Duplicate

06-Mar-2014

MR. MANOHAR F MANNAGI

AT ALADAKATTI
TQ HAVERI
.,ALADAKATTI
HAVERI 581110
KARNATAKA
G.O. Name : X0825
Policy No. : 203468335
Telephone : 9741764841,8105920921
Email ID : Please inform us for regular updates

Subject - Welcome to Max Life Insurance Family

Dear MR. MANOHAR F MANNAGI,
Thank you for choosing Max Life Insurance as your preferred life insurance partner.
I welcome you to the rapidly expanding and satisfied family of Max Life Insurance policyholders. Max Life Insurance
is driven by the vision to be India's most admired life insurance company by securing the financial future of its
customers. We are committed to offering you long-term savings, protection and retirement solutions backed by the
highest standards of customer service.
Over the last thirteen years of our journey, we have created a strong, profitable and successful organization. Today,
the Company has presence in over 1,200 cities across India, with a strong base of over 31 lakh policies in-force. It
also gives me immense pleasure to inform you that Max Life Insurance has been recognized as a Superbrand for
the Year 2013-14.
In the financial year 2012-13, the Company progressed well on key business parameters:
■ The Revenue of the Company grew 4% to Rs. 6,639 crore. The Company declared a Bonus of Rs. 297 crore
for its participating policyholders.
■ The Company had Assets Under Management of Rs. 20,458 crore, Sum Assured in-force of Rs. 1,69,167 crore
& a Solvency Ratio of 521%, more than 3 times the mandatory requirement of 150%.
Our belief in customer centricity & service excellence is the driving force behind this strong performance. Max Life
Insurance offers a Claims Guarantee to all its policyholders under which the Company commits to pay claims within
10 working days of the receipt of all the death claim documents/clarifications from the nominee, else the Company will
pay interest at the rate of 6% per annum.
The enclosed policy documents explain all the features, benefits and terms of your Max Life Insurance policy in a simple
and easy to understand manner. We will be delighted to offer you any further assistance or clarification you may require
about your policy. We look forward to being your partner for life.
Yours Sincerely,

Rajesh Sud
CEO & Managing Director
AGENT NAME: AXIS BANK LTD RANIBENNUR (383028), PH.NO.:
ADDRESS:88, R S No. 821, P B Road, Dist. Haveri, Ranibennur 581115 (N/A)

NB13
Max Life Insurance Co. Ltd.
Plot No. 90A, Sector 18, Gurgaon, 122015, Haryana
Phone 4219090 Fax 4159397 (From Delhi and Other cities: 0124) Customer Helpline: 1800-200-4006
Regd Office: Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India
Visit us at: www.maxlifeinsurance.com E-mail: axis.helpdesk@maxlifeinsurance.com

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 Max Life Insurance Company Limited
Regd. Office: Max House, 1, Dr. Jha Marg, Okhla, New Delhi -110020

Max Life Life Gain Premier

A Traditional Participating Endowment Insurance Plan
UIN - 104N079V01

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

The Company agrees to pay the benefits under this Policy on the happening of the insured event, while
this Policy is in force subject to the terms and conditions stated herein.

On examination of this Policy, if You notice any mistake or error, this Policy should be returned to
Us for rectifying the same.

Signed by and on behalf of

Max Life Insurance Company Limited

AnaljitSingh
Chairman

Max Life Insurance Co. Ltd.

Plot No. 90A, Sector 18, Gurgaon, 122015, Haryana
Phone 4219090 Fax 4159397 (From Delhi and Other cities: 0124) Customer Helpline: 1800-200-4006
Regd Office: Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India
Visit us at: www.maxlifeinsurance.com E-mail: axis.helpdesk@maxlifeinsurance.com

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 SCHEDULE
BASE POLICY - Max Life Life Gain Premier TYPE OF POLICY - Traditional Participating Endowment
Insurance Plan
UIN - 104N079V01 OFFICE - AXIS BANK LTD Ranibennur
Policy No./ Proposal No.: 203468335 Client ID: 5002942306
Date of Proposal: 28-Feb-2014
Policyholder/Proposer : Age Admitted: Yes
MR. MANOHAR F MANNAGI Gender: Male
PAN: NA Tel No./Mobile No.: / 9741764841,8105920921
Identification Source & I.D No.: Email:
Relationship with Life Insured: Same Person
Date of Birth: 17-Jun-1967
Address:
AT ALADAKATTI
TQ HAVERI .,ALADAKATTI
HAVERI 581110
KARNATAKA
Life Insured: Age Admitted: Yes
MR. MANOHAR F MANNAGI Gender: Male
Identification Source & ID No. :
Date of Birth: 17-Jun-1967
Age: 46
Nominee(s): Appointee (if nominee is minor):
MRS.VIJAYLAXMI M MANNAGI
Date of Birth:
10-Apr-1971
Effective date: 28-Feb-2014 Premium Payment Mode: Annual
Premium Payment Method: Two-stage autopay Bill Draw Date: 08TH
Bonus Option: Paid-up Additions Bank Account Number: 913010048736206

Agent's name/Broker's name: AXIS BANK LTD Agent's code/Broker's code: 383028
RANIBENNUR
Agent's/Broker's License No.: Dummy500312
Email:
Address: Mobile/Landline Telephone Number:
88, R S No. 821, P B Road, Dist. Haveri
Ranibennur 581115 (N/A)
List of Maturity Insured Guaranteed Guaranteed Policy Premium Annual Extra *Premium Service Due Date
Coverage Date Event Maturity Death Benefit Payment Premium (INR) tax When
Term Premium
Sum on the Term (INR) (INR) Premium
Assured Effective (INR) is Payable/
(INR) Date Date
(INR) When the
Last
Premium
is Payable
BASE POLICY
Max Life 28-FEB-34 Maturity or 262350 320098.46 20 08 29099.86 NA 29099.86 449.59 28th of Feb
Life Gain death of the Every Year;
Premier Life Insured 28-Feb-2021

Annualised Premium: 29099.86

Total Premium including rider premium : 29099.86
Total Service Tax: 449.59
Total Premium payable on the due dates along with service tax : 29549.45
*Please note that the Premium is (Annual Premium plus Extra Premium) multiplied by the applicable Modal Factor.
NOTE: On examination of this Policy, if You notice any mistake or error, this Policy should be returned to Us for rectifying the same.

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1. DEFINITIONS AND INTERPRETATION Practitioner is not the Life Insured covered under this Policy
or the Policyholder or is not a spouse, lineal relative of the
1.1. Definitions
Life Insured and/or the Policyholder or a Medical Practitioner
The words and phrases listed below shall have the meanings attributed employed by the Policyholder/Life Insured;
to them wherever they appear in this Policy unless the context
xviii. "Modal Factor" means the applicable factor used by Us for
otherwise requires:
determining the Premium payable by You under this Policy,
i. "Actuarial Valuation Surplus" means the surplus arising if You have opted to pay the Premium in any mode other
in the Participating life policyholders' fund, established by than annual Premium payment mode. The Modal Factor for
Us for Participating life insurance policies and calculated by semi-annual Premium payment mode is 0.52, for quarterly
the Appointed Actuary in accordance with the standards or Premium payment mode is 0.265 and for monthly Premium
guidance issued by the Institute of Actuaries of India and in payment mode is 0.09;
accordance with the Insurance Regulatory and Development xix. "Nominee" means the person named by You and registered
Authority (Distribution of Surplus) Regulations, 2002; with Us in accordance with Section 10.6, who is authorized to
ii. "Age" means the Life Insured's age on last birthday as on the receive the death benefit under this Policy, on the death of the
Effective Date or on the previous Policy Anniversary, as the Life Insured;
case may be; xx. "Paid Up Additions" means the additional sum assured
iii. "Annual Premium" means an amount specified in the purchased from the Cash Bonus(es) declared under this
Schedule, which is payable under the annual Premium Policy at rates approved by the Authority, which are not
payment mode under this Policy, excluding Extra Premium, if guaranteed;
any and excluding service tax or any other taxes, cesses or xxi. "Participating" means participating in the Actuarial Valuation
levies, if any; Surplus of the participating life policyholders' fund;
iv. "Annualised Premium" means the sum total of Annual xxii. "Policy" means this Max Life Life Gain Premier plan,
Premium and Extra Premium, if any, as specified in the the operation, regulation and management of which is
Schedule; governed by the documents comprising these terms and
v. "Authority" means the Insurance Regulatory and conditions, the Proposal Form, the Schedule and any
Development Authority established under the Insurance additional information/document(s) provided to Us in respect
Regulatory and Development Authority Act, 1999 or any other of the Proposal Form along with any written instructions from
regulatory authority regulating insurance companies in India; You subject to Our acceptance of the same;
vi. "Cash Bonus" means a share in the Actuarial Valuation Surplus xxiii. "Policy Anniversary" means the annual anniversary of the
determined by Our Appointed Actuary, to be communicated to Effective Date;
You, based on the declaration made by Us, which can be utilized xxiv. "Policyholder", "Proposer", "You", "Your" means the
in the manner specified under Section 3.5.1; person named in the Schedule who has taken this Policy from
vii. "Company", "We", "Us", "Our", "Insurer" means Max Life Us;
Insurance Company Limited; xxv. "Policy Term" means the term of this Policy as specified in
viii. "Diagnosis" or "Diagnosed" means the definitive diagnosis the Schedule;
made by a Medical Practitioner, based upon radiological, xxvi. "Policy Year" means a period of 12 (Twelve) months
clinical, and histological or laboratory evidence acceptable commencing from the Effective Date and every Policy
to Us provided the same is acceptable and concurred by Anniversary thereafter;
Our appointed Medical Practitioner. In the event of any
doubt regarding the appropriateness or correctness of the xxvii. "Premium" means an amount as specified in the Schedule,
Diagnosis, We will have the right to call for an examination payable by You, by the due dates and in the manner specified
of the Life Insured and/or the evidence used in arriving at in the Schedule, to secure the benefits under this Policy,
such Diagnosis, by an independent expert selected by Us. excluding service tax or any other taxes, cesses or levies, if
The opinion of such an expert as to such Diagnosis shall be any;
binding on both You and Us; xxviii. "Premium Payment Term" means the term as specified in
ix. "Effective Date" means the date as specified in the the Schedule, during which the Premiums are payable by You
Schedule, on which the insurance coverage under this Policy to Us under this Policy;
commences; xxix. ''Proposal Form" means the form filled in and completed
x. "Extra Premium" means an additional amount charged by by You, giving full particulars, for the purpose of obtaining
Us, as per Our board approved underwriting policy, which insurance coverage under this Policy;
is determined on the basis of disclosures made by You in xxx. "Reduced Paid Up Death Benefit" means an amount equal
the Proposal Form or on the basis of any other information to the Guaranteed Death Benefit multiplied by the resultant of
received by Us including through medical examinations of the the total Premiums less Extra Premium (if any) received by Us
Life Insured in relation to this Policy; till the date of the death of the Life Insured divided by the total
xi. "Guaranteed Death Benefit" means an amount which will be Premiums less Extra Premium (if any) payable by You;
highest of the following: xxxi. "Reduced Paid Up Maturity Sum Assured" means an
amount equal to the Guaranteed Maturity Sum Assured
a. 11 (Eleven) times the Annualised Premium; or
multiplied by the resultant of the total Premiums less Extra
b. 105% (One Hundred Five percent) of all the Premiums Premium (if any) received by Us divided by total Premiums
received from You till the date of death of the Life less Extra Premium (if any) payable by You;
Insured; or
xxxii. ''Reduced Paid Up Mode" means the Policy with reduced
c. Guaranteed Maturity Sum Assured. paid up benefits as specified under Section 3.4;
xii. "Guaranteed Maturity Sum Assured" means a guaranteed xxxiii. "Schedule" means the schedule and any endorsements
amount as specified in the Schedule, payable on the Maturity attached to and forming part of this Policy and if an updated
Date, if the Life Insured has survived on such date and all due Schedule is issued, then, the Schedule which is latest in time;
Premiums have been received by Us; xxxiv. "Special Surrender Value" means the special surrender
xiii. "Guaranteed Surrender Value" means the minimum value computed in accordance with Section 8.5;
surrender value computed in accordance with Section 8.4, xxxv. ''Special Surrender Value Factors" are factors determined
which is guaranteed by Us; by Us in consultation with and approved by the Authority to
xiv. "Insurance Act" means the Insurance Act, 1938; compute the Special Surrender Value. These factors can be
xv. "Life Insured" means the person named in the Schedule, on revised by Us on the basis of Our experience from time to time
whose life this Policy is effected; in consultation with and approval of the Authority;
xvi. "Maturity Date" means the date specified in the Schedule, xxxvi. "Surrender Value" means an amount payable as per Section
on which the Policy Term expires and the maturity benefit as 8 on surrender of this Policy, which will be the higher of the
specified in Section 3.1 or Section 3.4.2(i), as the case may Guaranteed Surrender Value or the Special Surrender Value;
be, becomes payable; xxxvii. ''Terminal Bonus" means the bonus payable by Us in
xvii. "Medical Practitioner" means a person who holds a valid accordance with Section 3.5.2; and
registration from the medical council of any State of India or xxxviii. ''Terminal Illness" means the Life Insured being Diagnosed
Medical Council of India or any other such body or Council for with a disease which, in the opinion of a Medical Practitioner
Indian Medicine or for homeopathy set up by the Government and on approval of such an opinion by Our appointed Medical
of India or by a State Government and is thereby entitled to Practitioner, is likely to result in the death of the Life Insured
practice medicine within its jurisdiction and is acting within the within 6 (Six) months from the date of such certification by a
scope and jurisdiction of his license, provided such Medical Medical Practitioner.
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 1.2. Interpretation by You to Us, this Policy will not lapse and will continue with
reduced paid up benefits in accordance with this Section 3.4.
i. References to the masculine or the singular will include A Policy under the Reduced Paid Up Mode will thereafter be
references to the feminine and the plural, and vice versa. free from all liabilities of payment of the future Premiums to Us.
ii. References to any statute or statutory enactment shall include 3.4.2. If this Policy is under Reduced Paid Up Mode, then, the
re-enactment or amendment to the same. benefits payable shall be as follows:
iii. Section headings are for sake of reference only and have no i. Maturity Benefit
interpretive value.
Subject to Sections 4, 5, 10.3 and 10.4 below, if the Life
iv. Reference to days, unless context otherwise requires, means Insured has survived on the Maturity Date, then, We shall
calendar days only. pay the sum total of the following, to a person specified
2. ELIGIBILITY under Section 4.1 on the Maturity Date:
2.1. This Policy has been written on a single life basis. a. Reduced Paid Up Maturity Sum Assured; and
2.2. The minimum Age of the Life Insured on the Effective Date should be b. accrued Paid Up Additions, if any.
18 (Eighteen) years. ii. Death Benefit
2.3. The maximum Age of the Life Insured on the Effective Date should be: Subject to Sections 4, 5, 10.3 and 10.4 below, upon the
i. 55 (Fifty Five) years for a Policy where the Policy Term is of death of the Life Insured during the Policy Term, We shall
15 (Fifteen) years and 20 (Twenty) years; and pay the sum total of the following, to a person specified
ii. 50 (Fifty) years for a Policy where the Policy Term is of 25 under Section 4.1:
(Twenty Five) years. a. Reduced Paid Up Death Benefit; and
2.4. The maximum Age of the Life Insured on the Maturity Date cannot b. accrued Paid Up Additions, if any.
exceed: iii. If this Policy is under the Reduced Paid Up Mode:
i. 70 (Seventy) years for a Policy where the Policy Term is of 15 a. the Terminal Illness benefit payable, if any, will be
(Fifteen) years; and computed on the basis of the Reduced Paid Up
ii. 75 (Seventy Five) years for the Policy where the Policy Term Maturity Sum Assured;
is of 20 (Twenty) years and 25 (Twenty Five) years. b. all rider benefits will cease under this Policy;
3. BENEFITS c. You shall not be entitled to withdraw the cash value
3.1. Maturity Benefit of the Paid Up Additions;

Subject to Sections 3.4, 4, 5, 10.3, 10.4 and 10.10 below, if 3.5. Bonus(es)
the Life Insured has survived on the Maturity Date and We Under this Policy during the Policy Term, You shall be eligible
have received all the due Premiums, then, We shall pay the to receive the following bonus(es), if any, declared by Us:
sum total of the following, on the Maturity Date, to a person
specified under Section 4.1: i. Cash Bonus; and
ii. Terminal Bonus.
i. Guaranteed Maturity Sum Assured;
ii. accrued Paid Up Additions, if any; and 3.5.1. Cash Bonus
iii. Terminal Bonus, if any. i. Under this Policy, We may declare a Cash Bonus
on the Guaranteed Maturity Sum Assured and on the
3.2. Death Benefit accrued Paid Up Additions, if any, based on the Actuarial
3.2.1. Subject to Sections 3.4, 4, 5, 10.3, 10.4 and 10.10 below and Valuation Surplus.
provided the insurance coverage under this Policy is in force, ii. The Cash Bonus(es) on the Guaranteed Maturity Sum
then, upon the death of the Life Insured during the Policy nd
Assured shall be payable from the end of 2 (Second)
Term, We shall pay the sum total of the following, to a person th
specified under Section 4.1: Policy Year (i.e. from the end of 24 Policy month)
onwards and thereafter at the end of every subsequent
i. Guaranteed Death Benefit;
Policy Year as and when declared by Us, till the date
ii. accrued Paid Up Additions, if any; and of death of the Life Insured or the date of termination
iii. Terminal Bonus, if any. of the Policy in accordance with Section 11, whichever
is earlier. The Cash Bonus(es) on the accrued Paid Up
3.3. Terminal Illness Benefit rd
Additions, if any, shall be payable from the end of 3
3.3.1. Subject to Sections 3.4, 4, 5, 10.3, 10.4 and 10.10 below, if th
the Life Insured is Diagnosed with Terminal Illness at any time (Third) Policy Year (i.e. from the end of 36 Policy month)
during the Policy Term, We shall on receipt of Your written onwards and thereafter at the end of every subsequent
request, pay the following benefits to the Life Insured: Policy Year as and when declared by Us, till the date of
death of the Life Insured or the date of termination of
i. Up to 50% (Fifty percent) of the Guaranteed Maturity the Policy in accordance with Section 11, whichever is
Sum Assured or the Reduced Paid Up Maturity Sum earlier. We may or may not declare the Cash Bonus(es)
Assured, as the case may be, on the date of intimation, as the same are not guaranteed.
subject to a maximum cumulative amount of INR
iii. You can utilize the Cash Bonus as per one of the
10,00,000 (Rupees Ten Lakhs) under all Our policies
following options chosen by You in the Proposal Form or
issued with respect to the Life Insured which provide
subsequently in accordance with Section 3.5.1(iv):
for Terminal Illness benefit, on the approval of Terminal
Illness claim filed by You. Upon payment of the Terminal a. Paid in Cash
Illness benefit, the benefits under all policies then in You have an option to take the Cash Bonus as and
force, which provide for the Terminal Illness benefit, when declared by Us, by cheque or by any other
will be proportionately reduced and will be payable in means as determined by Us.
accordance with the terms of the respective policies. b. Premium Offset
ii. The maturity benefit or the death benefit or the Surrender You have an option to offset the Premium payable
Value, as the case may be, will be reduced by the under this Policy by the Cash Bonus payable to You
amount of Terminal Illness benefit already paid and the by Us, if any. In the event the Cash Bonus exceeds
remaining maturity benefit or remaining death benefit or the Premium payable by You to Us under this Policy,
the remaining Surrender Value, as the case may be, will We shall pay such balance to You. However, if the
be payable, subject to the terms of this Policy. Cash Bonus payable to You is not sufficient to offset
3.3.2. If the Life Insured is alive during the Policy Term and the Policy the Premium payable by You to Us under this Policy,
is not under Reduced Paid Up Mode, You shall continue to then, You shall pay the balance Premium to Us.
pay all the due Premiums. c. Purchase Paid Up Additions
3.3.3. The bonus(es), if any, will be declared by Us on the basis of 1) You have an option to utilize the Cash
the original Guaranteed Maturity Sum Assured. Bonus(es) declared by Us, if any, as premium
3.3.4. Terminal Illness benefit can be availed under this Policy only for purchasing Paid Up Additions. Such Paid
once during the Policy Term. Up Additions shall participate in the future Cash
3.4. Reduced Paid Up Benefit Bonus(es) as and when declared by Us and
shall mature along with this Policy. The Cash
3.4.1. If this Policy has acquired a Surrender Value as per Section 8 Bonus(es) will be declared on the Guaranteed
below, then, in the event of non-payment of the due Premiums
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 Maturity Sum Assured and on the accrued Paid i. claimant's statement in the prescribed form;
Up Additions, if any which were purchased and
ii. original Policy document;
have not been withdrawn by You in the past.
iii. death certificate issued by the local/municipal authority (only in
2) In the event of death of the Life Insured prior to
the case of the death of the Life Insured);
the Maturity Date or if the Life Insured survives
on the Maturity Date, We shall pay Paid Up iv. identity proof of the beneficiary including Nominee(s) bearing their
Additions accrued till such date, if any, to a photographs and signatures (only in the case of the death of the
person specified in Section 4.1. In case of Life Insured); and
surrender of this Policy, We shall only pay the v. any other documents or information required by Us for assessing
cash value of the Paid Up Additions to You. and approving the claim request.
3) We reserve the right to change/ amend the 5.2. We reserve the right to scrutinize the documents submitted by the
rates to buy Paid Up Additions, as such rates claimant and/or investigate the cause of death of the Life Insured/ the
are not guaranteed and may be revised on the Policyholder and deny the claim partially or completely on the basis of
basis of Our actual experience, subject to the Our scrutiny of the documents or investigation, as the case may be.
prior approval of the Authority. We shall only pay the appropriate benefits under this Policy subject to
4) You have an option to withdraw the cash Our satisfaction:
value of accrued Paid Up Additions, partially
i. that the benefits have become payable as per the terms and
or in full subject to a minimum withdrawal
conditions of this Policy; and
amount of INR 5,000 (Rupees Five Thousand).
The cash value of the Paid Up Additions will ii. of the bonafides and credentials of the said person claiming the
be determined using the Paid Up Addition benefits under this Policy.
purchase rates which are not guaranteed and 5.3. Any person claiming the benefits under this Policy can
can be revised by Us, subject to prior approval download the claim request documents from Our website
of the Authority. However, such withdrawal will www.maxlifeinsurance.com or can obtain the same from any of Our
not be permitted, if this Policy is under the branches and offices.
Reduced Paid Up Mode or if the loan under
the Policy is outstanding. The remaining Paid 6. PREMIUMS
Up Additions will continue to participate in 6.1. The Premiums under this Policy can be paid by You annually,
bonus(es), as and when declared by Us. semi-annually, quarterly or monthly as per the Premium payment mode
that You have chosen.
iv. Subject to Sections 10.7.6 and 10.8.1, You may send
a written request to Us for changing the bonus option. 6.2. You have an option to change the Premium payment mode by
However, such a change shall become effective on the submitting a written request to Us. We will allow the change in the
Policy Anniversary date, which follows the receipt of such Premium payment mode provided the minimum premium excluding
written request. Extra Premium, if any, as mentioned in the table below, are adhered to
and the Guaranteed Maturity Sum Assured remains unchanged:
3.5.2. Terminal Bonus
Minimum premium (excluding
i. Under this Policy, We may at Our discretion pay an
Extra Premium, service tax,
additional 1 (One) time Terminal Bonus on the earlier of Premium payment mode
any other taxes, cesses or
the death of the Life Insured or on the survival of the
levies, if any)
Life Insured till the Maturity Date or on surrender of this
Policy, provided this Policy is in force for at least 10 (Ten) Annual INR 8,500 to be paid annually
complete Policy Years from the Effective Date. INR 6,000 to be paid
Semi - Annual
ii. Upon surrender of this Policy after completion of 10 (Ten) semi-annually
Policy Years from the Effective Date, only the cash value
Quarterly INR 4,000 to be paid quarterly
of the Terminal Bonus will be payable by Us. The cash
value of the Terminal Bonus, if any, will be determined Monthly INR 1,500 to be paid monthly
using the Paid Up Addition purchase rates which are not 6.3. Any change in the Premium payment mode will result in a change in
guaranteed and can be revised by Us, subject to the prior the Premium amount basis the applicable Modal Factors. A change
approval of the Authority. in Premium payment mode shall be effective only on the Policy
4. PAYMENT OF BENEFITS Anniversary following the receipt of such request.
4.1. Subject to Sections 3, 5 and 10.4, the benefits are payable under this 6.4. The Premiums are to be paid by You by the due dates and in the
Policy only on submission of satisfactory proof of the Life Insured's manner specified in the Schedule.
death to Us or of the Life Insured surviving on the Maturity Date. The 6.5. You can pay the Premiums at any of Our offices or through our website
benefits under this Policy shall be payable to: www.maxlifeinsurance.com or by any other means, as informed by Us from
i the Policyholder, if the Policyholder and the Life Insured are time to time. Any Premium paid by You through a cheque or any other
different; or instrument/ medium will be deemed to have been received only after the
same has been fully realized and credited to Our bank account.
ii. You, if the Life Insured and the Policyholder are same (only in
the case of maturity benefit); or 6.6 The Premium payment receipt shall be issued in Your name,
which shall be subject to realization of cheque or any other
iii. Nominee(s), in case of the death of the Life Insured, if the
instrument/medium.
Policyholder and the Life Insured are same, provided a valid
nomination has been recorded with Us in accordance with 7. TAXES
Section 10.6; or 7.1. All Premiums are subject to applicable taxes, cesses, levies including
iv. assignee(s), where an assignment and/or endorsement has service tax, education cess, etc. which shall be entirely borne by You
been recorded with Us in accordance with Section 10.7; or and will be paid by You along with the Premium. If any imposition (tax
v. proving executors, administrators or other legal representatives or otherwise) is levied on Us by any statutory or administrative body
who have obtained representation to Your estate from a under this Policy, We reserve the right to claim the same from You.
competent court, if You or the Nominee are not living at that time; Alternatively, We have the right to deduct the amount from the benefits
or payable by Us under this Policy.
vi. such person or persons as directed by a court of competent 7.2. Tax benefits and liabilities under this Policy are subject to prevailing
jurisdiction in India, limited at all times to the monies payable tax laws. Tax laws and the benefits arising from the same are subject
under this Policy. to change. You are advised to seek the opinion of Your tax advisor in
relation to applicable tax benefits and liabilities.
4.2. Any benefit/ claim payment under this Policy shall be made by Us
8. SURRENDER
in Indian Rupees or in any other currency in accordance with the
applicable guidelines issued by the Reserve Bank of India from time 8.1. This Policy shall acquire a Surrender Value provided:
to time. i. all the due Premiums for the first 2 (Two) Policy Years have been
4.3. Once the benefits under this Policy are paid to a person specified in received and applied by Us on or after the due dates for the Policy
Section 4.1, the same shall constitute a valid discharge of Our liability where the Premium Payment Term is of 6 (Six) years or 8 (Eight)
under this Policy. years; or
5. CLAIM PROCEDURE ii. all the due Premiums for the first 3 (Three) Policy Years have
been received and applied by Us on or after the due dates for the
5.1. For processing a claim request under this Policy, We will require all of Policy where the Premium Payment Term is of 10 (Ten) years or
the following documents: 12 (Twelve) years.
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 8.2. You may request in writing to surrender this Policy at any time only 9.3. If You have obtained a loan under this Policy, then, You are required
if the Policy has acquired the Surrender Value. On receipt of such a to pay interest on such loan as may be determined by Us from time
request, this Policy shall terminate and the Surrender Value (if any) to time. The interest on the loan will be compounded and applied
prevailing on the date of request for the surrender of this Policy, shall annually on the Policy Anniversary at 11% (Eleven percent) per
be payable by Us. If the Policy has not acquired the Surrender Value annum, which rate may be revised by Us from time to time.
in accordance with Section 8.1 above, then, no Surrender Value shall 9.4. If the loan amount granted to You and the accumulated interest on
become payable by Us. such loan exceeds the Surrender Value, this Policy will terminate.
8.3. The Surrender Value payable will be subject to the condition that there However, if You have availed a loan under this Policy and We have
are no statutory or other restrictions to the contrary. Upon surrender received all due Premiums, then, this Policy shall not terminate and
of this Policy, no benefits under this Policy shall be payable thereafter will continue with benefits payable under this Policy.
and this Policy will terminate. 9.5. If You have availed loan under this Policy, accordingly, the paid-in
8.4. Guaranteed Surrender Value Cash Bonus option and Premium offset Cash Bonus option as
8.4.1. The Guaranteed Surrender Value will be determined in the Policy specified in Sections 3.5.1.iii.a) and 3.5.1.iii.b) respectively will not
Year in which the surrender is effected, as a percentage of be available to You and We will change the Cash Bonus option to
the total Premiums less Extra Premium (if any) received and purchase Paid Up Additions option.
applied by Us on or after the due dates, in accordance with the 9.6. Upon grant of a loan under this Policy, this Policy shall automatically
table below, plus guaranteed cash value of accrued Paid Up be assigned in Our favour, till the time the entire loan amount
Additions, if any, which have not been withdrawn by You. The including interest or dues towards such loan has been repaid to Us.
guaranteed cash value of accrued Paid Up Additions is based On repayment of the loan and accumulated interest to Us, if any, this
on guaranteed cash value rates which are determined by Us Policy will be reassigned to You. On such repayment and on receipt
in consultation and approval from the Authority and which are of Your request to change the Cash Bonus option, We will change
different from the Paid Up Addition purchase rates as mentioned the Cash Bonus option.
in Section 3.5.1.iii.c.4).

Percentage (%) of total Premiums less Extra Premium (if any) Received (subject to the condition that Premiums for the first 2 (Two) Policy Years
or first 3 (Three) Policy Years, as the case may be, have been received and applied by Us, in accordance with the Section 8.1)
Policy Year of surrender Policy with Premium Policy with Premium Policy with Premium Policy with Premium
Payment Term of 6 years Payment Term of 6 years Payment Term of 10 Payment Term of 12
or 8 years and with the or 8 years and with the years and with the years and with the
Policy Term of 15 years Policy Term of 20 years Policy Term of 20 years Policy Term of 25 years
1% 0% 0% 0% 0%
2% 30% 30% 30% 0%
3% 30% 30% 30% 30%
4-7% 50% 50% 50% 50%
8% 56% 53% 53% 52%
9% 61% 57% 57% 55%
10% 67% 60% 60% 57%
11% 73% 63% 63% 59%
12% 79% 67% 67% 62%
13% 84% 70% 70% 64%
14% 90% 73% 73% 66%
15% 90% 77% 77% 69%
16% - 80% 80% 71%
17% - 83% 83% 74%
18% - 87% 87% 76%
19% - 90% 90% 78%
20% - 90% 90% 81%
21% - - - 83%
22% - - - 85%
23% - - - 88%
24% - - - 90%
25% - - - 90%
8.5. Special Surrender Value 9.7. We reserve the right to recover the outstanding loan along with the
8.5.1. Special Surrender Value will be determined by Us from time accrued interest from the benefits payable in the case of surrender
to time, in consultation with and approval by the Authority. or maturity or death of the Life Insured, by deducting the appropriate
This Special Surrender Value will always be greater than amounts from the benefits payable on happening of such events.
or equal to the Guaranteed Surrender Value. The Special 10. GENERAL PROVISIONS
Surrender Value is not guaranteed.
10.1. Free Look
8.5.2. Special Surrender Value is the sum of:
10.1.1. You have a period of 15 (Fifteen) days from the date of
i. (Reduced Paid Up Maturity Sum Assured divided
receipt of this Policy to review the terms and conditions of
by 1000) multiplied by the Special Surrender Value
this Policy. If You disagree to any of the terms or conditions
Factor;
of this Policy, You have the option to return the original
ii. cash value of accrued Paid Up Additions, if any; and Policy to Us, by stating the objections/ reasons for such
iii. cash value of Terminal Bonus, if any. disagreement. Upon return of this Policy by You, this Policy
shall terminate forthwith and all rights, benefits including
9. LOANS
the death and maturity benefit and interests under this
9.1. Once this Policy has acquired the Surrender Value, then, You will Policy shall cease immediately. We will only refund the
be eligible for grant of loans from Us. Premiums received by Us, after deducting the proportionate
9.2. The minimum amount of loan which can be granted by Us under risk Premium for the period of cover, charges of stamp duty
this Policy is INR 10,000 (Rupees Ten Thousand). The maximum paid and the expenses incurred on medical examination of
amount of loan which can be granted under this Policy during the the Life Insured, if any.
Policy Term shall not exceed 50% (Fifty percent) of the Special 10.2. Suicide Exclusion
Surrender Value payable under this Policy, subject to such terms
10.2.1. Notwithstanding anything stated herein, if the Life Insured
and conditions as may be determined by Us from time to time.
commits suicide, whether sane or insane, within 12
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 (Twelve) months from the Effective Date or the date of 10.6.4. While processing the claim request for the death benefit
revival of this Policy, all risks and benefits under this Policy under this Policy, the Nominee will be required to produce
shall cease and no benefits are payable under this Policy. all the necessary documents to give valid discharge for the
In such an event, We will only pay the following to a person payment of the death benefit secured under this Policy.
specified under Section 4.1: 10.6.5. We do not express any opinion on the validity or legality of
i. higher of the Special Surrender Value or total the nomination made by You.
Premiums received (excluding rider premiums, if any), 10.7. Assignment
if the Policy has acquired a Surrender Value; or
10.7.1. You may assign this Policy either by an endorsement on the
ii. the total Premiums received (excluding rider
Policy document or by way of a separate legal instrument in
premiums, if any) by Us, if the Policy has not acquired
accordance with Section 38 of the Insurance Act, in favour
a Surrender Value.
of a person named by You whereby the beneficial interest,
10.3. Declaration of the Correct Age right and title under this Policy are transferred to such
10.3.1. Declaration of the correct Age of the Life Insured is person. In either case, it must be signed by the assignor
important for Our underwriting process, before issuance of stating the fact of assignment.
this Policy. The Premiums are calculated on the basis of the 10.7.2. You may assign this Policy by informing Us in writing, which
Age of the Life Insured. If the Age declared in the Proposal We shall duly record upon receipt of Your information in
Form is found to be incorrect at any time during the Policy this behalf. You should submit the notice of assignment
Term or at the time of claim, We may: (including any change thereof) for registration with Us.
i. revise the Premium and/or applicable benefits payable 10.7.3. An absolute assignment shall automatically cancel a
under the Policy in accordance with the premium and nomination except any assignment in Our favour, in
benefits that would have been payable, if the correct accordance with Section 39 of the Insurance Act.
Age of the Life Insured would have made him eligible 10.7.4. In registering an assignment, We do not accept any
to be covered under this Policy on the Effective Date; responsibility or express any opinion as to its validity or
or legality.
ii. cancel the Policy by paying the Surrender Value, if any, 10.7.5. Assignment is not permitted if this Policy is taken under the
subject to Section 45 of the Insurance Act, if the correct Married Women's Property Act, 1874.
Age of the Life Insured would have made him ineligible 10.7.6. If this Policy is assigned to any person other than
to be covered under this Policy on the Effective Date. an individual by You, then, the Cash Bonus option
10.4. Full Disclosure and Incontestability shall automatically be changed by Us to purchase Paid
Up Addition option as specified in Section 3.5.1.iii.c)
10.4.1. Insurance is a contract of utmost good faith and We irrespective of any other option that may have been chosen
rely and trust upon Your representations. This Policy by You.
has been underwritten and issued by Us based on the
information provided by You in/ with the Proposal Form. 10.8. Upon Death of Policyholder and Change in Policyholder
In case of any concealment, non-disclosure or fraud or 10.8.1. If You and the Life Insured are different then, upon Your
misrepresentation, We shall cancel the Policy immediately death, no benefits shall become payable under this Policy
by paying the Surrender Value, if any, subject to such and the Cash Bonus option shall automatically be changed
concealment, non-disclosure, fraud or misrepresentation by Us to purchase Paid Up Addition option as specified in
being established by Us in accordance with Section 45 of Section 3.5.1.iii.c) irrespective of any option that may have
the Insurance Act. been chosen by You. Your legal heirs may continue to avail
10.4.2. We also draw Your attention to Section 45 of the the benefits under this Policy, by paying the due Premiums
Insurance Act which states as follows: to Us and by submitting the requisite documents as
specified by Us and subject to other conditions prescribed
"No policy of life insurance effected after the expiry of two years from the by Us from time to time.
date on which it was effected be called in question by an insurer on the
ground that a statement made in the proposal form for insurance or in any 10.8.2. You may request Us to make the Life Insured, the
report of a medical officer, or referee, or friend of the insured, or in any Policyholder under the Policy by giving Us prior written
other document leading to the issue of the policy, was inaccurate or false, notice provided that the Life Insured shall not become the
unless the insurer shows that such statement was on a material matter Policyholder unless the Life Insured meets all our eligibilty
or suppressed facts which it was material to disclose and that it was criteria in accordance with Our guidelines and policies and
fraudulently made by the policyholder and that the policyholder knew at We have issued a written endorsement under the Policy
the time of making it that the statement was false or that it suppressed confirming the change in Policyholder.
facts which it was material to disclose. 10.8.3. From the date of Our written endorsement confirming the
Life Insured as the Policyholder, You shall automatically
Provided that nothing in this section shall prevent the insurer from calling cease to have any rights, benefits or obligations under the
for proof of age at any time if he is entitled to do so, and no policy shall be Policy and all rights, benefits and obligations shall vest
deemed to be called in question merely because the terms of the policy entirely with the Life Insured.
are adjusted on subsequent proof that the age of the life insured was
incorrectly stated in the proposal." 10.9. Grace Period
10.5. Fraud 10.9.1. We will allow a grace period of 15 (Fifteen) days if You have
chosen monthly mode for payment of the Premium and 30
10.5.1. If You or anyone acting at Your direction or within Your (Thirty) days, if You have chosen any other mode, from the
knowledge, or any person under or in respect of this Policy due date of the unpaid Premium, for paying the overdue
makes or advances any claim knowing it to be false or Premium to Us. During the grace period, We will accept the
fraudulent in any way, then, We will cancel this Policy overdue Premium without any interest and the insurance
immediately by paying the Surrender Value, if any, subject coverage under this Policy will continue.
to such fraud being established by Us in accordance with
Section 45 of the Insurance Act. 10.9.2. During the grace period, if the overdue Premium is not paid
and the Life Insured dies, then, We will pay the death benefit
10.6. Nomination under this Policy, after deducting the said overdue Premium
10.6.1. In the Proposal Form, You can nominate a person as Your from the amount payable under this Policy.
Nominee in accordance with Section 39 of the Insurance 10.10. Lapsation of Policy
Act. The person named by You in the Proposal Form or the
person who has been nominated and registered with Us at a 10.10.1. Subject to Section 3.4, if the Premium (along with the
later date as Your Nominee(s), shall be the person to whom service tax or any other taxes, cesses or levies, if any) is not
the death benefit under this Policy will be paid in the event received by Us by the end of the grace period as specified in
of death of the Life Insured. Section 10.9 above, this Policy shall lapse and no benefits
under Section 3 shall be payable under this Policy and no
10.6.2. A change in nomination may be made by You at any rights can be exercised by You till the revival of the Policy.
time during the Policy Term by informing Us in writing and
registering the same with Us. 10.10.2. If You revive this Policy in accordance with Section 10.11
below, then, the benefits and the rights under this Policy
10.6.3. Where the Nominee is a minor, You are required to appoint shall be revived.
an appointee to receive the benefits in the event of the Life
Insured's death during such time the Nominee remains a 10.10.3. However, if this Policy has acquired a Surrender Value and
minor. In case of a minor Nominee, You must inform Us of upon non-payment of the overdue Premiums by You till
the name and relationship of the appointee to receive the the expiry of the grace period as specified in Section 10.9
benefits on behalf of the minor Nominee.
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 above, then, this Policy shall not lapse and shall by default 10.16. Other Restrictions
become a Policy under Reduced Paid Up Mode.
10.16.1. This Policy contains no restrictions as to travel or
10.11. Revival of Policy occupation.
10.11.1. A lapsed Policy can be revived at Our discretion, within 2 11. TERMINATION OF POLICY
(Two) years from the due date of the first unpaid Premium:
11.1. This Policy shall terminate upon the happening of any of the
i. on receipt of Your written request to revive this Policy following events:
by Us;
i. on the date on which We receive free look cancellation request
ii. if You produce an evidence of insurability at Your own as per Section 10.1 from You; or
cost which is acceptable to Us; and
ii. upon payment of the death benefit to a person as specified in
iii. on payment of all overdue Premiums (along with the Section 4.1 or the date of intimation of repudiation of the claim
service tax or any other taxes, cesses or levies, if any) by Us in accordance with the provisions of this Policy; or
to Us with late fee and/ or interest at such a rate as
may be determined by Us from time to time. iii. if this Policy has not acquired a Surrender Value and the due
Premiums have not been received by Us, on the expiry of the
10.11.2. The revival of the lapsed Policy shall take effect only after prescribed period for revival of the lapsed Policy, in accordance
We have approved the same in accordance with Our board with Section 10.11.2; or
approved underwriting policy and communicated to You in
iv. on the date of surrender of this Policy; or
writing. All the accrued Cash Bonus(es) and the benefits
under the lapsed Policy shall be revived upon such revival v. on the Maturity Date; or
without interest. If a lapsed Policy is not revived within vi. if the loan and accumulated interest exceeds the Surrender
the prescribed period allowed for revival, this Policy shall Value payable in accordance with Section 9.4.
terminate on the expiry of such prescribed period for revival.
12. DISPUTE REDRESSAL PROCESS UNDER THE POLICY
10.11.3. You have an option to revive a Policy under Reduced Paid
12.1. All consumer grievances and/or queries may be first addressed to
Up Mode, within 2 (Two) years from the due date of the first
Our customer helpdesk as mentioned below or to the office address
unpaid Premium, by:
as mentioned in the Schedule:
i. requesting Us in writing; Max Life Insurance Company Limited
ii. paying all the overdue Premiums (along with the Plot No. 90A, Sector 18, Gurgaon, 122015, Haryana, India
service tax or any other taxes, cesses or levies, if any), Tel No : 0124-4219090
together with interest and/ or late fee as determined by Email : axis.helpdesk@maxlifeinsurance.com
Us from time to time; and 12.2. In case You are not satisfied with the decision of the above office,
iii. submitting an evidence of insurability at Your own or have not received any response within 10 (Ten) days, You may
cost which is acceptable to Us. contact by way of a written complaint signed by You/ complainant
10.11.4. The revival of the Policy under the Reduced Paid Up or by Your/complainant's legal heirs with full details of the complaint
Mode shall take effect only after We have approved the and Your/complainant's contact information, to the following official
same in accordance with Our board approved underwriting for resolution:
policy and communicated Our decision to You in writing. Head Operations and Customer Services
All accrued bonus(es) and original benefits including death, Max Life Insurance Company Limited
survival and maturity benefits which were originally payable Plot No. 90A, Sector 18,
will be restored on such revival. However, no interest shall Gurgaon, 122015, Haryana, India.
be payable by Us on such restoration. Toll free No. - 1800-200-4006
10.11.5. If a Policy under Reduced Paid Up Mode is not revived Email : manager.services@maxlifeinsurance.com
within the prescribed period as specified in Section 10.11.3, 12.3. In case You are not satisfied with Our decision, or have not received
then, the Policy under Reduced Paid Up Mode cannot be any reply from Us within a period of 1 (One) month, You may
revived and will continue to be under Reduced Paid Up approach the Insurance Ombudsman at the address mentioned in
Mode for the remaining part of the Policy Term. Annexure A or at the Authority's website www.irda.gov.in, if Your
grievance pertains to:
10.12. Electronic Transactions
i. any partial or total repudiation of claims by Us; or
10.12.1. You will comply with all such terms and conditions
as prescribed by Us from time to time, and all ii. any dispute on the legal construction of the Policy in so far as
transactions effected by or through facilities for such disputes relate to claims; or
conducting remote transactions including the internet, iii. delay in settlement of claim; or
world wide web, electronic data interchange, call centres, iv. any dispute with regard to Premium paid or payable in terms
tele-service operations (whether voice, video, data or any of this Policy; or
combination thereof) or by means of electronic, computer,
v. non issuance of any insurance document to customers after
automated machines network or through other means of
receipt of Premium.
telecommunication, established by Us or on Our behalf, for
and in respect of this Policy, or in relation to any of Our 12.4. As per provision 13(3) of the Redressal of Public Grievances Rules
products and services, shall constitute legally binding and 1998, a complaint to the Insurance Ombudsman can be made
valid transactions when executed in adherence to and in within a period of 1 (One) year after the insurer has rejected the
compliance with the terms and conditions for such facilities, representation or sent its final reply on the representation of the
as may be prescribed by Us from time to time. complainant, provided the complaint is not on the same matter, for
which any proceedings before any court, or consumer forum or
10.13. Amendment
arbitrator is pending.
10.13.1. No amendments to this Policy will be effective, unless such
13. COMMUNICATION & NOTICES
amendments are expressly approved in writing by Us.
13.1. Our contact details are mentioned in Section 12.1 of this Policy. For
10.14. Administrative and Judicial Intervention
any updates, please visit Our website www.maxlifeinsurance.com.
10.14.1. If any administrative or judicial body imposes any condition You should mention the correct Policy number for all
on this Policy for any reason, We are bound to follow the communications made by You to Us and for all Premium remittances
same which may include suspension of all benefits and made by You.
obligations under this Policy. 13.2. All notices meant for Us must be in writing and delivered to Our
10.15. Force Majeure address as mentioned in Section 12.1 above, or such other address
10.15.1. If Our performance or any of Our obligations are in any as We may notify from time to time.
way prevented or hindered as a consequence of any act 13.3. All notices meant for You will be in writing and will be sent by Us
of God or State, strike, lock out, legislation or restriction to Your address as shown in the Schedule or as communicated by
by any government or any other authority or any other You and registered by Us. We will send You the notices by post,
circumstances beyond Our anticipation or control, the courier, hand delivery, fax or e-mail/electronic mode or by any other
performance of this Policy shall be wholly or partially means as determined by Us. If You change Your address, or if the
suspended during the continuance of such force majeure. address of the Nominee changes, You must notify Us immediately
Under an intimation/approval of the Authority, We will and should ensure that the updated information has reached Us.
resume Our obligations under the Policy, to the extent 14. GOVERNING LAW AND JURISDICTION
possible, after the force majeure conditions ceased to
14.1. Indian law shall govern this Policy and the relationship between You
exist even for the period during which the force majeure
and Us.
conditions existed.
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14.2. This Policy and all rights, obligations and liabilities arising
hereunder, shall be enforced in accordance with the laws of India.
14.3. The competent courts in India shall have exclusive jurisdiction in all
matters and causes arising out of this Policy.

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ENDORSEMENT

Total stamp value : `64.01

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 APPENDIX A: List of Ombudsman
Office of the Contact Details Areas of Jurisdiction
Ombudsman
Ahmedabad Office of the Insurance Ombudsman, 2nd floor, Ambica House, Near C.U. Shah College, 5, Gujarat and Union Territories
Navyug Colony, Ashram Road, Ahmedabad - 380 014. of Dadra & Nagar Haveli and
Tel.:- 079-27546150/139 Daman and Diu.
Fax:- 079-27546142
Email:-ins.omb@rediffmail.com
Bhopal Office of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Madhya Pradesh and
Airtel, Chattisgarh.
Bhopal - 462 011.
Tel.:- 0755-2769200/201/202
Fax:- 0755-2769203
Email:-bimalokpalbhopal@airtelmail.in
Bhubaneshwar Office of the Insurance Ombudsman, 62, Forest park, Bhubneshwar - 751 009. Orissa.
Tel.:- 0674-2596461/2596455
Fax:- 0674-2596429
Email:-ioobbsr@dataone.in
Chandigarh Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Punjab, Haryana, Himachal
Sector 17 - D, Chandigarh - 160 017. Pradesh, Jammu & Kashmir
Tel.:- 0172-2706196/5861/6468 and Union territory of
Fax:- 0172-2708274 Chandigarh.
Email:-ombchd@yahoo.co.in
Chennai Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453 (old 312), Anna Salai, Tamil Nadu and Union
Teynampet, CHENNAI - 600 018. Territories - Pondicherry
Tel.:- 044-24333678/664/668 Town and Karaikal (which
Fax:- 044-24333664 are part of Union Territory of
Email:-chennaiinsuranceombudsman@gmail.com Pondicherry).
New Delhi Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi and Rajasthan.
Delhi - 110 002.
Tel.:- 011-23239611/7539/7532
Fax:- 011-23230858
Email:-iobdelraj@rediffmail.com
Guwahati Office of the Insurance Ombudsman, 'Jeevan Nivesh', 5th Floor, Nearr Panbazar over bridge, Assam, Meghalaya, Manipur,
S.S. Road, Guwahati - 781001 (ASSAM). Mizoram, Arunachal Pradesh,
Tel.:- 0361-2132204/2131307/2132205 Nagaland and Tripura.
Fax:- 0361-2732937
Email:- ombudsmanghy@rediffmail.com
Hyderabad Office of the Insurance Ombudsman, 6-2-46, 1st floor, "Moin Court" Lane Opp. Saleem Function Andhra Pradesh, Karnataka
Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. and Union Territory of Yanam -
Tel.:- 040-23325325/23312122 a part of the Union Territory of
Fax:- 040-23376599 Pondicherry.
Email:-insombudhyd@gmail.com
Kochi Office of the Insurance Ombudsman, 2nd Floor, CC 27 / 2603, Pulinat Building, Opp. Cochin Kerala and Union Territory of
Shipyard, M. G. Road, Ernakulam - 682 015. (a) Lakshadweep (b) Mahe-a
Tel.:- 0484-2358734/759/9338 part of Union Territory of
Fax:- 0484-2359336 Pondicherry.
Email:- iokochi@asianetindia.com
Kolkata Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 4, C.R. Avenue, 4th Floor, West Bengal, Bihar, Sikkim,
KOLKATA - 700 072. Jharkhand and Union
Tel.:- 033-22124346/22124339 Territories of Andaman and
Fax:- 033-22124341 Nicobar Islands.
Email:-insombudsmankolkata@gmail.com
Lucknow Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Uttar Pradesh and
Hazratganj, Lucknow-226 001. Uttaranchal.
Tel.:- 0522-2201188/31330/1
Fax:- 0522-2231310
Email:-insombudsman@rediffmail.com
Mumbai Insurance Ombudsman, Office of the Insurance Ombudsman, S. V. Road, Santacruz (W), Maharashtra and Goa.
Mumbai - 400 054.
Tel.:- 022-26106928
Fax:- 022-26106052
Email:- ombudsmanmumbai@gmail.com

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 INSURANCE PREMIUM RECEIPT
Policy Number: 203468335 Date: 06-Mar-2014
Name: Mr. Manohar F Mannagi Base Life Insured: MR. MANOHAR F MANNAGI
Address: AT ALADAKATTI Receipt Number: 203468335 /2013-14/01
TQ HAVERI .,ALADAKATTI Your Agent Advisor: Axis Bank Ltd Ranibennur
HAVERI - 581110
Karnataka General Office AXIS BANK LTD Ranibennur

Telephone: 9741764841,8105920921,

Dear Mr. Manohar F Mannagi,

Thank you for choosing Max Life Insurance. This is to acknowledge receipt of your premium as per details below.
Should you need any further assistance, please call our Customer Help Line - 1800-200-4006 (Toll free from any network). You can
also email at axis.helpdesk@maxlifeinsurance.com

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

SUMMARY OF POLICY INFORMATION

Plan Premium paid For Due Date Frequency Effective Date
inclusive of of Coverage
Service Tax # ***
Max Life Life Gain Premier 29,999.05 28-Feb-2014 Annual 28-Feb-2014
Total 29,999.05
Minimum Guaranteed Death Benefit of base plan and term rider (if any) : RS 3,20,098.46

Next Premium Due on - 28-FEB-2015

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

Max Life Insurance Co. Ltd.

Plot No. 90A, Sector 18, Gurgaon, 122015, Haryana
Customer Help Line -1800-200-4006 (Toll free from any network)
Regd Office: Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India
Visit us at: www.maxlifeinsurance.com E-mail: axis.helpdesk@maxlifeinsurance.com
Service Tax Regn. No. AACCM3201EST001
PRM20 V1.5 24052005
E.&O.E

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