Quotation No : 60066976620

Bajaj Allianz Life Guaranteed Pension Goal II

A Non-Linked Non-Participating Immediate & Deferred Annuity Plan

Name of the First Annuitant: Life Insured Name of the Product: Bajaj Allianz Life Guaranteed Pension
Age(in years) : 62 Goal II
Name of the Second Annuitant Tag Line: A Non-Linked Non-Participating
NA Immediate & Deferred Annuity Plan
(if any):
Age(in years) : NA Unique Identification Number: 116N187V03
Premium Payment Term(in GST Rate(First Year): 4.50%
6
years): GST Rate(2nd Year onwards): 2.25%
Premium Payment Frequency Annual
:
Amount of Instalment 2,00,000
Premium(in Rs.):
Annuity Payment Frequency : Yearly

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.
Policy Details
Policy Option Deferred Annuity Deferment Period(in years) 6
Life annuity with Return of
Annuity Option Purchase Price (ROP) on death Sum Assured* Rs. NA
of annuitant

Selected % of ROP, if applicable 100 Annuity Amount Payable 89,820

Yearly (in Rs.)
Is BALIC Deferred Pension
Policy proceeds to be used for No
the purchase of this Annuity?

Premium Summary
Total Installment Premium
Installment Premium without GST 2,00,000
Instalment Premium with First Year GST 2,09,000
Installment Premium with GST 2nd year Onwards 2,04,500

(Amount in Rupees )
Guaranteed Non Guaranteed

Policy Annualized Premium Annuity Payable/ survival Benefit Maturity Death Benefit Guaranteed Surrender Special Surrender Surrender Value
Year (excluding GST) Payable (EOY) Benefit (EOY) Value (EOY) Value (EOY) Payable (EOY)
1 2,00,000 0 0 2,10,000 0 1,31,193 1,31,193
2 2,00,000 0 0 4,20,000 1,20,000 2,79,653 2,79,653
3 2,00,000 0 0 6,30,000 3,90,000 4,47,141 4,47,141
4 2,00,000 0 0 8,40,000 6,40,000 6,35,643 6,40,000
5 2,00,000 0 0 10,50,000 9,00,000 8,47,371 9,00,000
6 2,00,000 0 0 12,60,000 10,80,000 10,84,790 10,84,790
7 0 89,820 0 12,00,000 0 10,40,382 10,40,382
8 0 89,820 0 12,00,000 0 10,43,009 10,43,009
9 0 89,820 0 12,00,000 0 10,45,690 10,45,690
10 0 89,820 0 12,00,000 0 10,48,415 10,48,415
11 0 89,820 0 12,00,000 0 10,51,170 10,51,170
12 0 89,820 0 12,00,000 0 10,53,945 10,53,945
13 0 89,820 0 12,00,000 0 10,56,729 10,56,729

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Quotation No : 60066976620

Guaranteed Non Guaranteed

Policy Annualized Premium Annuity Payable/ survival Benefit Maturity Death Benefit Guaranteed Surrender Special Surrender Surrender Value
Year (excluding GST) Payable (EOY) Benefit (EOY) Value (EOY) Value (EOY) Payable (EOY)
14 0 89,820 0 12,00,000 0 10,59,513 10,59,513
15 0 89,820 0 12,00,000 0 10,62,288 10,62,288
16 0 89,820 0 12,00,000 0 10,65,048 10,65,048
17 0 89,820 0 12,00,000 0 10,67,784 10,67,784
18 0 89,820 0 12,00,000 0 10,70,491 10,70,491
19 0 89,820 0 12,00,000 0 10,73,164 10,73,164
20 0 89,820 0 12,00,000 0 10,75,797 10,75,797
21 0 89,820 0 12,00,000 0 10,78,388 10,78,388
22 0 89,820 0 12,00,000 0 10,80,932 10,80,932
23 0 89,820 0 12,00,000 0 10,83,427 10,83,427
24 0 89,820 0 12,00,000 0 10,85,870 10,85,870
25 0 89,820 0 12,00,000 0 10,88,261 10,88,261
26 0 89,820 0 12,00,000 0 10,90,597 10,90,597
27 0 89,820 0 12,00,000 0 10,92,880 10,92,880
28 0 89,820 0 12,00,000 0 10,95,108 10,95,108
29 0 89,820 0 12,00,000 0 10,97,282 10,97,282
30 0 89,820 0 12,00,000 0 10,99,403 10,99,403
31 0 89,820 0 12,00,000 0 11,01,473 11,01,473
32 0 89,820 0 12,00,000 0 11,03,496 11,03,496
33 0 89,820 0 12,00,000 0 11,05,473 11,05,473
34 0 89,820 0 12,00,000 0 11,07,411 11,07,411
35 0 89,820 0 12,00,000 0 11,09,316 11,09,316
36 0 89,820 0 12,00,000 0 11,11,198 11,11,198
37 0 89,820 0 12,00,000 0 11,13,070 11,13,070
38 0 89,820 0 12,00,000 0 11,14,950 11,14,950
39 0 89,820 0 12,00,000 0 11,16,866 11,16,866
40 0 89,820 0 12,00,000 0 11,18,855 11,18,855
41 0 89,820 0 12,00,000 0 11,20,974 11,20,974
42 0 89,820 0 12,00,000 0 11,23,310 11,23,310
43 0 89,820 0 12,00,000 0 11,25,990 11,25,990
44 0 89,820 0 12,00,000 0 11,29,216 11,29,216
45 0 89,820 0 12,00,000 0 11,33,299 11,33,299
46 0 89,820 0 12,00,000 0 11,38,734 11,38,734
47 0 89,820 0 12,00,000 0 11,46,321 11,46,321
48 0 89,820 0 12,00,000 0 11,57,365 11,57,365
49 0 89,820 0 12,00,000 0 11,74,037 11,74,037

Notes:
*Sum Assured is not applicable for Annuity products.
#Total Annuity receivable in a policy year, subject to annuitant/s is/are alive
EOY - End of the Year. The benefits shown above are as at the end of the year.
I, ____ ____ (name), have explained the premiums and I, ___ Life Insured ______ (name), having received the informa on
benefits receivable and the Terms and Conditions under the product with respect to the above, have understood the above statement
fully to the prospect / policyholder. before entering into the contract.

Place:
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect / Policyholder

Disclaimers:
a) Please consult our 'Sales representative' for any clarifications on this illustration.
b) All benefits payable under the Policy will be subject to the prevailing tax laws and other financial enactments, as they exist at the me. Tax
laws & financial enactments are subject to change from time to time.
c) This product is available for purchase by the Policyholder on payment of a single premium/ Regular premium.
d) The first annuity payment is corresponding to the annuity payment mode chosen ( namely monthly, quarterly, half-yearly or yearly) where
annuity.shall be due one month, three months, six months or one year respec vely post commencement of the policy in an immediate
annuity and after deferment period in a deferred annuity.
e) Surrender Value is applicable :
Under Annuity Options B,F,G,H & I during Annuity period ( for immediate and deferred Annuity )
All annuities during deferment period ( under deferred Annuitiy ).

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Quotation No : 60066976620

The Special Surrender Value (SSV),if any,displayed in this benefit illustar on are not guaranteed and only indica ve. The Company shall
comply with prevailing guidelines w.r.t SSV issued by IRDAI from time to time.
Surrender Value will be acquired:
Any time after payment of single Premium in an immediate annuity and deferred Annuity
A er payment of one (1) full year Premium in a regular/limited Premium payment deferred Annuity and will be payable a er
completion of first policy year.
Please refer to the Sales Literature available on Company website for details
f) Minimum Purchase Price & Minimum Age restric ons would not apply in case a nominee/ policyholder of a Deferred Pension plan of BALIC
or NPS wishes to take an immediate Annuity policy under Bajaj Allianz Life Guaranteed Pension Goal II.
g) Goods & Service tax (GST) needs to be paid additionally. GST rates are subject to change
h) All the benefits under this plan are guaranteed.
i) Figures in the special surrender value calculation includes any annuity payable amount due at the time of policy surrender.
j) Depending upon the prevailing market condition, the Special Surrender Value may be revised.
k) For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.

It shall be the resposibility of the Annuitant to produce the existence cer ficate at least 30 days before any policy anniversary ,failing which,
the Annuity Instalment due from the next Policy Anniversary may be withheld ll produc on of Existence Cer ficate, at the sole discre on of
the Comapny. The Company shall not under any circumstances pay any interest for any delay in payment of Annuity Instalment on account of
non-receipt of existence certificate by the Company.

Bajaj Allianz Life Insurance Co. Ltd.

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116.
Tel: (020) 66026777.
Email: customercare@bajajallianz.co.in
www.bajajallianzlife.com

R.O.X
 CUSTOMER INFORMATION SHEET / KNOW Y OUR POLICY.

This document provides key information about your policy. You are also advised to go through your policy
document.
We request you to kindly review the CIS and acknowledge the same through a link shared to you on your
registered mobile number/Email ID/WhatsApp.

Policy
Sr. Description in Simple Words
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
Name of the
Insurance
Product and Bajaj Allianz Life Guaranteed Pension Goal II Policy
1
Unique (UIN - 116N187V03) Schedule
Identification
Number (UIN)
Quotation Policy
2 60066976620
number Schedule
Type of
3 Insurance Immediate and Deferred Annuity NA
Policy
Installment Premium (Rs.): 2,09,000
Mode of Premium Payment: Annual
Sum Assured on Death: Not Applicable
Basic Policy Sum Assured on Maturity: Not Applicable Policy
4
Details Premium Payment Term (Years): 6 Schedule
Policy Term (Years): Whole Life
Annuity Amount (Rs.): 89,820
Mode of Annuity Payment: Yearly
Benefits payable on maturity
NA
There is no maturity benefit under the Policy
Benefits payable on Death

On death of the annuitant (in case of single life) and primary annuitant (in
case of Joint Life), Death Benefit as mentioned in the below table is payable
to the nominee:

For Deferred Annuity Option

Annuity
For Immediate Annuity Option During
Option After Deferment
Deferment
Period
Period

Option A
105% of Total No Death Benefit
(Single No Death Benefit
Premiums Paid
Life)

Option B
105% of Total X%1 of Total
(Single X%1 of Total Premiums Paid Premiums Paid
Life) Premiums Paid
 1) During Chosen Certain Period:
Option C Annuity to continue till end of chosen
(Single certain period - -
Life) 2) After Chosen Certain Period: No
Death Benefit
Option D If spouse is alive, 50% of Annuity
(Joint amount shall continue to be paid to - -
Life) spouse till he/she is alive
On first death,
No Death
If spouse is alive,
Benefit
Option E 100% of Annuity
If spouse is alive, 100% of Annuity On death of last amount shall
(Joint amount shall continue to be paid to survivor, 105%
continue to be paid
Life) spouse till he/she is alive of Total
to spouse till he/she
Premiums Paid
is alive
shall be
payable
On first death,
No Death X%1 of Total
Benefit Premiums Paid Part C
Option F X%1 of Total Premiums Paid On death of last If spouse is alive,
(Joint If spouse is alive, 100% of Annuity survivor, 105% 100% of Annuity Section 4
Life) amount shall continue to be paid to of Total amount shall
spouse till he/she is alive Premiums Paid continue to be paid
shall be to spouse till he/she
payable is alive
1) Before Survival
Benefit is Paid:
Option G 1) Before Survival Benefit is Paid: 100% of Total
(Single 100% of Total Premiums Paid 105% of Total
Premiums Paid
2) After Survival Benefit is Paid: No Premiums Paid
Life) Death Benefit
2) After Survival
Benefit is Paid: No
Death Benefit
100% of Total
Option H Premiums Paid
(Single 100% of Total Premiums Paid 105% of Total
minus Survival
minus Survival Benefits already paid Premiums Paid
Life) Benefits already
paid
If spouse is alive, 100% of Annuity
amount shall continue to be paid to
spouse till he/she is alive

On death of both annuitant and

spouse, ROP shall be used to pay
annuity to dependant mother (if
Option I alive) of NPS subscriber.
(Family - -
On death of the mother, ROP shall
Pension) be used to pay annuity to dependant
father (if alive) of NPS subscriber.

On the death of the last surviving

annuitant (out of the NPS subscriber,
the spouse, the mother, the father),
100% of Total Premiums Paid shall
be paid to the nominee

1As per the % opted by Policyholder at inception

Survival Benefits excluding that payable on maturity

 Survival Benefits excluding that payable on maturity
Policy
5 Coverage/ben Till Annuitant (in case of single life) and Primary Annuitant (in case of Joint
efits payable Life) is alive, Survival/Annuity Benefit as mentioned in the below table is
payable to him/her:

For Deferred Annuity Option

Annuity For Immediate Annuity
Option Option During
After Deferment
Deferment
Period
Period

Option A No Survival Annuity will be payable

(Single Annuity will be payable throughout Benefit
life throughout life
Life)

Option B
(Single Annuity will be payable throughout No Survival Annuity will be payable
life Benefit throughout life
Life)

Option C
(Single Annuity will be payable throughout - -
life
Life)

Option D
(Joint Annuity will be payable throughout - -
life
Life)

Option E
(Joint Annuity will be payable throughout No Survival Annuity will be payable
life Benefit throughout life
Life)

Option F Part C
(Joint Annuity will be payable throughout No Survival Annuity will be payable
life Benefit throughout life
Life) Section 4
Annuity will be payable
Annuity will be payable throughout throughout life.
Option G life. Additionally, on survival
(Single Additionally, on survival till Age 85 No Survival
till Age 85 or 25th policy
or 25th policy year (whichever is Benefit year (whichever is later),
Life) later), 100% of Total Premiums 100% of Total
Paid shall be paid Premiums Paid shall be
paid
Annuity will be payable
throughout life.
Annuity will be payable throughout Additionally, starting
life. from the policy
Additionally, starting from the anniversary after the
policy anniversary after the 15th 15th Policy Year or the
Option H Policy Year or the policy policy anniversary after
(Single anniversary after attaining Age 70 No Survival attaining Age 70
Benefit
Life) (whichever is later), Survival (whichever is later),
benefit would be payable at each Survival benefit would
policy anniversary in instalments be payable at each
as per the Annuity payment policy anniversary in
frequency. instalments as per the
Annuity payment
frequency.
Option I
(Family Annuity will be payable throughout - -
life
Pension)
 The first annuity payment is corresponding to the annuity payment mode
chosen (namely monthly, quarterly, half-yearly or yearly) where annuity shall
be due one month, three months, six months or one year respectively post
commencement of policy in an immediate annuity and after deferment period
in a deferred annuity.

Surrender Benefits

1. During Deferment Period: Surrender Value shall be higher of

Guaranteed Surrender Value (GSV) or the Special Surrender Value Part D
(SSV)
Section 8
2. During Annuity Period: Surrender Value shall be Special Surrender
Value (SSV)

Options to policyholders for availing benefits, if any, covered under

the policy: NA
Not Applicable
Other benefits/options payable, specific to the policy, if any:
NA
Not Applicable
Options
available (in
6 case of Linked Not Applicable NA
Insurance
Products)
Option A: Life annuity
Option B: Life annuity with Return of premiums on death of Annuitant
Option C: Annuity Certain for period 5, 10, 15 or 20 years and life
thereafter
Option Option D: Joint Life Last Survivor with 50% of annuity to spouse
available(in Option E: Joint Life Last Survivor with 100% of annuity to spouse Part C
7 case of Option F: Joint Life Last Survivor with 100% of annuity to spouse &
Annuity with Return of Premiums (ROP) on death of Last Survivor Section 2
product Option G: Life annuity with Return of Premiums (ROP) on death or
survival
Option H: Life annuity with Return of Premiums (ROP) on death or in
instalments on survival
Option I: Family Pension (For NPS subscribers only)
Riders Opted if
8 Not Applicable NA
Any
 Under a deferred annuity during the deferment period, in case of the
death of the annuitant or the death of the last survivor in a joint life
policy is due to suicide within 12 months from the date of
Exclusions
commencement of risk or the date of latest revival of the policy,
(events where Part F
whichever is later, the higher of 80% of the total premiums paid or the
insurance
9 surrender value as on the date of death will be paid as death benefit, Section
coverage is
provided the policy is in force. There are no exclusions other than 11
not payable), if
suicide clause.
any
Under a deferred annuity during the annuity period or under an
immediate annuity, suicide clause or any other exclusion is not
applicable.
Waiting/ Lien
10 Not Applicable NA
Period, if any
Applicable only for Regular Premium
Part B
11 Grace Period Thirty (30) days for premium payment frequencies other than monthly and
Section 1
fifteen (15) days for monthly frequency

Free Look Part D

12 Thirty (30) Days
Period Section 5
Lapse
Part D
For Single Premium: Not Applicable
For Limited/Regular Premium: The policy shall lapse if at least one Section 6
(1) full year premium has not been paid
Paid-up
Lapse, paid-up For Single Premium: Not Applicable Part D
13 and Revival of For Limited/Regular Premium: If at least one (1) full year premium
the Policy Section 6
has been paid, the policy shall be converted to a paid-up policy post
completion of first policy year
Revival

For Single Premium: Not Applicable Part B

For Limited/Regular Premium: Five (5) years from the due date of
first unpaid premium
Part D
Policy Loan If
14 Not Applicable Section
Applicable
10
 1. Turn Around Time (TAT) for claims settlement and brief
procedure: https://www.bajajallianzlife.com/life-insurance-claim-
assistance.html

2. Helpline/Call Centre Numbers:

Toll free no (24*7) : 1800 2201 02

Sr. Citizens Toll free no. : 1800 2269 70

Customer Care No: (022) 40881000

Claims / Board No.: (022) 66867575 Part F
15 Claims
3. Contact details of the insurer: Section
Procedure
21
Bajaj Allianz Life Insurance Company Limited

House, Ground Floor, Bajaj Allianz, Airport Rd, Yerawada, Pune,

Maharashtra 411006

4. Link for downloading claim form and list of documents required

including bank account details:

https://www.bajajallianzlife.com/life-insurance-claim-assistance.html

WhatsApp- 8806727272

1. Turn Around Time (TAT):

https://www.bajajallianzlife.com/content/dam/balic/pdf/customer-
services/services-tat.pdf

2. Helpline/Call Centre number: 1800 209 7272

3. Contact details of the insurer: In case you have any query, you may
communicate with the Company: Part F
Policy 1. By post at: Customer Care Desk, Bajaj Allianz Life Insurance
16 Company Ltd., Bajaj Allianz House, 5th floor, Airport Road, Section
Servicing
Yerawada, Pune – 411006 26
2. By Email: customercare@bajajallianz.co.in

4. Link for downloading applicable form and list of documents

required including bank account details:

https://bajajallianzlifeonline.co.in/online/portal/logon/serviceRequest.do
?user_name=WEBSITE&p_flag=0
 1. Contact details of Grievance Redressal Officer of the insurer:
Grievance Redressal Officer of the insurer - In case you do not receive
a response within 15 days or if you are not satisfied with the resolution,
you may approach Grievance Redressal Officer at
gro@bajajallianz.co.in
Part F
2. Link for registering the grievance with the insurer’s portal:
Insurance company grievance portal Section
Grievances 26
17 https://webpartner.bajajallianz.com/GrvOnlineApi/indexOnlineGrv.jsp#_
/Complaints
ga=2.7272630.541013491.1717475077- and
1601763320.1694668355&_gac=1.52751388.1715749803.EAIaIQobC Section
hMIy_eqivKOhgMVdWsPAh0NFQrEEAAYASAAEgJObPD_BwE 27

3. Contact details of Ombudsman: Find your nearest Ombudsman

office at

http://www.cioins.co.in/ombudsman

Declaration by the policyholder

I have read the above and confirm having noted the details
Place:
Date: (Signature of the Policy Holder)

Web-link for the product where sample policy document can be downloaded:
https://www.bajajallianzlife.com/retirement-pension-plans/guaranteed-pension-goal.html
Disclaimer:
In case of conflict in the content mentioned hereinabove, the terms and conditions mentioned in the policy
document shall prevail.