PART A

Welcome to Max Life Insurance

-----------------------------------------------------------------------------------------------------------------------------------------------------------
Date 21-Nov-2024
To Saravanan Arumugam Contact number: 9360030025
3 68 Amman Kovil Branch Code: WAH76
Chettimankurichi
Post Office Chettimankurichi
Salem 637101
Tamil Nadu India
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Welcome Dear Saravanan Arumugam,
Thank you for choosing us as Your life insurance partner. We are committed to financially protect You and Your
TM
loved ones because for them YOU ARE THE DIFFERENCE
We request you to go through the enclosed Policy contract for Max Life Online Savings Plan (A Unit-Linked
Non-Participating Individual Life Insurance Plan) with Policy Number 625460506

Please also refer to the Customer Information Sheet for key information about Your Policy.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
What to do in On examination of the Policy (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. We will rectify the mistake/error and send an updated Policy to You.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Free Look In case You disagree with the Policy terms and conditions or otherwise, and have not made any claim, you
Cancellation have the option to cancel it by returning the Policy with a written request, stating the reasons for the same,
within the Freelook period of 30 (Thirty) days beginning from the date of receipt of the Policy document.

Upon return, the Policy will terminate immediately and all rights, benefits and interests under the policy will
cease immediately. You will be entitled to refund of Premiums paid less proportionate risk premium for the
period of cover and the expenses, if any, incurred on medical examination of the Life Insured, and stamp
duty charges. Additionally, We will repurchase the Units at the Net Asset Value (NAV) of the Units on the
date of cancellation.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Long term We are committed to giving You honest advice and offering You long-term savings, protection and retirement
protection solutions backed by the highest standards of customer service. We will be delighted to offer You any
assistance or clarification You may require about Your policy or claim-related services at the address
mentioned below.

We value Your association with us and assure You the best of our service, always.

Yours Sincerely,
Max Life Insurance Company Limited
Digitally signed by DS MAX LIFE INSURANCE
COMPANY LIMITED 1
Date: 2024.11.21 12:43:49 IST
Reason: Max Life Insurance
Location: 90C, Gurugram

Suhail Ghai
Chief Digital Officer & Head Operations

Intermediary Name & Code: Policy Bazaar Ins Broker Pvt.Ltd

(IRDA/DB797/19)
Seller Name & Code: Ins Broker Pvt.Ltd Policy Bazaar (80507D)
Contact Number: 18601205577, 18002585970 , Address: Plot No. 119,
Sector-44, Gurgaon - 122001
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 .

1 of 40
Policy Number: 625460506 Plan Name: Max Life Online Savings Plan
Date of Proposal: 16-Nov-2024 Plan UIN: 104L098V06
Policyholder: Saravanan Arumugam Date of Birth: 04-Jun-1987
Address (For all communications): Gender: Male
3 68 Amman Kovil Contact Number: 9360030025
Chettimankurichi Post Office Chettimankurichi Email: Vipsaravana@Gmail.Com
Salem 637101
Tamil Nadu India
Life Insured: Saravanan Arumugam Date of Birth: 04-Jun-1987
Address (For all communications): Gender: Male
3 68 Amman Kovil
Chettimankurichi Post Office Chettimankurichi
Salem 637101
Tamil Nadu India

Nominee's
Nominee Relationship with Date of Birth Age Gender % Share
Policyholder
Kokila Chinnapaiyan Spouse 02-May-1996 28 Female 100

Appointee (if Nominee is minor)

Name: N.A.
Gender: N.A.

Do inform us immediately in case there is any change in the above details. Refer the last page of this
document for contact information.

2 of 40
 Max Life Online Savings Plan (UIN:104L098V06)
Policy Number: 625460506 Sum Assured on Death (on date of commencement of risk): 1,22,001.40
Date of Commencement of Risk: 18-Nov-2024 Cover Multiple Selected: 10
Policy issue date: 18-Nov-2024 Policy Variant: Variant 2
Policy Term (in years): 20 Premium Payment Term (in years): 5
Policy will Mature on: 18-Nov-2044 Annualized premium*: 12,200.14
Premium Frequency: Monthly Due Date of Premium: 18th of every month
Premium as per Chosen Frequency**: 1016.68 Last Premium Date: 18-Oct-2029
Bank Account Details for Payout Investment Strategy Opted: N.A
Bank Name:
Bank Account Number:
*Excluding underwriting extra premium, loading for modal premium and applicable taxes, cesses or levies, if any.
**Including underwriting extra premium, loading for modal premium and applicable taxes, cesses or levies, if any.
For Rider details, please refer to Rider section.
Funds Chosen (% Allocation):
Nifty Momentum Quality 50 Fund (100),

3 of 40
POLICY PREAMBLE

MAX LIFE INSURANCE COMPANY LIMITED

Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144 533

Max Life Online Savings Plan

(A Unit-Linked Non-Participating Individual Life Insurance Plan)

UIN [104L098V06]

Max Life Insurance Company Limited has entered 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

4 of 40
POLICY SCHEDULE
In this Policy, the investment risk in the investment portfolio is borne by You.

Type of Policy: A Unit-Linked Non-Participating Individual Life

Policy: Max Life Online Savings Plan
Insurance Plan
UIN: 104L098V06 Office: Policy Bazaar Ins Broker PVT.LTD Head Office
Policy No.: 625460506 Client ID: 6006250609
Date of Proposal: 16-Nov-2024
Policyholder: Saravanan Arumugam Age Admitted: Yes
PAN: DYXPA5079R Gender: Male
Relationship with Life Insured: Same Person Contact Number:9360030025
Date of Birth: 04-Jun-1987 Email: Vipsaravana@Gmail.Com
Address (For all communication purposes):
3 68 Amman Kovil
Chettimankurichi Post Office Chettimankurichi
Salem 637101
Tamil Nadu India
Life Insured: Saravanan Arumugam Age Admitted: Yes
Address (For all communication purposes): Date of Birth: 04-Jun-1987
3 68 Amman Kovil Age: 37 years
Chettimankurichi Post Office Chettimankurichi Gender: Male
Salem 637101
Tamil Nadu India
Nominee(s):
Nominee(s) Name Relationship of Date of Birth Age Gender % Appointee(s) Name (if Relationship
Nominee(s) of Nominee share Nominee is a minor) with Nominee
with
Policyholder:
Kokila Chinnapaiyan Spouse 02-May-1996 28 Female 100 N.A.
Date of Commencement of Risk: 18-Nov-2024 Date on which survival benefits are payable: N/A
Details of the riders, if any: N.A Date of Issuance of Policy: 18-Nov-2024
Premium Payment mode: Monthly Bill Draw Date: 20TH
Dynamic Fund Allocation Option, if any: No Bank Name: N.A.
Death Benefit Variant Applicable: Variant 2 Bank Account Number: N.A.
Cover Multiple chosen: 10
Intermediary Name & Code:Policy Bazaar Ins Broker Pvt.Ltd
Seller Name & Code: Ins Broker Pvt.Ltd Policy Bazaar (80507D)
(IRDA/DB797/19)
Address: Intermediary License No.: MAX80507D
Plot No. 119, Sector-44, Contact Number: 18601205577, 18002585970
Gurgaon 122001 Email: N.A.
Details of Sales Personnel (for direct sales only): N.A
Rider Premium
Rider Policy Term
Rider Name Variant Payment Term
(in Years)
(in Years)
NA NA NA NA

5 of 40
 List of Maturity Insured Sum Assured Policy Premium Premium Premium as Annualised Due Date
Coverage Date Event on Death (At Term Payment payment per mode Premium when
Inception) Term mode (INR) (INR) Premium
(INR) is payable/
Date when
the Last
Premium
is payable

BASE POLICY
Max Life
As per Clause 2 of 18th of every
Online
18-Nov-2044 1,22,001.40 20 5 Monthly 1016.68 12,200.14 month;
Savings Part C
18-Oct-2029
Plan

I. ALLOCATION PROPORTION AT THE DATE OF COMMENCEMENT OF RISK (Applicable only if dynamic fund allocation
option is not chosen by You)
ALLOCATION PROPORTION
FUND NAME
(as a % of the Premium received)
Secure Fund
Balanced Fund
Growth Fund
Growth Super Fund
High Growth Fund
Dynamic Bond Fund
Money Market II fund
Diversified Equity Fund
Sustainable Equity Fund
Pure Growth Fund
NIFTY Smallcap Quality Index Fund
Midcap Momentum Index Fund
Nifty Alpha 50 Fund
Nifty 500 Momentum 50 Fund
Nifty Momentum Quality 50 Fund 100

6 of 40
PART B Segregated Fund at which the Units are Allocated to the Unit Account or
DEFINITIONS APPLICABLE TO YOUR POLICY cancelled from the Unit Account as per the terms and conditions specified in
The words and phrases listed below shall have the meaning attributed to them wherever Part E and determined on each Valuation Date;
they appear in the Policy unless the context otherwise requires.
29. "Nominee" means nominee nominated by You (Only if You are the Life
1. "Age" means the Life Insured's age on last birthday as on the Date of
Insured) in accordance with Section 39 of Insurance Act, 1938 as amended from
Commencement of Risk or on the previous Policy Anniversary, as the case may be;
time to time, to receive the benefits under the Policy and whose name is
2. "Annualised Premium" is the amount specified in the Schedule, and means
mentioned in the Schedule;
Premium amount payable in a Policy Year, excluding taxes, any Rider premiums,
30. "Non-Participating" means products where policies are not entitled for any
and underwriting extra premium on Riders;
share in surplus (profits) during the Policy Term;
3. "Allocation" or "Allocate" or "Allocated" for linked insurance product means
31. "Paid Up Policy" means the Policy under which the due Premiums have been
the process of Allocating premium to create units, at the prevailing unit price, in the
discontinued after the completion of the Lock-in Period;
Segregated Funds offered under the linked insurance product, as and when the
premiums are received or Switches from one fund to another fund are made; 32. "Paid Up Sum Assured" means the amount payable under a Paid Up Policy
4. "Appointee" means the person named by the policyholder, registered with us and which is equal to original Sum Assured on Death multiplied by the ratio of " the
specified in the Schedule who is authorised to receive and hold in trust the benefits total period for which Premiums have already been paid" to the "maximum
under this Policy on behalf of the Nominee/(s), if the Nominee/(s) is/are less than 18 period for which Premiums were originally payable" by You during the
years, on the date of payment; Premium Payment Term as per terms and conditions of the Policy;
5. "Business Day" shall mean days other than holidays where stock exchanges with 33. "Partial Withdrawals" means any amount withdrawn partially out of unit fund
national wide terminals are open for trade or any day declared by the IRDAI as by the policyholder during the term of the policy;
business day; 34. "Policy" means the contract of insurance entered into between You and Us as
6. "Claimant" means You (if You are not the Life Insured), Nominee(s) (if valid evidenced by this document, the Proposal Form, the Schedule, the Customer
nomination is effected), assignee(s) or their heirs, legal representatives or holders of Information Sheet and any additional information/document(s) provided to Us in
a succession certificate in case Nominee(s) or assignee(s) is/are not alive at the time respect of the Proposal Form along with any written instructions from You,
of claim, as the case may be; subject to Our acceptance of the same and any endorsement issued by Us;
7. "Cover Multiple" means the multiple for both variants as specified in the Policy 35. "Policy Anniversary" means the annual anniversary of the Date of
contract. Commencement of Risk;
8. "Date of Commencement of Risk"/ "Date of Inception" means the date as 36. "Policy Administration Charge" means a charge , if any, levied by Us for
specified in the Schedule, on which the insurance cover /risk under the Policy administration of the Policy during the Policy Term, starting from the Date of
commences; Commencement of Risk on each Monthly Anniversary by cancelling an
9. "Date of Payment of Premium" means the date on which Premium payment is appropriate number of Units in the Unit Account at the prevailing NAV and is
received by Us in accordance with the provisions of Section 64 VB (2) of the specified in Part E;
Insurance Act, 1938; 37. "Policy Term" means the term of the Policy as specified in the Schedule;
10. "Date of Revival" is the approval Date of Revival of the Policy; 38. "Policy Year" means a period of 12 (Twelve) months commencing from the
11. "Death Benefit" means the benefit which is payable on death of Life Insured, as Date of Commencement of Risk and every Policy Anniversary thereafter;
stated in the Policy; 39. "Premium" means an amount specified in the Schedule, payable by You, by the
12. "Date of Discontinuance" means the date on which We receive a written due dates to secure the benefits under the Policy, excluding any Rider premiums,
intimation from You about the Surrender of the Policy or on expiry of the Grace underwriting extra premium on Riders and applicable taxes, cesses and levies, if
Period, whichever is earlier; any;
13. "Discontinuance" means the state of the Policy that could arise on account of 40. "Premium Allocation Charge" means a charge, if any, as specified in Part E
Surrender of the Policy or on non-payment of the Premium due before the expiry of which is levied by Us and calculated as a percentage of the Premium and
the Grace Period; deducted from the Premium received by Us before the same is Allocated to the
14. "Discontinuance/ Surrender Charge" means a charge levied by Us on the Unit Account;
Discontinuance/ Surrender of the Policy in accordance with the rates as specified in 41. "Premium Payment Term" means the term as specified in the Schedule,
Part E; during which the Premiums are payable by You;
15. "Discontinuance Policy Fund" means Our Segregated fund constituted by the 42. "Premium Redirection" means an option which allows the policyholder to
Fund Value as applicable for all linked insurance policies discontinued during the modify the Allocation of amount of renewal premium to various Segregated
Lock in Period on which a minimum guaranteed interest rate of 4% (Four percent) Funds under the policy.
per annum (or as mandated by IRDAI from time to time) is payable by Us; 43. "Proposal Form" means the form filled in and completed by You for the
16. "Free Look" means a period during which, in case You disagree with any of the purpose of obtaining insurance coverage under the Policy;
terms and conditions of the Policy, subject to the Clause 8 Part D of the Policy, You 44. "Regular Premium " means the Premium payable to Us in regular instalments
have an option to return the Policy to Us by stating the reasons for /reasons for such throughout the Policy Term in the manner and at the intervals specified in the
disagreement in writing. Schedule;
17. "Funds or Segregated Fund" mean the segregated investment funds established 45. "Revival" means restoration of the Policy, which was discontinued due to the
and managed by Us; nonpayment of premium, by Us with all the benefits mentioned in the Policy,
18. "Fund Management Charge" means a charge levied by Us for management of the with or without Rider Benefits if any, upon the receipt of all the Premiums due
Funds and calculated as a percentage of the Fund Value and appropriated by and other charges or late fee if any, during the Revival Period, as per the terms
adjusting the NAV. The Fund Management Charge shall be levied on each and conditions of the Policy, upon being satisfied as to the continued insurability
Valuation Date throughout the Policy Term and shall not change during the Policy of the Life Insured or Policyholder on the basis of the information, documents
Term; and reports furnished by the Policyholder, in accordance with the Underwriting
19. "Fund Value" means summation of number of Units in each Segregated Fund(s) Policy.
multiplied by the NAV for respective the Segregated the Fund(s) under the Policy; 46. "Revival Period" means a period of 3 (Three) consecutive years from the date
20. "Grace Period" (other than single premium policies) means the time granted by Us of first unpaid Premium;
from the due Date of Payment of Premium, without any penalty or late fee, during 47. "Rider" means the insurance cover(s) added to the Policy for additional
which time the Policy is considered to be in-force with the risk cover without any Premium or change under the Policy;
interruption, as per the terms & condition of the Policy. The Grace Period for 48. "Rider Benefits" means an amount of benefit payable on occurrence of a
payment of the Premium for all types of life insurance policies shall be 15 (Fifteen) specified event covered under the Rider, and is an additional benefit to the
days, where the policyholder pays the premium on a monthly basis and 30 (thirty) benefit under the Policy, and may include waiver of premium benefit on other
days in all other cases; applicable Riders;
21. "IRDAI" means the Insurance Regulatory and Development Authority of India 49. "Schedule" means the Policy schedule and any endorsements attached to and
established under the Insurance Regulatory and Development Authority Act, 1999; forming part of the Policy and if an updated Schedule is issued, then, the
22. "Life Insured" means the person named in the Schedule, on whose life the Policy Schedule Which is latest in time;
is effected; 50. "Settlement Option" means a facility made available to receive the maturity or
23. "Limited Premium" means the Premium payable to Us during the Premium death proceeds in instalments in accordance with the terms and conditions;
Payment Term which is limited compared to the Policy Term and is paid in regular 51. "Sum Assured" or "Sum Assured on Death" means an absolute amount of
instalments in the manner and at the intervals specified in the Schedule; benefit as specified in the Schedule and which is guaranteed to become payable
24. "Lock in Period" means a period of 5 (Five) consecutive Policy Years from the on death of Life Insured in accordance with the terms of the Policy terms and
Date of Commencement of Risk during which period the proceeds of the Policy conditions;
cannot be paid by Us to You or to the Life Insured, as the case may be, except in the 52. "Sum at Risk" means :
case of death or upon the happening of any other contingency covered under the i. For Variant 1: An amount which is maximum of:
Policy; 1. higher of [Sum Assured on Death (reduced by applicable Partial
25. "Maturity Date" means the date specified in the Schedule, on which the Policy Withdrawals, if any) or 105% of the Total Premium Paid until the
Term expires; date of calculation of sum at risk] less Fund Value; or
26. "Monthly Anniversary" means the date in every month corresponding with the 2. 0 (Zero).
Date of Commencement of Risk; ii. For Variant 2: An amount which is a sum of the following:
27. "Mortality Charge" means a charge levied by Us on the Sum at Risk for providing 1. Higher of Sum Assured on Death or 105% of all Premiums paid till
life insurance cover to the Life Insured during the Policy Term on the basis of his the date calculation of sum at risk: and
attained Age during the Policy Term in accordance with the rates as specified in 2. Present value of future 'family income benefit' plus funding of
Part E; Premium. Please note the present value of these benefits will be
27. "Net Asset Value" or "NAV" or "Unit Price" means the price per Unit of the calculated at a discount rate of 5.5% p.a.
Segregated

7 of 40
 Note: Under both the variants during the settlement period, 'Sum at Risk' 1.1.3. Settlement Option will not be provided in respect of Death Benefit payable
shall be higher of (105% of Total Premiums Paid less the Fund Value) or 0 under either of the Variants.
(Zero); 1.2. Maturity Benefit
53. "Surrender" means complete withdrawal or termination of the entire Policy; 1.2.1. If the Life Insured is alive on the Maturity Date and the insurance cover
54. "Surrender Value" means an amount, if any, that becomes payable on Surrender under the Policy is in force or if the Policy is a Paid Up Policy, then, We will
of the Policy during its term, in accordance with the terms and conditions of the pay the Fund Value applicable on the Maturity Date to You unless you have
Policy; opted for the Settlement Option.
55. "Switch(es)" or "Switched" or "Switching" means a facility allowing the 1.3. Survival Benefits
policyholder to move from one Segregated Fund, either wholly or in part, to other 1.3.1. There are no survival benefits payable under this Policy other than maturity
Segregated Fund(s) amongst the Segregated Funds offered as per the terms and benefit.
conditions of the policy. 2. PAYMENT OF BENEFITS
56. "Total Premiums Paid" means total of all the Premiums received under the Policy 2.1. The benefits under the Policy will be payable to the Claimant on submission of
including top-ups premium paid, if any. satisfactory proof to Us.
57. "Underwriting Policy" means an underwriting policy approved by Our board of 2.2. Once the benefits under the Policy are paid to the Claimant, the same will constitute
directors; a valid discharge of Our liability under the Policy.
58. "Unit" means a specific portion of the underlying Segregated Fund which is 3. PAYMENT OF PREMIUMS
representative of Your entitlement in such Funds; 3.1. The Premium is due and payable to Us during the Premium Payment Term by the
59. "Unit Account" means a notional account opened and managed by Us for You, in due date specified in the Schedule. If the Premium is not paid by the due date, You
which the Units are Allocated following the receipt of the Premium from You and may pay the same during the Grace Period. During the Grace Period the insurance
in which the Units are cancelled by Us for the purpose of paying the benefits and for cover will continue and all charges under the Policy will continue to apply. You are
recovering the applicable charges; not permitted to change the Limited Premium or Regular Premium option or the
60. "Unit Linked" are the products where the benefits are partially or wholly Premium Payment Term during the Policy Term.
dependent on the performance of the underlying assets under each of the Segregated 3.2. The Premium can be paid by You annually, semi-annually, quarterly or monthly, as
Fund offered; per the Premium payment mode chosen by You. You may change the Premium
61. "Valuation Date" means every Business Day on which We value the assets to payment mode by submitting a written request to Us, provided that such change in
which each of the Funds is referenced for the purpose of declaring the NAV; Premium payment mode will be effective only on the Policy Anniversary following
62. "We", "Us" or "Our" or "Company" means Max Life Insurance Company the receipt of such request.
Limited; and 3.3. You may pay the Premium at any of Our offices or through Our website
63. "You" or "Your" or "Policyholder" means the holder of this Policy as named in www.maxlifeinsurance.com or by any other means as informed by Us from time to
the Schedule. time. Any Premium paid by You will be deemed to have been received by Us only
after the same has been realised and credited to Our bank account.
PART C 3.4. The Premium payment receipt shall be issued in Your name and shall be subject to
POLICY FEATURES, BENEFITS AND PREMIUM PAYMENT realisation of the cheque or any other instrument/medium.
1. BENEFITS 3.5. We will not accept any additional premium or top-up premium under this Policy.
1.1. Death Benefit 3.6. Premium Reduction
1.1.1. In the event of the Life Insured's death during the Policy Term, provided the 3.6.1. Upon payment of full Premiums for the first Five Policy Years, You have an
Policy is in force, We shall pay in accordance with the applicable variants option to decrease the Premium upto 50% of the original Annualized
specified to be in force in the Schedule and as described below: Premium subject to the minimum Premium limit as approved by the Authority
i. Variant 1: The Death Benefit payable shall be the highest of the under the product. To opt for such reduction, an intimation should be given to
following benefits: Us 15 days prior to the Premium due date.
a. Sum Assured on Death equal to higher of Cover Multiple times the 3.6.2. The Sum Assured on Death under the Policy will be also be reduced
Annualised Premium or 0.5* Policy Term*Annualised Premium proportionately and all the applicable charges will be deducted accordingly.
(reduced by applicable Partial Withdrawals, if any), or; Both, the Family Income Benefit and Funding of Premium Benefit will then
b. 105% (Hundred and Five percent) of the total Premium Paid until be based on the reduced Sum Assured and reduced Premium respectively.
the Life Insured's death; or 3.6.3. This option may be exercised only once during the Policy Term and once
c. The total Fund Value (as on the date of death of the Life Insured). reduced, the Premium cannot be subsequently increased.
Under Variant 1, this Policy terminates on the death of the Life Insured. 3.6.4. The Sum Assured on Death of attached Rider (if any) and the Rider premium
i. Variant 2: You shall be the Life Insured under this Variant. The Death will also be reduced proportionately, subject to the regulatory boundary
Benefit payable to the Claimant shall consist of the sum of the following conditions for Riders. If the revised Rider benefit is not within the prescribed
benefits: limits, the Rider benefit will be terminated and termination conditions of the
a. Lump Sum Benefit: Immediately on the Life Insured's death, We Rider shall apply.
will pay the higher of the following benefits: 4. GRACE PERIOD
i. Sum Assured on Death equal to higher of Cover Multiple 4.1. The Premium is due and payable by the due date specified in the Schedule. If the
times the Annualised Premium or 0.5*Policy Premium is not paid by the due date, You may pay the same during the Grace
Term*Annualised Premium; or Period without any late fee or penalty.
ii. 105% (Hundred and Five percent) of the Total Premium Paid 4.2. The insurance coverage continues during the Grace Period. During the Grace
until the Life Insured's death. Period all charges under the Policy will continue to apply..
b. Family Income Benefit: The following benefits shall be payable:
We will pay a family income benefit equal to 1% of the Sum PART D
Assured on Death on every Monthly Anniversary immediately POLICY SERVICING CONDITIONS & OPTIONS AVAILABLE UNDER
following or coinciding with the Life Insured's death until the end THE POLICY
of Policy Term (including the payout at the Maturity Date) subject 1. DISCONTINUANCE OF PAYMENT OF PREMIUMS/ NON-
to the following: FORFEITURE BENEFITS
1. We shall pay a minimum of 36 instalments of the family 1.1. Discontinuance of Payment of Premium during the Lock-in Period
income benefit. In case of death where less than 36 months 1.1.1. If the Premium is not received before the expiry of the Grace Period, We
are left till the end of Policy Term, We will pay the remainder will, within 3 (Three) months of the first unpaid Premium, give a written
of the instalments of the family income benefit as a lumpsum notice to You informing You the status of the Policy and provide You the
on the Maturity Date; option to revive the Policy within the Revival Period.
2. We shall pay a maximum of 120 instalments of the family 1.1.2. In the event that You opt to revive the Policy but do not revive the Policy
income benefit even if the Maturity Date has not occurred. during the Revival Period, We will close the Unit Account and pay the
c. Funding of Premium: We will fund the outstanding Premium that proceeds of the Discontinuance Policy Fund to You at the end of the
would otherwise have been payable for the remainder of the Revival Period or Lock in Period whichever is later.
Premium Payment Term on each subsequent Premium due date; 1.1.3. If You do not exercise the above option to revive the Policy during the
and Revival Period, the Policy shall continue without any risk cover (and
d. We will pay the total Fund Value on the Maturity Date. Rider cover, if any) and the Funds shall remain invested in the
Under Variant 2, following the Life Insured's death, the Claimant shall Discontinuance Policy Fund, and at the end of the Lock in Period, We
not be entitled to exercise Switches, Partial Withdrawals, Premium will close the Unit Account and pay the proceeds of the Discontinuance
Redirection, Settlement Option or Surrender the Policy. Under Variant Policy Fund to You, and terminate the Policy.
2, this Policy shall continue even after the death of the Life Insured till 1.1.4. Upon expiry of the Grace Period, in case of Discontinuance of the Policy
the end of the Policy Term. due to non-payment of Premium, on the Date of Discontinuance, We will
1.1.2. The Cover Multiple for both Variants shall be as follows: credit the Fund Value, by creation of Units, into the Discontinuance
Policy Fund after deducting applicable Discontinuance/Surrender Charge.
Age Cover Multiple options Cover Multiple for The risk cover under the Policy and any applicable Riders will cease and
for Variant 1 Variant 2 no further charges will be levied by Us other than the Fund Management
18 to 45 years 7, 10, 15, 20 Charge applicable on the Discontinuance Policy Fund.
7, 10 1.1.5. If the Policy is Surrendered by You, any time before the proceeds under
46 to 49 years 7, 10, 15
the Policy are paid out, the provisions as mentioned in Clause 2 of Part
50 to 55 years 5, 7, 10, 15
5, 7, 10 D, relating to Surrender of the Policy within the Lock in Period will be
56 years and above 5, 7, 10 applicable.

8 of 40
 1.1.6. If You have chosen in writing the option to revive the Policy within the 2.1. Surrender within the Lock - in Period
Revival Period, You may exercise the option to revive the Policy during the 2.1.1. If You Surrender the Policy within the Lock- in Period, We will credit the
Revival Period, subject to the following conditions: Fund Value by creation of Units into the Discontinuance Policy Fund after
i) You give Us a written request to revive the Policy or the Policy along deducting applicable Discontinuance/Surrender Charges and the risk cover
with Rider cover; and under the Policy and any applicable Riders, if any, will cease
ii) Life Insured produces an evidence of insurability (in form of 2.1.2. From the Date of Discontinuance, the risk cover under the Policy will stop
declaration of health condition and/or relevant medical reports) at and only the Fund Management Charge applicable on the Discontinuance
Your own cost, acceptable to Us as per Our Underwriting Policy; and Policy Fund shall be levied and no other charges will be levied by Us.
iii) You pay Us all overdue Premiums, in full. 2.1.3. If the Life Insured dies anytime within the Lock in Period after the Fund
1.1.7. On Revival, the insurance cover under the Policy as at the Date of Value has been transferred to the Discontinuance Policy Fund, We will
Discontinuance will be restored and the Fund Value of the Units in the close the Unit Account and the value of Units in the Discontinuance
Discontinuance Policy Fund as on the date of the Revival shall be credited Policy Fund on the date of death of Life Insured shall be paid to the
back to the Fund(s) chosen by You. The Discontinuance/Surrender Charges, Claimant.
if any, deducted will also be added back to Your Unit Account. 2.1.4. On the expiry of the Lock in Period or the date of Surrender of the Policy,
1.1.8. The amount of Premium paid on Revival, less Premium Allocation Charges, whichever is later, We will close the Unit Account and the value of Units
if any, attributable to the Premium paid on Revival in accordance with the in the Discontinuance Policy Fund as at that date shall be paid to You and
ratio in which the Premium should be Allocated in the Funds specified by the Policy will terminate.
You will be used to purchase Units at the Unit Price as on the Date of 2.2. Surrender after the completion of the Lock- in Period
Revival. 2.2.1. If You Surrender the Policy after the completion of the Lock in Period,
1.1.9. An amount equal to the Policy Administration Charge, if any, falling due We shall close the Unit Account and pay the Surrender Value which is
between the Date of Discontinuance and the Date of Revival will be levied equal to the Fund Value prevailing on the date of receipt of a valid request
on Revival by cancelling Units in the Unit Account at their Unit Price. for Surrender.
1.1.10. In case the Life Insured dies during the period of discontinuance, We shall 2.3. No guaranteed Surrender Value is applicable under this Policy.
pay the Fund Value as on the date of death and any Discontinuance charges 3. LOANS
deducted by Us, shall be added back to the Fund Value, in case You have 3.1. You are not entitled to loans under the Policy.
exercised the option to revive the Policy. 4. PREMIUM REDIRECTION
1.1.11. During the period of Discontinuance, You shall not be allowed to exercise 4.1. You may redirect the Premium between available Funds by giving Us written
Switches or Partial Withdrawals. notice before Premium due date. We will redirect the Premiums, provided the
1.2. Discontinuance of payment of Premium after the Lock in Period amount/ proportion of Premium to be paid into each Fund at the time of re-
1.2.1. If the Premium is not received in full by the expiry of the Grace Period, the direction is specified by You in such request.
Policy shall be immediately and automatically converted into a reduced Paid 4.2. We will not permit more than 6 (Six) Premium redirections in any Policy Year.
Up Policy with the Paid Up Sum Assured. The Policy shall continue to be in 5. SWITCH
reduced paid-up status without Rider cover, if any. On such discontinuance,
5.1. You may Switch Units from one Fund to another Fund by giving Us a written
We will, within 3 (Three) months of the first unpaid Premium, give a written
request. We will cancel Units from the Fund from which You wish to Switch out
notice to You informing the status of the Policy and provide You the option
and purchase Units in the Fund in which You have chosen to re-invest, provided
to exercise one of the following options in writing:
that the amount to be Switched is at least Rs. 5,000 (Rupees Five Thousand).
i) revive the Policy within the Revival Period;
5.2. You may Switch any number of times without any charges.
ii) complete withdrawal (Surrender) of the Policy without any risk cover;
5.3. We may, in Our discretion and with the prior approval of the IRDAI, impose a
1.2.2. If the complete withdrawal option is exercised by You, the provisions partial or complete ban on Switches for a period not exceeding 30 (Thirty) days,
relating to Surrender of the Policy after the Lock in Period as per Clause 2 of if in Our view it is appropriate in order to maintain the stability of a Fund or if it
Part D will be applicable. is necessary to protect the interests of the policyholders. This ban may be
1.2.3. Rider benefits, if applicable, will cease when Policy is converted into Paid imposed under extraordinary circumstances such as non-availability of market
Up Policy. prices or the occurrence of any catastrophe where the declaration of the Unit
1.2.4. In the event You opt to revive the Policy but do not revive the Policy during Price is not possible.
the Revival Period, We will pay the Fund Value to You at the end of the 5.4. Switching shall be allowed during the settlement period.
Revival Period.
6. PARTIAL WITHDRAWALS
1.2.5. If You do not exercise any of the above options , the Policy will continue to
6.1. You may make a Partial Withdrawal by giving Us a written request. We will
be a reduced Paid Up Policy and at the end of the Revival Period, We will
allow Partial Withdrawal, which will be effected by cancelling Units, provided
pay the Fund Value to You, and terminate the Policy.
that:
1.2.6. During the Revival Period, the risk cover under a Paid Up Policy shall be
6.1.1. Under both variants, the amount to be withdrawn is at least Rs. 5,000
restricted to the Paid Up Sum Assured on Death and all applicable Charges
(Rupees Five Thousand);
i.e. Policy Administration Charge, Mortality Charge and Fund Management
6.1.2. Under both variants, You may make a maximum of 2 (Two) Partial
Charge will continue to be levied. However, the mortality charges shall be
Withdrawals in a Policy Year such that the total Fund Value withdrawn is
deducted based on the reduced Paid Up Sum Assured only.
not more than 50% (Fifty percent) of the Fund Value as on the date of the
1.2.7. If You have opted to revive the Policy as per Clause 1.2.1. (i), You may
Partial Withdrawal(s) and subject to the Fund Value immediately after the
exercise any of the following options in writing during the Revival Period:
Partial Withdrawal(s) being at least equal to one Annualised Premium;
i. Revive the Policy
6.1.3. Under both variants, You shall not be allowed to make any Partial
a) Revive the Policy, subject to the following conditions:
Withdrawal before the commencement of the 6th Sixth) Policy Year;
i) You give Us a written request to revive the Policy or the
6.1.4. Under Variant 1, the Sum Assured on Death shall be reduced by all Partial
Policy along with Rider cover; and
Withdrawals made during the 2 (Two) Policy Years immediately
ii) Life Insured produces an evidence of insurability (in form preceding the Life Insured's death.
of declaration of health condition and/or relevant medical
6.2. We may, in Our discretion and with the prior approval of the IRDAI, impose a
reports) at Your own cost, acceptable to Us as per Our
partial or complete ban on Partial Withdrawals for a period not exceeding 30
Underwriting Policy; and
(Thirty) days, if in Our view it is appropriate in order to maintain the stability of
iii) You pay Us all overdue Premiums in full. a Fund or if it is necessary to protect the interests of the policyholders. This ban
b) The amount of Premium paid on Revival, less any Premium may be imposed under extraordinary circumstances such as non-availability of
Allocation Charges, if any, attributable to the Premium paid on market prices or the occurrence of any catastrophe where the declaration of the
Revival in accordance with the ratio in which the Premium Unit Price is not possible.
shoul be Allocated in the Funds specified by You will be used to 7. UPON DEATH OF POLICYHOLDER OR CHANGE IN
purchase Units at the Unit Price as on the Date of Revival. POLICYHOLDER UNDER VARIANT 1
c) During the period up to the expiry of the Revival Period or the 7.1. If You and the Life Insured are different then, upon Your death, no benefits shall
earlier exercise of any of the above options, the Policy will become payable under the Policy. Your legal heirs may continue by paying the
continue with reduced risk cover and all applicable charges i.e. due Premiums to Us and by submitting the requisite documents as specified by
Policy Administration Charge (if any), Mortality Charge and Us and subject to other conditions prescribed by Us from time to time.
Fund Management Charge will be levied during the Revival
7.2. You may request Us to make the Life Insured the Policyholder under the Policy,
Period.
by giving Us prior written notice provided that the Life Insured shall not become
ii. Complete Withdrawal from the Policy without any risk cover the Policyholder unless the Life Insured meets all our eligibility criteria in
a) If You exercise the option of complete withdrawal, then, on accordance with Our guidelines and policies and We have issued a written
such date, the provisions relating to Surrender of the Policy after endorsement under the Policy confirming the change in Policyholder.
the Lock in Period as per Clause 2.2 of Part D shall be 7.3. From the date of Our written endorsement confirming the Life Insured as the
applicable. Policyholder, You shall automatically cease to have any rights, benefits or
2. SURRENDER obligations under the Policy and all rights, benefits and obligations shall vest
At any time during the Policy Term, You have the right to Surrender the Policy by entirely with the Life Insured.
giving Us a written notice:

9 of 40
8. FREELOOK CANCELLATION
"Free Look" means a period of thirty (30) days beginning from the date of receipt
of the Policy, to review the terms and conditions of the Policy, where if You
disagree with any of those terms and conditions or otherwise and have not made any
claim, You have the option to return the Policy stating the reasons for the same.
Upon return, the Policy will terminate immediately and all rights, benefits and
interests under the Policy will cease immediately. You shall be entitled to refund of
the Premium paid less proportionate risk premium for the period of cover, and the
expenses, if any, incurred on medical examination of the Life Insured, and stamp
duty charges. Additionally, We will repurchase the Units at the Net Asset Value
(NAV) of the Units on the date of cancellation.
9. SETTLEMENT OPTION
9.1. You may opt to exercise the Settlement Option by giving a written request to Us at
least 15 (Fifteen) days before the Maturity Date. On Our acceptance of Your request
for the Settlement Option:
i. You will be entitled to receive the value of Units, as per the prevailing NAV,
in periodic instalments as may be chosen by You (i.e. annually,
semi-annually, quarterly or monthly) for a maximum period of 5 (Five) years
from the Maturity Date. We will pay the first instalment under the Settlement
Option on the Maturity Date. Under the Settlement Option, the Units payable
towards each installment will be equal to the number of Units available before
payment of the installment divided by the number of remaining installments;
ii. Your written request to apply for the Settlement Option shall specify the
proposed duration for payment and the frequency of payment of each
instalment;
iii. During the period when the Settlement Option is in force:
a) the Policy will continue after the Maturity date for a period not
exceeding 5 years from the Maturity Date with risk cover equal to
105% of the total Premiums paid and applicable Mortality Charges
will be deducted by Us;
b) We will deduct the applicable Fund Management Charge;
c) You shall not be permitted to make any Partial Withdrawals
d) You may Switch Units between the Funds upon which applicable
Switching charges will be deducted; and;
e) You shall continue to bear all inherent risks in the investment
portfolio.
9.2. You may opt to terminate the Settlement Option by giving a written notice to Us.
We shall pay the Fund Value prevailing on the date of receipt of such notice and
terminate the Policy; and
9.3. If Life Insured dies when the Settlement Option is in force, We will pay the Fund
Value prevailing as on the date death of the Life Insured, subject to a minimum of
105% of Total Premiums Paid and terminate the Policy.

PART E
INVESTMENT OPTIONS & APPLICABLE CHARGES
1. FUNDS
1.1. The Funds currently available for investment under the Policy and the investment
objectives of each Fund are as follows:

10 of 40
 Risk
Name of Fund Investment objectives Investment mix
rating
Secure Fund Fund invests in debt instruments such as Government securities, corporate bonds, money Government securities: 50-100%
(SFIN: market instruments etc. issued primarily by Government of India/State Governments, Corporate bonds: 0-50%
Low
ULIF00425/06/04 corporates and banks. The Fund also invests in money market instruments as prescribed by Money market & Cash instruments: 0-40%
LIFESECURE104) the IRDAI. No investment is made in equities. Equities: Nil
Balanced Fund Fund invests primarily in debt instruments such as Government securities, corporate bonds, Government Securities: 20-50%
(SFIN: money market instruments etc. issued primarily by Government of India/State Governments Corporate bonds: 20-40%
Medium
ULIF00225/06/04 and to some extent in corporate bonds and money market instruments. The Fund invests Money market & Cash instruments: 0-40%
LIFEBALANC104) minimum of 10% and up to maximum of 40% of Fund corpus in equities. Equities: 10-40%
Growth Fund Fund invests primarily in various asset classes such as Equities, Government Securities, Government Securities: 0-30%
(SFIN: Corporate Bonds and Money Market Instruments. The equities exposure in the Fund will at Corporate bonds: 0-30%
High
ULIF00125/06/04 all times be at a minimum of 20% but not more than 70%. The Fund invests the remaining Money market & Cash instruments: 0-40%
LIFEGROWTH104) Fund corpus in debt instruments across Government, corporate and money market papers. Equities: 20-70%
Sustainable Equity Fund Government Securities: 0-20%
The objective of the fund is to focus on investing in select companies from the investment
(SFIN: Corporate bonds: 0-20%
universe, which conduct business in socially and environmentally responsible manner while High
ULIF02505/10/21 Money market & cash instruments: 0-30%
maintaining governance standards.
SUSTAINEQU104) Equities: 70-100%
The objective of the fund is to provide medium to long term return to the investors by
Pure Growth Fund Government Securities: 0%
actively managing portfolio through investment in equities, cash and money market
(SFIN: Corporate bonds: 0%
instruments. Fund will not invest in companies that derive significant share of income from High
ULIF02630/12/22 Money market & cash instruments: 0-40%
sectors such as alcoholic beverages, tobacco and tobacco products, certain animal produce,
PUREGROWTH104) Equities: 60-100%
gambling, banking & financial Services and entertainment (cinema, TV etc.).
Growth Super Fund Government securities: 0-20%
Fund is primarily equity oriented by ensuring at least 70% of the Fund corpus is invested in
(SFIN: Corporate bonds: 0-20%
equities at all times. The remaining is invested in debt instruments across Government, High
ULIF01108/02/07 Money market & Cash instruments: 0-30%
corporate and money market papers.
LIFEGRWSUP104) Equities: 70-100%
Diversified Equity Fund The investment objective of the fund is to invest at least 70% of the fund corpus in a Government securities: 0-20%
SFIN: diversified basket of equity stocks over the entire market capitalisation range, primarily Corporate bonds: 0-20%
High
ULIF02201/01/20 focusing on large and mid-cap companies covering a wide variety of sectors to provide Money market & Cash instruments: 0-30%
LIFEDIVEQF104 investors with long term growth opportunities while ensuring liquidity of investments. Equities: 70-100%
Fund is a multi-cap fund with a focus on mid cap equities, where predominant investments
High Growth Fund Government securities: 0-30%
are in equities of companies with high growth potential in the long term (to target high
(SFIN: Corporate bonds: 0-30% Very
growth in capital value assets). At least 70% of the Fund corpus is invested in equities at all
ULIF01311/02/08 Money market & Cash instruments: 0-30% High
times. However, the remaining is invested in government securities, corporate bonds and
LIFEHIGHGR104) Equities: 70-100%
money market instruments; hence the risk involved is relatively higher.
NIFTY Smallcap Quality
The objective of the fund is to invest in a basket of stocks drawn from the constituents of Government securities: Nil
Index Fund
NSE Smallcap 250 Quality 50 index. The fund will invest in the companies of the above Corporate bonds: Nil Very
SFIN:
index with similar weights as the index and generate returns as closely as possible, subject Money market & Cash instruments: 0-20% High
ULIF02702/08/23
to tracking error. Equities: 80-100%
NIFTYSMALL104
Midcap Momentum Index
Government securities: Nil
Fund The objective of the fund is to invest in a basket of stocks drawn from the constituents of
Corporate bonds: Nil Very
(SFIN: NSE Midcap 150 Momentum 50 index. The fund will invest in the companies with similar
Money market & Cash instruments: 0-20% High
ULIF02801/01/24 weights as in the index and generate returns as closely as possible, subject to tracking error
Equities: 80-100%
MIDMOMENTM104)
The fund to invest in a basket of stocks drawn from the constituents of NSE�s NiftyAlpha
Nifty Alpha 50 Fund Government securities: Nil
50 Index that invests in 50 stocks across small cap, mid cap and large cap segment with
(SFIN: Corporate bonds: Nil Very
highest alphas within the top 300 stocks by average freefloat market capitalisation. The
ULIF02914/05/24 Money market & Cash instruments: 0-20% High
objective of the fund is to invest in companies with similar weights as in the index and
ALPHAFIFTY104) Equities: 80-100%
generate returns as closely as possible, subject to tracking error.
Nifty 500 Momentum 50 The objective of fund is to invest in a basket of stocks drawn from the constituents of NSE's
Government securities: Nil
Fund NIFTY 500 Momentum 50 Index that invests in 50 stocks across small cap, mid cap and
Corporate bonds: Nil Very
SFIN: large cap segment, with highest normalized momentum scores within the top 500 stocks by
Money market & Cash instruments: 0-20% High
ULIF03015/08/24 average free-float market capitalization. The fund will invest in companies with similar
Equities: 80-100%
MOMENFIFTY104) weights as in the index and generate returns as closely as possible, subject to tracking error.
The objective of this fund is to invest in companies with similar weights as in the NSE's
Nifty Momentum Nifty 500 Multicap Momentum Quality 50 Index and generate returns as closely to the
Government securities: Nil
Quality 50 Fund index as possible, subject to tracking error. Nifty 500 Multicap Momentum Quality 50
Corporate bonds: Nil Very
(SFIN: Index invests in 50 stocks, i.e. 10 companies from large cap universe (stocks forming part of
Money market & Cash instruments: 0-20% High
ULIF03127/10/24 the Nifty 100), 15 companies from midcap universe (stocks forming part of the Nifty
Equities: 80-100%
MOMQUALITY104) Midcap 150) and 25 companies from the small-cap universe (stocks forming part of the
Nifty Smallcap 250) based on the combination of momentum and quality factor scores.
Dynamic Bond Fund The investment objective of the fund is to generate superior returns by investing in high Government securities And
SFIN: quality debt instruments including Government securities, corporate bonds and money Corporate bonds: 60-100%
Low
ULIF02401/01/20 market instruments with an objective to maximize returns keeping in mind safety and Money market & Cash instruments: 0-40%
LIFEDYNBOF104 liquidity of the portfolio. Equities: 0%
Money Market II Fund Government securities: 0%
The investment objective of the fund is to deliver returns linked to Money Market levels
SFIN: Corporate bonds: 0%
through a portfolio with minimal interest rate and credit risk so as to provide a high level of Low
ULIF02301/01/20 Money market & Cash instruments: 100%
safety of capital.
LIFEMONMK2104 Equities: 0%
Discontinuance Policy Fund Our Segregated fund that is set aside and is constituted by the fund value of all discontinued
(SFIN: policies on which a minimum guaranteed interest rate of 4% (Four percent) per annum (or
ULIF02021/06/13 as mandated by the IRDAI from time to time) is payable by Us. The excess income earned Money market instruments: 0% - 40%
Low
LIFEDISCON104) in the Discontinuance Policy Fund over and above the minimum guaranteed interest rate Government securities: 60% - 100%
(Available only in case of shall also be apportioned to the Discontinuance Policy Fund and shall not be made available
Discontinuance of Policy) to Our shareholders.

11 of 40
1.2. We may add, close, combine or modify any Fund with the prior approval of the
Fund Management Charge (per
IRDAI. We will send You prior written notice of at least 60 (Sixty) days of Our Fund Name
annum)
intention to add, close, combine or modify any Fund.
2. DYNAMIC FUND ALLOCATION Secure Fund 0.90%
2.1. You may opt to exercise the dynamic fund Allocation option only prior to the Date Dynamic Bond Fund 0.90%
of Inception of the Policy. If this option is in force, then We will automatically Money Market II Fund 0.90%
Allocate the Premiums received on the later of the date of receipt of the Premium or Nifty Smallcap Quality Index Fund 1.00%
the due Date of Premium Payment and Switch Units in the Funds on each Policy
Balanced Fund 1.10%
Anniversary, in a pre-determined proportion specified in the applicable table below:
Midcap Momentum Index Fund 1.25%
Assets under Assets under Nifty Alpha 50 Fund 1.25%
Policy Years to the management to be management to be
Maturity Date maintained under the maintained under Nifty 500 Momentum 50 Fund 1.25%
Growth Super Fund the Secure Fund Nifty Momentum Quality 50 Fund 1.25%
16-30 80% 20% Growth Fund 1.25%
11-15 60% 40% Growth Super Fund 1.25%
6-10 40% 60% High Growth Fund 1.25%
0-5 20% 80% Diversified Equity Fund 1.25%
2.2. You shall not be permitted to make Premium Re-directions or Switch Units between Sustainable Equity Fund 1.25%
the Funds during the period when this option is in force. Pure Growth Fund 1.25%
2.3. You may opt out of the dynamic fund Allocation option during the Policy Term by Discontinuance Policy Fund 0.50%
giving Us a prior written request, in which case this option will cease to be effective
5.1.4. Switch charge: Nil
from the Policy Anniversary following the receipt of Your request. Once You have
5.1.5. Partial withdrawal charge: Nil
opted out, You shall not be permitted to recommence the dynamic fund Allocation
5.1.6. Premium redirection charge: Nil
option during the Policy Term.
5.1.7. Miscellaneous charge: Nil
3. ALLOCATION OF PREMIUM
5.1.8. Mortality Charge: The Mortality Charge shall be levied in accordance
3.1. We will Allocate the Premium, on the later of the date of receipt of the Premium or
with the table specified below and are guaranteed for the Policy Term:
the Premium due date as the case may be, to the Funds chosen by You and in the
allocation proportion specified in the Schedule (or as modified from time to time) Mortality Charge per INR 1,000 Sum at Risk
after deduction of the Premium Allocation Charge, if any. Mortality Mortality
4. UNITS & UNIT PRICE Age Age
Rate Rate
4.1. We will initially open a Unit Account as on the Date of Commencement of Risk.
18 0.64 55 6.31
4.2. Units will be purchased and cancelled at the Unit Price/NAV. The number of Units
shall be expressed up to 3 (Three) decimal places. 19 0.68 56 6.83
4.3. Units will be cancelled from the Unit Account for recovering applicable charges and 20 0.71 57 7.38
for payment of benefit amounts and other amounts which are payable from the Fund 21 0.74 58 7.96
Value. 22 0.75 59 8.57
4.4. The underlying assets in all Funds belong to Us. Units are purely notional and are
23 0.77 60 9.23
only for the purpose of determining the charges recoverable and amounts payable
under the Policy. Neither the Units nor the Unit Account gives rise or shall be 24 0.78 61 9.94
deemed to give rise to any legal or beneficial ownership or right to You, the Life 25 0.79 62 10.73
Insured, Nominee or the Claimant in either the assets to which the Funds are 26 0.80 63 11.60
referenced or the income from those assets or any surpluses in any Funds or in Our 27 0.80 64 12.55
profits or assets. 28 0.81 65 13.61
4.5. The price of a Unit shall be calculated as per the following formula:
29 0.83 66 14.77
"Market value of investments held by the Segregated Fund plus value of current
assets minus (value of current liabilities and provisions, if any) divided by number 30 0.84 67 16.05
of Units on Valuation Date (before creation/redemption of Units).". 31 0.87 68 17.46
4.6. The NAV shall be determined on each Valuation Date. The NAV in respect of each 32 0.90 69 19.00
Fund will be determined by dividing the value of the Fund with the number of Units 33 0.93 70 20.68
on the Valuation Date subject to rounding up or down by not more than 1% (One
34 0.97 71 22.53
percent) of a Rupee.
4.7. You can, through a secured login, access the value of Policy-wise Units held by you 35 1.03 72 24.54
and Fund-wise NAV on Our website. 36 1.09 73 26.73
4.8. Unit Encashment 37 1.16 74 29.12
4.8.1. For Premium received by a local cheque or a demand draft payable at par at 38 1.24 75 31.71
the place where Premium is received in cash before 3:00 p.m. on a Business 39 1.33 76 34.53
Day, the closing NAV of the day on which the Premium is received by Us
40 1.44 77 37.59
shall be applicable.
4.8.2. For Premium received by a local cheque or a demand draft payable at par at 41 1.57 78 40.92
the place where the Premium is received in cash after 3:00 p.m. on a Business 42 1.71 79 44.53
Day, the closing NAV of the next Business Day shall be applicable. 43 1.88 80 48.45
4.8.3. For Premium received through an outstation cheque/demand draft, the closing 44 2.07 81 52.70
NAV of the Business Day on which such cheque/demand draft is realized
45 2.30 82 57.30
shall be applicable.
4.8.4. For valid requests for maturity, Switching, Partial Withdrawal, Re-direction 46 2.56 83 62.30
or Surrender received up to 3.00 p.m. on a Business Day, the closing NAV of 47 2.85 84 67.72
the same day shall be applicable. 48 3.19 85 73.59
4.8.5. For valid requests for maturity, Switching, Partial Withdrawal, Re-direction 49 3.56 86 79.94
or Surrender received after 3.00 p.m. on a Business Day or in case of any 50 3.96 87 86.83
request received on a day which is not a Business Day, the closing NAV of
51 4.39 88 94.29
the next Business Day shall be applicable.
4.8.6. For all transactions including Death Benefit or maturity benefit payments that 52 4.84 89 102.37
arise on a day which is not a Business Day, the closing NAV of the next 53 5.31 90 111.12
Business Day shall be applicable. 54 5.80 - -
4.8.7. For all transactions including Death Benefit or maturity benefit payments that During the Policy Term or settlement period, a proportionate Mortality Charge
arise on a last day of the quarter, which is not a Business Day, the closing shall be levied by Us on every Monthly Anniversary by cancelling an
NAV of the last Business Day of the quarter shall be applicable. appropriate number of Units from the Unit Account at the prevailing NAV.
5. CHARGES 5.1.9. Discontinuance/Surrender Charge: This charge shall be levied on the
5.1. The following charges shall be levied by Us under the Policy during the Policy Discontinuance/ Surrender of the Policy in accordance with the following
Term: table:
5.1.1. Premium Allocation Charge: NIL Maximum discontinuance charges for the Policies
5.1.2. Policy Administration Charges: NIL
5.1.3. Fund Management Charge: Fund Management Charge shall be levied at Where the Having Annualised Premium Up Having Annualised Premium
Policy is to Rs.50,000 shall be lower of Above Rs.50,000 shall be lower of
rates equal to the annual rate, as given below, divided by 365 (Three Hundred
disconti-
Sixty Five) and multiplied by the number of days that have elapsed since As a As a Fixed As a As a Fixed
nued
previous Valuation Date: percentage percentage Amount percentage percentage Amount
during the
of of Fund (in Rs.) of of Fund (in Rs.)
Policy
Annualised Value Annualised Value
Year
Premium Premium

12 of 40
 1st 20% 20% 3000 6% 6% 6000
3.3. Subject to provisions of Section 45 of the Insurance Act 1938 as amended
2nd 15% 15% 2000 4% 4% 5000
from time to time, We shall pay the benefits under the Policy subject to
3rd 10% 10% 1500 3% 3% 4000 Our satisfaction:
4th 5% 5% 1000 2% 2% 2000 3.3.1. that the benefits have become payable as per the terms and
5th conditions of the Policy; and
Policy 3.3.2. of the bonafides and credentials of the Claimant.
Nil Nil
Year 3.4. Subject to Our discretion and satisfaction, in exceptional circumstances
onwards such as on happening of a Force Majeure Event, We may decide to waive
6. AUTOMATIC TERMINATION /FORECLOSURE OF THE POLICY all or any of the requirements set out in this Clause.
6.1. At any time during the Policy Term or during the settlement period, when the Fund 3.5. For any support or guidance in relation to claims, please contact us at
Value becomes equal to or less than zero, the Policy will terminate even if all due Helpline No. - 1860 120 5577,
Premium(s) have been paid. Email: service.helpdesk@maxlifeinsurance.com.
PART F 4. DECLARATION OF THE CORRECT AGE
GENERAL TERMS & CONDITIONS Declaration of the correct Age and/ or gender of the Life Insured is important for
1. TAXES Our underwriting process and calculation of Annualised Premiums payable
1.1. All charges are subject to applicable taxes, cess and levies,if any which will entirely under the Policy. If the Age and/or gender declared in the Proposal Form is
be borne by You and will always be paid by You along with the payment of found to be incorrect at any time during the Policy Term or at the time of claim,
Premium. If any imposition (tax or otherwise) is levied by any statutory or We may exercise Our rights under Section 45 of the Insurance Act, 1938 as
administrative body under the Policy, We reserve the right to claim the same from amended from time to time or revise the Premium with interest and/or applicable
You. Alternatively, We have the right to deduct the amount from the benefits benefits payable under the Policy in accordance with the Premium and benefits
payable by Us under the Policy. that would have been payable, if the correct Age and/ or gender would have
1.2. Tax benefits may be available as per the prevailing tax laws. Tax laws and the made the Life Insured eligible to be covered under the Policy on the Date of
benefits arising thereunder are subject to change. You are advised to seek an Commencement of Risk.
opinion from Your tax advisor in relation to the tax benefits and liabilities 5. FRAUD, MIS-STATEMENT AND FORFEITURE
applicable to You. Fraud, mis-statement and forfeiture would be dealt with in accordance with
2. RISK FACTORS provisions of Section 45 of the Insurance Act, 1938 as amended from time to
2.1. You understand and agree that: time. [A leaflet containing the simplified version of the provisions of the above
2.1.1. "Max Life Insurance Company Limited"is only the name of the insurance section is enclosed in Annexure - (1) for reference]"
company and "Max Life Online Savings Plan" is a Unit Linked Non- 6. SUICIDE EXCLUSION
Participating Individual Life Insurance plan. Unit Linked life insurance 6.1. Notwithstanding anything stated herein, if the Life Insured commits
products are different from the Non-linked life insurance products and are suicide, whether sane or insane, within 12 (Twelve) months from the Date
subject to investment riskswhich are to be borne by You. of Commencement of Risk or from the Date of Revival of the Policy, all
2.1.2. "Max Life Online Savings Plan" is only the name of the Policy and does risks and benefits under the Policy will immediately cease and no benefits
not in any way indicate the quality of the Policy, its future prospects or will be payable. In such an event. We will terminate the Policy by paying
returns. only the Fund Value prevailing on the date of intimation of death of the
2.1.3. We do not guarantee the Fund Value or Unit Price. Depending on market risk Life Insured to Claimant. For avoidance of any doubt, any charges other
and the performance of the Funds to which the Units are referenced, the Fund than Fund Management Charges recovered subsequent to the date of death
Value may fall, rise or remain unchanged and You are responsible for Your of the Life Insured shall be added back to the Fund Value as available on
decisions. There can be no assurance that the objectives of any Fund will be the date of intimation of death.
achieved and none is given by Us. 7. TRAVEL AND OCCUPATION
2.1.4. The past performance of any Fund is not necessarily indicative of the future There are no restrictions on travel or occupation under the Policy.
performance of any Fund. 8. NOMINATION
2.1.5. The Funds do not offer a guaranteed or assured return except in case of Nomination is allowed as per Section 39 of the Insurance Act, 1938 as amended
Discontinuance Policy Fund which offers minimum guarantee of 4% (Four from time to time. [A leaflet containing the simplified version of the provisions
percent) currently or as prescribed by the IRDAI from time to time during the of the above section is enclosed in Annexure - (2) for reference] You may
Lock in Period. request for a cancellation or change of nomination(s) for a Policy along with
2.1.6. The various Funds offered under "Max Life Online Savings Plan" are the necessary details of substituted nominee. Additional charges, not exceeding Rs.
names of the Funds and do not in any way indicate the quality of the product, 100/- on each occasion may be applicable for cancellation or change of nominee.
its future prospects or returns. This option is not available in case the Policy is sold under Married Woman's
3. CLAIM PROCEDURE Property Act, 1874.
3.1. For processing a claim request under this Policy, We will require all of the 9. ASSIGNMENT
following documents: Assignment is allowed as per Section 38 of the Insurance Act, 1938 as amended
3.1.1. Death claim documents: from time to time. [A leaflet containing the simplified version of the provisions
a. claimant's statement in the prescribed form (death claim application of the above section is enclosed in Annexure - (3) for reference] You may
form -form A); request for written acknowledgement of the receipt of notice of assignment or
b. original Policy document; transfer assignment for a Policy. Additional charges, not exceeding Rs. 100/- on
c. a copy of police complaint/ first information report (only in the case of each occasion may be applicable for granting a written acknowledgement of the
death by accident or unnatural death or suicidal death of the Life receipt of notice of assignment or transfer assignment. This option is not
Insured); available in case the Policy is sold under Married Woman's Property Act, 1874.
d. a copy of duly certified post mortem report, autopsy/viscera report and 10. POLICY CURRENCY
a copy of the final police investigation report /charge sheet (only in the The Policy is denominated in Indian Rupees. Any benefit/claim payments under
case of death by accident or unnatural death or suicidal death of the the Policy will be made in Indian Rupees by Us or in any other currency in
Life Insured); accordance with the applicable guidelines issued by the Reserve Bank of India
e. original/ attested copy of death certificate issued by the local/ from time to time.
municipal authority (only in the case of death of the Life Insured); 11. ELECTRONIC TRANSACTIONS
f. discharge summary / indoor case papers in case death happened due to You will comply with all the terms and conditions with respect to all
medical reasons in a hospital; transactions effected by or through facilities for conducting remote transactions
g. medical booklet / CGHS card details in case of defence and central including the internet, world wide web, electronic data interchange, call centre,
government personnel; tele-service operations or by other means of telecommunication established by
h. body transfer certificate / embassy documents / postmortem report Us or on Our behalf, for and in respect of the Policy or services, which will
whichever applicable in case of death in foreign country; constitute legally binding and valid transactions when executed in adherence to
i. complete passport copy in case of death in foreign country; and in compliance with the terms and conditions for such facilities.
j. identity proofs of the Claimants bearing their photographs and 12. AMENDMENT
signatures (only in case of death of the Life Insured) No amendments to the Policy will be effective, unless such amendments are
k. other life / health insurance details with claim history details; expressly approved in writing by Us and/or by the IRDAI (wherever applicable).
l. employer certificate with complete leave records (Form E); 13. REGULATORY AND JUDICIAL INTERVENTION
m. copy of bank passbook / cancelled cheque of the Claimant; If any competent regulatory body or judicial body imposes any condition on the
n. ITR for last 3 years / GST certificate in case of self employed; Policy for any reason, We are bound to follow the same which may include
o. Bank statement of last 2 years of the Life Insured and suspension of all benefits and obligations under the Policy.
p. any other documents or information required by Us for assessing and 14. FORCE MAJEURE
approving the claim request. 14.1. We shall derive the NAV on each Business Day. However, We may do so
3.1.2. Maturity claim documents: less frequently in case of a Force Majeure Event, where the value of the
a. NEFT Form (if not provided earlier); assets is too uncertain. In such circumstances, We may defer the valuation
b. a cancelled cheque or copy of passbook with pre-printed name and of assets for up to 30 days until we are certain that the valuation of Funds
bank account number, for payout through NEFT (if not provided can be resumed. In which case, We shall inform IRDAI of such deferment
earlier); in the valuation.
c. a self-attested photo ID proof 14.2. During the continuance of the Force Majeure Eevents, all requests for
3.2. A Claimant can download the claim request documents from Our website servicing the Policy including Policy related payment shall be kept in
www.maxlifeinsurance.com or can obtain the same from any of Our branches. abeyance. We shall continue to invest as per the Fund mandates submitted
with
13 of 40
 with IRDAI. However, We reserve Our right to change the exposure of all or Greivance Redressal Officer,
any part of the Funds to money market instruments [as defined under IRDAI Max Life Insurance Company Limited
(Actuarial, Finance and Investment Function of Insurers) Regulations, 2024] Plot No. 90C, Sector 18, Gurugram, 122015, Haryana, India
in circumstances mentioned under above. The exposure of the Fund as per the Helpline No. - 1860 120 5577 or (0124) 4219090
Fund mandates submitted with IRDAI, shall be reinstated within reasonable Email: manager.services@maxlifeinsurance.com
timelines once the Force Majeure Event ends. 1.2.2. the complainant may approach the Grievance Cell of the IRDAI on
14.3. Some of the examples of the Force Majeure Event circumstances as the following contact details:
mentioned are: IRDAI Grievance Call Centre (Bima Bharosa Shikayat Nivaran
14.3.1. when one or more stock exchanges which provide a basis for valuation Kendra)
of the assets of the fund are closed otherwise than for ordinary Toll Free No:155255 or 1800 4254 732
holidays. Email ID: complaints@irdai.gov.in
14.3.2. when, as a result of political, economic, monetary or any which are not Website: - bimabharosa.irdai.gov.in
in Our control, the disposal of the assets of the fund would be 1.2.3. the complainant can also register Your complaint online at
detrimental to the interests of the continuing policyholders. http://www.igms.irdai.gov.in/
14.3.3. in the event of natural calamities, acts of god, epidemic, pandemic, 1.2.4. the complainant can also register Your complaint through fax/paper
strikes, war, civil unrest, riots and bandhs. by submitting the complaint to:
14.3.4. in the event of any force majeure or disaster that affects Our normal
Policyholder Protection & Grievance Redressal Department
functioning.
(PPGR)
14.4. In such an event, an intimation of Force Majeure Event shall be uploaded on
Insurance Regulatory and Development Authority of India
Our website for information.
Sy No. 115/1, Financial District,
15. COMMUNICATION AND NOTICES
Nanakramguda, Gachibowli, Hyderabad - 500032, India
15.1. All notices meant for Us should be in writing and delivered to Our address as
Ph: (040) 20204000
mentioned in Part G or such other address as We may notify from time to
1.3. If the complainant are not satisfied with the redressal or there is no
time. You should mention the correct Policy number in all communications
response within a period of 1 (One) month, or within 1 year after rejection
including communications with respect to Premium remittances made by You.
of complaint by Us, the complainant may approach Insurance Ombudsman
15.2. All notices meant for You will be in writing and will be sent by Us to Your
at the address mentioned in Annexure A or on the IRDAI website
address as shown in the Schedule or as communicated by You and registered
www.irdai.gov.in or on Council of Insurance Ombudsmen website at
with Us. We may send You notices by post, courier, hand delivery or e-mail/
www.cioins.co.in if the grievance pertains to:
electronic mode or by any other means as determined by Us. If You change
Your address, or if the address of the Nominee changes, You must notify Us i. delay in settlement of a claim beyond the time specified by Us;
immediately. Failure in timely notification of change of address could result ii. any partial or total repudiation of a claim by Us;
in a delay in processing of benefits payable under the Policy. iii. disputes over the Premium paid or payable in terms of the Policy;
15.3. For any updates, please visit Our website www.maxlifeinsurance.com. iv. misrepresentation of Policy terms and conditions at any time in the
16. GOVERNING LAW AND JURISDICTION Policy document or Policy contract;
The Policy will be governed by and enforced in accordance with the laws of India. v. legal construction of the Policy in so far as such dispute relate to a
The competent courts in India will have exclusive jurisdiction in all matters and claim;
causes arising out of the Policy. vi. Policy servicing by Us, our agents or intermediaries;
17. ISSUANCE OF DUPLICATE POLICY vii. issuance of insurance Policy, which is not in conformity with the
You may request for a duplicate copy of the Policy to Us along with relevant proposal form submitted by You;
documents. Additional charges, not exceeding Rs.250/- may be applicable for viii. non issuance of any insurance document after receipt of the
issuance of the duplicate Policy. Premium.
18. ELIGIBILITY CONDITIONS ix. Any other matter resulting from non-observance of or non-
18.1. The Policy has been written on a single life basis only. adherence to the provisions of any regulations made by the IRDAI
18.2. The minimum Age of the Life Insured on the Date of Commencement of Risk with regard to protection of policyholders' interests or otherwise, or
should be 18 (Eighteen) years. of any circulars, guidelines or instructions issued by the IRDAI or
18.3. The maximum Age of the Life Insured on the Date of Commencement of of the terms and conditions of the policy contract, in so far as they
Risk cannot exceed relate to issues mentioned in this para 1.3 above.
18.3.1. For Variant 1 - 60 (Sixty) years.
1.4. As per Rule 14 of the Insurance Ombudsman Rules, 2017, a complaint to
18.3.2. For Variant 2 - 54 (Fifty-Four) years
the Insurance Ombudsman can be made only within a period of 1 (One)
18.4. The maximum Age of the Life Insured on the Maturity Date cannot exceed
year after receipt of Our rejection of the representation or after receipt of
18.4.1. For Variant 1 - 85 (Eighty-Five) years.
Our decision which is not to Your satisfaction or if We fail to furnish reply
18.4.2. For Variant 2 - 64 (Sixty-Four) years.
after expiry of a period of one month from the date of receipt of the
19. TERMINATION
written representation of the complainant, provided the complaint is not on
19.1. The Policy shall terminate upon happening of the earliest of the following
the same matter, for which any proceedings before any court, or consumer
events:
forum or arbitrator is pending.
19.1.1. on the date on which We receive a valid Free Look cancellation
request from You;
19.1.2. on payment of Death Benefit as per Clause 1.1 of Part C if the Death ENDORSEMENT
Benefit applicable is Variant 1 or the date of intimation of repudiation
STAMP DUTY AMOUNT : ` 24.60
of the claim in accordance with the provisions of the Policy;
19.1.3. payment of proceeds of the Discontinuance Policy Fund or Surrender Paid by e-Stamps Certificate no. 497/Issue Date: 23-10-2024/Vide Treasury
Value, as applicable; (E-CHALLAN) GRN NO.122667444 for Rs. 50000000
19.1.4. upon the Fund Value becoming equal to or less than zero in
accordance with Clause 6 of Part E;
19.1.5. on the Maturity Date; or
19.1.6. in case You have chosen the Settlement Option, on receipt of Your
request for termination of the Settlement Option or on the expiry of the
settlement period chosen by You.
20. TRANSLATION
In the event of any conflict or discrepancy between any translated version and the
English language version of this Policy contract, the English language version of
this Policy contract shall prevail. Suhail Ghai
PART G Authorized Signatory
GRIEVANCE REDRESSAL MECHANISM AND OMBUDSMAN DETAILS
1. DISPUTE REDRESSAL PROCESS UNDER THE POLICY
1.1. All consumer grievances and/or queries may be first addressed to your agent
or our customer helpdesk as mentioned below:
a. Max Life Insurance Company Limited, Plot 90C, Sector 18,
Gurugram, 122015, Haryana, India, Helpline No. - 1860 120 5577,
Email: service.helpdesk@maxlifeinsurance.com; or
b. To any office of Max Life Insurance Company Limited.
1.2. If our response is not satisfactory or there is no response within 14 (Fourteen)
days:
1.2.1. the complainant may file a written complaint with full details of the
complaint and the complainant's contact information to the following
official for resolution:

14 of 40
 Annexure 1 paid to him because of his death, his nominee(s) shall be entitled to the proceeds and
Section 45 - Policy shall not be called in question on the ground of mis-statement benefit of the policy. 17. The provisions of Section 39 are not applicable to any life
after three years insurance policy to which Section 6 of Married Women's Property Act, 1874 applies
Provisions regarding policy not being called into question in terms of Section 45 of the or has at any time applied except where before or after Insurance Act, 1938 as
Insurance Act, 1938, as amended from time to time are as follows: 1.No Policy of Life amended from time to time, a nomination is made in favour of spouse or children or
Insurance shall be called in question on any ground whatsoever after expiry of 3 yrs from spouse and children whether or not on the face of the policy it is mentioned that it is
a. the date of issuance of policy or b. the date of commencement of risk or c.the Date of made under Section 39. Where nomination is intended to be made to spouse or
Revival of policy or d. the date of rider to the policy, whichever is later. 2. On the ground children or spouse and children under Section 6 of MWP Act, it should be
of fraud, a policy of Life Insurance may be called in question within 3 years from a.the specifically mentioned on the policy. In such a case only, the provisions of Section
date of issuance of policy or b.the date of commencement of risk or c.the Date of Revival 39 will not apply.
of policy or d. the date of rider to the policy, whichever is later. For this, the insurer
should communicate in writing to the insured or legal representative or nominee or [Disclaimer: This is only a simplified version prepared for general information.
assignees of insured, as applicable, mentioning the ground and materials on which such You are advised to refer to the Insurance Act 1938 as amended from time to time
decision is based. 3. Fraud means any of the following acts committed by insured or by for complete and accurate details.]
his agent, with the intent to deceive the insurer or to induce the insurer to issue a life
Annexure 3
insurance policy: a.The suggestion, as a fact of that which is not true and which the
Section 38 - Assignment and Transfer of Insurance Policies
insured does not believe to be true; b. The active concealment of a fact by the insured
Assignment or transfer of a policy should be in accordance with Section 38 of the
having knowledge or belief of the fact; c. Any other act fitted to deceive; and d.Any such
Insurance Act, 1938 as amended from time to time from time to time. The extant
act or omission as the law specifically declares to be fraudulent. 4. Mere silence is not
provisions in this regard are as follows: 1. This policy may be transferred/assigned,
fraud unless, depending on circumstances of the case, it is the duty of the insured or his
wholly or in part, with or without consideration. 2. An Assignment may be effected
agent keeping silence to speak or silence is in itself equivalent to speak. 5. No Insurer
in a policy by an endorsement upon the policy itself or by a separate instrument
shall repudiate a life insurance policy on the ground of fraud, if the insured / beneficiary
under notice to the Insurer. 3. The instrument of assignment should indicate the fact
can prove that the misstatement was true to the best of his knowledge and there was no
of transfer or assignment and the reasons for the assignment or transfer, antecedents
deliberate intention to suppress the fact or that such mis-statement of or suppression of
of the assignee and terms on which assignment is made. 4. The assignment must be
material fact are within the knowledge of the insurer. Onus of disproving is upon the
signed by the transferor or assignor or duly authorized agent and attested by at least
policyholder, if alive, or beneficiaries. 6. Life insurance Policy can be called in question
one witness. 5. The transfer or assignment shall not be operative as against an insurer
within 3 years on the ground that any statement of or suppression of a fact material to
until a notice in writing of the transfer or assignment and either the said endorsement
expectancy of life of the insured was incorrectly made in the proposal or other document
or instrument itself or copy there of certified to be correct by both transferor and
basis which policy was issued or revived or rider issued. For this, the insurer should
transferee or their duly authorised agents have been delivered to the insurer. 6. Fee to
communicate in writing to the insured or legal representative or nominee or assignees of
be paid for assignment or transfer can be specified by the Authority through
insured, as applicable, mentioning the ground and materials on which decision to
Regulations. 7. On receipt of notice with fee, the insurer should Grant a written
repudiate the policy of life insurance is based.7.In case repudiation is on ground of mis-
acknowledgement of receipt of notice. Such notice shall be conclusive evidence
statement and not on fraud, the premium collected on policy till the date of repudiation
against the insurer of duly receiving the notice. 8. If the insurer maintains one or
shall be paid to the insured or legal representative or nominee or assignees of insured,
more places of business, such notices shall be delivered only at the place where the
within a period of 90 days from the date of repudiation. 8.Fact shall not be considered
policy is being serviced. 9. The insurer may accept or decline to act upon any
material unless it has a direct bearing on the risk undertaken by the insurer. The onus is on
transfer or assignment or endorsement, if it has sufficient reasons to believe that it is
insurer to show that if the insurer had been aware of the said fact, no life insurance policy
a.not bonafide;b.not in the interest of the policyholder;c.not in public interest; ord.is
would have been issued to the insured. 9.The insurer can call for proof of age at any time
for the purpose of trading of the insurance policy. 10. Before refusing to act upon
if he is entitled to do so and no policy shall be deemed to be called in question merely
endorsement, the insurer should record the reasons in writing and communicate the
because the terms of the policy are adjusted on subsequent proof of age of life insured. So,
same in writing to policyholder within 30 days from the date of policyholder giving a
this Section will not be applicable for questioning age or adjustment based on proof of age
notice of transfer or assignment. 11. In case of refusal to act upon the endorsement
submitted subsequently.
by the insurer, any person aggrieved by the refusal may prefer a claim to IRDAI
within 30 days of receipt of the refusal letter from the insurer. 12. The priority of
[Disclaimer: This is only a simplified version prepared for general information. You are
claims of persons interested in an insurance policy would depend on the date on
advised to refer to the Insurance Act, 1938 as amended from time to time for complete
which the notices of assignment or transfer is delivered to the insurer; where there
and accurate details.]
are more than one instruments of transfer or assignment, the priority will depend on
Annexure 2 dates of delivery of such notices. Any dispute in this regard as to priority should be
Section 39 - Nomination by Policyholder referred to the Authority. 13. Every assignment or transfer shall be deemed to be
Nomination of a life insurance policy is as below in accordance with Section 39 of the absolute assignment or transfer and the assignee or transferee shall be deemed to be
Insurance Act, 1938 as amended from time to time. The extant provisions in this regard absolute assignee or transferee, except a.where assignment or transfer is subject to
are as follows: 1. The policyholder of a life insurance policy on his own life may terms and conditions of transfer or assignment OR b.where the transfer or assignment
nominate a person or persons to whom money secured by the policy shall be paid in the is made upon condition that i.the proceeds under the policy shall become payable to
event of his death. 2. Where the nominee is a minor, the policyholder may appoint any policyholder or nominee(s) in the event of assignee or transferee dying before the
person to receive the money secured by the policy in the event of policyholder's death insured; or ii.the insured surviving the term of the policy.Such conditional assignee
during the minority of the nominee. The manner of appointment is to be laid down by the will not be entitled to obtain a loan on policy or Surrender the policy. This provision
insurer. 3. Nomination can be made at any time before the maturity of the policy. 4. will prevail notwithstanding any law or custom having force of law which is contrary
Nomination may be incorporated in the text of the policy itself or may be endorsed on the to the above position. 14. In other cases, the insurer shall, subject to terms and
policy communicated to the insurer and can be registered by the insurer in the records conditions of assignment, recognize the transferee or assignee named in the notice as
relating to the policy. 5. Nomination can be cancelled or changed at any time before the absolute transferee or assignee and such persona shall be subject to all liabilities
policy matures, by an endorsement or a further endorsement or a will as the case may be. and equities to which the transferor or assignor was subject to at the date of transfer
6. A notice in writing of change or cancellation of nomination must be delivered to the or assignment; b.may institute any proceedings in relation to the policy; and c.obtain
insurer for the insurer to be liable to such nominee. Otherwise, insurer will not be liable if loan under the policy or Surrender the policy without obtaining the consent of the
a bonafide payment is made to the person named in the text of the policy or in the transferor or assignor or making him a party to the proceedings. 15. Any rights and
registered records of the insurer. 7. Fee to be paid to the insurer for registering change or remedies of an assignee or transferee of a life insurance policy under an assignment
cancellation of a nomination can be specified by the Authority through Regulations. 8. On or transfer effected before commencement of the Insurance Laws (Amendment) Act,
receipt of notice with fee, the insurer should grant a written acknowledgement to the 2015 shall not be affected by this section.
policyholder of having registered a nomination or cancellation or change thereof. 9. A
transfer or assignment made in accordance with Section 38 shall automatically cancel the [Disclaimer: This is only a simplified version prepared for general information.
nomination except in case of assignment to the insurer or other transferee or assignee for You are advised to refer to the Insurance Act, 1938 as amended from time to time
purpose of loan or against security or its reassignment after repayment. In such case, the for complete and accurate details.]
nomination will get affected to the extent of insurer's or transferee's or assignee's interest
in the policy. The nomination will get revived on repayment of the loan. 10. The right of
any creditor to be paid out of the proceeds of any policy of life insurance shall not be
affected by the nomination. 11. In case of nomination by policyholder whose life is
insured, if the nominees die before the policyholder, the proceeds are payable to
policyholder or his heirs or legal representatives or holder of succession certificate. 12. In
case nominee(s) survive the person whose life is insured, the amount secured by the
policy shall be paid to such survivor(s). 13. Where the policyholder whose life is insured
nominates his a.parents or b.spouse or c.children or d.spouse and children e.or any of
them, the nominees are beneficially entitled to the amount payable by the insurer to the
policyholder unless it is proved that policyholder could not have conferred such beneficial
title on the nominee having regard to the nature of his title. 14. If nominee(s) die after the
policyholder but before his share of the amount secured under the policy is paid, the share
of the expired nominee(s) shall be payable to the heirs or legal representative of the
nominee or holder of succession certificate of such nominee(s). 15. The provisions of sub-
section 7 and 8 (13 and 14 above) shall apply to all life insurance policies maturing for
payment after the commencement of Insurance Laws (Amendment) Act 2015. 16. If
policyholder dies after maturity but the proceeds and benefit of the policy has not been

15 of 40
 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, , 1st Floor, Jeevan Shikha, 60-B,Hoshangabad Road, Opp. Gayatri Mandir, Bhopal-462 011.
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. 20-27, Ground Floor, Jeevan Deep Building, Sector 17-A,
Chandigarh-160017. Tel.:- 0172 - 4646394/2706468 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 / 24333678 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 - 23237539
Email: bimalokpal.delhi@cioins.co.in (State of Delhi, 4 districts of Haryana viz, Gurugram, Faridabad, Sonepat and Bahadurgarh)
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/
2740798 Email: bimalokpal.jaipur@cioins.co.in (State of Rajasthan)
KOCHI - Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash, LIC Building, Opp to Maharaja's College Ground, M.G. Road, Kochi
68201 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)
KOLKATA - Office of the Insurance Ombudsman, Hindustan Building. Annexe, 7th Floor, 4, C.R. Avenue, Kolkata-700 072. Tel :
033-22124339/22124341 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 - 4002082 / 3500613 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-
69038800/27/29/31/32/33 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.: 020-24471175 Email: bimalokpal.pune@cioins.co.in (State of Maharashtra including Navi Mumbai and Thane and excluding
Mumbai Metropolitan Region.)

16 of 40
 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 Proposer Payor
Phase-II, Gurugram - Haryana, 122002
For Unit linked Plans, THE INVESTMENT RISK Attach Recent Photograph Attach Recent Photograph
Unit Linked Proposal Form IN INVESTMENT PORTFOLIO IS BORNE BY
THE POLICYHOLDER

Proposal Number: 625460506 GO/CA/Broker Code: 80507D

Do you have a Max Life Insurance Policy or have currently applied simultaneous policies? Yes No. If yes give Policy/Proposal number: 168667715

Purpose of Insurance Savings Child Future Pension Protection Tax Benefit

Objective of Insurance E/E MWPA HUF CEIP Keyman Partnership Individual

Product Solution ________________ Existing Customer I want to receive physical policy document Yes

A. PERSONAL DETAILS
PROPOSER LIFE TO BE INSURED (if other than proposer)
1. Title MR

First Saravanan

2. Name Middle

Last Arumugam

First ARUMUGAM
3. Father's /
Husband Name
Last A

4. Date of Birth 04/06/1987

5. Gender Male Female Transgender Male Female Transgender

6. Nationality Indian NRI PIO Foreign National Indian NRI PIO Foreign National
6a. Residing Country if Nationality other than Indian if Nationality other than Indian
Residence for Tax purposes in Jurisdiction(s) outside India: No

(If Yes then FATCA & CRS-Self Certification Form to be mandatorily completed)

7. Marital Status Married

8. Education Post Graduate
9. Relationship with
SELF
proposer

OTHERS
10. Industry Type
SALES

11. Organisation Type Pvt Ltd

12. Occupation / Job Title Salaried / SALESMAN
13. Name of entity /
Smfg India Credit Company
employer
14. Annual Income (Rs) 300000

15. Is the Life to be Insured / Proposer / Nominee / Payor a Politically Exposed Person ? Yes No

16. NOMINEE DETAILS Nominee 1 (Mandatory) Nominee 2 (Optional) Nominee 3 (Optional)

a. Title MS

First KOKILA
b. Name
Middle

-1- ULIP_STD_1024_5.14

17 of 40
 Last CHINNAPAIYAN

c. Date of Birth 02/05/1996

d. Gender Female
e. Percentage of share 100 % _ _% _ _%
f. Relationship with
proposer Spouse Parents Other Spouse Parents Other Spouse Parents Other

g. Appointee Full Name (if

nominee is under age 18)
h. Appointee Relationship to
Nominee

17. CURRENT RESIDENTIAL ADDRESS

House No./Apt. Name 3 68 AMMAN KOVIL

Society Road/Area/Sector CHETTIMANKURICHI

Landmark POST OFFICE CHETTIMANKURICHI

Village/Town City / District SALEM

Pin Code 637101 State / U.T. TAMIL NADU Country India

Mobile # 1 9360030025 Mobile # 2 STD Code Telephone #
E-mail ID vipsaravana@gmail.com

18. PERMANENT RESIDENTIAL ADDRESS (optional)

House No./Apt. Name 3 68 AMMAN KOVIL CHETTIMANKURI

Society Road/Area/Sector CHI
Landmark

Village/Town City/ District SALEM

Pin Code 637101 State / U.T. TAMIL NADU Country India

19. Preferred Mailing Address Current Residential Permanent Residential

19a. I/We agree to receive regular promotional updates / alerts from Max Life from time to time. Yes No

20. Do you wish to hold this Policy electronically under e-insurance ? Yes No

a. e-Insurance Account No. (if available): and Insurance Repository name:

b. Preferred Insurance Repository you would like to have your e-Insurance Account CAMSRep Karvy CIRL NSDL

B. COVERAGE INFORMATION - Type of Coverage

Coverage Premium Annual Target
a. Base Plan Coverage Term Modal Premium GST
Multiple Payment Term Premium
MAX LIFE ONLINE SAVINGS
20 10 5 12192.0 1016 0
PLAN CHILD SOLUTION_CO

Modal Premium without GST* and Cess 1016 GST* and applicable Cess 0 Total Premium Paid 1016

*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.

c. INVESTMENT OPTIONS You can either opt for one of the below mentioned automated strategies or choose to manage your funds on
your own through self-managed Portfolio Strategy. Please tick if any of the below Strategy is applicable.

i. Systematic Transfer Plan iii. Dynamic Fund Allocation Strategy v. Self-Managed Portfolio Strategy

ii. Lifecycle Based Portfolio Strategy iv. Trigger Based Portfolio Strategy

NIFTY
Midcap Nifty 500
Growth Diversified Sustainable Pure Growth Smallcap Nifty Alpha
High Growth Momentum Growth Fund Momentum
Super equity equity fund Fund Quality Index 50 Fund
Index Fund 50 Fund
Fund

% % % % % % % % % %

Dynamic
Nifty Momentum Quality 50 Fund Balanced Secure Secure Plus* Conservative Money Market II
bond fund

100% % % % % % %

-2- ULIP_STD_1024_5.14

18 of 40
 *Secure Plus fund is not applicable with Self-Managed Portfolio Strategy

d. Would you like to opt for Smart Withdrawal Option? NO

e. When would you like your Smart Withdrawal Payouts to begin from? Please specify the policy year here. NA

f. Please state your required frequency of Smart Withdrawal Payouts.

g. Please state the % of Fund Value that you would require in an year NA %

2. NEFT BANK A/C DETAILS OF PROPOSER 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).
Bank Account Number:- 345100050308590 Account Holder's Name:- Saravanan Arumugam
MICR Code:- 637060345 IFSC Code:- TMBL0000345
Bank Name & Branch: TAMILNAD MERCANTILE BANK LTD,NO.39B, SALEM MAIN ROAD, EDAPPADI- 637 105, SALEM DISTRICT

Type of Bank Account: Saving Current Others

3. PERMANENT ACCOUNT NUMBER (PAN) DYXPA5079R (for proposer) (for insured)

Form 60
Form 60

TDS may be applicable, in accordance with Income Tax Act 1961, as amended from time to time.
4. MODE OF PAYMENT Monthly
5. RENEWAL PREMIUM BY Direct Debit
6. SOURCE OF FUNDS Salary

7. IS PAYOR DIFFERENT FROM THE PROPOSER? Yes No

Name: Gender:

DOB: PAN:

Address: Income:

Relationship to Proposer: Banking Since:

BANK ACCOUNT DETAILS OF THE PAYOR

Bank Account Number: Bank Name & Branch:

8. Are you a Max Life Agent Advisor or an employee of a Max group company/ Corporate Agents? NA

9. PREMIUM PAYMENT DETAILS

Amount in Words: One Thousand Sixteen
Paid Rs: 1016 Payment by Net Banking
Cheque / Draft No. / Instrument No Date: 16/11/2024 12:00:00 AM
Bank Name & Branch:

Proposer Insured
C. INFORMATION OF LIFE TO BE INSURED
Yes No Yes No

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
postponed ?

Issued or Pending LIFE: TOTAL Sum Assured:- CI / DD: TOTAL Sum Assured:-

Offered at modified terms, rejected or postponed

2. In the next 12 months you intend to travel or reside abroad other than on holiday of more than 4 weeks?

3. Do you participate or do you intend to participate in any hazardous activities as part of your Occupation/ Sports/ Hobby?
Details:

4. Have you ever been convicted or are you under investigation for any criminal charges ?
Details:

5. FOR FEMALE LIFE TO BE INSURED

Spouse
Occupation: Income: Insurance Amount: Are you pregnant? Yes No
Detail:
Do you have any complications related to pregnancy? If "Yes", give details:
If "Yes", how many months? < 6 months > 6 months

-3- ULIP_STD_1024_5.14

19 of 40
 Yes No

6. FOR MINOR LIFE TO BE INSURED (Age <18 yrs.)

Parent's Annual Income:- Parent's - Total insurance cover:- NA Sibling's - Total insurance cover:-

Proposer Insured
D. MEDICAL INFORMATION
Yes No Yes No

1. FAMILY HISTORY : Has any two (2) or more of your family members (Parents & Siblings) ever been diagnosed with
Diabetes or Hypertension or Kidney Failure or Cancer or Heart Attack or any Hereditary Disorder before the age of 60 ?

2. Proposer Life To Be Insured

Height 155 cms feet inch cms feet inch

Weight 54 Kgs. kgs.

ABHA Number

3. HAVE YOU EVER BEEN INVESTIGATED, TREATED OR DIAGNOSED WITH ANY OF THE FOLLOWING CONDITIONS. If
Proposer Insured
YES, PLEASE PROVIDE DETAILS : No
Yes No Yes No

i). Diabetes /High blood sugar levels

ii). Hypertension/ High Blood Pressure, High Cholesterol or Thyroid disorder

iii). Heart or vascular disorder including chest pain, stroke, heart attack or Angioplasty, CABG or any other heart surgery.

iv). Breathing or lung disorders including asthma, emphysema, tuberculosis.

v). Liver or digestive system related disorder including jaundice ,gall bladder, pancreas or Hepatitis B/C.

vi). Any abnormal growth like tumour,lump,cancer or blood disorder, including anemia or thalassaemia or Sexually transmitted disease ( STD )
including HIV or AIDS.

vii). Any kind of Kidney or bladder disorder, including kidney failure, renal stone, nephritis or prostrate disorder.

viii). Any neurological or mental health problem like paralysis, multiple sclerosis, Parkinson's, epilepsy, depression or anxiety.

ix). Muscular-skeletal or joint disorders, including any kind of arthritis, gout, osteoporosis.

x). Are you having history of any hospitalization, treatment or investigation?

xi). Have you advised now or in last 5 yrs tests like X-Ray/CT scan/MRI/ Ultrasonography/ ECG/Blood test or any other 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 present
since birth, and which is abnormal with reference to form, structure or position?

xiii). Have you had any genetic testing before?

4. TOBACCO / ALCOHOL / DRUGS CONSUMPTION: Do you consume any of the following ?

i). Tobacco ( Smoking /Chewing) currently or even occasionally in last 1 year ?

Are you smoking more than 20 cigrattes/ day or chew more than 10 sachet/day of tobacco?

ii). Are you drinking any kind of liquor more than 3 days a week?

Have you ever been advised to quit alcohol?

iii). Are you taking drugs like Cannabis/Marijuana/Ecstacy/Heroin/LSD/Amphetamines or any other illegal drugs?

E. DECLARATION AND AUTHORISATION

-4- ULIP_STD_1024_5.14

20 of 40
DECLARATION BY PROPOSER

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.

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, action will be initiated as per Section 45 of
Insurance Act, 1938, as amended from time to time. 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 or
TPAs/ other insurance companies/ service providers/ National Health Authority (NHA) through ABHA 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 letter, E-mail, SMS. I/We agree to receive regular reminders,
updates / alerts from Max life from time to time. I/ We authorize Max Life to send all communication by electronic means.

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.

16/11/2024

Signature / OTP Confirmation Date / Thumb Impression / Electronic Signature of Proposer

Place: SALEM Date:- 16/11/2024

VERNACULAR /ILLITERATE DECLARATION

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 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 / OTP Confirmation Date / Thumb Impression / Electronic Signature / OTP Confirmation Date / Thumb Impression / Electronic
Signature of Declarant Signature of Proposer

DISABILITY DECLARATION

Declaration to be made by authorized representative of the policyholder or prospect, who is a person with disability (unconnected with Max Life Insurance Company
Limited)

I hereby declare that I have been fully explained the contents of this proposal form, policy documents, terms and conditions.

Name of the Declarant: Address of the Declarant:

Relationship with the prospect: Contact details of the Declarant:

I certify that I have understood the content of the proposal form, policy documents, terms and conditions and the eIA as explained to me and confirm the above by
affixing/appending my signature/thumb-impression/ OTP.

Signature / OTP Confirmation Date / Thumb Impression / Electronic Signature / OTP Confirmation Date / Thumb Impression / Electronic
Signature of Declarant Signature of Proposer

DECLARATION BY PRINCIPAL OFFICER/AGENT ADVISOR/SPECIFIED PERSON

-5- ULIP_STD_1024_5.14

21 of 40
I 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 to the customer. Yes No

Relationship of Principal Officer/Agent Advisor/Specified Person with the Proposer/Life

Insured
Name of Principal Officer/Agent Advisor/Specified Person Policybazaar Insurance Brokers Pvt Ltd.
Principal Officer/Agent Advisor/Specified Person Code
Phone No. with STD Code
Date:- Place:

Signature / OTP Confirmation Date / Thumb Impression / Electronic Signature of Signature / OTP Confirmation Date / Thumb Impression
Principal Officer/Agent Advisor/Specified Person /Electronic Signature of Sales Manager

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 Principal Officer/AA/Spec Person Principal Officer/AA/Spec Person's Signature / OTP %
Person Code Confirmation Date Share

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) may be 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, 45 and 41 of the Insurance Act, 1938, as amended
from time to time and Regulation 18 of Insurance Regulatory and Development Authority of India (Protection of Policyholders Interests, Operations and Allied
Matters of Insurers) Regulations, 2024, which reads as follows-

Regulation 18(1): No proposal shall be accepted unless nomination is obtained as per section 39 of the Act.

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 Insured/legal representatives in writing specifying the grounds and
materials on which such decision is based. For other details please refer to 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:

ULIP_STD_1024_5.14

CKYC Annexure
1. CENTRAL KYC REGISTRY | Know Your Customer(KYC) Application Form | Individual
Application Type: EXISTING
KYC Number: 60032742598573
2. PERSONAL DETAILS (Please refer instruction A at the end)
Prefix First Name Middle Name Last Name
Name(Same as ID proof) Mr Saravanan Arumugam
Maidan Name(If any)

-6- ULIP_STD_1024_5.14

22 of 40
Father/ Spouse Name ARUMUGAM A
Mother Name Ms pAAVAAYE A
Date Of Birth* 04/06/1987
Gender Male
Marital Status Married
Nationality Indian
Resident Status India
Occupation Type Salaried
3.RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA
Tax Identification number or Equivalent
Country Code of Jurisdiction of Residence

Place/City of Birth* : Country Code of Birth :

4. PROOF OF IDENTITY/ADDRESS(Please refer instruction C at the end)

ID/Address proof name Aadhar/UID Card
ID/Address proof Number xxxxxxxx9037
ID/Address Expiry date
5. PROOF OF ADDRESS(PoA)*
Address proof name Aadhar/UID Card
Address Line1 3 68 AMMAN KOVIL
Address Line2 CHETTIMANKURICHI
Address Line3 POST OFFICE CHETTIMANKURICHI
City SALEM
State TAMIL NADU
PIN 637101
Country INDIA
6. Address in the Jurisdiction details where Applicant is Resident Outside India for Tax Purposes
Overseas Address
7. Contact Details
Mobile Number 9360030025
Email -ID vipsaravana@gmail.com
8. APPLICATION DECLARATION

■ I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any change
therein immediately. In case of the above Information is found to be false or untrue or misleading or misrepresenting. I am aware that I am be held liable for
it.
■ I hereby consent to receiving information from Canral KYC Registry through SMS/Email on the above registered number/email address

Name/Date/Place
Name of the applicant Mr Saravanan Arumugam
Place SALEM
Date 16/11/2024

Proposal Form Annexure- Additional Questions Annexure

Proposer Life to be Insured
Others
Industry Type
SALES
Defence/CRPF
a. Are you currently posted in any
sensitive/border location
b. Your nature of job/role
Aviation
a. Exact Nature of duties
b. If in Flying role what do you fly?
Diving
a. Are you a professional diver?
Where do you dive?
Oil and Natural Gas

-7- ULIP_STD_1024_5.14

23 of 40
a. Are you based at offshore or your job
involves travelling to offshore?
Merchant Marine
a. Type of vessel where working?
Mining
a. Does your role involves going inside any kind
of mine?
Have you ever had any illness related to your
occupation?
Nature of Duties/Business MARKETING EXECUTIVE

Are you/your Nominee a Politically Exposed Person (PEP)? Yes No

If above Question "Yes" then answer below:

a. Which of the following persons is PEP (Tick as applicable) Life insured Family member of life insured
Specify:
b. Please specify the extent of Political involvement:
i. Political Experience (Years) :
ii. Affiliation to Political Party :

ii. Role in Political Party : Social Worker MLA MP Others

iv. Portfolio Handled :

v. Whether Party in Power : Yes No

c. Whether the concerned PEP has ever been posted in foreign office/portfolio? Yes No
Specify:
d. Please specify all sources of income of concerned PEP? :

e. Has the concerned PEP ever been convicted or is under any investigation for any crime punishable by 3 or more years of imprisonment? : Yes

No
Specify:

Insurance History Annexure

Do you have any Life, Disability, Critical Illness or Health Insurance policy issued/pending/lapsed with or any other insurance company? Yes No

Has any proposal/reinstatement for life or health Insurance ever been refused, modified, postponed or offered with extra premium ? Yes No

Medical and Travel Questions Annexure

In next 12 months you intend to travel or reside abroad other than on holiday of more than 4 weeks ? Yes No

Has any two (2) or more of your family members (Parents & Siblings) ever been diagnosed with Diabetes or Hypertension or Kidney Failure or Cancer or

Heart Attack or any Hereditary Disorder before the age of 60 ? Yes No

Have you ever been investigated/diagnosed or treated for any of the following? No

Tobacco/Alcohol/Drugs Consumption: (In case you consume or have ever consumed) Yes No
Give Details :

-8- ULIP_STD_1024_5.14

24 of 40
 Proposal No: 625460506

Name of the Saravanan A rumugam Name of the Product: Max Life Online Savings plan
Prospect/Policyholder: A Unit-Link ed Non-Participating Individual
Tag Line:
A ge & Gender: 37 Years, Male Life Insurance Plan
Name of the Life A ssured: Saravanan Arum ugam Policy Option: Variant 2
A ge & Gender: 37 Years, Male Unique Identification No: 104L098V06
Sum A ssured: Rs. 1,21,920 GST Rate: 18.00%
Policy Term & Premium Max Life State: Haryana
20 Years & 5 Years
Payment Term:
Policyholder Residential State: TAMIL NADU
A mount of Installment
Premium: Rs. 1,016 Investment Strategy Opted for: NA
Mode of payment of Monthly
premium:

Funds opted for along with their risk

level
[Please specify the customer specific
fund option):

Nifty Mom entum Q uality 50 Fund (Risk

Rating-Very High) : 100%

How to read and understand this benefit illustration?

This benefit illustration is intended to show what charges are deducted from your premiums and how the unit fund, net of charges and taxes, may
grow over the years of the policy term if the fund earns a gross return of 8% p.a. or 4% p.a. These rates, i.e., 8% p.a. and 4% p.a. are assumed
only for the purpose of illustrating the flow of benefits if the returns are at this level. It should not be interpreted that the returns under the plan
are going to be either 8% p.a. or 4% p.a.

Net Yield mentioned corresponds to the gross investment return of 8% p.a., net of all charges but does not consider mortality, morbidity charges,
underwriting extra, if any, guarantee charges and cost of riders, if deducted by cancellation of units. It demonstrates the impact of charges
exclusive of taxes on the net yield. Please note that the mortality charges per thousand sum assured in general, increases with age.

The actual returns can vary depending on the performance of the chosen fund, charges towards mortality, morbidity, underwriting extra, cost of
riders, etc. The investment risk in this policy is borne by the policyholder, hence, for more details on terms and conditions please read sales
literature carefully.

Part A of this statement presents a summary view of year-by-year charges deducted under the policy, fund value, surrender value and the death
benefit, at two assumed rates of return. Part B of this statement presents a detailed break-up of the charges, and other values.

Note: 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 benefits then these will be clearly marked "guaranteed" in the illustration table on this page.
If your policy offers variable benefits then the illustration on this page will show two different rates of assumed future investment returns. 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 actual future investment performance.

Rider Details
Critical Illness and Disability-Secure Rider -
Coverage Variant NA
Critical Illness and Disability-Secure Rider - Rider
Prem ium Paym ent Term and Rider Term NA
Critical Illness and Disability-Secure Rider -
NA
Rider Sum Assured

Premium Summary
Max Life Critical Illness and Disability-Secure
Base Plan Rider Total Installment Premium

Installment Premium without GST (in Rs.) 1,016 0 1,016

Installment Premium with First Year GST (in Rs.) 1,016 0 1,016
Installment Premium with GST 2nd Year Onwards (in
1,016 0 1,016
Rs.)

UIN: 104L098V06

25 of 40
 Part A
(A mount in Rupees)
A t 4% p.a. Gross Investment Return A t 8% p.a. Gross Investment Return
Policy A nnualized Mortality, Fund
Mortality, Fund at
Year Premium Morbidity Other at Surrender Death Other Surrender Death
Charges* GST End of Value Benefit Morbidity Charges* GST End of Value Benefit
Charges Charges Year
Year
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 12,192 330 81 74 11,960 9,137 1,21,920 330 82 74 12,209 9,331 1,21,920
2 12,192 340 234 103 24,203 22,045 1,21,920 340 242 105 25,187 23,029 1,21,920
3 12,192 351 390 133 36,734 35,296 1,21,920 351 410 137 38,984 37,545 1,21,920
4 12,192 364 550 165 49,559 48,840 1,21,920 364 590 172 53,648 52,929 1,21,920
5 12,192 379 713 197 62,683 62,683 1,21,920 379 781 209 69,235 69,235 1,21,920
6 0 403 796 216 63,749 63,749 1,21,920 403 898 234 73,180 73,180 1,21,920
7 0 443 809 225 64,792 64,792 1,21,920 443 949 251 77,330 77,330 1,21,920
8 0 487 823 236 65,808 65,808 1,21,920 487 1,003 268 81,691 81,691 1,21,920
9 0 542 835 248 66,785 66,785 1,21,920 542 1,059 288 86,265 86,265 1,21,920
10 0 603 847 261 67,712 67,712 1,21,920 603 1,118 310 91,058 91,058 1,21,920
11 0 659 858 273 68,595 68,595 1,21,920 659 1,180 331 96,090 96,090 1,21,920
12 0 708 870 284 69,441 69,441 1,21,920 708 1,246 352 1,01,383 1,01,383 1,21,920
13 0 756 880 294 70,250 70,250 1,21,920 756 1,314 373 1,06,957 1,06,957 1,21,920
14 0 802 889 304 71,025 71,025 1,21,920 802 1,386 394 1,12,833 1,12,833 1,21,920
15 0 842 899 313 71,771 71,771 1,21,920 842 1,462 415 1,19,037 1,19,037 1,21,920
16 0 874 908 321 72,497 72,497 1,21,920 874 1,543 435 1,25,599 1,25,599 1,21,920
17 0 896 917 326 73,215 73,215 1,21,920 896 1,628 454 1,32,554 1,32,554 1,21,920
18 0 943 926 337 73,893 73,893 1,21,920 943 1,718 479 1,39,898 1,39,898 1,21,920
19 0 1,030 935 354 74,485 74,485 1,21,920 1,030 1,814 512 1,47,606 1,47,606 1,21,920
20 0 1,125 941 372 74,977 74,977 1,21,920 1,125 1,913 547 1,55,692 1,55,692 1,21,920
*See Part B for details

IN THIS POLICY, THE INVESTMENT RISK IS BORNE BY THE POLICYHOLDER AND THE ABOVE INTEREST RATES ARE ONLY FOR
ILLUSTRATIVE PURPOSE.

I, ................ (nam e), have ex plained the prem ium s, charges and
benefits under the policy fully to the prospect / policyholder.
I, Saravanan Arum ugam , having received the inform ation with
respect to the above, have understood the above statem ent
Place : Signature / O TP Confirm ation Date before entering into the contract.
Date :16 Nov 2024 / Thum b Im pression / Electronic
Signature of Agent/ Interm ediary /
O fficial Date :16 Nov 2024 Signature / O TP Confirm ation Date
/ Thum b Im pression / Electronic
Signature of Prospect/ Policyholder
This system generated benefit illustration shall be treated as
signed by m e.

UIN: 104L098V06

26 of 40
 Gross
Part B Yield 8% pa Net Yield 6.65% (A mounts in Rupees)

Premium A nnualized Policy A dditions Fund Fund at

Premium -
Policy A nnualized A llocation Premium Mortality GST A dmin. Guarantee Other to before FMC End Surrender Death
Year Premium(A P) Charge A llocation Charge Charge Charges* the FMC of the value Benefit
(PA C) Charges Charge fund* Year

1 12,192 - 12,192 330 74 - - - - 12,224 82 12,209 9,331 1,21,920

2 12,192 - 12,192 340 105 - - - - 25,218 241 25,187 23,029 1,21,920
3 12,192 - 12,192 351 137 - - - - 39,032 410 38,984 37,545 1,21,920
4 12,192 - 12,192 364 172 - - - - 53,715 590 53,648 52,929 1,21,920
5 12,192 - 12,192 379 209 - - - - 69,321 781 69,235 69,235 1,21,920
6 0 - 0 403 234 - - - - 73,271 898 73,180 73,180 1,21,920
7 0 - 0 443 251 - - - - 77,426 949 77,330 77,330 1,21,920
8 0 - 0 487 268 - - - - 81,792 1,003 81,691 81,691 1,21,920
9 0 - 0 542 288 - - - - 86,372 1,059 86,265 86,265 1,21,920
10 0 - 0 603 310 - - - - 91,171 1,118 91,058 91,058 1,21,920
11 0 - 0 659 331 - - - - 96,209 1,180 96,090 96,090 1,21,920
12 0 - 0 708 352 - - - - 1,01,509 1,245 1,01,383 1,01,383 1,21,920
13 0 - 0 756 373 - - - - 1,07,089 1,314 1,06,957 1,06,957 1,21,920
14 0 - 0 802 394 - - - - 1,12,973 1,386 1,12,833 1,12,833 1,21,920
15 0 - 0 842 415 - - - - 1,19,184 1,462 1,19,037 1,19,037 1,21,920
16 0 - 0 874 435 - - - - 1,25,754 1,543 1,25,599 1,25,599 1,21,920
17 0 - 0 896 454 - - - - 1,32,718 1,628 1,32,554 1,32,554 1,21,920
18 0 - 0 943 479 - - - - 1,40,071 1,718 1,39,898 1,39,898 1,21,920
19 0 - 0 1,030 512 - - - - 1,47,788 1,813 1,47,606 1,47,606 1,21,920
20 0 - 0 1,125 547 - - - - 1,55,884 1,913 1,55,692 1,55,692 1,21,920

UIN: 104L098V06

27 of 40
 Gross 4% pa (A mounts in Rupees)
Yield

Premium A nnualized Policy A dditions Fund

Policy A nnualized A llocation Premium - Mortality GST A dmin. Guarantee Other to Fund
Year Premium(A P) Charge Premium Charge Charge Charges* the before FMC at End Surrender Death
of the value Benefit
A llocation FMC
(PA C) Charges Charge fund* Year

1 12,192 - 12,192 330 74 - - - - 11,975 81 11,960 9,137 1,21,920

2 12,192 - 12,192 340 103 - - - - 24,232 234 24,203 22,045 1,21,920
3 12,192 - 12,192 351 133 - - - - 36,780 390 36,734 35,296 1,21,920
4 12,192 - 12,192 364 165 - - - - 49,621 550 49,559 48,840 1,21,920
5 12,192 - 12,192 379 197 - - - - 62,761 713 62,683 62,683 1,21,920
6 0 - 0 403 216 - - - - 63,827 796 63,749 63,749 1,21,920
7 0 - 0 443 225 - - - - 64,872 810 64,792 64,792 1,21,920
8 0 - 0 487 236 - - - - 65,890 822 65,808 65,808 1,21,920
9 0 - 0 542 248 - - - - 66,867 835 66,785 66,785 1,21,920
10 0 - 0 603 261 - - - - 67,796 847 67,712 67,712 1,21,920
11 0 - 0 659 273 - - - - 68,680 858 68,595 68,595 1,21,920
12 0 - 0 708 284 - - - - 69,527 869 69,441 69,441 1,21,920
13 0 - 0 756 294 - - - - 70,337 880 70,250 70,250 1,21,920
14 0 - 0 802 304 - - - - 71,113 890 71,025 71,025 1,21,920
15 0 - 0 842 313 - - - - 71,860 899 71,771 71,771 1,21,920
16 0 - 0 874 321 - - - - 72,587 908 72,497 72,497 1,21,920
17 0 - 0 896 326 - - - - 73,305 917 73,215 73,215 1,21,920
18 0 - 0 943 337 - - - - 73,985 926 73,893 73,893 1,21,920
19 0 - 0 1,030 354 - - - - 74,577 934 74,485 74,485 1,21,920
20 0 - 0 1,125 372 - - - - 75,070 941 74,977 74,977 1,21,920

*There are no charges included in other charges. There are no additions included on Additions to the fund.
Notes: 1. Refer the sales literature for explanation of terms used in this illustration.
2. Fund management charge is based on the specific fund option(s) chosen.
3. In case rider charges are collected explicitly through collection of rider premium, and not by way of cancellation of units, then, such charges are
not considered in this illustration. In other cases, rider charges are included in other charges.

I, ................ (nam e), have ex plained the prem ium s, charges and
benefits under the policy fully to the prospect / policyholder.
I, Saravanan Arum ugam , having received the inform ation with
respect to the above, have understood the above statem ent
Place : Signature / O TP Confirm ation Date before entering into the contract.
Date : 16 Nov 2024 / Thum b Im pression / Electronic
Signature of Agent/ Interm ediary /
O fficial Date : 16 Nov 2024 Signature / O TP Confirm ation Date
/ Thum b Im pression / Electronic
Signature of Prospect/ Policyholder
This system generated benefit illustration shall be treated as
signed by m e.

UIN: 104L098V06

28 of 40
 CUSTOMER INFORMATION SHEET / KNOW YOUR POLICY

*This document provides key information about your policy. You are also advised to go through your policy document.

Sl. No Title Description in Simple Words Policy

(Please refer to applicable Policy Clause Number in next column) Clause
number

1. Name of the Max Life Online Savings Plan Policy

Insurance Product UIN: 104L098V06 Preamble
and Unique
Identification
Number
(UIN)

2. Policy Number 625460506 Policy

Schedule

3. Type of Insurance A Unit Linked Non-Participating Individual Life Insurance Plan Policy
Policy Preamble

4. Basic Policy Policy

details Instalment Premium: 1016.00 Schedule
Mode of Premium payment: Monthly
Sum Assured on Death: 121920.00 *
Sum Assured on Maturity: Applicable fund value at the time of Maturity
Policy Term: 20
Premium Payment Term: 5

5. Policy • Benefits payable on Maturity: Clause

Coverage/benefits 1.2 of
> We will pay the applicable Fund Value on the Maturity Date unless you have opted for
payable Part C
the Settlement Option.

29 of 40
• Benefits payable on Death: Clause
1.1 of
> In case of death of the Life Insured during the Policy Term, provided the Policy is in
Part C
force, we will pay the following Death Benefit as per your chosen variant:
- Variant 1: The death benefit payable under this variant will be the highest of the
following benefits:

i. Sum Assured on Death equal to higher of Cover Multiple times the Annualised
premium or 0.5 times the product of Policy Term and Annualised Premium
(reduced by applicable partial withdrawals, if any), or
ii. 105% of Total Premiums Paid until the date of death of Life Insured, or
iii. Total Fund Value (as on the date of death).

- Variant 2: The Death Benefit payable under this variant will be the sum of the following
benefits:
> Lump Sum Benefit: We will pay the higher of the following:

i. Sum assured on Death (equal to higher of Cover Multiple times the Annualised
Premium or 0.5 times the product of Policy Term and Annualized premium), or
ii. 105% of Total Premiums Paid upto the date of death of the Life Insured.

> Family Income Benefit: On Life Insured’s death, We will pay a Family Income Benefit
equal to 1% of the Sum Assured on Death per month till the end of the Policy Term. We
shall pay a minimum of 36 instalments of the family income benefit and a maximum of
120 instalments of the family income benefit even if the Maturity Date has not occurred.
If the Life Insured dies during the Policy Term, where less than 36 months are remaining
till the end of Policy Term on the date of death, such remaining instalments will be paid
by Us on the Maturity Date in lump sum.
> Funding of Premium: On each Premium due date(s), after the death of the Life
Insured, We will credit the Premium under the Policy to the Funds. The Fund Value will
be payable on the Maturity Date.
Under the variant 2, following the Life Insured’s death, no Switches, Partial Withdrawals,
Premium Re-Direction, Settlement Option or Surrender of the Policy will be allowed. The
Policy shall continue even after the death of the Life Insured till the end of the Policy
Term.

• Survival Benefits excluding that payable on maturity: Clause

1.3 of
> No survival benefits are payable in the Policy
Part C

30 of 40
 • Surrender Benefits: Clause 2
of Part D
> Surrender Benefits are classified into two categories:

a. Surrender within the Lock-in Period: In case of Surrender within the Lock- in
Period, the Fund Value will be credited into the Discontinuance Policy Fund post
deducting applicable Discontinuance/Surrender Charge and the applicable Fund
Value shall be paid on the expiry of the said Lock-in Period. Upon Surrender, the
risk cover under the Policy and applicable Riders (if any), will cease.
b. Surrender after completion of the Lock- in Period: In case of Surrender post
completion of the Lock- in Period, the applicable Fund Value prevailing on the
date of receipt of a valid request for Surrender shall be paid.

• Options to policyholders for availing benefits, if any, covered under the policy.:
Not Applicable
• Other benefits/options payable, specific to the policy, if any: Not Applicable
• Lock-in period for Linked Insurance products:

> 5 years from Date of Commencement of Risk Clause 24

of Part B

6. Options available • Partial Withdrawal: Clause 6

(in case of Linked of Part D
> You are entitled for the Partial Withdrawal under both the variants of the Policy,
Insurance
subject to the following:
Products)

i. The minimum withdrawal amount should be at least INR 5,000 and it will be
made after the commencement of the 6th Policy Year.
ii. 2 Partial Withdrawal(s) may be made in a Policy Year such that the total Fund
Value withdrawn is not more than 50% of the Fund Value as on the date of the
Partial Withdrawal(s) and subject to the Fund Value immediately after the Partial
Withdrawal(s) being at least equal to one Annualised Premium.
iii. Under Variant 1: The Sum Assured on Death shall be reduced by all Partial
Withdrawals during the 2 (Two) Policy Years immediately preceding the Life
Insured's death.

• Top–up Provision: Clause

3.5 of
> Additional premium or top-up premium are not accepted under the Policy.
Part C

• Switches: Clause 5
of Part D
• You may switch Units from one Fund to another Fund by giving a written request to us,
provided the minimum amount to be Switched is at least INR 5,000. There is no limit on
the maximum number of Switches during the Policy Term and the settlement period
thereafter (if applicable).

31 of 40
 • Settlement Option: Clause 9
of Part D
> This option is available wherein maturity benefit may be received in instalments upon
providing a written request to Us, specifying the proposed duration and frequency of
payment. The period under the Settlement Option shall not exceed 5 (Five) years from
the Maturity Date. During the period in which Settlement Option is in force, the Policy
will continue and applicable Fund Management Charge, Switching charges and
Mortality Charge on Death Benefit will be deducted. No Partial Withdrawals are allowed
during such period.

• Any other option Clause 4

of Part D
• Premium Redirection:
> You may redirect renewal Premium amongst available Funds by placing a written
request, specifying the amount/ proportion of Premium to be paid into each Fund,
before your Premium payment due date. You can request for maximum 6 (Six)
Premium redirections in any Policy Year.

7. Option available
(in case of Type of immediate annuity, for example Life annuity with Return of Purchase price etc.
Annuity NA
product) Proportion of annuity amount guaranteed for variable pay-out option. NA
Any other option. NA

8. Riders opted, if • Summary of coverage Policy

any Schedule
> No riders are offered under this plan

9. Exclusions Brief list of the applicable exclusions, if any Clause 6

(events where of Part F
• Suicide Exclusion - If the Life Insured commits suicide, whether sane or insane,
insurance
within 12 (Twelve) months from the Date of Commencement of Risk or from the date of
coverage is not
revival of the Policy, all risks and benefits under the Policy will immediately cease and
payable), if any.
no benefits will be payable. In such an event, we will terminate the Policy by paying
only the Fund Value prevailing on the date of intimation of death of the Life Insured to
Claimant.
For exclusions under the Riders, please refer to the Rider’s customer information sheet
document.

10. Waiting /lien Number of Days NA

Period, if any

11. Grace period Number of Days: 15 Clause 4

of Part C

12. Free Look Period Number of days: 30 days from the date of receipt of the Policy Clause 8
of Part D

32 of 40
13. Lapse, paid-up • Grace Period: Clause 20
and revival of the of Part B
> Premium is due and payable during the Premium Payment Term by the due date. If not
Policy
paid, You may pay the same during the Grace Period. During the Grace Period the
insurance cover will continue and all charges under the Policy will continue to apply.
• Lapse Period
> Not Applicable
• Paid Up Period
> Not Applicable

• Revival Period: Clause 45

and 46 of
> In case the Policy goes into discontinuous mode, You may request us in writing for
Part B
Revival anytime within three consecutive years from the date of first unpaid premium.
Upon receipt of all overdue Premiums and any applicable charges or late fees within
the Revival Period, we will revive the Policy upon being satisfied as to the continued
insurability of the Life Insured or Policyholder based on the information, documents
and reports furnished by the Policyholder, in accordance with the Underwriting Policy.

14. Policy Loan, if • Brief description Clause 3

applicable of Part D
> No loans are granted under the Policy

15. Claims / Claims • Turn Around Time (TAT) for claims settlement: 30 days after receipt of entire
Procedure documents or completion of investigations, if any, whichever is later and
brief procedure.
Notice of Claim – All cases of death must be notified immediately to us in writing.
However, We may condone delay on merit for delayed claims where the reason for
delay is proved to be for reasons beyond the control of the Claimant.
> Please note that all death claims will be payable to the nominee/legal heir of the
Policyholder.
> Claim forms as required by us must be completed and furnished to us, at the
Claimant’s expense, within 90 days after the date the insured event happens, unless
specified otherwise. A list of primary claim documents listing the normally required
documents is attached to the Policy. Submission of the listed documents, forms or
other proof, however, shall not be construed as an admission of liabilities by the
Company. We reserve the right to require any additional proof and documents in
support of the claim.

• Helpline number
> 1860-120-5577 (Call charges apply) or 0124-4219090
• Contact Details of the Insurer:
> Max Life Insurance Company Limited, Plot No. 90C, Udyog Vihar, Sector 18,
Gurugram, 122015, Haryana, India. Website - www.maxlifeinsurance.com
• Link for downloading claim form and list of documents required including
bank account details:

> https://www.maxlifeinsurance.com/downloads Clause 3

of Part F
> We will require the following documents in case of claim under this Policy regarding the
death of the Life Insured:

33 of 40
 Claimant's statement in the prescribed form (death claim application form -form A);
original Policy document (if any);
In case of a Medical/Natural death of the Life Insured, the attending physician's
statement (Form C) and the Medical records (admission notes, discharge/death
summary, test reports, etc.) are required;
In case of an Accidental/Unnatural death of the Life Insured, a copy of the First
Information Report (FIR)/ Police complaint, a copy of the Postmortem Report (PMR)/
Autopsy/Viscera Report and a copy of the Final Police Investigation report
(FPIR)/Charge sheet is required;
original/ attested copy of death certificate issued by the local/municipal authority
(only in the case of death of the Life Insured);
identity proofs (such as copy of Passport, PAN card, Voter identity card, Aadhar
(UID) card, etc.) of the Claimants (bearing their photographs and signatures (only in
case of death of the Life Insured);
NEFT mandate form attested by bank authorities, along with a cancelled cheque or
bank account passbook (only in the case of the death of the Life Insured);
any other documents or information required by Us for assessing and approving the
claim request;
Employer certificate with complete leave records- Form E;
ITR for last 3 years / GST certificate in case of Self employed;
Other life / health insurance details with claim history details;
Bank statement of last 2 years of the Life Insured;
Body transfer certificate / Embassy documents / Postmortem report whichever
applicable in case of death in foreign country;
Complete Passport copy in case of death in foreign country;
Medical booklet / CGHS card details in case of Defence and Central Government
personnel; and
Discharge Summary / Indoor Case papers in case death happened due to medical
reasons in a hospital.

> We will require the following documents in case of claim under this Policy regarding the
Maturity claim documents:

NEFT Form (if not provided earlier)

a cancelled cheque or copy of passbook with pre-printed name and bank account
number, for payout through NEFT (if not provided earlier or in case of any change in
details provided earlier)
a self-attested photo ID proof

34 of 40
 16. Policy Servicing • Turn Around Time (TAT) up to 15 days Clause
1.1
• Helpline number
(Dispute
> 1860-120-5577 (Call charges apply) or 0124-4219090 Redressal
• Contact Details of the Insurer: process
under
> Max Life Insurance Company Limited, Plot No. 90C, Udyog Vihar, Sector 18, policy) –
Gurugram, 122015, Haryana, India. Website - www.maxlifeinsurance.com Part G
• Link for downloading applicable forms and list of documents required
including bank account details:

> https://www.maxlifeinsurance.com/downloads
> We will require the following documents in case of policy servicing under this Policy:

Application in the prescribed form;

original Policy document (if any);
identity proofs (such as copy of Passport, PAN card, Voter identity card, Aadhar
(UID) card, etc.) of the Policyholder or Life Insured (bearing their photographs and
signatures);
NEFT mandate form attested by bank authorities, along with a cancelled cheque or
bank account passbook;
any other documents or information required by Us for assessing and approving the
claim request;

17. Grievances / • Contact Details of Grievance Redressal Officer of the insurer: Clause
Complaints 1.2.1 of
> Grievance Redressal Officer, Max Life Insurance Company Limited, Plot No. 90C,
Part G
Udyog Vihar, Sector 18, Gurugram, 122015, Haryana, India
• Link for registering the grievance with the insurer’s portal

> https://www.maxlifeinsurance.com/customer-service/grievance-redressal As per

Annexure
• Contact details of Ombudsman
A
Refer Annexure A for the Ombudsman details

Declaration by the Policyholder

35 of 40
I have read the above and confirm having noted the details.

Place: SALEM, TAMIL NADU Saravanan Arumugam

Date: 16/11/2024 (Signature of the Policyholder)

Note

i. For the product related documents including the Customer Information sheet please refer to the
https://www.maxlifeinsurance.com/investment-plans/ulip-plans/child-investment-plan
ii. In case of any conflict, the terms and conditions mentioned in the Policy document shall prevail.
iii. *Sum Assured on Death is subject to underwriting, for actual Sum Assured details & updated UIN number (in case of modification),
please refer to the Policy document.
iv. In the event of any conflict or discrepancy between any translated version and the English language version of this CIS, the English
language version of this CIS shall prevail.

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, 1st Phase, Bengaluru - 560 078. Tel.: 080-26652049/26652048 Email: bimalokpal.bengaluru@cioins.co.in. (State of Karnataka)
BHOPAL - Office of the Insurance Ombudsman, , 1st Floor, Jeevan Shikha, 60-B,Hoshangabad Road, Opp. Gayatri Mandir, Bhopal-462
011. 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, Bhubaneswar - 751 009. Tel.:- 0674-2596461/2596455 Email:
bimalokpal.bhubaneswar@cioins.co.in (State of Odisha.)
CHANDIGARH - Office of the Insurance Ombudsman, S.C.O. No. 20-27, Ground Floor, Jeevan Deep Building, Sector 17-A, Chandigarh-
160017. Tel.:- 0172 - 4646394/2706468 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 / 24333678 Email: bimalokpal.chennai@cioins.co.in [State of Tamil Nadu and Union Territories - Puducherry Town and
Karaikal (which are part of Union Territory of Puducherry).]
DELHI - Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi-110 002. Tel.:- Tel.:- 011 -
23237539 Email: bimalokpal.delhi@cioins.co.in (State of Delhi, 4 districts of Haryana viz, Gurugram, Faridabad, Sonepat and Bahadurgarh)
KOCHI - Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash, LIC Building, Opp to Maharaja’s College Ground, M.G. Road,
Kochi 682011. Tel : 0484-2358759 Email: bimalokpal.ernakulam@cioins.co.in (State 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 Puducherry.)
JAIPUR - Office of the Insurance Ombudsman, Ground Floor, Jeevan Nidhi II Bldg, Bhawani Singh Marg, Jaipur - 302005 Tel : 0141-
2740363/ 2740798 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-
22124339/22124341 Email: bimalokpal.kolkata@cioins.co.in (States of West Bengal, Sikkim, and Union Territories of Andaman and Nicobar
Islands.)

36 of 40
LUCKNOW - Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-2, Nawal Kishore Road, Hazratganj, Lucknow-226 001.
Tel.: 0522 - 4002082 / 3500613 Email: bimalokpal.lucknow@cioins.co.in (Following Districts of Uttar Pradesh: Lalitpur, Jhansi, Mahoba,
Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur,
Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti,
Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar.)
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 Metreturn of premiumolitan
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 Uttarakhand and the following Districts of
Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad,
Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli,
Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.)
PATNA - Office of the Insurance Ombudsman, 2nd floor, Lalit Bhawan, Bailey Road, Patna - 800001 Tel No: 0612-2547068, Email id :
bimalokpal.patna@cioins.co.in (State of Bihar, Jharkhand.)
PUNE - Office of the Insurance Ombudsman, 3rd Floor, Jeevan Darshan Bldg, C.T.S. Nos. 195 to 198, N.C. Kelkar Road, Narayan Peth,
Pune - 411030. Tel.: 020-24471175 Email: bimalokpal.pune@cioins.co.in (State of Maharashtra including Navi Mumbai and Thane and
excluding Mumbai Metreturn of premiumolitan Region.)

37 of 40
 PREMIUM RECEIPT
Receipt No.: 625460506NOV2401 Receipt date: 20-NOV-2024
PERSONAL DETAILS
Policy no.: 625460506 Address: 3 68 Amman Kovil
Policyholder's name: Saravanan Arumugam Chettimankurichi
Mobile No: 9360030025 Post Office Chettimankurichi
E-mail ID: vipsaravana@gmail.com Salem 637101
PAN Number: DYXPA5079R Tamil Nadu India
POLICY DETAILS
Life Insured: Saravanan Arumugam Premium Payment Term: (period of which
premium to be paid): 5 Years
Plan Name: Max Life Online Savings Plan Risk Date of maturity: 18-NOV-2044
Policy Commencement Date: 18-NOV-2024 Rider Sum Assured: ` 0.00
Policy Term: 20 Years Base Sum Assured: ` 1,22,001.40
Premium payment frequency: Monthly Modal Premium (including GST): ` 1,016.68
CONNECT WITH US
Life Advisor: Ins Broker Pvt.Ltd Policy Bazaar
Life Advisor contact: 18601205577
Mudrank : NA

FUND STATEMENT AS ON 20-NOV-2024

CLOSING SUMMARY
Particulars Closing Units (A) (Nos) NAV/Market Price (B) Market Value of fund (A x B)
Nifty Momentum Quality 50 Fund -
98.42200 ` 10.00000 ` 984.22
ULIF03127/10/24MOMQUALITY104
Total ` 984.22

Premium payment Premium received Duration for which the Next premium due date
frequency (including Top-Up)* premium is received

18-NOV-2024 to
Monthly ` 1,016.68 17-DEC-2024 18-DEC-2024

Important Note:
. If the payment has been made other than in cash, this receipt is conditional upon realization of the amount in Max Life's account.
. Amount received would be adjusted against the due premium as per the policy contract. In case policy contract is lapsed, the risk coverage is subject to the reinstatement as per terms and conditions of
policy.
. Premiums may be eligible for tax benefits under section 80C/80CCC/80D/37(1) of the Income Tax Act 1961. You are advised to seek an opinion of a Tax advisor in relation to the applicable tax benefits and
liabilities. The above mentioned amount includes GST which is applicable as and when the charges are levied and 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. Currently base GST rate is 18% apart from cess in some states.
. You may request a detailed policy account statement by writing to us at the below mentioned details.
. Applicable charges as per Part E of the Policy terms and conditions, would be charged from the Fund Value and Goods and Service Tax would be levied thereon @18%
. 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.

URM20
Authorised Signatory E.&O.E PRODUCT UIN: 104L098V06

Important: DO NOT believe in calls, SMS, E-mail offering discounts. For NEFT Payments, please transfer only to " HSBC Bank A/C No. 1165 <Followed by 9 digit Policy No>
IFS Code: HSBC0110002". Max Life does not collect Premium in any other account.
Max Life Insurance Co. Ltd.: Plot No. 90 C, Sector 18, Udyog Vihar, Gurugram, Haryana - 122 015.
Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab - 144 533.
Fax: 0124-4159397 , CIN: U74899PB2000PLC045626 | Customer Helpline Number: 1860 120 5577 IRDAI Registration. No. 104
BEWARE OF SPURIOUS / FRAUD PHONE CALLS!
.IRDAI is not involved in activities like selling insurance policies, announcing bonus or Investment of premiums
.Public receiving such phone calls are requested to lodge a police complaint

38 of 40
This page has been left blank
intentionally

39 of 40
This page has been left blank
intentionally

40 of 40