable and the Rider will continue with the
0 to 12 Nil original Rider Premium and revised Rider Sum Assured.
4.6.3. In case the revision, as noted above, is done after the end of Rider
13 to 26 5%
Premium Payment Term, Rider Sum Assured shall be adjusted to allow
27 to 36 7.5% for the revision in the Premium.
Above 36 10% 4.6.4. The revision as noted above may be upward or downward.
5. LAPSATION OF RIDER
b. For Limited Premium Payment Variant: the discount shall be equal to If You discontinue the payment of Premium during the of Rider Premium Payment
the discount in Table in (a) above, multiplied by the 'Factor'. Here the Term, the Rider will become a Lapsed Rider on the expiry of the Grace Period and
'Factor' shall be computed as per the formula given below: no benefits under the Rider shall be payable.
6. GRACE PERIOD
'Factor' = {1-1/1.055PPT}/ {1-1/1.055PT} 6.1. The Rider Premium is due and payable by the due date specified in the Schedule.
If the Rider Premium is not paid by the due date, You may pay the same during
Where PPT means chosen Premium Payment Term of the Rider and the Grace Period without any interest or late fee.
PT means Rider Term. 6.2. The insurance coverage continues during the Grace Period and in case a valid
Critical Illness claim is made by the Claimant during the Grace Period, then, We
For example, in case of 5 years Premium Payment Term of the Rider
will pay the Critical Illness benefit payable under the Rider after deducting the
and 10 years Rider Term, the Factor is equal to 57% and if the
number of Healthy Weeks recorded are above 36 in first 11 months of due Rider Premium, if any,
Rider Year, You shall be eligible for premium discount of 5.7% on the 7. ALTERATIONS
upcoming renewal Premium. 7.1. Rider can be attached to the Base Policy at inception or at any policy anniversary
of the Base Policy as per board approved Underwriting Policy and the applicable
Note: For the purpose of above calculations noted above, any of the Rider terms and conditions.
Healthy Weeks accumulated during the last month before the Rider 7.2. Rider shall automatically get surrendered if the Base Policy is surrendered and
Anniversary will not be considered. Exit Value under the Rider, if any shall be payable.
8. HOSPITALIZATION BENEFITS
ii) One Healthy Week can be accumulated by recording minimum 50,000 No Hospitalization benefits shall be payable under this Rider.
steps in a week subject to maximum 15,000 steps per day.
iii) For the sake of clarity, the Healthy Weeks accumulated by you in the PART - D
immediately preceding Rider Year will be considered for providing any SERVICING CONDITIONS APPLICABLE TO THE RIDER
discount on the next due Annualised Premium and will be communicated 1. EXIT VALUE
to You via email, SMS/ letter/ calls as a part of renewal communication 1.1. The Rider can be surrendered even without surrendering the Base Policy,
and these Healthy Weeks cannot be carried forward. No discount on the however, the Exit Value shall be paid only in case the Limited Premium Payment
Annualised Premium shall be provided in case You fail to accumulate the Variant Rider has acquired an Exit Value.
minimum Healthy weeks as noted in the table above. 1.2. The Rider shall acquire Exit Value provided that all the due Rider Premiums for
iv) The level of discount provided may be revised as per the emerging the following minimum period have been received in full and applied by Us:
experience, with prior approval of IRDAI.

4.6. Premium and Rider Sum Assured Guarantee: Limited Premium Payment On receipt of two full years' Rider Premium
4.6.1. The Rider Premium and Rider Sum Assured under this Rider are Variant
guaranteed only for a period of 10 years from the date of Commencement Regular Premium Payment No Exit Value shall be payable
of Risk under the Rider and the same may be revised thereafter with prior Variant
approval of IRDAI.
4.6.2. After every revision the Rider Premium and Rider Sum Assured remain 1.3. The Exit Value shall be determined basis the formula given below:
guaranteed for a period of 10 years from the date of such revision and may
be revised thereafter at every 10 years of interval. The guarantee will be 75% * (sum of Total Rider Premiums Paid and Underwriting Extra Rider
applicable in the following manner: Premium, if any) * (Remaining Rider Term in months / Total Rider Term in
4.6.2.1. For cases where Rider Premium Payment Term is completed or months) * (sum of Total Rider Premium Paid and Underwriting Extra Rider
for Limited Premium Payment Variant where the remaining Rider Premium, if any / sum of total Rider Premium and Underwriting Extra Rider
Premium Payment Term is less than 10 years: Premium, if any payable) * {(Rider Sum Assured at the Date of Commencement
of Risk under Rider less Minor Critical Illness claim paid, if any) / Rider Sum
In case of revision of the Rider Sum Assured opted by You
Assured at the Date of Commencement of Risk under Rider}
at inception, You shall be notified with the revised Rider Sum
Assured, three months prior to the next Rider Anniversary post 1.4. Rider shall automatically terminate if the Base Policy is surrendered. In such
the revision, providing the below options to choose from: cases only Exit Value, if any, under the Rider, shall be payable.
a. Accept the revised Rider Sum Assured and continue the Rider, 2. LOANS
where: You are not entitled to any loans under this Rider.
3. REVIVAL OF THE RIDER
Revised Rider Sum Assured = Rider Sum Assured x {(Rider Lapsed Rider can be revived only if Base Policy has been revived. Rest of the
Premium) / (revised Rider Premium)} conditions for reinstatement/revival of this Rider shall be same as that applicable for
the Base Policy.
Note: the revised Rider Premium above will be for same entry 4. PAYMENT OF RIDER BENEFITS
Age, Rider Term and Rider Premium Payment Term as at Date 4.1. The benefits under this Rider shall be payable only on submission of satisfactory
of Commencement of Risk under Rider. proof of the Life Insured's Diagnosis of Critical Illness to Us. The benefits under
b. Fully terminate the Rider and take the applicable Exit Value this Rider shall be payable to the Life Insured upon Claimants written request
(if any). and submission of the required documents.
4.2. Once the benefits under this Rider are paid to the Claimant, this Rider will
If none of the above options is exercised by You option (a) will
terminate and the same shall constitute a valid discharge of Our liability under
be applicable and Rider will continue with the revised Rider
this Rider.
Sum Assured.
5. TERMINATION OF THE RIDER
4.6.2.2. For Regular Premium Payment Variant or Limited Premium
Payment Variant where the remaining Rider Premium Payment 5.1. The Rider shall continue to be in force for the Rider Term as specified in the
Term is more than 10 years: Schedule from the Date of Commencement of Risk under Rider.
5.2. The insurance coverage of a Life insured under this Rider shall automatically
You shall be notified with the revised Rider Premium / revised terminate on the occurrence of any of the first of the following events during
Rider Sum Assured three months prior to the date of revision of the Rider Term:
Rider Premium providing the below options to choose from: 5.2.1 on the date on which we receive the Freelook cancellation request from
You;
a. Accept/ pay the revised Rider Premium and continue the 5.2.2 on the date of death of Life Insured;
Rider with the original Rider Sum Assured any Critical Illness occurring within Waiting Period, in which case We
5.2.3 will only refund the Rider Premium received.
b. Continue the Rider with the original Rider Premium but with 5.2.4 on payment of 100% of a Rider Sum Assured under this Rider;
revised Rider Sum Assured, where: 5.2.5 on date on which the Rider or Base Policy expires, or is cancelled or
terminated for any reason whatsoever;
Revised Rider Sum Assured = Rider Sum Assured x {(Rider
5.2.6 on receipt of written request from the Life Insured or You for Surrender
Premium) / (revised Rider Premium)}
of the Rider or the Base Policy;
Note: the revised Rider Premium above will be for same entry 5.2.7 on the expiry of the Revival Period, if the Lapsed Rider has not been
Age, Rider Term and Rider Premium Payment Term as at revived.
Date of Commencement of Risk under Rider.

27 of 44
6. FREELOOK CANCELLATION 8. ASSIGNMENT
"Freelook" means a period of 15 days or 30 days (if the Rider is sourced through Same as Base Policy.
distance marketing modes such as internet, SMS, tele marketing, interactive electronic 9. TRAVEL RESTRICTION
medium etc.) from the date of receipt of the Rider, to review the terms and conditions There are no restrictions on travel under this Rider.
of the Rider, where if You disagree to any of those terms and conditions, You have 10. RIDER CURRENCY
the option to return the Rider stating the reasons for objection. Upon return, the Rider As per Base Policy.
will terminate forthwith and all rights, benefits and interests under the Rider will cease 11. ELECTRONIC TRANSACTIONS
immediately. You shall be entitled to a refund of the Premium received by Us after As per Base Policy.
deducting the proportionate risk premium for the period of cover, charges of stamp 12. AMENDMENT
duty paid and the expenses incurred by Us on medical examination of the Life Insured, As per Base Policy.
if any. 13. REGULATORY AND JUDICIAL INTERVENTION
As per Base Policy.
PART - E 14. FORCE MAJEURE
RIDER CHARGES As per Base Policy.
APPLICABLE FEES/ CHARGES UNDER THIS RIDER 15. COMMUNICATION AND NOTICES
This Rider is a non-linked non-participating individual pure risk premium health As per Base Policy.
insurance rider, so Part E is not applicable to this Rider. 16. GOVERNING LAW AND JURISDICTION
As per Base Policy.
PART - F
GENERAL TERMS & CONDITIONS OF THE RIDER PART - G
These general terms and conditions are applicable in addition to the general terms and GRIEVANCE REDRESSAL MECHANISM AND OMBUDSMAN DETAILS
conditions of the Base Policy. As per Base Policy.
1. ELIGIBILITY FOR RIDER BENEFITS
1.1. The minimum Age of the Life Insured on the Date of Commencement of Risk
under Rider should be 18 (Eighteen) years.
1.2. The maximum Age of the Life Insured on the Date of Commencement of Risk
under Rider cannot exceed 65 (Sixty Five) years.
1.3. The maximum Age of the Life Insured on the Maturity Date for Gold Variant and
Platinum Variant cannot exceed 85 (Eighty Five) years, however, under Gold
Plus Variant, Platinum Plus Variant and Total and Permanent Disability Variant
of this Rider, the maximum Age of Life Insured on the maturity cannot exceed
75 (Seventy Five) years.
1.4. Minimum Rider Term is 5 (Five) years and maximum allowable Rider Term,
subject to the above Clauses, is 67 years. However, in no case the Rider Term
under this Rider can exceed the remaining tenure of the Base Policy.
2. REDUCTION IN SUM ASSURED
The Rider Sum Assured, can in no case be higher than the sum assured under the Base
Policy. Thus in case, You have an option to reduce Sum Assured under Base Policy
and the same is exercised by You in a manner that the Sum Assured under the Base
Policy becomes less than the Rider Sum Assured, then the Rider Sum Assured shall
automatically be reduced to make the Rider Sum Assured equal to the Sum Assured
under the Base Policy.
3. TAXES
3.1. All Rider Premiums are subject to applicable taxes, cesses, and levies which
will entirely be borne by You and will always be paid by You along with the
payment of Rider Premium. If any imposition (tax or otherwise) is levied by any
statutory or administrative body under the Rider, We reserve the right to claim
the same from You. Alternatively, We have the right to deduct the amount from
the benefits payable by Us under the Rider.
3.2. Tax benefits may be available are subject to prevailing tax laws. Tax laws and
the benefits arising there under are subject to change. You are advised to seek an
opinion of Your tax advisor in relation to applicable tax benefits and liabilities.
4. CLAIM PROCEDURE
4.1. A Claimant claiming benefits under this Rider shall endeavor to notify Us of
the same, in writing, within 90 (Ninety) days from the Diagnosis of the Critical
Illness.
4.2. We will require the following documents in case of claim under this Rider:
a) Claimant's statement in the prescribed form;
b) a copy of police complaint/ first information report (wherever applicable);
c) attending physician's statement;
d) certificate by a Medical Practitioner confirming Diagnosis of Critical Illness
of the Life Insured;
e) All medical/ hospital records (including diagnostic records) pertaining to
Critical illness/ Total and Permanent Disability Diagnosis and treatment.
f) identity proof of the Claimant including nominee(s) bearing their
photographs and signatures; and
g) any other documents/information required by Us for assessing and approving
the claim request.
4.3. A Claimant can download the claim request documents from Our website
www.maxlifeinsurance.com or can obtain the same from any of Our branches.
4.4. We reserve the right to scrutinize the documents submitted by the Claimant
and/or investigate the cause leading to the occurrence of the Insured event
and deny the claim partially or completely on the basis of Our scrutiny of the
documents or investigation, as the case may be. We shall pay the benefits under
this Rider subject to Our satisfaction:
a) that the benefits have become payable as per the terms and conditions of this
Rider; and
b) of the bonafides and credentials of the Claimant.
Subject to Our sole discretion and satisfaction, in exceptional circumstances such
4.5. as on happening of a Force Majeure Event, We may decide to waive all or any
of the requirements set out in Section 2.1 of Part F.

5. DECLARATION OF THE CORRECT AGE AND GENDER

Same as Base Policy.
6. FRAUD, MISREPRESENTATION AND FORFEITURE
Same as Base Policy.
7. NOMINATION
Same as Base Policy.

28 of 44
Annexure A: List of Insurance Ombudsman

AHMEDABAD - Office of the Insurance Ombudsman, 6th Floor, Jeevan Prakash Bldg, Tilak Marg, Relief Road,Ahmedabad-380
001. Tel.:- 079-25501201/02/05/06 Email: bimalokpal.ahmedabad@cioins.co.in (State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman
and Diu.)
BENGALURU - Office of the Insurance Ombudsman, Jeevan Soudha Bldg. ,PID No. 57-27-N-19, Ground Floor 19/19, 24th Main Road, JP Nagar, Ist Phase,
Bengaluru - 560 078. Tel.:- 080-26652049/26652048 Email: bimalokpal.bengaluru@cioins.co.in (State of Karnataka)
BHOPAL - Office of the Insurance Ombudsman, 2nd Floor, Janak Vihar Complex, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal(M.P.)-462
003. Tel.: 0755 - 2769201 / 2769202 Email: bimalokpal.bhopal@cioins.co.in (States of Madhya Pradesh and Chhattisgarh)
BHUBANESHWAR - Office of the Insurance Ombudsman, 62, Forest park, Bhubneshwar - 751 009. Tel.: 0674 - 2596461 /2596455 Email:
bimalokpal.bhubaneswar@cioins.co.in (State of Orissa).
CHANDIGARH - Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 - D, Chandigarh- 160 017. Tel.:
0172 - 2706468 / 2706196 Email: bimalokpal.chandigarh@cioins.co.in [States of Punjab, Haryana (excluding 4 districts viz, Gurugram, Faridabad, Sonepat
and Bahadurgarh) Himachal Pradesh, Union Territories of Jammu & Kashmir, Ladakh and Chandigarh]
CHENNAI - Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai - 600 018. Tel.: 044
- 24333668/ 24335284 Email: bimalokpal.chennai@cioins.co.in (State of Tamil Nadu, and Union Territories - Puducherry Town and Karaikal (which are part
of Union Territory of Pondicherry)).
DELHI - Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building., Asaf Ali Road, New Delhi-110 002. Tel.:- 011-23232481/23213504 Email:
bimalokpal.delhi@cioins.co.in (State of Delhi, 4 districts of Haryana viz, Gurugram, Faridabad, Sonepat and Bahadurgarh)
ERNAKULAM - Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, M. G. Road, Ernakulam - 682015. Tel.: 0484 - 2358759
/ 2359338 Email: bimalokpal.ernakulam@cioins.co.in (States of Kerala and Union Territory of (a) Lakshadweep (b) Mahe - a part of Union Territory of
Puducherry)
GUWAHATI - Office of the Insurance Ombudsman, "Jeevan Nivesh", 5th Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati-781
001(ASSAM) Tel.:- 0361-2632204/2602205 Email: bimalokpal.guwahati@cioins.co.in (States of Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh,
Nagaland and Tripura.)
HYDERABAD - Office of the Insurance Ombudsman, 6-2-46, 1st Floor, Moin Court, Lane Opp. Saleem Function Palace, A.C. Guards, Lakdi-Ka-Pool,
Hyderabad-500 004. Tel.: 040 - 23312122 Email: bimalokpal.hyderabad@cioins.co.in (State of Andhra Pradesh, Telangana and Yanam and part of the Union
Territory of Pondicherry.)
JAIPUR - Office of the Insurance Ombudsman, Ground Floor, Jeevan Nidhi II Bldg, Bhawani Singh Marg, Jaipur - 302005 Tel.: 0141 - 2740363 Email:
bimalokpal.jaipur@cioins.co.in (State of Rajasthan)
KOLKATA - Office of the Insurance Ombudsman, Hindustan Building. Annexe, 7th Floor, 4, C.R. Avenue, Kolkata-700 072. Tel :
033-22124339/22124340 Email: bimalokpal.kolkata@cioins.co.in (States of West Bengal, Sikkim, and Union Territories of Andaman & Nicobar Islands)
LUCKNOW - Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-2, Nawal Kishore Road, Hazaratganj, Lucknow-226 001. Tel : 0522
-2231331/2231330 Email: bimalokpal.lucknow@cioins.co.in (Following Districts of Uttar Pradesh: Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
Allahabad, Mirzapur, Sonbhadra, 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.)
MUMBAI - Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz(W), Mumbai - 400054. Tel :
022- 69038821/23/24/25/26/27/28/29/30/31 Email: bimalokpal.mumbai@cioins.co.in (State of Goa and Mumbai Metropolitan Region excluding areas of Navi
Mumbai and Thane)
NOIDA - Office of the Insurance Ombudsman, 4th Floor, Bhagwan Sahai Palace,Main Road, Naya Bans, Sector-15, Distt: Gautam Buddh Nagar, U.P.
- 201301. Tel : 0120-2514252/2514253 Email: bimalokpal.noida@cioins.co.in (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.)
PATNA - Office of the Insurance Ombudsman, 2nd floor, North Wing, Lalit bhawan, Bailey Road, Patna - 800001 Tel : 0612-2547068 Email:
bimalokpal.patna@cioins.co.in (State of Bihar, Jharkhand.)
PUNE - Office of the Insurance Ombudsman,3rd Floor, Jeevan Darshan Bldg, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan peth, Pune - 411030 Tel :
020-41312555 Email: bimalokpal.pune@cioins.co.in (State of Maharashtra including Navi Mumbai and Thane and excluding Mumbai Metropolitan Region.)

29 of 44
 MAX LIFE INSURANCE COMPANY LIMITED
Regd. Office : 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab-
144533
Head Office: 11th & 12th Floor, DLF Square, Jacaranda Marg, DLF City Phase-II, Gurugram Haryana,
122002.

NON LINKED PROPOSAL FORM PROPOSAL NUMBER: 144887924

GO/CA/Broker Code: EBRL1

Do you have Max Life Insurance Policy or have currently applied for simultaneous policies? If yes give policy/proposal number? YES-(341495133)

Purpose of Insurance: WEALTH ACCUMULATION/INVESTMENT

Objective of Insurance: INDIVIDUAL POLICY

Product Solution: N/A Affinity Customer: N/A Existing Customer: YES

A. Personal Details
Proposer/Joint Life Life to be Insured(if other than proposer)
1. Title MR

First SHER

2. Name Middle

Last SINGH

First ZORAWAR
3. Father's / Husband
Name
Last SINGH

4. Date of Birth 15-08-1974

5. Gender MALE
6. Nationality INDIAN
7. Marital Status MARRIED
8. Education POST GRADUATE
9. Relationship with Proposer/ Joint Life SELF

10. Industry Type OTHERS

11. Organisation Type GOVT

12. Occupation/Job Title SALARIED
13. Name of Entity / Employer OTHERS
14. Annual Income(Rs.) 1250000

15. Is the Life to be Insured / Proposer / Joint Life / Nominee / Payor a Politically Exposed Person ? : NO

16. Nominee Details

Title MS

First KUMARI

Name Middle

Last SEEMA

Date of Birth 01-07-1986

Gender FEMALE
Percentage of Share 100
Relationship with Proposer/ Joint Life WIFE

17. Current Residential Address

House No./Apt. Name: 139/A/B ANANDA SUPER CITY

Society Road/Area/Sector: DOHRA ROAD

Landmark:
Village/Town: BAREILLY

Page 1 of 6 30 of 44
 City/District: BAREILLY

Pin Code: 243006 State/UT: UTTAR PRADESH Country: INDIA

Mobile STD
Mobile No. 1: 9897848677 9999999999 Landline:
No. 2: Code:
Email: Sssbharti1508@gmail.com

18. Permanent Residential Address (Optional)

House No./Apt. Name: 139/A/B ANANDA SUPER CITY

Society Road/Area/Sector: DOHRA ROAD
Landmark:
Village/Town: BAREILLY
City/District: BAREILLY
Pin Code: 243006 State/UT: UTTAR PRADESH Country: INDIA

19. Preferred Mailing Address. Current Residential

20. Do you wish to hold for this policy electronically under e-Insurance ? NO

B. Coverage Information-Type of Coverage

Premium Sum Income Premium Modal

Coverage
a. Base Plan Variant Back Assured/Annual Payout Payment Premium
Term
Option Income Payout Frequency Term (Rs.)
BALANCED
MAX LIFE SMART WEALTH ADVANTAGE GROWTH PAR PLAN NA 612240 ANNUAL 37 12 25500
INCOME
Income
Income Income Start
Deferment
Period Year
Period

NA NA NA

Premium Back Coverage Premium Payment Sum Modal Premium

b. Riders/Optional Benefits
Option Term Term Assured (Rs.)
CRITICAL ILLNESS AND DISABILITY RIDER - PLATINUM PLUS NA 17 12 300000 2708

Modal Premium without

GST* and Applicable Cess: 1635 Total Premium Paid: 29843
GST* and Cess: 28207.9
(*GST shall comprise of CGST, SGST/UTGST or IGST (whichever is applicable) including cesses and levies, if any. All applicable taxes, cesses and levies, as per
prevailing laws, shall be borne by you)
e. Policy Continuance Benefit (PCB): No f. Avail Income on a Special Date: No
Bonus Option: NA
(Not Applicable for plans that offer reversionary Bonus)

2. NEFT Bank A/C Details of Proposer/ Joint Life: All Payouts will be credited to this account through Electronic mode of payment. (This will be applicable at
select cities as per facilities/arrangements of Max Life Insurance).
MICR Code: 243802000 Bank Account Number: 000400320002935
IFSC Code: ICIC00ZSBLB Account Holder's Name: SHER SINGH
Bank Name & Branch: ZILA SAHKARI BANK LTD ZILA SAHKARI BANK LTD. BAREILLY
Type of Bank Account: SAVINGS ACCOUNT
BAHE
Banking Since: 14-01-2003

3. Permanent Account
Number (PAN): Form 60 NO (for proposer/jointlife) Form 60 NA (for Insured)
ARQPS3623N
TDS may be applicable, in accordance with Income Tax Act 1961, as amended from time to time.
4. Mode of Payment:
5. Renewal premium by: ECS 6. Source of Funds SALARY
SEMI-ANNUAL
7. IS PAYOR DIFFERENT FROM THE PROPOSER ? NO

8. Are you a Max Life Agent or an employee of a Max group company/ Corporate Agents? NO
9. Effective Date of Coverage: 12-06-2023

10. Premium Payment Details

Amount in Words: TWENTY NINE THOUSAND EIGHT HUNDRED FORTY TWO
Paid Rs: 29842.84 Payment by CHEQUE
Cheque / Draft No. / Instrument no 710272 Date: 13-06-2023
Bank Name & Branch: ZILA SAHKARI BANK LTD

Page 2 of 6 31 of 44
C. INFORMATION OF LIFE TO BE INSURED

Proposer/Joint Life to be
Life Insured

1. Do you have any life or Critical Illness insurance policy issued, pending approval from any other insurance companies or has
your application for Life/Health/Critical illness insurance or its reinstatement ever been offered at modified terms,rejected or NO NA
postponed ?

Proposer/Joint Life to be
Life Insured

2. In the next 12 months do you intend to travel or reside abroad other than on holiday of less than 4 weeks? NO NA

3. Do you participate or do you intend to participate in any hazardous activities as part of your Occupation/ Sports/ Hobby? NO NA

4. Have you ever been convicted or are you under investigation for any criminal charges ? NO NA

5. For Female Life To Be Insured NO

6. For Minor Life To Be Insured (Age < 18 yrs.) NO

D. Medical Information

Proposer/Joint Life to be
1. FAMILY HISTORY
Life Insured

Has any two (2) or more of your family members (parents & Siblings) ever been diagnosed with diabetes or
NO NA
hypertension or kidney failure or cancer or heart Attack or any Hereditory Disorder before the age of 60 ?

2.

Proposer/Joint Life Life To Be Insured

Height 160 cm NA
Weight 60 kg NA

3. Have you ever been investigated, treated or diagnosed with any of the following conditions. Proposer/Joint Life to be
If yes, please provide details Life Insured

i) Diabetes /High blood sugar levels NO NA

ii) Hypertension/ High Blood Pressure, High Cholesterol or Thyroid disorder NO NA

iii) Heart or vascular disorder including chest pain, stroke, heart attack or Angioplasty, CABG or any other heart surgery. NO NA

iv) Breathing or lung disorders including asthma, emphysema, tuberculosis. NO NA

v) Liver or digestive system related disorder including jaundice ,gall bladder, pancreas or Hepatitis B/C. NO NA

vi) Any abnormal growth like tumour,lump,cancer or blood disorder, including anemia or thalassaemia or Sexually transmitted
NO NA
disease ( STD ) including HIV or AIDS.

vii) Any kind of Kidney or bladder disorder, including kidney failure, renal stone, nephritis or prostrate disorder. NO NA

viii) Any neurological or mental health problem like paralysis, multiple sclerosis, Parkinson's, epilepsy, depression or anxiety. NO NA

ix) Muscular-skeletal or joint disorders, including any kind of arthritis, gout, osteoporosis. NO NA

x) Are you having history of any hospitalization, treatment or investigation? NO NA

xi) Have you advised now or in last 5 yrs tests like X-Ray/CT scan/MRI/ Ultrasonography/ ECG/Blood test or any other
NO NA
investigatory or diagnostic tests, or any type of surgery.

Xii) Have you ever been diagnosed with any form of internal or external congenital anomaly or defect i.e. any condition(s) which is
NO NA
present since birth, and which is abnormal with reference to form, structure or position?

Xiii) Have you had any genetic testing before? NO NA

Proposer/Joint Life to be
4. Tobacco/Alcohol/Drugs Consumption: Do you consume any of the following ?
Life Insured

i) Tobacco ( Smoking /Chewing) currently or even occasionally in last 1 year ? NO NA

ii) Alcohol (ML) - Beer/Wine/Hard Liquor. NO NA

iii) Are you taking drugs like Cannabis/Marijuana,Ecstacy,Heroin,LSD,Amphetamines or any other illegal drugs? NO NA

E. Declaration And Authorisation

1. DECLARATION BY PROPOSER/ JOINT LIFE

I/We hereby declare that I/We fully understand the meaning and scope of the Proposal form and the questions contained above and I am submitting the
completed proposal form of my/our own volition, and confirm that I/We have not been induced by anyone to make the Proposal. I/We have been explained the
nature of questions and the importance of disclosing all material information.

Page 3 of 6 32 of 44
I/We further declare that all the statements and declarations herein shall be the basis of a contract between me/us and the Company and that I/We have made
complete, true and accurate disclosure of all the facts and circumstances and have not withheld any information that may be relevant to enable the Company to
make an informed decision about the acceptability of the Proposal. I agree that in case of any fraud or misstatement, provisions of Section 45 of Insurance Act,
1938, as amended from time to time will apply. I/We undertake to notify the Company, forthwith in writing, of any change in any of the statements made in the
Proposal subsequent to the signing of this proposal and before acceptance of risk and issuance of the Policy by the Company. The first and subsequent year
premium will be paid out of legally acquired source of income. I will provide information as and when required by the Company, acting on its own or under any
order or instruction received from Statutory Authorities, as regards to the sources of funds or utilizations or withdrawals. I agree that the Company may provide
any information related to me in respect of this proposal; as available to the Company at any time, to any Statutory Authority in relation to the any laws including
the laws governing prevention of money laundering, applicable in the country. To enable the Company to assess the risk under my/our proposal or for any other
purpose in relation to the policy, l/we, my/our heirs, administrators or executors or assignees hereby authorize my past or present employer(s)/business
association/medical practitioners /other agencies or governmental and/or any regulatory bodies, insurance repositories, CERSAI/ UIDAI, reinsurers / hospitals or
diagnostic centres/ other insurance companies/ service providers to disclose and make available to the Company such details/records, as may be requested by
the Company. I understand that I have disclosed my personal information with Max life and I hereby provide consent to Max Life to share, store my information
with its authorized service providers for servicing this policy/proposal such as issuance, underwriting renewal and claims process with respect to this policy as per
the regulation applicable from time to time. I/We submit the mandate to credit My / Our account towards all payments against the above policy and agree and
understand that payouts would be processed through electronic mode of payment and will be affected at select cities as per facilities/ arrangements of Max Life
Insurance. I/We authorize Max Life to send all communications by E-mail, SMS or any other communication mode. I/We agree to receive regular reminders,
updates / alerts from Max life from time to time.

I do hereby certify that above stated information regarding the nationality and tax residential status is correct in all respects and may be used for all purposes,
including reporting to statutory authorities & compliances, and understand that it is my responsibility to report the changes, if any, to Max Life within 2 weeks of
occurrence of such change

Date: 13-06-2023 17:49:36 Place: BAREILLY

VERNACULAR /ILLITERATE DECLARATION

(Declaration to be made by a person unconnected with Max life Insurance Company Limited but whose identify can be easily
established.) I hereby declare that I have fully explained the contents of this proposal to the proposer/Life to be Insured in
language, as understood by him/her and that the left thumb impression/signature of the
proposer/Life to be Insured has been appended/affixed after fully understanding the contents thereof. I have truthfully recorded the
answers given by the Proposer/Life to be Insured.I have understood the content of the proposal form as explained to me in
language by the declarant, Mr./Ms. ,filling in the
proposal form and after the same, I am affixing my signature/thumb-impression.

Name of the Declarant: Address of the Declarant:

I hereby certify that I have understood the content of the proposal

form as explained to me in
language by the
declarant, Mr./Ms. ,
filling in the proposal form and after the same, I am affixing my
signature/thumb-impression.

Signature / Thumb Impression / Electronic Signature of Signature / Thumb Impression / Electronic Signature of
Declarant Proposer / Joint Life

2. DECLARATION BY PRINCIPAL OFFICER/AGENT ADVISOR/SPECIFIED PERSON

I MR. RISHABH SARIN do declare and confirm that I have met and explained the Product features, benefits, premium paying
term, nature of the questions contained in this Proposal form and other relevant terms and conditions to the Proposer and the Life Insured. I have also explained
that the answers to the questions forms the basis of the contract of the Insurance between the Company and the Proposer / Life Insured, and if any untrue
statement is contained therein and / or any information that may be relevant to enable the Company make an informed decision, the Company shall have the
right to vary the benefits which may be payable and / or treat the policy voidable at the option of the Company subject to section 45 of the Insurance Act, 1938 as
amended from time to time. I confirm that to the best of my knowledge the Life Insured does not suffer from any physical or mental abnormality or handicap or
has / had been hospitalised, undergone any surgery or treatment, or he /she is involved in activities including any hazardous avocation or occupation or any other
information material for underwriting this proposal form, unless expressly stated in this Proposal. I also declare and represent to the Company that I am in full
compliance with the regulatory requirements applicable to agent / corporate agent / specified person / broker prescribed by the Insurance Act 1938, as amended
from time to time and any other regulation, circular, instruction issued by IRDAI from time to time. I confirm that I have verified the identity, current / permanent
residential address of the Proposer/Life Insured, the nature of his/her business and his / her financial status basis the Max Life AML moral hazard checklist.

Is this a Replacement Sale? If yes, I have adequately explained the consequences of replacement sale
NO
to the customer.

Relationship of Principal Officer/Agent

Name of Principal Officer/Agent Principal Officer/Agent Advisor/Specified
Advisor/Specified Person with the Proposer/
Advisor/Specified Person Person Code
Joint Life/ Life Insured

Customer MR. RISHABH SARIN MAX909174

Signature / Thumb Impression / Electronic Signature of Principal

Officer/Agent Advisor/Specified Person :- 13-06-2023 17:49:36
Signature / Thumb Impression / Electronic Signature of Sales Manager 16-
06-2023 14:04:50
This system generated benefit Proposal form shall be treated as signed
by me.

Page 4 of 6 33 of 44
Phone No. with STD Code:-8077624761

Date:- 13-06-2023 Place:- BAREILLY

We confirm that we have made joint efforts in soliciting the prospect and will be jointly responsible for performing the service related to the policy. We further
confirm that the objective of sharing the commission is not for qualifying for any contest and/or reward & recognition programs of the company.

(Applicable only if more than one Agent Advisors share the commission)

Name(s) of Principal Officer/AA/Spec Person Principal Officer/AA/Spec Person Code Principal Officer/AA/Spec Person's Signature % Share

Mr. Rishabh Sarin 909174 16-06-2023 14:04:50 100

Important Notes: (1) Any payment/s including initial payment accompanying this proposal, cash or by bearer instrument must be made at any of the Company's
General Office only. (2) Crossed cheque or bank drafts must be made in favour of MAX LIFE INSURANCE COMPANY LIMITED ACCOUNT (Proposal No. as
above) maybe handed over to the Agent Advisor. (3} Receipt of the Completed Proposal and initial payment does not create any obligations upon the Company
to underwrite the risk. The Company shall not be liable until it has underwritten the risk and issued the Policy. If the Policy is sent by post it shall be deemed to
have been delivered to and received by you in the ordinary course within 3 (three) days of posting. We draw your attention to Section - 39, Section - 45 and
Section - 41 of the Insurance Act 1938 which reads as follows-

Section 39: In case nomination facility is availed, section 39 of the Insurance Act, 1938 as amended from time to time shall apply.

Section 45: No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of issuance of policy,
from the date of the Commencement of Risk or Revival of the policy or the date of the rider to the policy, whichever is later. However, Insurer may question the
Policy at any time within three years from the date of issuance of policy, from the date of Commencement of Risk or Revival of the policy or the date of the rider
to the policy, whichever is later, on the ground of fraud, in which case insurer shall inform Proposer/Life to be Insured/legal representatives in writing specifying
the grounds and materials on which such decision is based. For other details please referto Section 45 of the Insurance Act, 1938 as amended from time to time.

Section 41: (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.

Additional Declaration:

I am submitting my Electronic Application of my own volition and have understood the contents of the Electronic Application, and the relevant sales literature
including product features, benefits, applicable charges and am aware of the investment risk under the Policy.

I / We are aware that suitability information has been collected from me/us and recommendation on purchase of life insurance product has been made only
basis such information and any product selected by me/us that differs from such recommendation is on the basis of my/our personal choice. I / we have seen
and understood the benefit illustration shown to me / us on the screen electronically or provided to me / us in physical form, as the case may be. I / we have
disclosed all material information and not withheld any information that may be relevant to enable Max Life to take an informed decision about the acceptability
of the Electronic Application. I also confirm that the information in the Electronic Application, including the state of health and lifestyle habits of the life to be
insured is true and complete. I / we have submitted the confirmation number sent on my mobile number/ email id as a confirmation of the contents of the
Electronic Application and the benefit illustration and agreement to the terms therein.

I/We understand and agree that by submitting the Electronic Application, I / we will be bound by the statements / disclosures of material facts made therein in
the same manner, as if I / we have signed and submitted a written proposal for insurance to the Company and these shall be the basis of a contract between
me/us and the Company. I / we undertake to notify the Company of any change in statements made in the Electronic Application subsequent to its submission
and before acceptance of risk and issuance of the policy by the Company. I / we understand that in case the Company detects any fraud or mis-statement or
suppression of fact material to my/our life expectancy, the Company reserves the right to take appropriate action in accordance with Section 45 of the
Insurance Act.

I / we hereby declare and confirm that details provided in Form 60 attached to this Electronic Application (wherever applicable) are true and correct to the best
of my knowledge and belief. I declare that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse, minor
child etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in which the
above transaction is held will be less than maximum amount not chargeable to tax.

I / we understand that the Company will not be liable unless the premium is received and realized by it within the time period stipulated for the same subject to
underwriting by it. I / we hereby authorize the Company to conduct screening / confirmation of my / our health status through medical examinations on the
basis of which, the Company may accept, decline or offer alternate terms on my proposal. I/we hereby authorize my past and present employer(s) /
associate(s) / medical practitioner(s) / any insurer or any other organization to disclose and make available to the Company my/our information.

I / We have filled the proposal electronically and have received the benefit illustration and filled up proposal form on email and registered mobile OR reviewed
it on tablet / desktop and after observing the said copy, I /we confirm that all the content / information therein is correct to the best of my / our knowledge.

I have opted for the Combination Solution voluntarily (wherever applicable) as it would assist me in planning my finances. I also understand that these are
different products and can also be purchased separately.

I do hereby certify that above stated information regarding the nationality and tax residential status is correct in all respects and may be used for all purposes,
including reporting to statutory authorities & compliances, and understand that it is my responsibility to report the changes, if any, to Max Life within 2 weeks of
occurrence of such change.

Signature / Thumb Impression / Electronic Signature of Signature / Thumb Impression / Electronic Signature of Sales Manager 16-06-2023
Proposer/ Joint Life 13-06-2023 17:49:36 14:04:50

Phone No. with STD Code:8077624761

TRAD_STD_0523_5.10

Page 5 of 6 34 of 44
Page 6 of 6 35 of 44
 Pre Issuance Verification Confirmation

Date : 20-Jun-2023
Reference Number: 4004260090
Dear sher
Subject: Confirmation of successful completion of Pre Issuance
Verification Process
Greetings from Max Life Insurance Company!
Thank you for completing Pre Issuance verification of your
application. We would like to assure you that your decision to take
the Life Insurance Policy with us is a prudent one.
This is with regards to the Policy Number: 144887924 where in you have
completed pre issuance verification process for further processing of your
application. Details are as follows:

Pre Issuance Verification Questions Your Responses

Are you aware that you have agreed to pay Semi-Annual premium of
1 12
Rs. 29,801 for _______ years. Please select from the below.

Your life insurance policy will mature after 37 years and the sum
2 Yes
assured is Rs. 5,56,118 during this period.

Are you aware that the guaranteed maturity benefit for this product is
3 Rs. 5,56,118 and benefit illustration showing returns at 4% and 8% has Yes
been reviewed by you

Are you aware that You will get an income of INR 7,500 every Year if
4 Yes
all due premiums are paid.

Are you aware that You will get an income of INR 7,500 every Year
5 Yes
from 2036 if all due premiums are paid.

I’m aware that suitability information has been collected from me and in person recommendation on purchase of
life insurance product has been made only basis such information and if product selected by me that differs from
such recommendation is on the basis of my personal choice. (If ULIP product) I have gone through the risk
profiler and understood the risks associated with investments in the above funds. Basis my financial goals and
needs, I have made a conscious decision to allocate premium as given information. I hereby agree, declare and
confirm that I have read and understood the benefit illustration, key feature document (if applicable as per
regulation) and the proposal form sent on my registered mobile number and email. I have filled up the
verification, health &habit questions and agree for it to be part of the proposal form. I hereby confirm that all the
content / information therein are true and correct to the best of my knowledge and belief.
We look forward to being your partner for life and are committed to provide you with the best of our
services.

Regards,
Max Life Insurance Co. Ltd.
36 of 44
Please note:
- This letter does not confirm issuance of the insurance policy. Issuance of Policy is subject to
realization of premium and completion of underwriting requirements.
- Please ensure that all the information provided by you including the medical facts are accurate as
per Pre Issuance Verification Process completed by you. If incase of non-disclosure or
misrepresentation, company has the right to reject the policy.
- Once the Policy is issued, you have a freelook period of 15 days from receipt of the insurance policy
to review its terms and conditions.

This email is electronically generated

37 of 44
 BENEFIT ILLUSTRATION
[Date and Time of Illustration – 13 June 2023, 05:18 PM]

Name of the Prospect/Policyholder: Mr. Sher Singh Proposal No: 144887924

Age & Gender: 48 Years, Male Name of the Product: Max Life Smart Wealth Advantage Growth Par Plan

Name of the Life Assured: Mr. Sher Singh Tag Line: A Non-Linked Participating Individual Life Insurance Savings Plan

Age & Gender: 48 Years, Male Unique Identification No: 104N135V01

GST Rate (Base Policy, First Year): 4.50%
Policy Term: 37 Years GST Rate (Base Policy, Subsequent Year): 2.25%
GST Rate (Rider Policy, First Year): 18.00%
Premium Payment Term: 12 Years
GST Rate(Rider Policy,Subsequent Year): 18.00%
Amount of Installment Premium: `29,843
Max Life State: Null
Mode of payment of premium: Semi-Annual Policyholder Residential State: Uttar Pradesh

How to read and understand this benefit illustration?

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a.

Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your Insurer carrying on life insurance business. If your policy offers guaranteed returns benefits then these will be clearly marked “guaranteed” in the illustration
table on the next this page. If your policy offers variable returns benefits then the illustration on the next this page will show two different rates of assumed future investment returns, of 8% p.a. and 4% p.a..These assumed rates of return are not guaranteed and they are not
the upper or lower limits of what you might get back, as the value of your policy is dependent on a number of factors including future investment performance.

Policy Details
Variant Name Balanced Income Sum Assured on Maturity (in Rs.) 6,12,240
Policy Continuance Benefit Option No Additional Benefit on Maturity (only applicable for female lives) (in Rs.) -
Payment Frequency for Guaranteed Income & Cash Bonus Annual Sum Assured on Death (at inception of the policy) (in Rs.) 5,56,118
Save the date Option No Date of first Survival Benefit payment Wednesday, June 12, 2024

Rider Details
Accidental Death & Dismemberment (ADD) Rider Premium Payment Term and Rider Term NA
Accidental Death & Dismemberment (ADD) Rider Sum Assured (in Rs.) NA
Waiver of Premium (WOP) Plus Rider Term NA
Critical Illness and Disability Rider - Rider Premium Payment Term and Rider Term 12 Pay 17
Critical Illness and Disability Rider - Coverage Variant Platinum Plus
Critical Illness and Disability Rider - Rider Sum Assured 3,00,000
Term Plus Rider Term - Premium Payment Term and Rider Term NA
Term Plus Rider Sum Assured (in Rs.) NA

Premium Summary

Accidental Death & Waiver of Premium Critical Illness and Total Installment Premium
Base Plan Term Plus Rider
Dismemberment Rider Plus Rider Disability Rider

Installment Premium without GST (in Rs.) 25,500 0 0 0 2,708 28,208

Installment Premium with first year GST (in Rs.) 26,647 0 0 0 3,196 29,843

38 of 44
Installment Premium with GST 2nd year onwards (in Rs.) 26,606 0 0 0 3,196 29,801
UIN: 104N135V01 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 1 of 4
 (Amount in Rupees)

Non-Guaranteed Benefit @
Non-Guaranteed Benefit @ 8% per
Guaranteed Benefits 4% per annum investment Total Benefits including Guaranteed and Non- Guaranteed Benefits
annum investment return
return

Age at the
Single/
Policy start of
Annualized
Year the Policy
Premium
Year Guranteed Additional Special Total Death Total Death Total Survival & Total Survival &
Survival Death Maturity Special Surrender Value
Surrender Accidental Cash Bonus Surrender Cash Bonus Benefit Benefit Maturity Benefit @ Maturity Benefit @
Benefit Benefit Benefit (SSV)
Value (GSV) Death Benefit Value (SSV) @4% @8% 4% 8%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1 48 50,000 - - 5,56,118 - - 3,280 - 12,500 - 5,56,118 5,56,118 3,280 12,500

2 49 51,020 - 30,612 5,56,118 - - 3,280 35,714 12,500 35,714 5,56,118 5,56,118 3,280 12,500

3 50 51,020 - 53,571 5,56,118 - - 3,280 61,224 12,500 61,224 5,56,118 5,56,118 3,280 12,500

4 51 51,020 - 1,02,040 5,56,118 - - 3,280 1,06,122 12,500 1,06,122 5,56,118 5,56,118 3,280 12,500

5 52 51,020 - 1,27,550 5,56,118 - - 3,280 1,37,754 12,500 1,37,754 5,56,118 5,56,118 3,280 12,500

6 53 51,020 - 1,53,060 5,56,118 - - 3,280 1,77,550 12,500 1,77,550 5,56,118 5,56,118 3,280 12,500

7 54 51,020 - 1,78,570 5,56,118 - - 3,280 2,21,427 12,500 2,21,427 5,56,118 5,56,118 3,280 12,500

8 55 51,020 - 2,27,386 5,56,118 - - 3,280 2,69,386 12,500 2,76,383 5,56,118 5,56,118 3,280 12,500

9 56 51,020 - 2,82,074 5,56,118 - - 3,280 3,21,426 12,500 3,45,456 5,56,118 5,56,118 3,280 12,500

10 57 51,020 - 3,42,548 5,56,118 - - 3,280 3,91,144 12,500 4,24,030 5,56,118 5,56,118 3,280 12,500

11 58 51,020 - 4,08,905 6,01,067 - - 3,280 4,74,675 12,500 5,13,531 6,01,067 6,01,067 3,280 12,500

12 59 51,020 - 4,81,037 6,55,709 - - 3,280 5,67,360 12,500 6,14,682 6,55,709 6,55,709 3,280 12,500

13 60 - 7,500 5,16,057 6,55,709 - 2,78,059 4,592 6,25,176 17,500 6,82,439 6,55,709 6,55,709 12,092 25,000

14 61 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 6,48,794 17,500 7,19,650 6,55,709 6,55,709 12,092 25,000

15 62 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 6,67,185 17,500 7,52,275 6,55,709 6,55,709 12,092 25,000

16 63 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 6,86,032 17,500 7,86,054 6,55,709 6,55,709 12,092 25,000

17 64 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 7,05,378 17,500 8,21,149 6,55,709 6,55,709 12,092 25,000

18 65 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 7,25,181 17,500 8,57,657 6,55,709 6,55,709 12,092 25,000

19 66 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 7,45,367 17,500 8,95,563 6,55,709 6,55,709 12,092 25,000

39 of 44
20 67 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 7,66,021 17,500 9,34,931 6,55,709 6,66,927 12,092 25,000

UIN: 104N135V01 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 2 of 4
 Non-Guaranteed Benefit @
Non-Guaranteed Benefit @ 8% per
Guaranteed Benefits 4% per annum investment Total Benefits including Guaranteed and Non- Guaranteed Benefits
annum investment return
return

Age at the
Single/
Policy start of
Annualized
Year the Policy
Premium
Year Guranteed Additional Special Total Death Total Death Total Survival & Total Survival &
Survival Death Maturity Special Surrender Value
Surrender Accidental Cash Bonus Surrender Cash Bonus Benefit Benefit Maturity Benefit @ Maturity Benefit @
Benefit Benefit Benefit (SSV)
Value (GSV) Death Benefit Value (SSV) @4% @8% 4% 8%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

21 68 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 7,87,173 17,500 9,75,956 6,55,709 6,88,715 12,092 25,000

22 69 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 8,08,875 17,500 10,18,769 6,55,888 7,12,306 12,092 25,000

23 70 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 8,31,137 17,500 10,63,531 6,72,193 7,37,831 12,092 25,000

24 71 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 8,54,012 17,500 11,10,405 6,89,847 7,65,469 12,092 25,000

25 72 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 8,77,530 17,500 11,59,603 7,08,986 7,95,429 12,092 25,000

26 73 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 9,01,743 17,500 12,11,336 7,29,733 8,27,908 12,092 25,000

27 74 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 9,26,704 17,500 12,65,814 7,52,244 8,63,149 12,092 25,000

28 75 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 9,52,453 17,500 13,23,331 7,74,455 9,01,413 12,092 25,000

29 76 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 9,79,064 17,500 13,65,704 7,91,745 9,42,974 12,092 25,000

30 77 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 10,06,609 17,500 14,10,938 8,09,970 9,88,175 12,092 25,000

31 78 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 10,35,140 17,500 14,60,152 8,29,181 10,37,340 12,092 25,000

32 79 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 10,64,772 17,500 15,13,769 8,49,482 10,90,909 12,092 25,000

33 80 - 7,500 5,51,016 6,55,709 - 2,78,059 4,592 11,07,906 17,500 15,89,174 8,83,327 11,66,314 12,092 25,000

34 81 - 7,500 5,51,016 6,55,709 - - 4,592 11,52,056 17,500 16,70,542 9,18,179 12,47,682 12,092 25,000

35 82 - 7,500 5,51,016 6,55,709 - - 4,592 11,97,027 17,500 17,58,068 9,53,881 13,35,224 12,092 25,000

36 83 - 7,500 5,51,016 6,55,709 - - 4,592 12,42,673 17,500 18,51,963 9,90,259 14,29,152 12,092 25,000

37 84 - 7,500 - 6,55,709 6,12,240 - 4,592 - 17,500 - 10,24,156 15,23,615 10,49,961 16,49,762

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UIN: 104N135V01 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 3 of 4
 Notes:
1. Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Service Tax. Refer Sales literature for explanation of terms used in this illustration.
2. The survival benefits are payable at the end of the policy year.
3. The surrender benefit, death benefit and maturity benefit shown above are at the end of the Policy Year.
4. The Surrender Value is higher of the Guaranteed Surrender Value (GSV) and the Special Surrender Value (SSV).In case survival benefits have been paid out, the same shall be deducted from the Surrender Values indicated, at the time of pay out.
5. Refer Sales literature (Prospectus) and Policy Document for explanation of terms used in this illustration.
6. TB - Terminal Bonus
7. The above benefits are with assumptions that save the date option is not selected by you. For details on save the date option , please refer the Policy Document.

I, Mr. Rishabh Sarin (name),have explained the premiums, and benefits under the product fully I, Sher Singh (name), having received the information with respect to the above, have
to the prospect / policyholder. understood the above statement before entering into the contract.

Place: Date: 6/13/23

Signature / OTP Confirmation Date/ Thumb Impression / Signature / OTP Confirmation Date / Thumb Impression /
Date: 6/13/23 Electronic Signature of Agent / Intermediary / Official Electronic Signature of Prospect / Policyholder
This system generated benefit illustration shall be treated as signed by me.

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UIN: 104N135V01 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 4 of 4
 Premium Receipt
Receipt No.: 144887924JUN2301 | Receipt Date: 21-JUN-2023
Personal Details
Policy Number: 144887924 Email ID: sssbharti1508@gmail.com
Policyholder Name: Mr. Sher Singh PAN Number: ARQPS3623N
Address: 139/A/B Ananda Super City Dohra Road Customer GSTIN: Not Available
Bareilly Current Residential State: Uttar Pradesh
BAREILLY- 243006
Uttar Pradesh India
Mobile Number: 9897848677
Policy Details

Plan Name: Max Life Smart Wealth Advantage Growth Par Plan Policy Commencement Date: 12-JUN-2023
Life Insured: Mr. Sher Singh Policy Term: 37 Years Premium Payment Term: 12 Years
Premium Payment Frequency: Semi-Annual Date of Maturity: 12-JUN-2060 Modal Premium (incl. GST): ` 29,842.86
Late Payment Fee (incl GST): ` 0.00 Premium Received (incl. GST): ` 29,842.86
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (`) Rate Amount (`) Rate Amount (`) Rate Amount (`) Mr. Rishabh Sarin
Base 6,375.00 9% 573.75 9% 573.75 NA 0.00
Rider 2,708.11 9% 243.73 9% 243.73 NA 0.00
Contact Number
Late Payment 0.00 9% 0.00 9% 0.00 NA 0.00
8077624761
Total GST Value: ` 1,634.96
GSTIN: 09AACCM3201E1Z1 GST Regd. State: Uttar Pradesh SAC CODE: 997132

Mudrank: Paid by e-Stamps Certificate no. 01/Issue Date: 03/04/2023/ Vide Treasury (E-CHALLAN) GRN NO.100904462

Minimum Guaranteed
Death Benefit (of base plan
and term rider (if any))
12-JUN-2023 to
` 5,56,118.00 ` 29,842.86 11-DEC-2023 12-DEC-2023
*Important Note:
1.For payment mode other than in cash, this receipt is conditional upon the credit in our account. Payment of premium amount does not constitute commencement of risk. The risk
commencement starts after acceptance of risk by us.
2.Amount received would be adjusted against the due premium as per terms and conditions of the policy.
3.Premiums may be eligible for tax benefits under section 80C/80CCC/80D/37(1) of the income Tax Act 1961. Kindly consult your tax advisor for more information. Tax benefits are liable
to change due to changes in legislation or government notification.
4.GST shall comprise CGST, SGST / UTGST or IGST (whichever is applicable) including cesses and levies, if any as per prevailing laws and shall be borne by you. For GST purposes, this premium
receipt is Tax invoice. Assessable Value in GST for Endowment First Year is 25%, Renewal Year is 12.5%, Single Premium Annuity is 10%, Term and Health is 100%. Currently base GST
rate is 18% apart from cess in some states.
5.I/We hereby declare that though our turnover is more than the turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the said sub-rule.
6.Supply meant for Export under Letter of Undertaking without payment of Integrated Tax.
7.Whether the tax is payable on reverse charge basis - No.

Authorised Signatory
PRM20 PRODUCT UIN: 104N135V01
E.&O.E

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 144887924
---------------------------------------------------------------------------------------

** ACKNOWLEDGEMENT OF RECEIPT OF POLICY **

I hereby acknowledge the receipt of the Policy Document along with a copy of Proposal Form, Benefit Illustration
& Key Feature Document.
I am aware that the policy purchased by me is Max Life Smart Wealth Advantage Growth Par Plan a traditional
plan with below mentioned plan details :-

Policy No. 144887924

Policyholder Mr. Sher Singh
Policy Variant Balanced Income
Income Benefit payable as per the frequency selected 7,499.94
Income Benefit payment frequency Annual
Total Premium Payable (along with applicable taxes, cesses and 26,647.29
levies) payable as per premium payment mode selected)
Premium Frequency Semi-Annual
Policy Term (in years) 37
Premium Payment Term (in years) 12
Policy Maturity Date 12-Jun-2060

(Relationship with the Policy Holder)

Self

Spouse

Parents

Children (Only if above 18 years)

Others ___________________________ (please specify relationship)

___________ ___________________________
___________________________
Date Recipient's Signature Recipient's Full Name

c.c. : 909174 MR. RISHABH SARIN

Work Ph 1 : Home Ph 1 :
Work Ph 2 : Home Ph 2 :
Office : Max Life Agency Distribution Bareilly 1

"Note - Please submit this form within 10 days of receiving the Policy Pack to your nearby Max Life office/
Agent / Max Employee". Kindly submit self attested id proof of the receiver if signed by Spouse /Parents/ Major
Child/ Others."

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