January 21, 2022

AMARDEEP KUMAR
187 PARSHVANATH NAGAR
BHADAWASIYA
INSIDE RAWAT NAHAR
JODHPUR 342007
RAJASTHAN INDIA
M- 9928499152

, 
 ,
159271290496 COMBO

Dear Mr./Ms. AMARDEEP KUMAR

- Smart Solution from Tata AIA Life

We warmly welcome you to the Tata AIA Life family. At Tata AIA Life we've come together with only one purpose, to
make Good happen in the lives of people we connect with.

You have indeed made a smart choice by selecting , an excellent solution designed exclusively to meet your needs. A
combinition of two of our best products brought together to offer savings and financial protection for your family.

While we have attached a working of the solution, the kit also contains details of the individual products - Tata AIA Life
Insurance Fortune Pro and .

Important things to note

l This is not a product but a combination of products which are exclusive and independent of each other. To
understand the benefits, risk factors and terms & conditions of both these products, please read the respective
Policy Document carefully.
l The combined illustration attached with this kit is to help you understand the benefits of Smart Solution
purchased by you.
l Each of the two products in the solution are exclusive and independent of each other and you may access Tata
AIA Life Insurance website www.tataaia.com to know more about the plans offered in this package. You
may also log in to the customer portal with the log in id and password shared with you in a separate mail.
l Benefits offered under this solution are subject to regular payment of premiums for each of the policies. To
ensure that you enjoy the full benefit of this Solution and fulfill your needs, please pay the premiums regularly.

We are committed to giving you best-in-class products and professional service and look forward to a
long and cherished relationship with you.

Best wishes,

Naveen Tahilyani
CEO & Managing Director

Tata AIA Insurance Company Ltd.

These products are underwritten by Tata AIA Life Insurance Company Ltd. Tata AIA Life Insurance Company Ltd. (IRDA of India Regn. No.110 • CIN No.
U66010MH2000PLC128403). Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. For any
information including cancellation, claims and complaints, please contact your Relationship Manager or visit Tata AIA Life’s nearest branch office or call 1-860-266-9966
(local charges apply) or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com or SMS 'LIFE’ to 58888. • UIN XOXOXOXOXO • UIN XOXOXOXOXO
• L&C/Misc/2017/Jul/283
BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS:
IRDA of India claries to public that
• IRDA of India or its officials do not involve in activities like sale of any kind of insurance or financial products nor invest premiums.
• IRDA of India does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along with details of phone call, number.
 159271290496

XK//104002.X
MU01 U224373351 COMBO 1542/1780 BROK Fort Pro Non Term_NonEIA
January 21, 2022
AMARDEEP KUMAR
187 PARSHVANATH NAGAR
BHADAWASIYA
INSIDE RAWAT NAHAR
JODHPUR 342007
RAJASTHAN INDIA
M- 9928499152

1.Part A
Dear AMARDEEP KUMAR,

Thank You for choosing Us for Your insurance needs. Tata AIA Life Insurance Company Limited is committed to give
You world-class products and professional service.

We take great pleasure in presenting Your Policy document. Please check Your personal details and the Policy provisions
carefully. Should You have any queries, please contact your agent or contact Us at the address mentioned below. You
can also reach Us via email at customercare@tataaia.com or call Our helpline number 1860-266-9966 (Local charges
apply).

Agent Name: POLICYBAZAAR INSURANCE BROKERS PRIVATE LIMITED

Agency Code: 004665695
Agent Contact details: 18002585970 / care@policybazaar.com

In order to provide You better services, We request you to intimate us in the event of any change in the address of the
Policyholder or the nominee.

Free Look Provisions

You have a period of 30 days from the date of receipt of the Policy to review the terms and conditions of the Policy. If
You disagree to any of the terms or conditions, You have the option to return the original Policy document to Us, by
stating the objections/reasons for such disagreement. Upon return, this Policy will terminate forthwith and all rights,
benefits and interests under the Policy will cease immediately. We will only refund an amount which will be equal to
non-allocated Premium plus charges levied by cancellation of Units plus Fund Value at the date of cancellation less
Mortality Charges (including applicable taxes, duties, cesses and levies) for the period of cover, Rider Charges (if any,
including applicable taxes, cesses and levies), expenses incurred on medical examination, if any and stamp duty. The
units will be repurchased by the company at the price of the units on the date of cancellation and any surplus or deficit
shall be adjusted in the payout to the Policyholder.

At Tata AIA Life we believe that life inspires us to think ahead. Our insurance solutions are therefore designed to be a
step ahead, thus giving you an advantage to adapt to tomorrow’s changes, starting today.

We look forward to a long and cherished relationship with you.

Best wishes,
For and on behalf of
Tata AIA Life Insurance Company Limited

Naveen Tahilyani
CEO & Managing Director
Authorised Signatory
Policy Servicing Branch : 1st Flr,Simran Cntr,30/H Parsi, Panchayat Mrg,Andheri-E,Mumbai - 400093
Tata AIA Life Insurance Company Ltd (IRDA of India Regn.No.110) (CIN - U66010MH2000PLC128403)
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.
"Stamp duty of Rs. 122 is paid as provided under Article 47(C)/(D) of Indian Stamp Act, 1899 and included in
Consolidated Stamp duty paid to the Government of Maharashtra Treasury vide order of Addl. Controller of Stamps,
Mumbai at General Stamp office, Fort, Mumbai – 400001 vide his order No. LOA/CSD/212/2021/6126 / Date
14/12/2021 / Validity period Dt. 20/12/2021 to Dt. 31/12/2022"

(Signature)
Proper Officer

Tata AIA Life Insurance Fortune Pro

In this policy, the Investment risk in Investment portfolio is borne by the Policyholder

LIFE INSURED AMARDEEP KUMAR

POLICY NUMBER U224373351

PREAMBLE

Tata AIA Life Insurance Company Limited (“the Company”), having received a Proposal form and other related
documents with Declaration thereto and initial premium from the Policyholder hereby issues Tata AIA Life Insurance
Fortune Pro. The Company under this Policy; does agree in consideration and subject to Policy conditions to pay the
benefits under the Policy on the happening of an insured event, while the Policy is in force. The basic insurance plan
provided under this Policy, with its amount of coverage and Premium is specified on the Policy Schedule. Entitlement
to benefits, conditions for payment and other policy details are also set out inside. This Policy is subject to terms and
conditions motioned herein below and endorsements if any.

Signature valid
Signed by: Naveen Tahilyani
Date:
Location:

This is a system generated document requiring no physical signature.

 POLICY SCHEDULE

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04)

THIS SCHEDULE MUST BE READ WITH THE POLICY DOCUMENT AND IS PART OF THE LIFE INSURANCE CONTRACT

Personal Details
Name of Policyholder : AMARDEEP KUMAR Name of Life Insured : AMARDEEP KUMAR
Address of Policyholder : 187 PARSHVANATH NAGAR Address of Life Insured : N/A
BHADAWASIYA N/A
INSIDE RAWAT NAHAR N/A
JODHPUR N/A
N/A
342007 N/A
RAJASTHAN N/A
INDIA
Client ID of Policyholder : 317988075 Client ID of Life Insured : 317988075
Date of Birth of Policyholder : 1989/06/12 Date of Birth of Life Insured : 1989/06/12
Age at entry of Policyholder : 32 Age at entry of Life Insured : 32
Gender : Male Age Admitted : YES
Gender : Male

Policy Details
Policy Number : U224373351 Policy Term : 21
Date of Commencement of Policy : 2022/01/20 Premium Paying Term : 10
Date of Commencement of Risk : 2022/01/20 Mode of Premium Payment : Monthly
Date of Maturity of Policy : 2043/01/20 Annualised Premium (Excl. taxes) (Rs.) : 58000.00
Premium Due Date (s) : 2022/02/20 Premium (Excl. taxes) Rs. : 4831.00
Applicable taxes, cessess and levies (Rs.) : 0.00
Total Modal Premium (Incl. taxes) (Rs.) : 4831.00

Base Plan/Rider Name Basic Sum Modal Premium Maturity Date Due Date of Policy Premium
Assured (Incl. taxes) Last Premium Term Payment
(Rs.) (Rs.) Payment (Years) Term (Years)
Tata AIA Life Insurance
Fortune Pro 6,09,000.00 4831 2043/01/20 2031/12/20 21 10
(110L112V04)

Benefit Payable:
Maturity Benefit As per Clause 1 of Part C and Benefit Illustration
Death Benefit As per Clause 2 of Part C and Benefit Illustration

Nominee details (under section 39 of the Insurance Act 1938)

Name of the Nominee (s) Relationship with Life Insured Age Nomination %
JYOTI SINGARIYA Spouse 31 100.00

Appointee Details (Applicable in case the Nominee is a minor)

Name of the Appointee (s) Relationship with nominee Age
NA NA 0

On examination of the Policy, if you notice any mistake, please return the Policy to the Company immediately for correction.
OTHER ENDORSEMENT
Funds Available With Current Product Offerings
- A Snapshot (as on 31st December 2021)

THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER.

Equity Funds
Large Cap Equity Fund (ULIF 017 07/01/08 TLC 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV Nifty NAV INDEX
of the Fund is to generate long term capital appreciation from a
50 Change Change
portfolio that is invested predominantly in equity and equity linked
securities. Last 1 Month 30-Nov-21 43.6596 16983.20 2.55% 2.18%
Last 3 Months 30-Sep-21 45.3615 17618.15 -1.30% -1.50%
NAV as on 31 December, 21 : `44.7715 Last 6 Months 30-Jun-21 41.4726 15721.50 7.95% 10.38% 2.50%
Last 1 Year 31-Dec-20 34.7461 13981.75 28.85% 24.12%
Benchmark : Nifty 50 -100%
Last 2 Years 31-Dec-19 27.7549 12168.45 27.01% 19.42%
Corpus as on December, 21 : ` 1,817.32 Crs. Last 3 Years 31-Dec-18 24.1943 10862.55 22.77% 16.90% 97.50%
Last 4 Years 31-Dec-17 23.5366 10530.70 17.44% 13.30%
Last 5 Years 31-Dec-16 18.2283 8185.80 19.69% 16.22%
Since Inception 11-Jan-08 10.0000 6200.10 11.32% 7.64% Equity MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Whole Life Mid-Cap Equity Fund (ULIF 009 04/01/07 WLE 110)
Fund Details Fund Performance
Investment Objective : The primary investment objective Asset Allocation
PERIOD DATE NAV Nifty NAV INDEX
of the Fund is to generate long term capital appreciation from a
Midcap 100 Change Change
portfolio that is invested predominantly in Mid Cap Equity and
Mid Cap Equity linked securities. Investments in large cap equity Last 1 Month 30-Nov-21 83.3572 29650.65 2.55% 2.67%
shares will be restricted to not more than 20%. Last 3 Months 30-Sep-21 83.5801 30384.00 2.28% 0.19%
Last 6 Months 30-Jun-21 78.4127 26970.75 9.02% 12.87% 2.31%
NAV as on 31 December, 21 : `85.4864 Last 1 Year 31-Dec-20 62.2768 20842.50 37.27% 46.06%
Benchmark : Nifty Midcap 100 -100% Last 2 Years 31-Dec-19 48.7311 17102.50 32.45% 33.42%
Last 3 Years 31-Dec-18 44.9903 17875.50 23.86% 19.42%
Corpus as on December, 21 : ` 8,955.20 Crs. 97.69%
Last 4 Years 31-Dec-17 50.8031 21133.50 13.89% 9.55%
Last 5 Years 31-Dec-16 34.6601 14351.45 19.79% 16.23%
Since Inception 10-Jan-07 10.0000 5066.30 15.40% 12.71% Equity MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Super Select Equity Fund (ULIF 035 16/10/09 TSS 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV Nifty500 NAV INDEX
of the fund is to provide income distribution over a period of
Shariah Change Change
medium to long term while at all times emphasizing the importance
of capital appreciation. The fund will invest significant amount Last 1 Month 30-Nov-21 53.3201 5208.13 4.18% 5.54%
in equity and equity linked instruments specifically excluding Last 3 Months 30-Sep-21 53.8373 5347.34 3.18% 2.79% 6.76%
companies predominantly dealing in Gambling, Lotteries/ Last 6 Months 30-Jun-21 49.8139 4857.44 11.52% 13.16%
Contests, Animal Produce, Liquor, Tobacco, Entertainment (Films, Last 1 Year 31-Dec-20 41.1664 3984.24 34.94% 37.95%
TV etc) Hotels, Banks and Financial Institutions. Last 2 Years 31-Dec-19 32.2090 2976.18 31.33% 35.90% 93.24%
NAV as on 31 December, 21 : `55.5510 Last 3 Years 31-Dec-18 31.5848 2945.79 20.71% 23.11%
Benchmark : Nifty500 Shariah - 100% Last 4 Years 31-Dec-17 34.0849 3231.19 12.99% 14.20%
Last 5 Years 31-Dec-16 23.2007 2261.78 19.08% 19.43% Equity MMI & Others
Since Inception 21-Oct-09 10.0000 1208.56 15.09% 13.22%
Corpus as on December, 21 : ` 1,028.94 Crs. Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

Top 200 Fund (ULIF 027 12/01/09 ITT 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The Top 200 fund will invest PERIOD DATE NAV S&P BSE 200 NAV INDEX
primarily in select stocks and equity linked instruments which are Change Change
a part of BSE 200 Index with a focus on generating long term
capital appreciation. The fund will not replicate the index but aim to Last 1 Month 30-Nov-21 91.0352 7385.74 3.91% 2.04%
attain performance better than the performance of the Index. As a Last 3 Months 30-Sep-21 93.6163 7617.01 1.05% -1.05%
defensive strategy arising out of market conditions, the scheme may Last 6 Months 30-Jun-21 86.7766 6823.58 9.01% 10.45% 3.79%
also invest in debt and money market instruments. Last 1 Year 31-Dec-20 67.5178 5906.87 40.11% 27.59%
Last 2 Years 31-Dec-19 51.1462 5078.44 36.00% 21.82% 96.21%
NAV as on 31 December, 21 : `94.5977 Last 3 Years 31-Dec-18 44.0259 4653.68 29.04% 17.43%
Benchmark : S&P BSE 200 - 100% Last 4 Years 31-Dec-17 45.2704 4678.86 20.23% 12.66%
Last 5 Years 31-Dec-16 33.2993 3511.05 23.22% 16.51% Equity MMI & Others
Corpus as on December, 21 : ` 540.66 Crs.
Since Inception 12-Jan-09 10.0000 1091.37 18.91% 16.06%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.
Funds Available With Current Product Offerings
- A Snapshot (as on 31st December 2021)
Top 50 Fund (ULIF 026 12/01/09 ITF 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The Top 50 fund will invest primarily in PERIOD DATE NAV Nifty 50 NAV INDEX
select stocks and equity linked instruments which are a part of Nifty Change Change
50 Index with a focus on generating long term capital appreciation.
The fund will not replicate the index but aim to attain performance Last 1 Month 30-Nov-21 56.4141 16983.20 3.54% 2.18%
better than the performance of the Index. As a defensive strategy Last 3 Months 30-Sep-21 59.0093 17618.15 -1.01% -1.50%
5.58%
arising out of market conditions, the scheme may also invest in debt Last 6 Months 30-Jun-21 53.8493 15721.50 8.47% 10.38%
and money market instruments. Last 1 Year 31-Dec-20 46.3599 13981.75 25.99% 24.12%
Last 2 Years 31-Dec-19 39.4191 12168.45 21.73% 19.42%
NAV as on 31 December, 21 : `58.4104 Last 3 Years 31-Dec-18 35.6812 10862.55 17.86% 16.90% 94.42%
Benchmark : Nifty 50 -100% Last 4 Years 31-Dec-17 34.8962 10530.70 13.74% 13.30%
Last 5 Years 31-Dec-16 26.6663 8185.80 16.98% 16.22% Equity MMI & Others
Corpus as on December, 21 : ` 120.68 Crs.
Since Inception 12-Jan-09 10.0000 2773.10 14.57% 15.18%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

Multi Cap Fund (ULIF 060 15/07/14 MCF 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
of the Fund is to generate capital appreciation in the long term PERIOD DATE NAV S&P BSE NAV INDEX
by investing in a diversified portfolio of Large Cap and Mid Cap 200 Change Change
companies. The allocation between Large Cap and Mid Cap Last 1 Month 30-Nov-21 33.9429 7385.74 4.04% 2.04% 6.82%
companies will be largely a function of the relative valuations of Last 3 Months 30-Sep-21 34.7609 7617.01 1.59% -1.05%
Large Cap companies as against Mid Cap companies.
Last 6 Months 30-Jun-21 31.8422 6823.58 10.90% 10.45%
Last 1 Year 31-Dec-20 24.6977 5906.87 42.98% 27.59%
NAV as on 31 December, 21 : `35.3127
Last 2 Years 31-Dec-19 18.7447 5078.44 37.25% 21.82% 93.18%
Benchmark : S&P BSE 200 – 100% Last 3 Years 31-Dec-18 16.0450 4653.68 30.08% 17.43%
Corpus as on December, 21 : ` 944.43 Crs. Last 4 Years 31-Dec-17 15.5648 4678.86 22.73% 12.66%
Last 5 Years 31-Dec-16 10.8070 3511.05 26.72% 16.51% Equity MMI & Others
Since Inception 05-Oct-15 9.9996 3426.34 22.39% 13.46%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

India Consumption Fund (ULIF 061 15/07/14 ICF 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
of the Fund is to generate capital appreciation in the long term PERIOD DATE NAV S&P BSE NAV INDEX
by investing in a diversified portfolio of companies which would 200 Change Change
benefit from India’s Domestic Consumption growth story. The
Last 1 Month 30-Nov-21 30.7896 7385.74 2.82% 2.04%
India Consumption Fund could provide an investment opportunity
Last 3 Months 30-Sep-21 31.7792 7617.01 -0.38% -1.05% 8.12%
in the theme of rising consumption power in India for long term
returns. Last 6 Months 30-Jun-21 29.5538 6823.58 7.12% 10.45%
91.88%
Last 1 Year 31-Dec-20 23.5259 5906.87 34.56% 27.59%
NAV as on 31 December, 21 : `31.6569
Last 2 Years 31-Dec-19 18.4922 5078.44 30.84% 21.82%
Benchmark : S&P BSE 200 – 100% Last 3 Years 31-Dec-18 15.7109 4653.68 26.31% 17.43%
Corpus as on December, 21 : ` 390.26 Crs Last 4 Years 31-Dec-17 15.4021 4678.86 19.74% 12.66%
Last 5 Years 31-Dec-16 10.7077 3511.05 24.21% 16.51% Equity MMI & Others
Since Inception 05-Oct-15 9.9996 3426.34 20.27% 13.46%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

Balanced Funds
Whole Life Aggressive Growth Fund (ULIF 010 04/01/07 WLA 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV NAV INDEX
of the fund is to maximize the returns with medium to high risk. 20.90%
Change Change
Last 1 Month 30-Nov-21 56.2833 2.36% 1.34% 5.83%
Last 3 Months 30-Sep-21 57.6362 -0.04% -0.78%
NAV as on 31 December, 21 : `57.6112 Last 6 Months 30-Jun-21 53.9701 6.75% 7.64% 5.55%

Benchmark : Nifty 50 - 65% Last 1 Year 31-Dec-20 46.8405 22.99% 16.88%

Last 2 Years 31-Dec-19 38.6487 22.09% 15.34%
CRISIL Composite Bond
Fund Index -35% Last 3 Years 31-Dec-18 34.0446 19.17% 14.05% 67.72%
Last 4 Years 31-Dec-17 33.0698 14.89% 11.46%
Corpus as on December, 21 : ` 606.58 Crs. Equity Government Securities
Last 5 Years 31-Dec-16 26.1478 17.12% 13.12%
Since Inception 12-Jan-07 10.0000 12.40% 9.35% MMI & Others Corporate Bonds
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Whole Life Stable Growth Fund (ULIF 011 04/01/07 WLS 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV NAV INDEX
of the fund is to provide reasonable returns with low to medium risk.
Change Change 41.00%
7.62%
Last 1 Month 30-Nov-21 42.1474 1.44% 0.74%
NAV as on 31 December, 21 : `42.7549 Last 3 Months 30-Sep-21 42.5227 0.55% -0.26% 6.40%
Benchmark : Nifty 50 - 40% Last 6 Months 30-Jun-21 40.3497 5.96% 5.69%
CRISIL Composite Bond Last 1 Year 31-Dec-20 36.7294 16.41% 11.71%
Fund Index - 60% Last 2 Years 31-Dec-19 30.8067 17.81% 12.43%
Last 3 Years 31-Dec-18 27.4565 15.91% 12.01% 44.99%
Corpus as on December, 21 : ` 171.63 Crs.
Last 4 Years 31-Dec-17 26.3476 12.87% 10.14%
Last 5 Years 31-Dec-16 22.6868 13.51% 10.90% Government Securities Equity
Since Inception 18-Jan-07 10.0000 10.20% 8.72% Corporate Bonds MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.
Funds Available With Current Product Offerings
- A Snapshot (as on 31st December 2021)
Fixed Income Funds
Whole Life Income Fund (ULIF 012 04/01/07 WLI 110)
Fund Performance Asset Allocation
Fund Details
PERIOD DATE NAV Crisil Composite NAV INDEX
Investment Objective : The primary investment objective of Bond Fund Index Change Change
the Fund is to generate income through investing in a range of debt 28.38%
24.49%
and money market instruments of various maturities with a view to Last 1 Month 30-Nov-21 32.2931 3999.82 -0.18% -0.22%
maximizing the optimal balance between yield, safety and liquidity. Last 3 Months 30-Sep-21 32.0454 3968.46 0.59% 0.57%
The Fund will have no investments in equity or equity linked Last 6 Months 30-Jun-21 31.3995 3891.67 2.66% 2.55%
instruments at any point in time. Last 1 Year 31-Dec-20 31.1395 3858.44 3.52% 3.44%
Last 2 Years 31-Dec-19 27.7779 3436.27 7.72% 7.77%
NAV as on 31 December, 21 : `32.2345 Last 3 Years 31-Dec-18 25.1230 3103.66 8.66% 8.74% 47.13%
Benchmark : CRISIL Composite Bond Last 4 Years 31-Dec-17 23.3646 2930.43 8.38% 8.03%
Fund Index -100% Last 5 Years 31-Dec-16 22.4860 2798.49 7.47% 7.36% Government Securities Corporate Bonds
Since Inception 06-Feb-07 10.0000 1301.73 8.17% 7.80%
Corpus as on December, 21 : ` 782.10 Crs. MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Whole Life Short Term Fixed Income Fund (ULIF 013 04/01/07 WLF 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
of the Fund is to generate stable returns by investing in fixed PERIOD DATE NAV CRISIL Short- Term NAV INDEX
Bond Fund Index Change Change 35.02%
income securities having shorter maturity periods. Under normal
circumstances, the average maturity of the Fund may be in the Last 1 Month 30-Nov-21 28.5374 4042.48 0.12% 0.20% 16.20%
range of 1-3 years. Last 3 Months 30-Sep-21 28.3958 4016.52 0.62% 0.85%
Last 6 Months 30-Jun-21 28.0295 3950.03 1.93% 2.55%
NAV as on 31 December, 21 : `28.5716 Last 1 Year 31-Dec-20 27.7116 3880.70 3.10% 4.38%
Benchmark : CRISIL Short Term Bond Fund Last 2 Years 31-Dec-19 25.6453 3514.61 5.55% 7.36%
Index -100% Last 3 Years 31-Dec-18 23.6259 3208.70 6.54% 8.08% 48.78%

Corpus as on December, 21 : ` 226.67 Crs. Last 4 Years 31-Dec-17 22.0995 3008.61 6.63% 7.72%
Last 5 Years 31-Dec-16 20.9702 2836.99 6.38% 7.38% Government Securities Corporate Bonds
Since Inception 12-Feb-07 10.0000 1286.08 7.30% 8.01% MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Disclaimer
1. IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICY HOLDER. The Linked Insurance Product do not offer any liquidity during the first five
years of the contract. The policy holder will not be able to surrender/withdraw the monies invested in Linked Insurance Products completely or partially till the end of the fifth year.
2. The fund is managed by Tata AIA Life Insurance Company Ltd. (hereinafter the “Company”).
3. Past performance is not indicative of future performance. Returns are calculated on an absolute basis for a period of less than (or equal to) a year, with reinvestment of dividends (if any)
4. All investments made by the Company are subject to market risks. The Company does not guarantee any assured returns. The investment income and price may go down as well as up depend-
ing on several factors
5. Every effort is made to ensure that all information contained in this publication is accurate at the date of publication, however, the Company shall not have any liability for any damages of any kind
(including but not limited to errors and omissions) whatsoever relating to this material.
6. Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfillment of conditions stipulated therein. Income Tax laws are subject to change from time to time. Tata
AIA Life Insurance Company Ltd. does not assume responsibility on tax implication mentioned anywhere in this document. Please consult your own tax consultant to know the tax benefits avail-
able to you.
7. Please know the associated risks and the applicable charges, from your Insurance agent or the Intermediary or policy document issued by the insurance company.
8. Various funds offered are the names of funds and do not, in any way, indicate the quality of the funds, their future prospects & returns.
9. Premium paid in ULIPs are subject to Investment risks associated with capital markets & the NAV of the units may go up or down based on the performance of the fund and factors influencing
capital markets & the insured is responsible for his/her decision.
10. Whilst every care has been taken in the preparation of this document, it is subject to correction and markets may not perform in a similar fashion based on factors influencing the capital and debt
markets; hence this review note does not individually confer any legal rights or duties.
11. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
12. Unit Linked Life Insurance products are different from traditional insurance products and are subject to risk factors
13. Tata AIA Life Insurance Company Limited is only the name of the Insurance Company & any contract bearing the prefix ‘Tata AIA Life” is only the name of the Unit Linked Life Insurance contract
and does not in any way indicate the quality of the contract, its future prospects or returns.
14. This publication is for general circulation only. This document is for information and illustrative purposes only and does not purport to any financial or investment services and do not offer or form
part of any offer or recommendation. This document is not, and should not be regarded as investment advice or as a recommendation regarding any particular security or course of action.
15. Please make your own independent decision after consulting your financial or other professional advisor.
16. In line with IRDAI regulations, “Since inception” date will be effective from “First Unit Allocation” date instead of “First NAV declaration” date.
17. The performance of the managed portfolios and funds is not guaranteed and the value may increase or decrease in accordance with the future experience of the managed portfolios and funds.
 PART B
Tata AIA Life Insurance Fortune Pro is a Unit Linked Individual Life Insurance Savings Plan

BASIC DEFINITIONS of at least three (3) months and on prior clearance from the IRDA of India.
In this Policy: “Policy Monthly Date” refers to the same date of each month as the Date
“Basic Sum Assured” is the guaranteed amount of the benefit that is of Commencement of Policy.
payable on the death of the Insured under the Basic Policy. The Basic Sum “Proceeds of the Discontinued Policy” means the Fund Value as on the
Assured is shown in the Policy Schedule. If the Basic Sum Assured is Date of Discontinuance of Policy plus entire income earned after deduction
subsequently altered according to the terms and conditions of the Policy, of the Fund Management Charges, subject to a minimum guarantee of
the adjusted amount after such alteration as evidenced by an endorsement interest @ 4% p.a. or as prescribed by IRDA of India from time to time.
issued by Us to this effect will become the Basic Sum Assured. “Date of Revival” is the approval date of revival of the Policy and /or
“Business Day” means days other than holidays where Stock exchanges Supplementary Contract.
with National wide terminals will open for trade (other than day on which “Revival” - When the Premium remains unpaid at the end of the Grace
exchanges are open for testing) or any day declared by the Authority as Period and the Policy has not been Completely Withdrawn for its Total
business day. Fund Value it can be revived, upon Your request, subject to
“Claimant” means the Policyholder or the Life Insured or the Nominee or Discontinuance clause 1 under Part D with all benefits, with or without
the assignee the legal heir of the Policyholder. Supplementary contract benefits if any, after the receipt of all the premiums
“Date of Discontinuance of Policy” means the date of receipt of due and other charges if any, and upon being satisfied on Your continued
intimation about Discontinuance of Policy from You or the date of intimation insurability on the basis of the documents and reports furnished.
about complete withdrawal of the Policy from You, whichever is earlier. “Supplementary Contract” refers to an additional agreement attached to
“Date of Commencement of Risk” is the date when risk coverage under and providing insurance benefits in addition to the Basic Policy. Such
this Policy or its relevant Top-Up Sum Assured or Supplementary Contract contract shall be co-existing and concurrent to the Basic Policy, unless
commences and is mentioned on the Policy Schedule. specified otherwise.
“Date of Payment of Premium” means the date the premium is received “Top-Up Fund Value” is equal to the number of Units under the Top-Up
by Us. Fund of this Policy multiplied by the NAV on the relevant Valuation Date.
“Deductible Partial Withdrawal” means partial withdrawal if any “Top-Up Premium” means an additional amount(s) of premium paid, if
made, during the last two Policy Years immediately preceding the death any, over and above the basic premium stipulated in the terms and
of the Life Insured. conditions, at irregular intervals during the period of contract.
“Discontinuance” means the state of the Policy that could arise on “Top-Up Sum Assured” refers to the Sum Assured to be added to the
surrender of Policy or non-payment of the due premiums, provided that no Basic Policy in respect of a Top-Up Premium.
Policy shall be treated as discontinued on non-payment of the said “Total Fund Value” is equal to the sum of the Fund Value and the Top-Up
premium if, within the Grace Period, the premium has not been paid due Fund Value under this Policy on the relevant Valuation Date.
to death of the Insured or upon the happening of any other contingency “Unit” means the specific portion or part of the underlying segregated Unit
covered under the Policy. Linked Fund, which is representative of the Policyholders entitlement in
“Discontinued Policy Fund” means Insurer’s segregated fund that is set such funds.
aside and is constituted by the fund value of all discontinued policies. “Valuation Date” refers to the date when the assets of the Fund are
“Fund” means a separately identifiable investment-linked fund set up and valued. The date shall be determined by Us from time to time.
managed by Us for the purpose of achieving the objectives of the fund. “We”, “Us”, or “Our” refers to Tata AIA Life Insurance Company Limited.
“Fund Value” means the total value of the Units at that point of time in a “You” or “Your” means the Policyholder of this Policy as shown in the
segregated fund i.e. total number of units under Policy x the Net Asset Policy Schedule.
Value (NAV) per unit of that fund on the relevant valuation date.
Interpretation: Whenever the context requires, the masculine form shall
“Fund Management Charge” is a charge levied as a percentage of the apply to feminine and singular terms shall include the plural.
value of assets and shall be appropriated by adjusting the Net Asset Value
as prescribed in the Fund Valuation section of the Fund Provisions. PART C
“IRDA of India” – means Insurance Regulatory and Development 1. MATURITY BENEFIT:
Authority of India. If the Insured is alive on the Maturity Date and the Policy is in force, Fund
“Life Insured” means the person whose life is insured under the Policy as Value (as applicable) and Top Up Fund Value valued at applicable NAV at
shown in the Policy Schedule. date of maturity shall be payable to You.
“Lock-in-period” means the period of five consecutive years from the 2. DEATH BENEFIT:
Date of Commencement of the policy, during which period the proceeds of Upon death of the Insured during the term of the Policy & while the
the discontinued policies cannot be paid by Us to You, as the case may Policy is inforce following shall be payable to the Claimant:
be, except in the case of death or upon the happening of any other Highest of
contingency covered under the Policy.
(i) the Basic Sum Assured net of all “Deductible Partial Withdrawal”, if
“Maturity Benefit” means the benefit which is payable on the maturity i.e. any, from the Fund Value (as applicable); or
at the end of the term as specified in the Policy Schedule. (ii) the Fund Value (as applicable) of the Policy; or
“Maturity Date / Expiry Date” of the Policy is shown in the Policy (iii) 105% of the total Regular Premiums / Single Premium paid up to the
Schedule. On such maturity / expiry all the benefits under the Policy / date of death
supplementary contract shall cease.
In addition to this:
“Net Asset Value (NAV) per Unit” (also called “NAV per Unit) means the
price per unit of the segregated fund is the value at which a Unit shall be Highest of
debited from / credited to this Policy. NAV per Unit at a Valuation Date is (i) the approved Top-Up Sum Assured(s); or
determined according to the Fund Valuation provisions. (ii) Top-Up Fund Value of this Policy; or
“Partial Withdrawals” means any part of a Fund that is withdrawn by You. (iii) 105% of the total Top-Up premium paid
“Policy” means this contract of Insurance. Is also payable provided You have a Top-Up Fund Value. Deductible Partial
“Policy Anniversary” refers to the same date each year as the Date of Withdrawals are not applicable in case of Top-Up Sum Assured up to the
Commencement of Policy. date of death
“Policy Charges” are the charges applicable to the Policy. The current 3. LOYALTY ADDITIONS
charges on the Policy as on the Issue Date are set out in the Schedule of a) Provided the Policy is in force and all due premiums have been paid,
Policy Charges. We may add new charges and alter the charges and fees following units shall be added in each fund, till death or maturity,
as shown in the said Schedule from time to time by giving advance notice whichever is earlier.

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
b) In case of single premium Policy 0.35% of the units in each of the 1) Date of Maturity of Policy
funds shall be credited (post deduction of applicable charges) to the (2)Date of Complete Withdrawal
respective funds annually from 6th Policy Anniversary till the end of
Policy Term. (3)Date of Death of the Life Insured,
c) In Limited/Regular premium policy, 0.20% of the units in each of the (4)Date of end of Lock-in-period / revival period, whichever is later, in
funds shall be credited (post deduction of applicable charges) to the case of Discontinuance of Premium within 5 years, provided the Policy
respective funds annually from 11th Policy Anniversary till the end of the is not revived during the revival period.
Policy Term. This clause shall not be applicable, while the Policy is in force during its
d) The above Loyalty additions shall not be applicable for the Top Up Premium paying term
Fund Value. 5) In case of Single Premium Policy, the Policy will terminate as and when
4. REGULAR PREMIUM the total Fund Value becomes less than or equal to 1% of Single
Premium and the balance Fund Value shall be payable to you. This
a) All Regular Premiums are payable on or before their due dates to Us. situation may result because of the combined impact of Partial
b) Change of Regular Premium is not allowed. Withdrawals at inopportune time and fund performance.
c) Regular Premiums received are subject to Regular Premium Allocation 6) In case of Regular Premium Policy, after completion of Premium
Charge if any, as set out in the Schedule of Policy Charges. Paying Term, the Policy will terminate as and when the total Fund Value
d) Subject to Our minimum premium requirements and approval, becomes less than or equal to one Annualised Premium and the
Regular Premium may be paid on annual, Semi annual, quarterly and balance Fund Value shall be payable to You.
monthly mode. 10. PAYMENT OF BENEFITS
5. TOP-UP PREMIUM The benefit under the Policy shall be payable to the Claimant who will be
a) After the Date of commencement and while the Policy is in force, and either the Policyholder, Life Insured, Nominee(s), Assignee(s), Legal Heir(s)
subject to below mentioned conditions/rules/ limits and availability of or a legal representative as declared by a Court of competent jurisdiction.
the relevant Fund(s), You may apply to pay a Top-Up premium into this Once the benefits under this Policy are paid to a Claimant, the same shall
Policy at any time, except during the last 5 years of the Policy Term. constitute a valid discharge of Our liability under this Policy.
Each Top-Up Premium shall not be less than Rupees Five Thousand
11. CLAIM PROCEDURES
(r5,000) and not more than four (4) Top-Up Premiums will be accepted
in each policy year. Top-Up premium can be allocated in various 11.1. DEATH CLAIMS REQUIREMENTS
available funds in any proportion between the funds offered as chosen For processing the claim request under this Policy, we will require the
by You. following documents:
b) Total Top-Up premium during the term shall never exceed the Total Type of Claim Requirement
amount of Premiums / Single premium paid during the term.
a) Claim Forms
c) Payment of Top-Up Premiums is subject to Charges as set out in the
• Part I: Application Form for Death Claim
Schedule of Policy Charges. (Claimant's Statement) along with NEFT form
Each Top-Up Premium paid shall have an additional Sum Assured of • Part II: Physician's Statement - to be filled by last
1.25 times of the Top-Up premium paid, subject to Underwriting attending physician
The premium multiple for Top Up Sum Assured if chosen can be b) Death Certificate issued by a local government
different for that chosen for the Regular Premiums. Death body like Municipal Corporation
d) The Change in Top-Up Sum Assured shall be effective from Policy (all causes of c) Medical Records (Admission Notes, Discharge/
Monthly Date. death other than Death Summary, Indoor Case Papers, Test
e) Top-Up Premium shall be approved subject to prevailing Board the Accidental Reports etc)1
Death)
approved underwriting guidelines. We shall return any un-approved d) Claimant's Photo ID with age proof & relationship
Top-Up Premium applied for. with the Insured along with Address proof of the
claimant and Cancelled cheque with name and
f) Top-Up premium will not be accepted while the Policy is in account number printed or cancelled cheque with
Discontinuance. copy of Bank Passbook / Bank Statement
g) We may also limit the frequency of or may stop accepting Top-Up If no nomination - Proof of legal title to the claim
Premium by sending a three (3) months prior written notice to You and proceeds (e.g. legal succession paper)
on prior approval of IRDA of India.
e) In case of accidental death in addition to the
6. PAYMENT AND CHANGE above documents, we would require the following
If Death due to documents -
You may change the frequency of the Regular Premium payments by Accident (to be
giving a written request to Us at any time when the Policy is in force, unless submitted in - Postmortem report (Autopsy report) & Chemical
Enhanced SMART is active, where Annual mode is compulsory, subject to addition to the Viscera report - if performed;
minimum premium criteria. above) - All Police Papers – Panchnama, Inquest, First
Premiums payable monthly shall be paid by auto-deduction through a Information Report (FIR) and Final Investigation
bank, unless We agree otherwise in writing. Report.
You will not be allowed to change the Premium Paying Term of the Policy.
1
This is applicable if insured was in hospital at the time of death or any time
prior to the date of death.
Increase or decrease in Basic Premium is not allowed.
Please submit copies of the following documents certified / attested by the
7. CHANGE IN SUM ASSURED issuing authority. (Original Seen Verified (OSV) by Branch Personnel will
Increase or Decrease in Top-Up Sum Assured is not allowed. also be accepted) –
You have an option to increase or decrease the Basic Sum Assured by - All Police papers – Panchnama, Inquest, First Information Report and
changing the premium multiple subject to prevailing underwriting rules and Final Investigation Report.
is subject to the minimum / maximum Basic Sum Assured allowed under - Medical Records (Admission Notes, Discharge/Death Summary,
this product. Indoor Case Papers, Test Reports etc).
8. GRACE PERIOD - Postmortem report (Autopsy report) & Chemical Viscera report
A Grace Period of fifteen days for monthly mode and thirty days for all (certified by Police / Magistrate / Court will also be accepted)
other modes, from the due date (the “Grace Period”) will be allowed for all Copies of the other documents to be submitted by self-attestation of
subsequent Regular Premium payments. The Policy will remain in force the claimant
during the Grace Period. If any Regular Premium remains unpaid at the
end of its Grace Period, the Policy will be subject to the Discontinuance of 11.2. CLAIMS INTIMATION PROCESS
Premium Provisions. Please inform the company immediately upon occurrence of death.
9. TERMINATION A claim can be made through any of the following avenues:-
All coverage under this Policy shall automatically terminate on the a. Online at www.tataaia.com
occurrence of the earliest of the following:
b. Email - Customercare@tataaia.com

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
c. Call our helpline number 1-860-266-9966 (local charges apply) Walk into Period.
any of the Company branch office - If You do not exercise any option as set out above, the Policy shall
d. Write directly to us on following address: continue to be Reduced Paid Up Policy. At the end of the Revival
Tata AIA Life Insurance Company Limited Period, the Proceeds of the Discontinued Policy Fund shall be paid
to You and the Policy shall terminate.
B - Wing, 9th Floor, I-Think Techno Campus, Behind TCS, Pokhran Road
No.2, Close to Eastern Express Highway, Thane (West) – 400 607, - However, You may opt for Complete Withdrawal anytime as per
Maharashtra. clause 3 under Part D (“Complete Withdrawal”) of this Policy.

12. CHANGE IN ADDRESS OF POLICYHOLDER OR NOMINEE:

ii. Single Premium Policy:
In order to provide You better services, We request You to intimate us in
You may opt for Complete Withdrawal anytime as per clause 3
the event of any change in the address of the Policyholder or the nominee.
under Part D (“Complete Withdrawal”) of this Policy.
PART D In case of death during this period, the death benefit as mentioned
1. DISCONTINUANCE OF PREMIUM PROVISION under Clause 2 Part C (“Death Benefit”) shall be payable
immediately on death.
A) Discontinuance of Premium Within Five Years from the Date of
Commencement of Policy 2. PARTIAL WITHDRAWAL OF FUND VALUE
b) Discontinuance of Premium within Five Year from the Date of a) You have an option to partially withdraw from the Fund Value at any
Commencement of Policy time provided the Policy has completed at least five (5) Policy
i. Other than Single Premium Policy: anniversaries from the Date of Commencement if Policy is in force or
Upon expiry of the Grace Period, in case of Discontinuance of in Reduced Paid Up.
Policy due to non-payment of Premium, the Fund Value after b) Partial withdrawal from the Top-Up Fund Value shall be allowed on
deducting the applicable Discontinuance Charges, shall be completion of five Policy Anniversaries from the date of acceptance of
credited to the Discontinued Policy Fund, and the risk cover and each such Top-Up Premium except in case of Complete Withdrawal of
rider cover, if any, shall cease. the Policy.
You shall be provided a period of three years from date of first c) Partial withdrawal shall be allowed only after Insured attains 18 years
unpaid premium (“Revival Period”). On such Discontinuance, We of age.
shall communicate the status of the Policy, within three months of
d) Partial Withdrawals shall be allowed first from the Top-Up Fund Value
the first unpaid Premium, to You and provide the option to revive
and then from the Fund Value, if Top Up fund is insufficient.
the Policy during the Revival Period.
- If You opt to revive but do not revive the Policy during the Revival e) In Regular Premium Policy, no partial withdrawal shall be allowed if the
Period, the Proceeds of the Discontinued Policy Fund shall be paid amount payable on such partial withdrawal is less than Five thousand
at the end of the Revival Period or Lock-in-period, whichever is Rupees (r5,000) or the Total Fund Value post such withdrawals is less
later. In respect of Revival Period ending after Lock-in-period, the than an amount equivalent to higher of One Annualised Regular
Policy will remain in Discontinuance Policy Fund till the end of Premium.
Revival Period. The Fund Management Charges shall be applicable f) In Single Premium Policy, no partial withdrawal shall be allowed if the
during this period and no other charges shall be applied. amount payable on such partial withdrawal is less than Five thousand
- In case You do not exercise the option as set out above, the Policy Rupees (r5,000) or the Total Fund Value post such withdrawals is less
shall continue without any risk cover and rider cover, if any, and the 5% of the Single Premium Paid.
Policy fund shall remain invested in the Discontinued Policy Fund. g) Partial withdrawal shall not be allowed if it would result in termination
At the end of the Lock-in-period, the Proceeds of the Discontinued of the contract
Policy Fund shall be paid to You and the policy shall terminate.
h) You may withdraw a part of the Fund Value by giving a written notice
- However, You may opt for Complete Withdrawal anytime as per to Us specifying the number of Units or the amount and the Fund to be
clause 3 under Part D (“Complete Withdrawal”) of this Policy. withdrawn from, subject to the conditions mentioned herein and Our
ii. Single Premium Policy: approval.
You may opt for Complete Withdrawal anytime as per clause 3 i) In the case of Partial Withdrawals from the Fund Value, the amount
under Part D (“Complete Withdrawal”) of this Policy. payable is equal to the number of Units to be withdrawn multiplied by
Upon receipt of request for Complete Withdrawal, the Fund Value, the NAV of the relevant Fund on the applicable NAV specified under the
after deducting the applicable Discontinuance Charges, shall be paragraph “Cut-off time for determining the appropriate valuation date”.
credited to the Discontinued Policy Fund. The Policy shall continue j) Partial withdrawal is allowed maximum up to 4 times in a Policy Year.
to be invested in the Discontinued Policy Fund.
k) The Company may alter the above partial withdrawal conditions/rules,
iii. In case of death of the Life Insured during Discontinuance
on prior clearance from the IRDA of India.
period, the “Proceeds of the Discontinued Policy” shall be
payable immediately 3. COMPLETE WITHDRAWAL
C) Discontinuance of Premium After Five Years from the Date of a) Complete withdrawal of this Policy within five Policy Years:
Commencement of Policy Other than Single Premium Policy:
i. Other than Single Premium Policy: On complete withdrawal of the Policy, Proceeds of the Discontinued
Upon expiry of the Grace Period, in case of Discontinuance of Policy shall be payable at the end of Lock-in-period or date of
Policy due to non-payment of Premium after Lock-in-period, the Complete Withdrawal, whichever is later.. All benefits in this Policy shall
Policy shall be converted into a Reduced Paid Up Policy (as per cease on the date of complete withdrawal.
Clause 4 under Part D of this Policy. The Policy shall continue to Single Premium Policy:
be Reduced Paid Up Policy without rider cover, if any. All charges
as per terms and conditions of the Policy may be deducted during The Proceeds of Discontinued Policy Fund shall be paid at the end of
the Revival Period. However, the Mortality Charges shall be Lock-in-period. Fund Management Charge shall be deducted from the
deducted based on the Reduced Paid Up Sum Assured. Discontinued Policy Fund this period. No risk cover shall be available
during the Discontinuance period.
We shall communicate the status of the Policy, within three months
of the first unpaid Premium, to You and provide the following b) Complete withdrawal of Policy after five Policy Years:
options: Upon complete withdrawal of the Policy after five Policy Years, the Total
1) To revive the policy within the revival period of three years, or Fund Value as on the date of complete withdrawal, shall be payable.
2) Complete withdrawal of the policy. In case of Discontinuance of Premium, if You opt for Complete
Withdrawal, the Proceeds of the Discontinued Policy Fund shall be
- If You opt to revive but do not revive the Policy during the Revival
payable as on the date of Complete Withdrawal.
Period, the Fund Value shall be paid to You at the end of the Revival

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
4. REDUCED PAID UP We shall levy Premium Allocation charge as applicable after
a) In the event the Policy is converted into Reduced Paid Up as per Lock-in-period. Upon revival, the risk cover shall be restored.
Clause 1 (b) under Part D of this Policy, the, Policy shall continue with d) Any evidence of insurability requested at the time of revival will
Reduced Paid Up Sum Assured as mentioned below: be based on the prevailing underwriting policy duly approved by
the Board of the Company.
b) Reduced Paid Up Sum Assured = Basic Sum Assured * (t/n),
Where t = Total number of Premiums Paid
8. LOAN
n = Total number of Premiums payable during entire term of the Policy
No loan is available from the Company under this Policy.
9. FUND SWITCHING
c) A Reduced Paid Up Policy will continue as per the Policy Terms and
conditions and charges shall continue to be deducted. a) You may send Us a written request to switch investment between
available Funds. The written request must specify the Fund(s)from
You shall have an option restoring the Policy to the Basic Sum Assured which Units are to be redeemed and the Fund(s)to which Units are
before the end of Revival Period. being allocated,
d) Top-Ups shall not be allowed when the Policy is in Reduced Paid Up b) The first twelve (12) switches in any one policy year will be processed
status. without a switching fee, but any further switches will be processed at
the Fund Switching Charge specified in the Schedule of Policy
5. FREE LOOK PERIOD
Charges, which may be amended by Us from time to time and the
If You are not satisfied with the terms & conditions/features of the Policy, same shall be binding on You.
You have the right to cancel the Policy by giving written notice to Us stating c) Any such request will be effected on the applicable NAV as specified in
objections/reasons and You will receive the non – allocated premiums plus the section Clause 5 under Part E “Cut-off time for determining the
charges levied by cancellation of units plus fund value at the date of appropriate valuation date” under Fund Provisions.
cancellation less (a) for proportionate risk premium for the period of cover
d) Switching may be restricted if the portfolio strategy is chosen.
(b) medical examination costs, if any and (c) stamp duty, along with
applicable taxes, cesses and levies on above which has been incurred for PART E
issuing the Policy. The units will be repurchased by the company at the
1. INVESTMENT POWER
price of the units on the date of cancellation and any surplus or deficit shall
be adjusted in the payout to the Policyholder. Such notice must be signed The selection of the underlying investments of each Fund established by
by You and received directly by Us within 15 days after You or person Us will be determined by Us from time to time according to the investment
authorized by you receives the Policy. This period of 15 days shall stand objectives of such Fund as stated in the Schedule of Fund. This may
extended to 30 days, if the policy is sourced through electronic or distance include, but not limited to, deployment of monies of the Fund in short term
investment vehicles (such as deposits of scheduled commercial banks,
marketing mode. Distance Marketing includes every activity of solicitation
cash or call deposits etc.) which may or may not earn any income.
(including lead generation) and sale of Insurance products through voice
mode, SMS electronic mode, physical mode (like postal mail) or any other 2. FUND VALUATION
means of communication other than in person. a) The value of each Fund (the “Fund Value”) specially created by Us
6. SETTLEMENT OPTION shall be determined by Us on daily basis on all Business Days under
normal circumstances.
a) Provided that the Insured is alive on the Maturity Date, You have an
b) The Fund’s liabilities shall consist of accrued and unpaid investment
option to receive Your Maturity Benefit either in lump sum or in the
expenses incurred by the Fund such as taxes and stamp duties,
form of periodical payments over a certain period of time (termed as
registration fees, legal, auditing and custodian fees and stock brokers’
“Settlement Period”) provided that such period shall not exceed five
brokerage incurred in the sales or purchases of assets, insurance
years from the Maturity Date. The frequency of periodical payments
costs and expenses incurred in the management and maintenance of
shall be chosen by You at time of exercising this option. The first
the Fund and expenses incurred to ensure compliance with statutory
payout shall commence from the Maturity Date. The value of such
and regulatory requirements relating to the Fund. It also includes any
periodical payments will depend on the performance of the Funds
Fund Management Charge chargeable to the Fund.
selected by You for investment. Switching and Partial Withdrawal
are not available during the Settlement Period. At any time during c) Fund Value of a particular fund is arrived at by multiplying the number
the settlement period You will have the option to withdraw the of Units in that particular Fund by the NAV of that particular Fund on
remaining Fund Value, without any charge. the relevant Valuation Date.
b) During this Settlement Period, life cover shall be equal to 105% of 3. NET ASSET VALUE AND UNIT PRICING
the Total Premiums Paid and upon Your death We shall return a) When We are required to purchase assets to allocate Units or sell
higher of below to the Nominee: assets to redeem Units at a Valuation Date, the Net Asset Value, NAV
per Unit is determined in the following method:
• the Fund Value of the selected Funds at the time of death as
per Clause 12 under Part F of this Policy; or b) NAV (Net Asset Value) = (Market Value of Investment held by the Fund)
+ (Value of Current Assets) – (Value of Current Liabilities & Provisions,
• 105% of the Total Premiums Paid. if any)
c) During this Settlement Period the Fund Management Charge and c) NAV per Unit = NAV / Total number of Units existing on Valuation Date
Mortality Charge will be deducted as per the Schedule of Policy (before creation/redemption of Units)
Charges and the inherent investment risk will be borne by You.
4. CREDIT/DEBIT OF UNITS
7. REVIVAL
a) The premiums received, after deducting the payable Premium
a) Subject to Clause 1 Part D (“Discontinuance of Premium Allocation Charge/Top-Up Premium Allocation Charge and applicable
provision”), and subject to (i) Your written application for revival; (ii) taxes, cesses & levies (as described in the Schedule of Policy Charges)
production of Insured’s current health certificate and other evidence of will be used to purchase Units at the NAV according to Your
insurability satisfactory to Us; (iii) payment of all overdue premiums; the instructions for allocation of premium. Units purchased by Regular
Policy may be revived. Premiums/Single Premium and Top-Up Premium, net of payable
b) Revival of Discontinued Policy during Lock-in-period: Allocation Charges and applicable taxes, cesses & levies will be
We shall levy Policy Administration charge and Premium Allocation deposited into the Fund Value and Top-Up Fund Value respectively.
charge as applicable during Lock-in-period. b) Where notice is required (Partial Withdrawal, Complete Withdrawal or
We shall add back to the fund, the Discontinuance charges deducted death of the Insured), Units being debited shall be valued by reference
at the time of Discontinuance of the Policy. to their NAV as specified in the section “Cut-off time for determining
the appropriate valuation date” under Fund Provisions.
Upon revival, the risk cover shall be restored, along with the
investments made in the segregated funds as chosen by You, out of 5. CUT-OFF TIME FOR DETERMINING THE APPROPRIATE
the Discontinued Policy Fund, less the applicable charges in VALUATION DATE
accordance with the terms and conditions of the Policy. The appropriate valuation date at which NAV will be used to purchase or
c) Revival of Discontinued Policy after Lock-in-period: redeem Units shall be determined in the following manner:-

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
a) Purchase & Allocation of Units in respect of Premiums received or
Fund Value(s) switched in: b) Through Enhanced SMART, Policyholder’s entire annual / single
• If the premiums, by way of cash or a local cheque or a demand allocable premium will be parked in the chosen debt oriented fund
along with any existing units in that fund, if any. These combined units
draft payable at par or the request for switching in Fund Value(s)
in the chosen debt oriented fund will be systematically transferred on
is/are received by us at or before 3:00 p.m. of a Business Day at
a monthly basis to the chosen equity oriented fund. All the future
the place where these are receivable, NAV of the date of receipt or allocable premiums will also follow the same pattern as long as
the due date, whichever is later shall apply. Enhanced SMART is active on the plan. Switching to/from the SMART
• If the premium/s, by way of cash or a local cheque or a demand funds will not be applicable from / to other available funds.
draft payable at par or the request for switching in Fund Value(s) c) Thus, while the stock market remains volatile and unpredictable,
is/are received by us after 3:00 pm of a business day, at the place Enhanced SMART Strategy offers a systematic way of rupee cost
where these are receivable, NAV of the next valuation date averaging. However, all investments through this option are still subject
following the receipt or the due date, whichever is later shall apply. to investment risks, which shall continue to be borne by You.
• If the premium/s is received by us by way of an outstation d) A portion of total units in the chosen debt oriented fund shall be
cheque/outstation demand draft, NAV of the date on which these switched automatically into the chosen equity oriented fund in the
instruments are realized shall apply. following way:
• In case of proposals or requests for Top-Up Premium where e) Monthly Enhanced SMART
underwriting or Our approval is required, the closing NAV of the day
Policy Month 1 1/12 of the units available at the beginning of Policy
on which underwriting/approval is completed in all respects or the
Month 1
date of receipt of premium (in case of cash or local cheque or
demand draft payable at par) or the date of cheque/demand draft Policy Month 2 1/11 of the units available at the beginning of Policy
realization (in case of an outstation cheque/demand draft) Month 2
whichever is later shall apply. ..........................
• If premiums are received via standing instruction (such as auto pay, Policy Month 6 1/ 7 of the units available at the beginning of Policy
credit cards, electronic clearing system etc) the same procedure as Month 6
for local cheques will apply with the date of sending the collection ..........................
request to the relevant bank/financial institution being taken as the
Policy Month 11 ½ of the units available at the beginning of Policy
date of receipt of the local cheque.
Month 11
b) Sale & Redemption of Units in respect of withdrawals, surrender, Fund
Policy Month 12 Balance units available at the beginning of Policy
Value(s) switched out, death claim: Month 12
• If a valid request/application is received by us at or before 3:00 pm
f) The following are the notable features of Enhanced SMART:-
of a Business Day, NAV of the date of receipt shall apply.
• If a valid request/application is received by us after 3:00 pm of a i. Enhanced SMART can be availed at Your option, exercisable at Date
Business Day, NAV of the next valuation date following the receipt of Commencement of Policy or on any policy anniversary. A written
shall apply. request to commence, change or restart Enhanced SMART should
be received 30 days in advance of the Policy Anniversary. The request
6. PREMIUM ALLOCATION shall take effect on the following Policy Anniversary. Once chosen the
a) Regular Premiums / Single Premium and Top-Up Premiums received strategy will be applicable for future premiums for all the premium
after deducting the Premium Allocation Charge / Top-Up Premium payment terms except single premium.
Allocation Charge as applicable, will be invested into the Fund ii. Request for commencement, change or restart of Enhanced
according to Your instruction of premium allocation. Units thus SMART will be subject to all due premiums being paid.
purchased by Regular / Single Premium and Top-Up Premium will be
credited to the Regular Premiums / Single Premium Fund and Top-Up iii. Enhanced SMART option is available only to the policies with the
Fund of the Policy respectively. Annual/Single Mode of payment
b) You may give Us a notice in writing to change the premium allocation iv. The automatic fund switches in the Enhanced SMART option are
(Premium Re-direction) for Regular Premium unless the Enhanced available out of the 12 free switches.
Systematic Money Allocation & Regular Transfer (Enhanced SMART) v. Enhanced SMART is free of any charge.
has been opted for. The change will be effected on the next premium vi. You will have the option to stop the Enhanced SMART at any point
allocation following Our approval. No Premium Re-direction Charge of time by a written request and it shall take effect from the next
is payable. Enhanced SMART switching that follows the Company’s receipt.
c) The premium allocation or Premium Re-direction shall be in whole vii. Manual fund switching for the two funds selected for activation of
integer percentage and if more than one Fund is involved, the sum of Enhanced SMART is not allowed. Manual fund switching is allowed
the allocations shall add up to one hundred (100) percent. on other available funds at applicable charges. For Top Up Premium,
d) Premium Re-direction will not be allowed if Enhanced SMART is chosen. manual switching options will be available at applicable charges.
e) Your instructions for premium allocation or premium re-direction are viii. Any amount remaining in regular / single premium funds other than
subject to the availability of the relevant Fund and Our rules for such the two funds selected for activation of Enhanced SMART, would
allocations and approval. continue to remain invested in those funds.
7. ENHANCED SYSTEMATIC MONEY ALLOCATION & REGULAR ix. Enhanced SMART Option will not be available during
TRANSFER (ENHANCED SMART) Discontinuance of Premium. On revival of the Policy, You can opt
a) Enhanced SMART is a systematic transfer plan available only to the for Enhanced SMART again.
policies with the annual / single mode of payment. It allows You to x. In case of Single Premium Paying Policy :
enter the volatile equity market in a structured manner under the • Enhanced Smart Strategy can only be opted for at Policy inception
Regular / Single Premium Fund. Under Enhanced SMART, You need
• Enhanced Smart Strategy will be applicable for policy year One only
to choose two funds, a debt oriented fund and an equity oriented fund.
Please refer to table below for the choice of available funds: • From the end of Year One, the amount will remain invested in
the equity oriented fund, as chosen by You under Enhanced
Debt Oriented Funds Equity Oriented Funds Smart Strategy.
Large Cap Equity Fund
•You have an option to do manual fund switching to other available
Whole Life Mid Cap Equity Fund funds after the end of policy year One.
Whole Life Income Fund
Multi Cap Fund g) We may cease offering Enhanced SMART by giving 30 days of written
India Consumption Fund notice subject to prior approval of Insurance Regulatory and
Top 50 Fund Development Authority of India.
Whole Life Short-Term h) This option is applicable only during Premium Paying Term of the
Top 200 fund
Fixed Income Fund Policy. Enhanced SMART Strategy is not available with Top Up
Super Select Equity Fund Premium fund.
Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
SCHEDULE OF POLICY CHARGES
The current charges on the Policy as on the Issue Date are as follows.
We may add new charges and alter the charges and fees as shown in this schedule (except the Mortality Charge and Premium Allocation Charge) from
time to time by sending advance notice of at least three (3) months and on prior clearance from Insurance Regulatory and Development Authority of India.
Discontinuance Charge:
Discontinuance charge is applicable in case of Complete Withdrawal and Discontinuance of Premium Payment as the case may be and is as follows:
There are no Discontinuance Charges applicable on the Top-Up Fund Value.
The maximum Discontinuance Charge shall not exceed the limits as decided by the IRDA of India from time to time.
For Single Premium Policy –
Where the policy is
discontinued during Maximum Discontinuance Charges for Maximum Discontinuance Charges for
the policy year the policies having Single Premium up to R 3,00,000/- the policies having Single Premium above R 3,00,000/-

Lower of 2% of Single Premium or Single Premium Fund Value Lower of 1% of Single Premium or Single Premium Fund Value
1
subject to a maximum of R 3000/- subject to a maximum of R 6000/-
2 Lower of 1.5% of Single Premium or Single Premium Fund Value Lower of 0.70% of Single Premium or Single Premium Fund Value
subject to a maximum of R 2000/- subject to a maximum of R 5000/-
3 Lower of 1% of Single Premium or Single Premium Fund Value Lower of 0.50% of Single Premium or Single Premium Fund Value
subject to a maximum of R1500/- subject to a maximum of R 4000/-
4 Lower of 0.5% of Single Premium or Single Premium Fund Value Lower of 0.35% of Single Premium or Single Premium Fund Value
subject to a maximum of R 1000/- subject to a maximum of R 2000/-
5 and onwards Nil Nil

For Regular/ Limited Pay –

Where the policy is
discontinued during Maximum Discontinuance Charges for the policies Maximum Discontinuance Charges for the policies
the policy year having annualized premium up to R 50,000/- having annualized premium above R 50,000/-

Lower of 20% of Annualised Premium or Regular Premium Fund Lower of 6% of Annualised Premium or Regular Premium Fund
1
Value subject to a maximum of R 3000 Value subject to a maximum of R 6000
2 Lower of 15% of Annualised Premium or Regular Premium Fund Lower of 4% of Annualised Premium or Regular Premium Fund
Value subject to a maximum of R 2000 Value subject to a maximum of R 5000
3 Lower of 10% of Annualised Premium or Regular Premium Fund Lower of 3% of Annualised Premium or Regular Premium Fund
Value subject to a maximum of R 1500 Value subject to a maximum of R 4000
4 Lower of 5% of Annualised Premium or Regular Premium Fund Lower of 2% of Annualised Premium or Regular Premium Fund
Value subject to a maximum of R 1000 Value subject maximum of R 2000
5 and onwards Nil Nil
Partial Withdrawal Charge: may be increased by up to a maximum of 5% per annum compounded
No Charges for Partial Withdrawal annually subject to a maximum of R 500 per month, which are the current
limit specified by the Authority and can change from time to time.
Regular Premiums/Single Premium Allocation Charge: Unit deduction will first be made from the Fund Value, and if insufficient,
Regular Premium Allocation Charge as below will be deducted from the then from the Top-Up Fund Value.
Regular Premiums/Single Premium, as a percentage of the Regular For Single Pay –
Premiums/Single Premium amount received as below: 0.9% per annum of Single Premium throughout the Policy term
For Single Pay For Regular / Limited Pay -
Premium Allocation Charge as a % of Single Premium 0.75% p.a. of Annualised premium throughout the Policy term
Annualised Premium is the amount of Regular Premiums payable for a
Policy Year % of Single Premium
complete 12-months period excluding applicable taxes, cesses and levies,
1 3% rider premiums and underwriting extra premiums on riders, if any. The
For Regular / Limited Pay modal Premium of the Policy is arrived at as below:

Premium Allocation Charge as a % of Annualised Premium If monthly paid Annualised Premium * 0.0833

Policy Year % of Annualised Premium If quarterly paid Annualised Premium * 0.25

1-2 6% If semi-annually paid Annualised Premium * 0.5
3-5 5.5% If annually paid Annualised Premium * 1
6-7 4.5%
Mortality Charge:
8-10 3.5%
The Mortality Charge of the Basic Policy will be deducted by cancelling
11 onwards 2% Units at the Current NAV price, from the Fund value of the Policy on each
Top-Up Premium Allocation Charge: Policy Month Anniversary. In case of the Top-Up Sum Assured, the same
will be deducted from the Top-Up Fund Value. If the Fund Value is
1.5% of Single Top-Up Premium insufficient, then mortality charge will be deducted from the Top-Up Fund
The Regular / Single Premium and Top-Up premium allocation charges are Value, if any and vice-versa.
guaranteed throughout the term of the Policy. Mortality charge = Sum at Risk (SAR) multiplied by the applicable Mortality
The premium allocation charges shall not exceed the maximum premium Rate for the month, based on the attained age of the Life Insured.
allocation charge as declared by the IRDA of India which currently stands
Sum at Risk in each month for Regular / Single Premium Account is the
at 12.5% of Annualised Premium for any Policy Year.
difference between:
Policy Administration Charge: a) Maximum of (Basic Sum Assured net of all Deductible Partial
A monthly Policy Administration Charge will be deducted by cancelling Withdrawals, if any, from the relevant Fund Value or 1.05 times total
Units at the NAV of the Units from the Fund Value of the Policy. With prior Regular/Single premium paid)
approval from IRDA of India, the monthly Policy Administration Charge and

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
b) Fund Value at the time of deduction of Mortality Charge Age Mortality Charges Age Mortality Charges
Sum at Risk in each month for Top-Up Account is the difference (per 1000 SAR) per annum (per 1000 SAR) per annum
between: 48 3.3700 65 12.4150
a) Maximum of (Top-Up Sum Assured, from the relevant Top-Up Fund 49 3.7560 66 13.4830
Value or 1.05 times total Top-Up premiums paid )
50 4.1710 67 14.6580
and
51 4.0370 68 15.9470
b) Top-Up Fund Value at the time of deduction of Mortality Charge
The Mortality Charge Table is based on Indian Assured Lives Mortality 52 4.4430 69 17.3600
(2006-08) (Modified) Ult. Table for standard lives, adjusted for last birthday 53 4.8640 70 18.9050
is given below.
54 5.3000 71 20.5910
Age Mortality Charges Age Mortality Charges 55 5.7510 72 22.4300
(per 1000 SAR) per annum (per 1000 SAR) per annum
56 6.2190 73 24.4320
0 5.0050 24 1.1750
57 6.7090 74 26.6110
1 4.0990 25 1.1870
58 7.2280 75 28.9790
2 3.0880 26 1.1980
59 7.7850 76 31.5530
3 2.3290 27 1.2120
60 8.3870 77 34.3490
4 1.7610 28 1.2300
61 9.0460 78 37.3840
5 1.3370 29 1.2530
62 9.7690 79 40.6770
6 1.0250 30 1.2830
63 10.5650 80 44.2500
7 0.8000 31 0.9360
64 11.4450
8 0.6490 32 0.9700
9 0.5590 33 1.0120 Age Band Mortality Charge as a % of IALM 2006-08
10 0.5210 34 1.0620 0 to 30 120.00%
31 to 40 85.00%
11 0.5250 35 1.1220
41 to 50 80.00%
12 0.5630 36 1.1920
>50 70.00%
13 0.6230 37 1.2730
Smokers and Female lives will be treated at par with other standard lives
14 0.6970 38 1.3670 and will not be charged any extra amount.
15 0.7760 39 1.4750 The rates have been modified for age last birthday by taking an average of
16 0.8540 40 1.5990 the mortality rates of two consecutive ages of Indian Assured Lives
Mortality (2006-08) (Modified) Ult. Table for standard lives.
17 0.9260 41 1.6400
The Mortality Charges will be guaranteed for the period of the policy term.
18 0.9890 42 1.7960
The Company may alter all the above charges (except Mortality Charge
19 1.0410 43 1.9770 and Premium Allocation Charges which are guaranteed throughout the
20 1.0840 44 2.1860 term) by giving an advance notice of at least 3 months to the policyholder
subject to prior approval of Insurance Regulatory and Development
21 1.1170 45 2.4280 Authority of India and will have prospective effect.
22 1.1420 46 2.7050 Premium Re-direction Charge:
23 1.1600 47 3.0200 There is no Premium Re-direction charge.

Fund Profile
Investment Fund Fund Objective Risk Profile Asset Allocation Minimum Maximum

The primary investment objective of the Fund is to generate capital Equity 60% 100%
Multi Cap Fund (ULIF 060 appreciation in the long term by investing in a diversified portfolio of High
15/07/14 MCF 110) Large Cap and Mid Cap companies The allocation between Large Cap Debt Instruments 0% 40%
and Mid Cap companies will be largely a function of the relative
valuations of Large Cap companies as against Mid Cap companies. Cash / Money
Market Instruments 0% 40%

The primary investment objective of the Fund is to generate capital

Equity 60% 100%
India Consumption Fund appreciation in the long term by investing in a diversified portfolio of High
(ULIF 061 15/07/14 ICF companies which would benefit from India’s Domestic Consumption Debt Instruments 0% 40%
110) growth story. The India Consumption Fund could provide an
investment opportunity in the theme of rising consumption power in Cash / Money
India for long term returns. Market Instruments 0% 40%
The Top 50 Fund (SFIN: ULIF 026 12/01/09 ITF 110) will invest primarily
Equity Instruments 60% 100%
Top 50 Fund (ULIF 026 in select stocks which are a part of Nifty 50 Index with a focus on
12/01/09 ITF 110) generating long term capital appreciation. The Fund will not replicate
the index but aim to attain performance better than the performance of
the Index. As a defensive strategy arising out of market conditions, the High
Cash/ Money
scheme may also invest in debt and money market instruments. Market Instruments 0% 40%
Objective: The primary investment objective of the fund is to generate (including CP/CD)
long term capital appreciation by investing in select stocks.
The Top 200 Fund (SFIN: ULIF 027 12/01/09 ITT 110) will invest
primarily in select stocks which are a part of BSE 200 Index with a focus Equity Instruments 60% 100%
Top 200 fund (ULIF 027 on generating long term capital appreciation. The Fund will not replicate
12/01/09 ITT 110) the index but aim to attain performance better than the performance of Cash/ Money
the Index. As a defensive strategy arising out of market conditions, the High Market Instruments
scheme may also invest in debt and money market instruments. 0% 40%
(including CP/CD)
Objective: The primary investment objective of the fund is to generate
long term capital appreciation by investing in select stocks.

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
 Investment Fund Fund Objective Risk Profile Asset Allocation Minimum Maximum
The Super Select Equity Fund will invest significant amount in equity Equity and Equity 60% 100%
Super Select Equity Fund and equity linked instruments specifically excluding companies Linked Instrument
(ULIF 035 16/10/09 TSS predominantly dealing in Gambling, Lotteries/Contests, Animal
110) Produce, Liquor, Tobacco, Entertainment (Films, TV etc) Hotels, sugar,
Debt Instruments 0% 40%
leather, Banks and Financial Institutions. The risk profile of the fund is High
high. The cash holding of the Fund will be kept below 40% of the Fund
or according to the prevailing regulatory guidelines at each point of Cash/ Money
time. Objective: The primary investment objective of the fund is to Market Instruments 0% 40%
provide income distribution over a period of medium to long term while (including CP/CD)
at all times emphasizing the importance of capital appreciation
Equity and Equity
Large Cap Equity Fund The primary investment objective of the Fund is to generate long - term 80% 100%
linked Instruments
(ULIF 017 07/01/08 TLC capital appreciation from a portfolio that is invested pre-dominantly in High
110) large cap equity and equity linked securities. Cash / Money
Market Instruments 0% 20%

Equity and Equity

Whole Life Mid Cap Equity The primary investment objective of the Fund is to generate long – 60% 100%
linked Instruments
Fund (ULIF 009 04/01/07 term capital appreciation from a portfolio that is invested High
WLE 110) pre-dominantly in Mid Cap Equity and Mid Cap Equity linked Cash / Money
Market Instruments 0% 40%
securities.
Equity and Equity 50% 80%
Whole Life Aggressive The primary investment objective of the Fund is to provide higher linked Instruments
Growth Fund (ULIF 010 returns in long term by investing primarily in Equities along with debt/ Medium
to High Debt Instruments 20% 50%
04/01/07 WLA 110) money market instruments.
Cash / Money
Market Instruments 0% 30%
Equity and Equity 30% 50%
linked Instruments
Whole Life Stable Growth The primary investment objective of the Fund is to provide stable
Fund (ULIF 011 04/01/07 returns by balancing the investment in Equities and debt/ money Low to Debt Instruments 50% 70%
WLS 110) market instruments. Medium
Cash / Money
Market Instruments 0% 20%
The primary investment objective of the Fund is to generate income by Debt Instruments 60% 100%
Whole Life Income Fund investing in a range of debt and money market instruments of various
(ULIF 012 04/01/07 WLI maturities with a view to maximizing the optimal balance between Low Cash / Money
110) Market Instruments 0% 40%
yield, safety and liquidity.
Debt Instruments
The primary investment objective of the Fund is to generate stable of duration less 60% 100%
Whole Life Short-Term returns by investing in fixed income securities having shorter maturity
Fixed Income Fund (ULIF periods. Under normal circumstances, the average maturity of the Low than 3 years
013 04/01/07 WLF 110) Fund may be in the range of 1-3 years. Cash / Money
Market Instruments 0% 40%

Fund Switching Charge: high level of safety and liquidity through judicious investment in high
Fund Switching Charge is payable on each switching from one Fund to quality short term debt. The strategy is to generate better returns with low
another except for the first twelve (12) such switches in each Policy Year. level of risk through investment in fixed interest securities having short
The Fund Switching charge is Rupees One Hundred only (r100/-) per term maturity profile. The risk profile of the fund is very low. There is a
switch and will be proportionately deducted from the fund(s) to be switched minimum guarantee of interest @4% p.a. or as prescribed by IRDA of
into. This charge may be revised as deemed appropriate by Us subject to India from time to time.
prior clearance from the Insurance Regulatory and Development Authority Asset Allocation
of India but shall not exceed a maximum of r250/- or the maximum
Switching Charge declared by the IRDAI of India from time to time. Instrument Allocation
Government Securities 60% -100%
Fund Management Charges
Money Market Instruments 0% - 40%
Sr. No. Fund Name Fund Management
Charge per annum There will be a Fund Management Charge for each of the Funds deducted
1 Multi Cap Fund 1.20% at Unit Valuation Dates, which is specified above. We may alter the Fund
2 India Consumption Fund 1.20% Management Charges like other Policy Charges by sending advance
notice to You of at least three (3) months subject to prior approval from the
3 Top 50 Fund 1.20% Insurance Regulatory and Development Authority of India.
4 Top 200 Fund 1.20% In case of exceptional circumstances, investment in Cash / Money Market
5 Super Select Equity Fund 1.20% Instruments in all above funds may go up to 100% subject to prior
6 Large Cap Equity Fund 1.20% approval of IRDA of India.
7 Whole Life Mid-cap Equity Fund 1.20% Exceptional circumstances may include
8 Whole Life Aggressive Growth Fund 1.10% a) Global financial or credit crisis,
9 Whole Life Stable Growth Fund 1.00% b) War like situation,
10 Whole Life Income Fund 0.80% c) Political uncertainty
11 Whole Life Short Term Fixed Income Fund 0.65%
d) Events like Political/ Communal disturbance which affects Indian
Fund Management Charge of 0.5% p.a. will be charged on Discontinued economy and in turn impacts severely on Fixed Income/ Equity market.
Policy Fund. The current cap on Fund Management Charge (FMC) for The various funds offered under this product are the names of the funds
Discontinue Policy Fund II is 0.5% p.a. and may be revised by the Authority and words like ‘Super’ etc are used as part of the names of the funds and
from time to time. All Fund Management Charges above are subject to do not in any way indicate the quality of these funds, their future prospects
revision by Us with prior approval of IRDA of India but shall not exceed and returns.
1.35% p.a. of the Fund Value, which is the current limit specified by the
Authority and can change from time to time. Subject to the laws and regulations as applicable, the asset allocation
pattern indicated for the Fund in the Schedule of Fund may change from
Discontinued Policy Fund – Description time to time, keeping in view market conditions, market opportunities,
The investment objective for Discontinued Policy fund is to provide capital applicable regulations and political and economic factors. The
protection and a minimum return as per regulatory requirement with a percentages of investment/asset allocation pattern as stated in Schedule

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
of Fund are only indicative and not absolute and can vary substantially support of the claim.
depending upon the decision of the investment manager, the intention Proof of Continuing Loss – In the case of disability or other losses as
being at all times to seek to protect the interests of the Policyholders, and We deem appropriate, We will require, at reasonable intervals, proof of
meet the investment objectives of the relevant Fund. In this Policy, all continuing disability or loss. If such proof is not submitted as required,
investment risk is borne by You. Investments are subject to market risks or such disability or loss ceases, claims for such disability or loss will not
and You acknowledge the same. be considered.
8. TAXES
PART F All Premiums, Charges, and interest payable under the policy are exclusive
1. POLICY CONTRACT of applicable taxes, duties, surcharge, cesses or levies which will be
This Policy Contract is issued on the basis of the details provided by You entirely borne/ paid by the Policyholder, in addition to the payment of such
in the Proposal Form and the Declaration signed by You, on receipt of the Premium, charges or interest. Tata AIA Life shall have the right to claim,
required premium amount and any attached endorsement given at the deduct, adjust and, recover the amount of any applicable tax or
time of issuing this Policy. The Policy, proposal for it, the Policy Schedule imposition, levied by any statutory or administrative body, from the benefits
and any attached endorsements constitute the entire contract. The terms payable under the Policy.
and conditions of this Policy cannot be changed or waived except by 9. UNIT STATEMENTS
endorsement duly signed by Our authorized officer. Unit statements will be provided to You periodically and shall form a part of
Your Policy consists of the basic insurance plan and any endorsements the Basic Policy.
which may be attached to it 10. PLAN CHANGE
2. EXCLUSIONS Change of plan is not allowed.
2.1 SUICIDE 11. NOMINATION
In case of death due to suicide within 12 months from the Date of Nomination allowed as per provisions of Section 39 of the Insurance Act
Commencement of Policy or Date of Revival of the Policy, Your nominee or 1938 as amended from time to time. The simplified version of the
legal heir shall be entitled to Total Fund value, available on the date of provisions of Section 39 is enclosed in Annexure – (3) for reference.
intimation of death. 12. ASSIGNMENT
Any charges, other than Fund Management Charge, recovered subsequent Assignment allowed as per Section 38 of the Insurance Act 1938 as
to the date of death shall be paid back to the nominee or beneficiary along amended from time to time. The simplified version of the provisions of
with death benefit. Section 38 is enclosed in Annexure – (2) for reference.
13. JUVENILE
3. FRAUD AND NON-DISCLOSURE
This provision is applicable, where the Insured is Minor
Any non-disclosure, fraud or mis-representation under the Policy shall be
a) All benefits or proceeds payable under this Policy shall belong to the
dealt in accordance with provisions of Section 45 of the Insurance Act
Insured or his Estate who shall constitute the irrevocable Nominee of
1938 as amended from time to time. this Policy and shall be paid through the Policyholder while the Insured
The simplified version of the provisions of Section 45 is enclosed in is under 18 years of age.
annexure – (4) for reference. b) Until the Insured attains 18 years of age, You shall have the right, to
4. MISSTATEMENT OF AGE AND GENDER exercise every option, benefit or privilege under this Policy in Your
This Policy is issued at the age and gender of the Insured shown on the capacity as Original Policyholder with the best interest of the Insured
Policy Schedule which is the Insured’s declared age at last birthday and in mind.
declared gender in the proposal. If the age / gender is misstated and All Your rights and interests in the Policy shall cease when the Insured
higher mortality rate should have been charged, the benefit payable under shall have attained 18 years of age. By then, only the Insured as new
this Policy shall payable after deduction of such difference of mortality Policyholder of this Policy can exercise all rights, entitlements and
along with interest thereon. In such cases the Policy shall be subject to options provided under this Policy.
re-underwriting and the Basic Sum Assured and Top-Up Sum Assured c) When Insured shall have attained 18 years of age, the Insured, as the
shall be subject to Your eligibility as per our Underwriting norms and the new Policyholder, appoint or change a Nominee/Appointee by filing a
mortality rate to be deducted shall be calculated proportionately on such written notice to Us. Such change is valid only if recorded by Us during
Basic Sum Assured and Top-Up Sum Assured payable. If the Insured’s the Insured's lifetime.
age/gender is mis-stated and lower mortality should have been charged, d) The risk on the juvenile’s life will commence immediately from the date
We shall reverse any excess mortality charges without interest to the Fund of risk acceptance.
Value. Any undercharged Mortality Charge, without interest, will be debited
in Units at NAV. PART G
If at the correct age it is found that the Life Insured was not eligible to be CONSUMER INFORMATION
covered under this Policy pursuant to Our Underwriting rules, then subject POLICYHOLDER'S SERVICING
to Section 45 of the Insurance Act 1938 the Policy shall be treated as void
With regards to any query or issue related to the Policy, the Policyholder
and We will pay the current Total Fund Value, after deducting all applicable
charges like, medical, stamp duty, risk, applicable taxes, cesses & levies, can contact the Company through the following service avenues
etc., incurred by Us under the Policy. • Contact Your Tata AIA Life Agent / Distributor
5. CURRENCY AND PLACE OF PAYMENT • Call our helpline number 1-860-266-9966 (local charges apply)
All amounts payable either to or by Us will be paid in the Indian currency. • E-mail us at customercare@tataaia.com
Such amounts will be paid by a negotiable bank draft or cheque drawn on • Visit the nearest the Tata AIA Life branch or CAMS Service Center
a bank or NEFT (National Electronic Funds Transfer) or electronic clearing • Log on to Online Customer Portal by visiting www.tataaia.com
systems. All amounts due from Us will be payable from Our office shown
on the Policy Schedule. • Write to us on the following address:
Tata AIA Life Insurance Company Limited - B- wing, 9th Floor, I-Think
6. FREEDOM FROM RESTRICTIONS
Techno Campus, Behind TCS, Pokhran Road No.2, Close to Eastern
Unless otherwise specified, this Policy is free from any restrictions upon the
Express Highway, Thane (West) – 400 607, Maharashtra.
Insured as to travel, residence or occupation.
7. CLAIM PROCEDURES GRIEVANCE REDRESSAL PROCEDURE
Notice of Claim – All cases of death must be notified immediately to us in 1) Resolution of Grievances
writing. However, any delay in notifying shall require to be substantiated to Customers can register their grievances through multiple service avenues:
Our satisfaction
• Call our helpline number 1-860-266-9966 (local charges apply)
Please note that all death claims will be payable to the nominee/legal heir
• Email us at life.complaints@tataaia.com
of the Life Insured or Policyholder.
Filing Proof of Claim – Affirmative proof of loss and any appropriate forms • Login to online policy account on www.tataaia.com
as required by us must be completed and furnished to us, at the • Visit any of the nearest Tata AIA Life branches or CAMS Service Centers
Claimant’s expenses, within 90 days after the date the Insured event • Contact Your Tata AIA Life Agent / Distributor
happens, unless specified otherwise. A list of primary claim documents • Write to us on the following address:
listing the normally required documents is attached to the Policy.
Grievance Redressal Department - Tata AIA Life Insurance
Submission of the listed documents, forms or other proof, however, shall
Company Limited - B- wing, 9th Floor, I-Think Techno Campus,
not be construed as an admission of liabilities by the Company.
Behind TCS, Pokhran Road No.2, Close to Eastern Express Highway,
We reserve the right to require any additional proof and documents in Thane (West) – 400 607, Maharashtra.

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
 - We shall acknowledge a customer's grievance within 3 business Building, 6th floor, Tilak Marg, Relief Road, Ahmedabad - 380 001. Tel.:
days by providing the customer with the name of the Grievance 079 - 25501201/02/05/06, Email: bimalokpal.ahmedabad@ecoi.co.in,
Redressal Executive who is responsible to handle the grievance. (Jurisdiction: Gujarat, Dadra & Nagar Haveli, Daman and Diu).
BENGALURU - Office of the Insurance Ombudsman, Jeevan Soudha
- We shall provide the customer with an equitable resolution within 2 Building, PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP
weeks of receipt of the grievance. Nagar, Ist Phase, Bengaluru - 560 078. Tel.: 080 - 26652048/26652049,
- In case customers wish to contact us during the course of the Email: bimalokpal.bengaluru@ecoi.co.in, (Jurisdiction: Karnataka).
assessment, they can contact us at any of the above mentioned BHOPAL - Office of the Insurance Ombudsman, Janak Vihar Complex,
touch points. 2nd Floor, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal -
462 003. Tel.: 0755 - 2769201 / 2769202, Fax: 0755 - 2769203, Email:
- All Tata AIA Life branches have a Grievance Redressal Officer who can bimalokpal.bhopal@ecoi.co.in, (Jurisdiction: Madhya Pradesh,
be contacted for any support during the grievance redressal process. Chattisgarh). BHUBANESHWAR - Office of the Insurance Ombudsman,
2) Escalation Mechanism 62, Forest park, Bhubneshwar – 751 009. Tel.: 0674 - 2596461/ 2596455,
In case the customer is not satisfied with the decision of the above offices, Fax: 0674 - 2596429, Email: bimalokpal.bhubaneswar@ecoi.co.in,
(Jurisdiction: Orissa). CHANDIGARH - Office of the Insurance
or has not received any response within the stipulated timelines, he, may Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building,
write to the following official for resolution: Sector 17 - D, Chandigarh - 160 017. Tel.: 0172 - 2706196/ 2706468,
• 1st level of Escalation: Head - Customer Service Fax: 0172 - 2708274, Email: bimalokpal.chandigarh@ecoi.co.in,
• 2nd level of Escalation: Grievance Redressal Officer (GRO) (Jurisdiction: Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir,
Chandigarh). CHENNAI - Office of the Insurance Ombudsman, Fatima
• For escalations, customers can email to Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai - 600 018.
head.customerservice@tataaia.com or write to – Tel.: 044 - 24333668 / 24335284, Fax: 044 - 24333664, Email:
Tata AIA Life Insurance Company Limited bimalokpal.chennai@ecoi.co.in, (Jurisdiction: Tamil Nadu, Pondicherry
B- Wing, 9th Floor, I-Think Techno Campus, Behind TCS, Pokhran Road Town and Karaikal {which are part of Pondicherry}). DELHI - Office of the
Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali
No.2, Close to Eastern Express Highway, Thane (West) – 400 607, Road, New Delhi - 110 002. Tel.: 011 - 23232481/ 23213504, Email:
Maharashtra. bimalokpal.delhi@ecoi.co.in, (Jurisdiction: Delhi). ERNAKULAM - Office
We request our customers to follow the escalation mechanism in case of of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin
non-receipt of response or unsatisfactory response from the concerned Shipyard, M. G. Road, Ernakulam - 682 015. Tel.: 0484 - 2358759/
persons mentioned above. 2359338, Fax: 0484 - 2359336, Email: bimalokpal.ernakulam@ecoi.co.in,
(Jurisdiction: Kerala, Lakshadweep, Mahe-a part of Pondicherry).
If you are not satisfied with the response or do not receive a response from GUWAHATI - Office of the Insurance Ombudsman, Jeevan Nivesh, 5th
us within a month after the insurer has received his Grievance Cell of the Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati - 781001(ASSAM).
Insurance Regulatory and Development Authority of India (IRDAI) on the Tel.: 0361 - 2132204 / 2132205, Fax: 0361 - 2732937, Email:
following contact details: bimalokpal.guwahati@ecoi.co.in, (Jurisdiction: Assam, Meghalaya,
IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: 155255 or Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura).
1800 4254 732 HYDERABAD - Office of the Insurance Ombudsman, 6-2-46, 1st floor,
Moin Court, Lane Opp. Saleem Function Palace, A. C. Guards,
Email ID: complaints@irdai.gov.in Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 - 67504123/ 23312122,
You can also register Your complaint online at http://www.igms.irda.gov.in / Fax: 040 - 23376599, Email: bimalokpal.hyderabad@ecoi.co.in,
Address for communication for complaints by fax/paper: (Jurisdiction: Andhra Pradesh, Telangana, Yanam and part of Territory of
Pondicherry). JAIPUR - Office of the Insurance Ombudsman, Jeevan
Consumer Affairs Department - Grievance Redressal Cell. Nidhi - II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005. Tel.: 0141
Insurance Regulatory and Development Authority of India - 2740363, Email: bimalokpal.jaipur@ecoi.co.in, (Jurisdiction: Rajasthan).
KOLKATA - Office of the Insurance Ombudsman, Hindustan Bldg.
Sy.No.115/1, Financial District, Nanakramguda, Gachibowli, Annexe, 4th Floor, 4, C.R. Avenue, Kolkata - 700 072. Tel.: 033 -
Hyderabad – 500 032. 22124339 / 22124340, Fax : 033 - 22124341, Email:
3) Insurance Ombudsman: bimalokpal.kolkata@ecoi.co.in, (Jurisdiction: West Bengal, Sikkim,
Andaman & Nicobar Islands). LUCKNOW - Office of the Insurance
Where the redressal provided by the Company is not satisfactory despite Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road,
the escalation above, the customer may represent the case to the Hazratganj, Lucknow - 226 001. Tel.: 0522 - 2231330/2231331, Fax:
Ombudsman for Redressal of the grievance, if it pertains to the following: 0522 - 2231310, Email: bimalokpal.lucknow@ecoi.co.in, (Jurisdiction:
a) Delay in settlement of claim Districts of Uttar Pradesh: Laitpur, Jhansi, Mahoba, Hamirpur, Banda,
Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
b) Partial or total rejection of claim; Jaunpur, Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
c) Dispute with regard to premium; Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad,
d) Misrepresentation of policy terms and conditions; Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur,
Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria,
e) Legal construction of the policy in so far as dispute related to claim; Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar). MUMBAI - Office of
f) Grievance relating to policy servicing; the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road,
g) Issuance of policy which is not in conformity with proposal form; Santacruz (W), Mumbai - 400 054. Tel.: 022 - 26106552/26106960, Fax:
022 - 26106052, Email: bimalokpal.mumbai@ecoi.co.in, (Jurisdiction:
h) Non- issuance of Your insurance document; and Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane).
i) Any other matter resulting from the violation of provisions of the NOIDA - Office of the Insurance Ombudsman, Bhagwan Sahai Palace,
Insurance Act, 1938 or the regulations, circulars, guidelines or 4th Floor, Main Road, Naya Bans, Sector 15, Dist: Gautam Buddh Nagar,
instructions issued by the IRDAI from time to time or the terms and U.P-201301. Tel.: 0120 - 2514250 / 2514252 / 2514253, Email:
conditions of the policy contract, in so far as they relate to issues bimalokpal.noida@ecoi.co.in, (Jurisdiction: State of Uttaranchal and the
mentioned at clauses (a) to (h). following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor,
Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut,
Please refer to our website www.tataaia.com for further details in this regard. Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad,
The list of Ombudsman address is attached as Annexure - 1 Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur,
The complaint should be made in writing duly signed by the complainant or Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar,
Saharanpur). PATNA - Office of the Insurance Ombudsman, 1st Floor,
through his legal heirs, nominee or assignee, and shall state clearly the name Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna 800 006.
and address of the complainant, the name of the branch or office of the Tel.: 0612-2680952, Email: bimalokpal.patna@ecoi.co.in, (Jurisdiction:
insurer against whom the complaint is made, the facts giving rise to the Bihar, Jharkhand). PUNE - Office of the Insurance Ombudsman, Jeevan
complaint, supported by documents, the nature and extent of the loss caused Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road,
to the complainant and the relief sought from the Insurance Ombudsman. Narayan Peth, Pune - 411 030. Tel.: 020-41312555, Email:
As per provision 14(3) of the Insurance Ombudsman Rules, 2017; the bimalokpal.pune@ecoi.co.in, (Jurisdiction: Maharashtra, Area of Navi
Mumbai and Thane excluding Mumbai Metropolitan Region).
complaint to the Ombudsman can be made:
• Only if the grievance has been rejected by the Grievance Redressal For further information or latest updated list of Ombudsman Office
Machinery of the Insurer; addresses, kindly visit the IRDA of India website
http://www.policyholder.gov.in/ - Ombudsman / List of Insurance
• Within a period of one year from the date of rejection by the insurer;
Ombudsmen OR our website www.tataaia.com
• If it is not simultaneously under any litigation
ANNEXURE – 1 ANNEXURE- 2
A. Section 38 - Assignment and Transfer of Insurance Policies
NAMES OF OMBUDSMAN AND ADDRESSES OF
OMBUDSMAN CENTRES Assignment or transfer of a policy should be in accordance with Section 38
AHMEDABAD - Office of the Insurance Ombudsman, Jeevan Prakash of the Insurance Act, 1938 as amended by Insurance Laws (Amendment)

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
Act, 2015.The extant provisions in this regard are as follows: general information. Policyholders are advised to refer to Insurance Laws
01. This policy may be transferred/assigned, wholly or in part, with or (Amendment) Act, 2015 for complete and accurate details.]
without consideration. ANNEXURE- 3
02. An Assignment may be effected in a policy by an endorsement upon
B. Section 39 - Nomination by Policyholder
the policy itself or by a separate instrument under notice to the Insurer.
Nomination of a life insurance Policy is as below in accordance with Section
03. The instrument of assignment should indicate the fact of transfer or
39 of the Insurance Act, 1938 as amended by Insurance Laws
assignment and the reasons for the assignment or transfer, (Amendment) Act, 2015. The extant provisions in this regard are as follows:
antecedents of the assignee and terms on which assignment is made.
01. The Policyholder of a life insurance on his own life may nominate a
04. The assignment must be signed by the transferor or assignor or duly person or persons to whom money secured by the policy shall be paid
authorized agent and attested by at least one witness. in the event of his death.
05. The transfer of assignment shall not be operative as against an insurer 02. Where the nominee is a minor, the Policyholder may appoint any
until a notice in writing of the transfer or assignment and either the said person to receive the money secured by the policy in the event of
endorsement or instrument itself or copy there of certified to be correct Policyholder’s death during the minority of the nominee. The manner of
by both transferor and transferee or their duly authorised agents have appointment to be laid down by the insurer.
been delivered to the insurer.
03. Nomination can be made at any time before the maturity of the policy.
06. Fee to be paid for assignment or transfer can be specified by the
04. Nomination may be incorporated in the text of the policy itself or may
Authority through Regulations.
be endorsed on the policy communicated to the insurer and can be
07. On receipt of notice with fee, the insurer should Grant a written registered by the insurer in the records relating to the policy.
acknowledgement of receipt of notice. Such notice shall be conclusive
05. Nomination can be cancelled or changed at any time before policy
evidence against the insurer of duly receiving the notice.
matures, by an endorsement or a further endorsement or a will as the
08. If the insurer maintains one or more places of business, such notices case may be.
shall be delivered only at the place where the policy is being serviced. 06. A notice in writing of Change or Cancellation of nomination must be
09. The insurer may accept or decline to act upon any transfer or assignment delivered to the insurer for the insurer to be liable to such nominee.
or endorsement, if it has sufficient reasons to believe that it is Otherwise, insurer will not be liable if a bonafide payment is made to
a. not bonafide or the person named in the text of the policy or in the registered records
of the insurer.
b. not in the interest of the Policyholder or
07. Fee to be paid to the insurer for registering change or cancellation of a
c. not in public interest or
nomination can be specified by the Authority through Regulations.
d. is for the purpose of trading of the insurance policy.
08. On receipt of notice with fee, the insurer should grant a written
10. Before refusing to act upon endorsement, the Insurer should record the acknowledgement to the Policyholder of having registered a
reasons in writing and communicate the same in writing to Policyholder nomination or cancellation or change thereof.
within 30 days from the date of Policyholder giving a notice of transfer
09. A transfer or assignment made in accordance with Section 38 shall
or assignment. automatically cancel the nomination except in case of assignment to
11. In case of refusal to act upon the endorsement by the Insurer, any the insurer or other transferee or assignee for purpose of loan or
person aggrieved by the refusal may prefer a claim to IRDA of India against security or its reassignment after repayment. In such case, the
within 30 days of receipt of the refusal letter from the Insurer. nomination will not get cancelled to the extent of insurer’s or
12. The priority of claims of persons interested in an insurance policy would transferee’s or assignee’s interest in the policy. The nomination will get
depend on the date on which the notices of assignment or transfer is revived on repayment of the loan.
delivered to the insurer; where there are more than one instruments of 10. The right of any creditor to be paid out of the proceeds of any policy of
transfer or assignment, the priority will depend on dates of delivery of life insurance shall not be affected by the nomination.
such notices. Any dispute in this regard as to priority should be referred 11. In case of nomination by Policyholder whose life is insured, if the
to Authority. nominees die before the Policyholder, the proceeds are payable to
13. Every assignment or transfer shall be deemed to be absolute Policyholder or his heirs or legal representatives or holder of
assignment or transfer and the assignee or transferee shall be deemed succession certificate.
to be absolute assignee or transferee, except 12. In case nominee(s) survive the person whose life is insured, the amount
a. where assignment or transfer is subject to terms and conditions of secured by the policy shall be paid to such survivor(s).
transfer or assignment OR 13. Where the Policyholder whose life is Life Assured nominates his
b. where the transfer or assignment is made upon condition that a. parents or
i. the proceeds under the policy shall become payable to b. spouse or
Policyholder or nominee(s) in the event of assignee or transferee c. children or
dying before the Life Assured OR
d. spouse and children
ii. the Life Assured surviving the term of the policy e. or any of them
Such conditional assignee will not be entitled to obtain a loan on policy the nominees are beneficially entitled to the amount payable by the insurer
or surrender the policy. This provision will prevail notwithstanding any law to the Policyholder unless it is proved that Policyholder could not have
or custom having force of law which is contrary to the above position. conferred such beneficial title on the nominee having regard to the nature of
14. In other cases, the insurer shall, subject to terms and conditions of his title.
assignment, recognize the transferee or assignee named in the notice 14. If nominee(s) die after the Policyholder but before his share of the
as the absolute transferee or assignee and such person amount secured under the policy is paid, the share of the expired
a. shall be subject to all liabilities and equities to which the transferor or nominee(s) shall be payable to the heirs or legal representative of the
assignor was subject to at the date of transfer or assignment and nominee or holder of succession certificate of such nominee(s).
b. may institute any proceedings in relation to the policy 15. The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to
c. obtain loan under the policy or surrender the policy without obtaining all life insurance policies maturing for payment after the
the consent of the transferor or assignor or making him a party to the commencement of Insurance Laws (Amendment) Act, 2015.
proceedings 16. If Policyholder dies after maturity but the proceeds and benefit of the
15. Any rights and remedies of an assignee or transferee of a life insurance policy has not been paid to him because of his death, his nominee(s)
policy under an assignment or transfer effected before commencement shall be entitled to the proceeds and benefit of the policy.
of the Insurance Laws (Amendment) Act, 2015 shall not be affected by 17. The provisions of Section 39 are not applicable to any life insurance
this section. policy to which Section 6 of Married Women’s Property Act, 1874
[Disclaimer: This is not a comprehensive list of amendments of Insurance applies or has at any time applied except where before or after
Laws (Amendment) Act, 2015 and only a simplified version prepared for Insurance Laws (Amendment) Act, 2015., a nomination is made in

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
 favour of spouse or children or spouse and children whether or not on insured, within a period of 90 days from the date of repudiation.
the face of the policy it is mentioned that it is made under Section 39.
08. Fact shall not be considered material unless it has a direct bearing on
Where nomination is intended to be made to spouse or children or
the risk undertaken by the insurer. The onus is on insurer to show that
spouse and children under Section 6 of MWP Act, it should be
specifically mentioned on the policy. In such a case only, the provisions if the insurer had been aware of the said fact, no life insurance policy
of Section 39 will not apply. would have been issued to the insured.
[Disclaimer: This is not a comprehensive list of amendments of Insurance 09. The insurer can call for proof of age at any time if he is entitled to do so
Laws (Amendment) Act, 2015 and only a simplified version prepared for and no policy shall be deemed to be called in question merely because
general information. Policyholders are advised to refer to Insurance Laws the terms of the policy are adjusted on subsequent proof of age of life
(Amendment) Act, 2015 for complete and accurate details. ] insured. So, this Section will not be applicable for questioning age or
adjustment based on proof of age submitted subsequently.
ANNEXURE - 4
[Disclaimer: This is not a comprehensive list of amendments of Insurance
C. Section 45 – Policy shall not be called in question on the ground of Laws (Amendment) Act, 2015 and only a simplified version prepared for
mis-statement after three years general information. Policyholders are advised to refer to Insurance Laws
Provisions regarding policy not being called into question in terms of (Amendment) Act, 2015 for complete and accurate details.]
Section 45 of the Insurance Act, 1938, as amended by Insurance Laws
(Amendment) Act, 2015. are as follows:
01. No Policy of Life Insurance shall be called in question on any ground
whatsoever after expiry of 3 yrs from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
02. On the ground of fraud, a policy of Life Insurance may be called in
question within 3 years from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
For this, the insurer should communicate in writing to the Life Assured
or legal representative or nominee or assignees of insured, as
applicable, mentioning the ground and materials on which such
decision is based.
03. Fraud means any of the following acts committed by Life Assured or
by his agent, with the intent to deceive the insurer or to induce the
insurer to issue a life insurance policy:
a. The suggestion, as a fact of that which is not true and which the Life
Assured does not believe to be true;
b. The active concealment of a fact by the Life Assured having
knowledge or belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be
fraudulent.
04. Mere silence is not fraud unless, depending on circumstances of the
case, it is the duty of the Life Assured or his agent keeping silence to
speak or silence is in itself equivalent to speak.
05. No Insurer shall repudiate a life insurance Policy on the ground of
Fraud, if the Life Assured/ beneficiary can prove that the misstatement
was true to the best of his knowledge and there was no deliberate
intention to suppress the fact or that such mis-statement of or
suppression of material fact are within the knowledge of the insurer.
Onus of disproving is upon the Policyholder, if alive, or beneficiaries.
06. Life insurance Policy can be called in question within 3 years on the
ground that any statement of or suppression of a fact material to
expectancy of life of the Life Assured was incorrectly made in the
proposal or other document basis which policy was issued or revived
or rider issued. For this, the insurer should communicate in writing to
the Life Assured or legal representative or nominee or assignees of
insured, as applicable, mentioning the ground and materials on which
decision to repudiate the policy of life insurance is based.
07. In case repudiation is on ground of mis-statement and not on fraud,
the premium collected on policy till the date of repudiation shall be paid
to the Life Assured or legal representative or nominee or assignees of

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04) • IRDA of India Regn no. 110

C2021-01
 CLAIM DOCUMENT LIST

Requirements for Hospitalization & Critical Requirements for Disability and Requirements for Death Claim (all causes of
Illness Claim Dismemberment Claim Death)
A Claim Forms A Claim Forms A Claim Forms
Part I: Application Form for Hospitalization/Critical Part I: Application Form for Part I: Application Form for Death Claim
Illness Claim (Claimant's Statement) along with Disability/Dismemberment Claim (Claimant's (Claimant's Statement) along with NEFT form
NEFT form Statement) along with NEFT form Part II:Physician's Statement - to be filled by last
Part II: Confidential Medical Report -to be filled by Part II: Confidential Medical Report -to be filled by attending physician
attending physician attending physician

B Hospital Bills for the confinement. B Attested True Copy of Indoor Case Papers of the B Death Certificate issued by a local government
Hospital body like Municipal Corporation
C Attested True Copy of Indoor Case Papers of the C Discharge Summary of Present and Past C Medical Records (Admission Notes,
Hospital Hospitalizations Discharge/Death Summary, Indoor Case Papers,
Test Reports etc)1

D Discharge Summary of Present and Past D Photo Identity of insured with age and address D Original Policy document
Hospitalizations proof

E Photo Identity of insured with age and address E Bank Details of the claimant – Cancelled cheque E Claimant's Photo ID with age proof & relationship
proof (with printed name and account number)/bank with the Insured along with Address proof of the
passbook and NEFT Form claimant and Cancelled cheque with name and
account number printed or cancelled cheque with
copy of Bank Passbook / Bank Statement

If no nomination - Proof of legal title to the claim

proceeds (e.g. legal succession paper)

F Bank Details of the claimant – Cancelled cheque F Disability Certificate by attending Physician /
(with printed name and account number)/bank Institute for disabled
passbook and NEFT Form
G Certificate of Diagnosis G Rehabilitation Certificate - if applicable

H Medical Examination Certificate (First H Employer’s written confirmation / statement - for

Consultation Notes). Disability claim

I All related clinical Reports pertaining to the claim I All related Medical Examination Reports, e.g. -
event - Laboratory test reports
Laboratory test reports X-Ray / CT Scan / MRI Reports & Plates
X-Ray / CT Scan / MRI Reports & Ultrasonography Report
PlatesUltrasonography Report Clinical / Hospital Reports
Histopathology Report
Clinical / Hospital Reports
Angiography Reports & Plates.
Others (please specify).
J All follow-up Consultation Notes in relation to the J Clinical Photographs showing the injured areas -
hospitalized condition. if available
If Claims is due to accidental causes (submit in If Claims is due to accidental causes (submit in In case of accidental death inaddition to the above
addition to the above) addition to the above). documents, we would require the following
documents –
K All police reports- K All police reports- F Postmortem report (Autopsy report) &
First Information Report First Information Report Chemical Viscera report - if performed
Final Investigation Report Final Investigation Report
G All Police Papers – Panchnama, Inquest, First
Information Report (FIR) and Final Investigation
Report
H Newspaper cutting / Photographs of the accident -
if available

1. This is applicable if insured was in hospital at the time of death or any time prior to the date of death.
• Please submit copies of the following documents certified / attested by the issuing authority. ( Original Seen Verified (OSV) by Branch Personnel will also be accepted) -
o All Police papers – Panchnama, Inquest, First Information Report and Final Investigation Report
o Medical Records (Admission Notes, Discharge/Death Summary, Indoor Case Papers, Test Reports etc)1
o Postmortem report (Autopsy report) & Chemical Viscera report (certified by Police / Magistrate / Court will also be accepted)
• Copies of the other documents to be submitted by self attestation of the claimant

NOTE:
- In case the claim warrants any additional requirement, TATA AIA LIFE reserves the right to call for the same.
- Notification of claim & submission of the claim requirements does not mean admission of the claim liability by the Company.
- No agent is authorized to admit any liabilities on behalf of the Company, nor to alter this list of documents or any claims requirements called for by the Company.
 FREQUENTLY ASKED QUESTIONS (FAQs)

1. How can I cancel my policy under Free Look?

 The policy can be cancelled anytime within 15 days from the date of receipt of the
policy document. Kindly submit the policy document along with a duly signed letter at any of the
Tata AIA Life branches#.

2. How can I change the premium payment mode?

 Please submit a duly signed copy of the Mode change form* at any of the Tata AIA Life
branches# at least 10 days before the due date of the policy.
 Please contact the branch or call center for mode changes allowed on your policy

3. How can I make the below mentioned changes in my policy?

- Name change - Address / Contact Number Change
- Ownership Change - Signature Change
- Nominee Change - Basic Plan Change
 Please submit a duly signed copy of the respective change form* along with the documents
mentioned in the form at any of the Tata AIA Life branches#.

4. Can I opt for automatic premium payment facility on my policy?

 You can avail of any of the following facilities wherein your account / Credit Card will be
debited on the due date of your policy.
o ECS - A signed copy of the ECS form* along with a cancelled cheque or copy of cancelled
cheque needs to be submitted at any of the Tata AIA Life branches at least 10 days prior to the
due date
o Credit Card – A signed copy of the Credit Card form* along with a copy of Front page of
credit card needs to be submitted at any of the Tata AIA Life branches at least 10 days prior to the
due date
o Direct debit – You can avail of Direct Debit facility by providing a copy of an 'ECS &
Direct Debit' form* with copy of cancelled cheque or bank attestation at least 30 days before the
due date. To know the list of banks wherein this facility is available, kindly visit the 'Premium
Payment Options' on www.tataaia.com.

5. I have lost my PIP and need a duplicate PIP.

 Please submit a duly signed copy of the Duplicate PIP form* along with the documents
mentioned in the form at any of the Tata AIA Life branches#.

6. How can I view my policy related details online?

 You can create your online account by logging in to www.tataaia.com and avail of the
following benefits –
o Easy access to policy related details (Premium Due Date, NAV, Payment Summary, etc.,)
o Single access for all your policies
o Perform Online ULIP transactions
o Pay Premium Online
o Generate e-statements (Premium Certificates, Unit Statements)
o Raise Service Requests

7. How do I request for a Premium Payment Certificate for my policies?

 You can request for your Premium Certificate through the following modes -
o Online Customer Portal - Kindly logon to your Online Account by visiting
www.tataaia.com
o SMS - Kindly SMS the following to 5676799:
  PCT <space> 10 digit policy no <space> email address (in case you wish to receive by
email, else will be sent to your communication address) <space> financial year (yyyy-yyyy
format)
 The mobile number from where the SMS has been sent should be registered with the
company. In case your mobile number is not registered, please send the following SMS to
5676799:
REG <space> 10 digit policy no <space> Insured's DOB in DDMMYYYY format <space>
Sum Assured
(For Health, Annuity and Pension plans, Sum Assured should be mentioned as '0')
o Email / Call / Branch - Request for the Premium Certificate by sending an email to
customercare@tataaia.com or call our helpline number at 1-860-266-9966 (local charges apply)
or visit the nearest branch#.

8. For my unit linked policy, how can I request for Fund Switch, Premium Redirection & Top-up?
 You can create your online account by logging in to www.tataaia.com and perform Fund
Switch, Premium Redirection and Top-up transactions instantly (or)
 Please submit a duly signed copy of the Fund Allocation, Switch & Top-up form* pertaining
to your product at any of the Tata AIA Life branches#.

* You can download the forms by visiting 'Customer Services' section on www.tataaia.com
#
For your nearest Tata AIA Life branch, please visit 'Contact Us' section on www.tataaia.com.

You can also send the forms along with the documents to the below mentioned address –
Policy Owners Services
Tata AIA Life Insurance Company Limited,
B-Wing, 9th Floor, I-Think Techno Campus,
Behind TCS, Pokhran Road No.2,
Close to Eastern Express Highway,
Thane (West) – 400 607, Maharashtra
 PROPOSAL FORM

Tata AIA Life Insurance Company Limited.

PROPOSAL FORM

Kindly Fill the form in CAPITAL and only in blue or black

(For Official Use only)

Proposal Number: U224373351 Branch Code: MU01

Channel: Broking Campaign Code:
Sub Office Code: RM CAMS Code: 4967389
Agent/Broker/Specified Person/Employee: Policy Bazaar
Code: Contact Details: License No. & Validity Details:
Customer Relationship No. (For Bancassurance Channel) PAN No.
IMPORTANT GUIDELINES: 1) IN UNIT-LINKED INSURANCE POLICIES (ULIPs), THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE
POLICYHOLDER. 2) Insurance is a contract of utmost good faith between the Insurer and the Insured. The Proposer and the Life to be Assured are required to disclose
all facts in response to the questions in this application form. 3) Any cancellation/alteration is to be signed by Proposer/Life to be assured as applicable. 4) KYC
documents will be required for all the parties to the contract.
I. GENERIC DETAILS
Is this policy self-proposed? Yes . If No, please answer the following details Type of Proposer: Individual Life
Relation with Life Assured: Self Type of Proposal:
II. ELECTRONIC INSURANCE ACCOUNT (eIA) DETAILS OF THE PROPOSER/POLICYOWNER
If you have an e-Insurance Account (eIA) Number, please provide:
I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Tata AIA Life Insurance Company Ltd. In (Physical
copy would be sent even if proposer opts for electronic format; however, in case proposer has e-Insurance Account, only electronic copy of the Insurance Policy will be
provided)
I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Insurance Repository in the Electronic Format as and
when applicable. Please select the name of the Insurance Repository.
NSDL Data Management Limited
III. PRODUCT DETAILS
Premium ( )
Base Plan/ Unit Premium Return of
Sum Policy (Inclusive of Premium
Rider (Benefit Linked Life Insured Name Paying Premium
Assured ( ) Term(Years) applicable taxes, Paying Mode
Option) Name (Yes/No) Term(Years) option
cesses & levies )
Tata AIA Life
Insurance Yes Amardeep Kumar 609000 21 10 4831 Monthly NA
Fortune Pro

Life Insured Details Benefit Payout Option Details

Rider (Benefit Benefit Payout
Option) Name Income p.a Income Income
Name DOB Gender Option Lumpsum ( )
( ) Duration(Years) Frequency

Kindly DATE BACK my Application to 1. Allowed only as per product specifications 2. Allowed within the same financial year 3. In case of juvenile (less than 1 year)
back date is not allowed. 4. Date Back of policy is allowed only up to the official launch date of the product.
FUND SELECTION DETAILS (To be filled for Unit Linked Products) a. Kindly mention the names of the fund chosen b. Incase you opt for a specific Portfolio Strategy
(as available with individual products), kindly mention the Fund Names or other details as applicable c. Kindly fill in whole numbers in percentage only. Decimals and
Fractions not allowed.
Name of Fund % Allocation Portfolio Strategy
Whole Life Income Fund 5
Whole Life Short-Term Fixed Income Fund 5 Funds for the chosen Portfolio Strategy (If Applicable )
Whole Life Aggressive Growth Fund 10 Debt oriented fund Equity oriented fund
Whole Life Stable Growth Fund 10
Other Details(if applicable)
Whole Life Mid Cap Equity Fund 10
OR
Large Cap Equity Fund 10
Multi Cap Fund 10
India Consumption Fund 10
Top 50 fund 10
Top 200 fund 10
Super Select Equity Fund 10
IV. PROPOSER / POLICYHOLDER DETAILS (Please fill in details of Life Assured if same as Proposer)
1. Title Mr
2. Name Amardeep Kumar
3. Father's Name / Spouse Name Narayan Lal
4. Mother's Name Leela Devi
5. Maiden Name(For female lives only)
6. Gender/Date of Birth MALE/ 12-06-1989
7. Which is your Dominant Hand? (Question to be answered only if ADDL Rider is
selected )
8. Marital Status Married
Nationality: Resident Indian
Country of Residence : India
9. Nationality (If other than resident Indian, Passport as an age proof is mandatory)
(If country of residence or nationality outside India then FATCA/ CRS-Self Certification Form
to be mandatorily completed)
Residence for Tax purposes in Jurisdiction(s) outside India No (If 'Yes' then FATCA/ CRS-Self Certification Form to be mandatorily completed)
10. Highest Educational Qualification Graduate
187 Parshvanath Nagar Bhadawasiya
11. Current Residence Address Landmark: Inside Rawat Nahar City: Jodhpur
State: Rajasthan Country: India Pin code: 342007
187 Parshvanath Nagar Bhadawasiya
12. Permanent Address Landmark: Inside Rawat Nahar City: Jodhpur
State: Rajasthan Country: India Pin code: 342007
13. Address for Communication Current Address
Residence No: Mobile No: 9928499152
14. Telephone and Email Details
E-mail: amardeepbar_2008@yahoo.com
15. Occupation Class Salaried
a. Name of Organisation /School / College Finova Capital Pvt Ltd
b. Organisation Type Private Limited
c. Industry Banking / Financial / Service / Insurance
d. Nature of Work Computer Network Specialists
e. Annual Income ( ) 1000000
16. Income Proof Salary Certificate Of Current Financial Year
17. Identity Proof (In case of Passport & Driving License please mention expiry date) Aadhar Card, Uid
18. Address Proof (Utility bills should not be older than 2 months) Aadhar Card, Uid
BGYPK6630F (kindly attach copy of Pan card)
19. Permanent Account Number ( PAN ) :
Yes I do have PAN (kindly attach copy of Form 60 duly signed)
20. CKYC No. (If available) 20072411532007
21. Source of Funds

22. Are you a Politically Exposed Person? No (Definition of PEP: "PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international
organisation /in a foreign country. This would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials,
senior executives of state owned corporations, important political party officials". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity)
or through marriage or similar (civil) forms of partnership. Close associates are individuals closely connected to a PEP, either socially or professionally")

V. LIFE ASSURED / SECONDARY ANNUITANT DETAILS (Please fill in this section only if Life Assured is different from Proposer)
1. Title
2. Name
3. Maiden Name(For female lives only)
4. Gender/Date of Birth
5. Which is your Dominant Hand?
6. Marital Status

7. Nationality (If other than resident Indian, Passport as an age proof is mandatory)
Country of Residence
8. Highest Educational Qualification
9. Occupation Class
10. Name of Organisation/ School/College
11. Organisation Type
12. Industry
13. Nature of Work
14. Annual Income ( )
15. Income Proof
Expiry Date :
16. Identity Proof (In case of Passport & Driving License please mention expiry date)
Others :
17. Address Proof (Utility bills should not be older than 2 months) Aadhar Card, Uid
(kindly attach copy of Pan card)
18. Permanent Account Number (PAN):
I Do not have PAN (kindly attach copy of Form 60 duly signed)
19. Are you a Politically Exposed Person? No (Definition of PEP: "PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international
organisation /in a foreign country. This would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials,
senior executives of state owned corporations, important political party officials". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity) or
through marriage or similar (civil) forms of partnership. Close associates are individuals closely connected to a PEP, either socially or professionally")

VI. HEALTH & LIFESTYLE DETAILS OF THE LIFE ASSURED

1. Nature of Age proof (Non-standard age proof submission will attract extra premium)
Aadhar Id Card - Standard
2. a) Height (cms or ft) b) Weight ( kg or lbs). 168cms 69Kg
PART A: LIFESTYLE DETAILS
1. Are you employed in the Armed Forces, Paramilitary, Police Forces, Fire Brigade or any other similar occupation? No
2. Is your occupation/your hobbies associated with any specific accident/health hazard or are dangerous in any way (e.g. working with dangerous
or corrosive chemicals, explosives, radiation, working underwater/underground or at height, working in mines, non-commercial flying activities, No
diving, mountaineering, any form of motorbike/car racing etc.)?
3. Have you ever been charge sheeted or convicted of any criminal proceedings or have any criminal case or charge pending against you in any
No
court of law in India or abroad? If Yes, please provide complete details.
4. Do you intend to live or travel outside India for more than 30 days for reason other than family vacation in next 6 months? No
5. Do you consume or have consumed any of the following? Please tick all relevant options and provide details
Substance Consumed Quantity/ Per Day for Tobacco & Per No. of If stopped consumption, mention month and year in
Yes/ No
Consumed As week for Alcohol and Narcotics Years which last consumed
Tobacco No
Alcohol No
Any Narcotics No

PART B: HEALTH & PERSONAL DETAILS

1. Has any of your insurance application or reinstatement application on life, accident, medical or health, critical illness, or disability ever been
No
declined, postponed or accepted at extra premium or modified terms?
2. Did you have any loss or Gain of weight of 10 kgs or more in the last six months? No
3. Do you have any physical deformity / handicap or congenital defect / abnormality? No
4. Have you ever been advised to and / or have undergone any tests, investigations or surgery or had signs or symptoms of any condition, aliment
No
or injury and / or were advised treatment for or have been hospitalized for check-up or treatment other than minor flu, cold or influenza?
5. Have you ever been diagnosed with or investigated for any of the following:
a. Cardio: High or Low Blood Pressure / Raised Cholesterol / Chest Pain / Palpitation / Rheumatic Fever / Heart Murmur / Shortness of Breath /
No
Heart Attack / Stroke / Any other heart condition
b. Hormonal: High Blood Sugar/ Diabetes / Thyroid or endocrine disorder / Sugar in Urine / Any other hormonal disorder No
c. Respiratory: Asthma / Tuberculosis / chronic cough, chronic bronchitis, emphysema, pneumonia / Any other respiratory disorder No
d. Blood/Cellular: Cancer / Tumor or malignant growth / Leukemia / Anemia / Enlarged lymph nodes/ Any blood disorder No
e. Digestive/Regulatory: Recurrent indigestion / Gastritis / Stomach or Duodenal Ulcer / Hernia / Jaundice / Disorders of the liver / Cirrhosis and
No
Gastrointestinal System/ Any other disease
 f. Mental/Psychiatric / Neurological ailment: Symptoms or ailment relating to Brain Depression / Anxiety / Brain Disorder or disease / Mental /
Psychiatric / Transient ischemic attack /Parkinson's disease / Multiple Sclerosis / Nervous disorder / Paralysis or Paraplegia / Epilepsy / Any No
other mental or psychiatric ailment
g. Neural/Skeletal/Muscular: Musculoskeletal disorders such as Arthritis / Recurrent Back Pain / muscular dystrophies/ musculoskeletal
deformities/ Slipped disc or any other disorder of Spine, Joints, Limbs or Leprosy; / Disorders of Eye, Ear, Nose,Throat including defective sight / No
Disorder of speech or hearing and discharge from ears / Any other disorder
h. Infectious/Contagious: Were you or your spouse ever tested for Hepatitis B or C, HIV /AIDS or any other Sexually Transmitted Disease / Any
No
other disorder
i. Genitourinary: Hydrocele / fistula / piles / symptoms or ailment relating to Kidney / Kidney Stones/ Prostate, Urinary System or Reproductive
No
System / Any other disorder
6. Have you had/ are having any other illness or impairment not mentioned above? No
7. Are you presently in good health? Yes
8. Has any of your family member (Parents and Siblings) ever been diagnosed with diabetes, Hypertension, Kidney Failure, Cancer, Heart Attack
No
or any Hereditary Disorder before the age of 60?
9. Have you ever been advised to undergo any surgery or treatment or laboratory investigations (stress ECG, echocardiogram, angiography,
No
MRI/CT scan etc.) by any doctor or specialist?
10. Have you been off work due to illness for a continuous period of 7 days and above during the last 5 years? No
11. Female Life Questionnaire
a. Are you now Pregnant? If Yes, kindly state expected delivery date
b. Have you undergone any gynecological investigations for illness, internal checkups, breast checks such as mammogram or biopsy?
c. Have you ever consulted a doctor because of an irregularity at the breast, vagina, uterus, ovary, fallopian tubes, menstruation, complications
during pregnancy or child delivery or a sexually transmitted disease?
d. Have you suffered from any other disorder of the breast or reproductive organs, abnormal smear test(s) and irregular menses?
12. If answer to any of the question above is 'yes', kindly give full details noting the question number (attach relevant copies)
Question No.: Details:
13. Family Details (Mandatory if the life to insured is Juvenile/Student/Housewife)
Gender (M / Date of
Family Details Name Occupation Annual Income ( ) Insurance Details (Existing /Applied for)
F) Birth
Father/Husband
First Child / Sibling
Second Child / Sibling
14. Family Details to be filled for Life Assured only Father Mother Brother Sister Spouse
a. If Alive, Health Status
b. If Deceased, Cause of Death
c. Age at Death/Current Age
VII. EXISTING INSURANCE DETAILS
Do you currently hold or have applied for Life Insurance/Pension/Health/Personal Accident Policies? Y / N If Yes, kindly provide details as below:
Life Assured Proposer (If Life Assured is Juvenile/Student/Housewife)
Type of Insurance (Life/ Health/ Unit Linked Company Basic Sum Type of Insurance (Life/ Health/ Unit Linked Company Basic Sum
/Pension/Personal Accident) Name Assured ( ) /Pension/Personal Accident) Name Assured ( )

VIII. NOMINEE DETAILS (Required only if Proposer & Life Assure are the same)
Base Plan/ Rider Gender Percentage ( % ) (Do not enter % in decimals & total % should be
Name Date of Birth Relationship
(Benefit Option)Name (M/F) equal to 100)
Tata AIA Life Insurance Jyoti
26-09-1990 Female Spouse 100
Fortune Pro Singariya
IX. APPOINTEE DETAILS (Required only if Nominee is less than 18 years of age)
Name Date of Birth Gender (M/F) Relationship
X. PAYMENT DETAILS

Premium Payment Method: Digital / Online Payment

Name of Credit Card/Debit Card Holder: Credit Card/Debit Card Number
Cheque/DD No. Issuing Bank Branch Amount Date: DD/MM/YYYY
Premium# 4831 + Taxes, cesses & levies 0 = Total Payment 4831 for months initial deposit (To be filled for monthly mode only)
On the first policy/modal anniversary I would like to change the premium payment mode to , subject to policy contract provisions. For Annual/Monthly mode issued #
policies mode change shall be accepted only on completion of first policy anniversary. #Premium is exclusive of applicable taxes, cesses & levies. All Premiums are
subject to applicable taxes, cesses & levies which will entirely be borne by the Policyholder and will always be paid by the Policyholder along with the payment of
Premium. If any imposition (tax or otherwise) is levied by any statutory or administrative body under the Policy, Tata AIA Life Insurance Company Limited reserves the
right to claim the same from the Policyholder. Alternatively, Tata AIA Life Insurance Company Limited has the right to deduct the amount from the benefits payable by Us
under the Policy. Cheque/DD should be drawn in favor of "Tata AIA Life Insurance Company Ltd. (Proposal No)". Do not issue blank cheque.
Renewal Payment Mode:

XI. Mandatory Bank Account Details:

Please provide below bank details. Bank details provided should be in the name of Proposer. All policy payouts will be made to the below mentioned bank account through
electronic transfer (NEFT). Payout would be in accordance and subject to terms and conditions of the policy.

Name of Account
Bank Account No. Bank Name and Branch Account Type IFSC Code
Holder

ICICI BANK LIMITED,ICICI BANK LTD. PLOT NO 28KHETANADIMANDORE

Amardeep Kumar 071901526652 Savings ICIC0000510
MANDI 342007DIST. JODHPUR RAJASTHAN
Note: 1. Please provide a cancelled copy of your personalized cheque. If personalized cancelled cheque is not available, attach bank statement showing account holder
name, address and account number. 2. In case of Non-Credit to the given bank account with/without assigning any reason thereof or if the transaction is delayed or not
effected at all for any reason of incomplete information, Tata AIA Life Insurance Co Ltd will not be responsible. 3. Further, the Company reserves the right to use any
alternative payout option inspite of opting for Direct Credit option. 4. If Account type is NRE/NRO then FATCA/CRS-Self Certification Form to be mandatorily completed.

XII. DECLARATION & CONSENT

• I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the
best of my knowledge and that I am authorised to propose on behalf of these other persons (applicable where the proposer and life insured are different).
• I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurer and that the policy will come into
force only after full payment of the premium chargeable.
• I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before
communication of the risk acceptance by the company.
• I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person to be insured/ proposer or from any past or
present employer concerning anything which affects the physical or mental health of the person to be insured/ proposer and seeking information from any insurer to whom an application for
insurance on the person to be insured /proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
• I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer (if any) for the sole purpose of underwriting the proposal and/or claims
settlement and with any Governmental and/or Regulatory authority.
• I confirm that I have understood the contents of this Proposal Form and I am submitting this Proposal Form with all the details which are true and correct. I have not withheld any material
information or suppressed any fact which are essential for issuance of the policy. I also hereby irrevocably authorize the Company to ascertain all the details from any third parties, as may be
required for assessing the risk.
• I agree to undergo all medical tests as determined by the Company for obtaining the policy and I further understand that the Company reserves the right to issue the policy if all the required criteria
are met and in case of any fraud or misrepresentation being established, the insurer shall take action in accordance with Section 45 of the Insurance Act, 1938 as amended time to time. I
understand that the contract will be governed by the provisions of the Insurance Act, 1938 as amended time to time, the IRDA Act, 1999 and the Regulations framed there under and that the
contract will not commence until the Company's written acceptance of this Proposal Form is received. In case of the life to be insured being a minor, I further declare and affirm that this proposal of
insurance is for the benefit of the life to be insured.
• Anti-Money Laundering Declaration: I hereby confirm that all premiums will be paid from bonafide sources and no premiums will be paid out of proceeds of crime related to any of the offence
listed in Prevention of Money Laundering Act, 2002. The Company has the right to peruse my financial profile and also agree that the Company has right to cancel the insurance contract in case I
have been found guilty of any of the provisions of any law, directly or indirectly, having relation to the laws governing prevention of money laundering in the country, by any competent court of law.
• I/We understand that in accordance with the IRDAI (Protection of Policyholders Interests) Regulations, 2017, the insurer is permitted to share policyholder information only with the statutory
authorities. I permit/authorize the Company to collect, store, communicate and process information relating to the Policy/Account and all transactions therein, by the Company and any of its
affiliates or service providers wherever situated including sharing, transfer and disclosure between them or with any entity or entities for the purpose of underwriting, policyholder servicing and
claims; and to the authorities in and/or outside India for compliance with any law or regulation whether domestic or foreign.

Date: 15-01-2022
Signature/Thumb Impression of Life Assured Place: Jodhpur
Signature/Thumb impression of Proposer
Authenticated through OTP

I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein,
immediately in case any of the above information is found to be false or untrue or misleading or misrepresenting, before issuance of the proposal. "I, the undersigned
confirm that I have verified photocopies of the proofs submitted along with this proposal form against the originals and certify the same to be true copy".

Signature of Agent/ Specified Person/ Broker/ Employee

________________________________________________________________________________________________________________________________________

ACKNOWLEDGEMENT
Tear away portion (To be handed over to the customer)
Proposal Number: ___________________

Dear Customer
We acknowledge receipt of your Cash/Cheque/DD for Rs.______________ by number ______________ dated ___ /___ /___ drawn on _______________ toward' s Initial
Deposit. We request you to kindly verify the details filled in the proposal form before signing the same. Please do insist on Official Receipt issued by Tata AIA Life from
your advisor within 2 working days from submission of this proposal form. In case you do not hear from us or do not receive your policy within 15 days from the date of
submission of your proposal, please visit us at www.tataaia.com or call our helpline number 1860 266 9966 (local charges apply) or email us at customercare@tataaia.com
or SMS "LIFE" to 58888.
This is only acknowledgement slip and not the premium receipt.
Agent code Agent name Signature of Agent Date of Acknowledgement
 IN CASE ANSWERS TO THE QUESTIONS ARE FILLED IN BY A PERSON OTHER THAN THE PROPOSER OR WHERE THE ANSWERS/SIGNATURE OF THE
PROPOSER/ ANNUITANTS ARE IN VERNACULAR.
Note: The below must be witnessed by someone other than advisor/employee of the company.
Declaration by Agent/Intermediary of Tata AIA Life Insurance Company Limited
I, _______________________________________ (name) have explained the contents of this proposal to the _________________________________________
(Proposer) in ____________________ (language) and ensured that the contents have been fully understood by him/her. I have accurately recorded the Proposer
responses to the information sought in the proposal form and I have read out the responses to the Proposer and he/she has confirmed that they are correct.

Date: 15-01-2022
Place: Jodhpur
(Signature of the person making the declaration)
Address of the person making the declaration:

Declaration by Proposer:
I have understood the contents of this proposal explained to me in language and confirm that the responses provided by me are correct.

Date: Date: 15-01-2022

Place: Place: Jodhpur
Signature/Thumb Impression of the Life Assured Signature/Thumb impression of Proposer

(Prohibition of Rebates) Section 41 - of the Insurance Act, 1938 as amended from time to time: 1. No person shall allow or offer to allow, either directly or indirectly,
as an inducement to any person to take out 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. 2. Any person making default in complying with the provisions
of this section shall be liable for a penalty which may extend to ten lakh rupees."
SECTION 45 OF THE INSURANCE ACT, 1938 STATES: No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years
from the date of policy, i.e. from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the
policy, whichever is later. A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of
commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud: Provided that the insurer shall have
to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision is based.
Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question
merely because the terms of the policy adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal. For further details, please refer to
the Insurance Act, as amended from time to time.
Disclaimers: IN CASE OF A ULIP POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. Tata AIA Life Insurance
Company Limited is only the name of the Company and any contract bearing the prefix "Tata AIA Life" is only the name of the contract and does not in any way indicate the
quality of the contracts, its future prospects or returns. Premium paid in ULIP is subject to investment risks associated with capital markets & the NAV of the units may go up
or down based on the performance of the funds and factors influencing capital markets and the insured is responsible for his decision. Past performance is not indicative of
future results. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.

L&C/Advt/2018/Oct/546/CAF/V1
________________________________________________________________________________________________________________________________________

1. Please carry valid Identity card to the medical examination center wherever applicable. 2. For cash payment, please visit our nearest Tata AIA Life branch. Please do
not handover cash to Agent. If handed over to the agent, the company will not be liable for any loss. 3. In case there is any change in the particulars given above including
Life Assured/Proposer's health and/or medical and/or financial and/or occupational status and/or being charged with and/or arrested for any criminal offence after the date
of proposal but before risk acceptance by the company; please inform the company. 4. Acceptance of premium does not constitute risk commencement. 5. Risk
commencement starts after the acceptance of risk by the company. 6. Freelook Period: If you are not satisfied with the terms & conditions/features of the policy, you have
the right to cancel the Policy by providing written notice to the Company and receive the premiums after deducting a) Proportionate risk premium for theperiod on cover &
b) Stamp duty and medical examination costs including applicable taxes, cesses & levies, which have been incurred for issuing the Policy. Such notice must be signed by
you and received directly by the Company within 15 days from the date of receipt of the policy document by you or person authorized by you. The said period of 15 days
shall stand extended to 30 days, if the policy sourced through distance marketing mode which includes solicitation through any means of communication other than in
person. For Unit Linked Life Insurance products, you would receive the non - allocated premiums plus charges levied by cancellation of units plus fund value at the date of
cancellation and after deducting the charges as mentioned in (a) & (b) above.

Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110 CIN: U66010MH2000PLC128403). Registered & Corporate Office: 14th Floor, Tower A, Peninsula
Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA
Life Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor/ Intermediary or visit
Tata AIA Life's nearest branch office or call 1- 860-266-9966 (local charges apply) or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com or SMS
'LIFE' to 58888.
BENEFIT ILLUSTRATION

Tata AIA Life Insurance Fortune Pro

Proposal No: U224373351

Name of the Prospect / Policyholder: Amardeep Kumar Name of the Product: Tata AIA Life Insurance Fortune Pro
Age (yrs) : 32 Tag Line : Unit Linked, Individual Life Insurance Savings Plan
Name of the Life Assured: Amardeep Kumar Unique Identification No.: 110L112V04
Age (yrs) : 32 GST Rate: 18.0%
Sum Assured (Rs.): 6,09,000 Investment Strategy Opted for: NIL
Policy Term (yrs): 21 Funds opted for along with their risk level
Premium Payment Term (yrs): 10 Allocation Risk
Fund Name
Amount of Instalment Premium (Rs.): 4,831 Percentage Profile
Mode of Payment of Premium : Monthly Large Cap Equity Fund (ULIF 017 07/01/08 TLC 110) 10% High
Whole Life Mid-cap Equity Fund (ULIF 009 04/01/07 WLE 110) 10% High

Whole Life Aggressive Growth Fund (ULIF 010 04/01/07 WLA 110) 10% Medium to
High

Whole Life Stable Growth Fund (ULIF 011 04/01/07 WLS 110) 10% Low to
Medium
Whole Life Income Fund (ULIF 012 04/01/07 WLI 110) 5% High
Whole Life Short Term Fixed Income Fund (ULIF 013 04/01/07 5% High
WLF 110)
Multi Cap Fund (ULIF 060 15/07/14 MCF 110) 10% High
India Consumption Fund (ULIF 061 15/07/14 ICF 110) 10% High
Super Select Equity Fund (ULIF 035 16/10/09 TSS 110) 10% High
Top 50 Fund (ULIF 026 12/01/09 ITF 110) 10% High
Top 200 fund (ULIF 027 12/01/09 ITT 110) 10% High

Rider Details
Rider Name (Benefit Option) UIN Sum Assured (Rs.) Coverage Term Premium Payment Term Premium without GST (Rs.)

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 and 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.
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, of 8% p.a. and 4% p.a. These assumed rates of return are not guaranteed and they are not the upper
or lower limits of what you might get back, as the value of your policy is dependant on a number of factors including future investment performance.
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.
 Tata AIA Life Insurance Fortune Pro

Part A
(Amount in Rupees)
At 4% p.a. Gross Investment Return At 8% p.a. Gross Investment Return
Policy Annualized Mortality, Commission
Fund at Surrender Mortality, Fund at payable to
Year Premium Morbidity Other Death Other Surrender Death
Charges* GST End Value Benefit Morbidity Charges* GST End Value Benefit intermediary(Rs.)
Charges of Year Charges of Year
1 58,000 563 4,238 864 53,438 49,655 6,09,000 562 4,243 865 54,549 50,687 6,09,000 0
2 58,000 532 4,847 968 1,08,318 1,05,581 6,09,000 530 4,877 973 1,12,727 1,09,989 6,09,000 0
3 58,000 499 5,185 1,023 1,65,028 1,62,975 6,09,000 492 5,267 1,037 1,75,132 1,73,078 6,09,000 0
4 58,000 463 5,832 1,133 2,23,274 2,21,905 6,09,000 448 5,993 1,159 2,41,695 2,40,326 6,09,000 0
5 58,000 422 6,496 1,245 2,83,101 2,83,101 6,09,000 394 6,768 1,289 3,12,703 3,12,703 6,09,000 0
6 58,000 373 6,602 1,255 3,45,255 3,45,255 6,09,000 327 7,019 1,322 3,89,172 3,89,172 6,09,000 0
7 58,000 314 7,311 1,373 4,09,113 4,09,113 6,09,000 244 7,909 1,467 4,70,773 4,70,773 6,09,000 0
8 58,000 243 7,464 1,387 4,75,431 4,75,431 6,09,000 138 8,284 1,516 5,58,579 5,58,579 6,09,000 0
9 58,000 156 8,220 1,508 5,43,597 5,43,597 6,09,000 21 9,306 1,679 6,52,304 6,52,304 6,52,304 0
10 58,000 48 8,998 1,628 6,13,686 6,13,686 6,13,686 0 10,397 1,871 7,52,220 7,52,220 7,52,220 0
11 0 0 7,426 1,337 6,30,569 6,30,569 6,30,569 0 9,184 1,653 8,02,773 8,02,773 8,02,773 0
12 0 0 7,619 1,371 6,47,931 6,47,931 6,47,931 0 9,772 1,759 8,56,760 8,56,760 8,56,760 0
13 0 0 7,817 1,407 6,65,785 6,65,785 6,65,785 0 10,400 1,872 9,14,412 9,14,412 9,14,412 0
14 0 0 8,020 1,444 6,84,146 6,84,146 6,84,146 0 11,070 1,993 9,75,980 9,75,980 9,75,980 0
15 0 0 8,229 1,481 7,03,027 7,03,027 7,03,027 0 11,787 2,122 10,41,729 10,41,729 10,41,729 0
16 0 0 8,445 1,520 7,22,443 7,22,443 7,22,443 0 12,552 2,259 11,11,944 11,11,944 11,11,944 0
17 0 0 8,666 1,560 7,42,411 7,42,411 7,42,411 0 13,369 2,406 11,86,927 11,86,927 11,86,927 0
18 0 0 8,894 1,601 7,62,944 7,62,944 7,62,944 0 14,241 2,563 12,67,002 12,67,002 12,67,002 0
19 0 0 9,128 1,643 7,84,060 7,84,060 7,84,060 0 15,172 2,731 13,52,515 13,52,515 13,52,515 0
20 0 0 9,368 1,686 8,05,775 8,05,775 8,05,775 0 16,167 2,910 14,43,836 14,43,836 14,43,836 0
21 0 0 9,616 1,731 8,28,106 8,28,106 8,28,106 0 17,230 3,101 15,41,359 15,41,359 15,41,359 0

*Other charges includes Premium Allocation Charge, Policy Admin Charge, Fund Management Charge and Rider Charges, if any. 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, ................ (name), have explained the premiums, charges and benefits under I,............. (name), having received the information with respect to the above, have
the policy fully to the prospect / policyholder. understood the above statement before entering into the contract.

Place :
Date : Signature of Agent/ Intermediary/ Official Date : Signature of Prospect/ Policyholder
 Tata AIA Life Insurance Fortune Pro
Part B
Gross Yield 8% p.a Net Yield 6.53% Amount in Rupees

Premium Annualized
Annualized Allocation Premium - Mortality Policy Guarantee Rider Additions Fund Fund Surrender Death
Policy Year Premium Charge Premium charge GST Admin Charge Charges to the before FMC at End Value Benefit
(AP) (PAC) Allocation Charge Fund* FMC of Year
Charges
1 58,000 3,478 54,522 562 865 435 0 0 0 54,610 329 54,549 50,687 6,09,000
2 58,000 3,478 54,522 530 973 435 0 0 0 1,12,852 964 1,12,727 1,09,989 6,09,000
3 58,000 3,188 54,812 492 1,037 435 0 0 0 1,75,325 1,643 1,75,132 1,73,078 6,09,000
4 58,000 3,188 54,812 448 1,159 435 0 0 0 2,41,962 2,369 2,41,695 2,40,326 6,09,000
5 58,000 3,188 54,812 394 1,289 435 0 0 0 3,13,049 3,144 3,12,703 3,12,703 6,09,000
6 58,000 2,609 55,391 327 1,322 435 0 0 0 3,89,602 3,975 3,89,172 3,89,172 6,09,000
7 58,000 2,609 55,391 244 1,467 435 0 0 0 4,71,293 4,865 4,70,773 4,70,773 6,09,000
8 58,000 2,029 55,971 138 1,516 435 0 0 0 5,59,196 5,819 5,58,579 5,58,579 6,09,000
9 58,000 2,029 55,971 21 1,679 435 0 0 0 6,53,024 6,842 6,52,304 6,52,304 6,52,304
10 58,000 2,029 55,971 0 1,871 435 0 0 0 7,53,052 7,932 7,52,220 7,52,220 7,52,220
11 0 0 0 0 1,653 435 0 0 1,602 8,02,056 8,748 8,02,773 8,02,773 8,02,773
12 0 0 0 0 1,759 435 0 0 1,710 8,55,994 9,336 8,56,760 8,56,760 8,56,760
13 0 0 0 0 1,872 435 0 0 1,825 9,13,596 9,964 9,14,412 9,14,412 9,14,412
14 0 0 0 0 1,993 435 0 0 1,948 9,75,109 10,635 9,75,980 9,75,980 9,75,980
15 0 0 0 0 2,122 435 0 0 2,079 10,40,799 11,351 10,41,729 10,41,729 10,41,729
16 0 0 0 0 2,259 435 0 0 2,219 11,10,951 12,116 11,11,944 11,11,944 11,11,944
17 0 0 0 0 2,406 435 0 0 2,369 11,85,867 12,933 11,86,927 11,86,927 11,86,927
18 0 0 0 0 2,563 435 0 0 2,529 12,65,870 13,805 12,67,002 12,67,002 12,67,002
19 0 0 0 0 2,731 435 0 0 2,700 13,51,307 14,737 13,52,515 13,52,515 13,52,515
20 0 0 0 0 2,910 435 0 0 2,882 14,42,547 15,732 14,43,836 14,43,836 14,43,836
21 0 0 0 0 3,101 435 0 0 3,077 15,39,982 16,794 15,41,359 15,41,359 15,41,359
 Gross Yield 4% p.a Amount in Rupees

Premium Annualized
Annualized Allocation Premium - Mortality Policy Guarantee Rider Additions Fund Fund Surrender Death
Policy Year Premium Charge Premium charge GST Admin Charge Charges to the before FMC at End Value Benefit
(AP) (PAC) Allocation Charge Fund* FMC of Year
Charges
1 58,000 3,478 54,522 563 864 435 0 0 0 53,497 324 53,438 49,655 6,09,000
2 58,000 3,478 54,522 532 968 435 0 0 0 1,08,438 933 1,08,318 1,05,581 6,09,000
3 58,000 3,188 54,812 499 1,023 435 0 0 0 1,65,211 1,561 1,65,028 1,62,975 6,09,000
4 58,000 3,188 54,812 463 1,133 435 0 0 0 2,23,521 2,208 2,23,274 2,21,905 6,09,000
5 58,000 3,188 54,812 422 1,245 435 0 0 0 2,83,414 2,872 2,83,101 2,83,101 6,09,000
6 58,000 2,609 55,391 373 1,255 435 0 0 0 3,45,636 3,558 3,45,255 3,45,255 6,09,000
7 58,000 2,609 55,391 314 1,373 435 0 0 0 4,09,565 4,267 4,09,113 4,09,113 6,09,000
8 58,000 2,029 55,971 243 1,387 435 0 0 0 4,75,956 4,999 4,75,431 4,75,431 6,09,000
9 58,000 2,029 55,971 156 1,508 435 0 0 0 5,44,198 5,756 5,43,597 5,43,597 6,09,000
10 58,000 2,029 55,971 48 1,628 435 0 0 0 6,14,365 6,533 6,13,686 6,13,686 6,13,686
11 0 0 0 0 1,337 435 0 0 1,259 6,30,006 6,991 6,30,569 6,30,569 6,30,569
12 0 0 0 0 1,371 435 0 0 1,293 6,47,352 7,183 6,47,931 6,47,931 6,47,931
13 0 0 0 0 1,407 435 0 0 1,329 6,65,190 7,381 6,65,785 6,65,785 6,65,785
14 0 0 0 0 1,444 435 0 0 1,366 6,83,535 7,585 6,84,146 6,84,146 6,84,146
15 0 0 0 0 1,481 435 0 0 1,403 7,02,399 7,794 7,03,027 7,03,027 7,03,027
16 0 0 0 0 1,520 435 0 0 1,442 7,21,798 8,009 7,22,443 7,22,443 7,22,443
17 0 0 0 0 1,560 435 0 0 1,482 7,41,748 8,230 7,42,411 7,42,411 7,42,411
18 0 0 0 0 1,601 435 0 0 1,523 7,62,263 8,458 7,62,944 7,62,944 7,62,944
19 0 0 0 0 1,643 435 0 0 1,565 7,83,360 8,692 7,84,060 7,84,060 7,84,060
20 0 0 0 0 1,686 435 0 0 1,608 8,05,055 8,933 8,05,775 8,05,775 8,05,775
21 0 0 0 0 1,731 435 0 0 1,653 8,27,366 9,180 8,28,106 8,28,106 8,28,106

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. *Additions to the Fund refers to the Loyalty Additions under the plan.

I, ................ (name), have explained the premiums, charges and benefits I,............. (name), having received the information with respect to the above, have
under the policy fully to the prospect / policyholder. understood the above statement before entering into the contract.

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

Unique Reference Number - L&C/Advt/2021/Feb/0110

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013 Trade logo displayed above belongs to Tata
Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license. For more information, Call the Tata AIA Life Insurance Company Ltd Helpline
number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com
 UNIT STATEMENT
IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT
PORTFOLIO IS BORNE BY THE POLICYHOLDER
20 /01/2022
Product Name Tata AIA Life Insurance Fortune Pro (UIN - 110L112V04)
Policy No U224373351
Policy Date 20/01/ 2022
Next Due date 20/02/ 2022
Basic Policy Premium (`) 4831.00
Rider Premium (`) .00
Service Tax on Rider Premium (`) .00
Policy Term 21
Premium Paying Term 10
Mode Monthly
Insured Name AMARDEEP KUMAR
Owner Name AMARDEEP KUMAR

Section I : FUND VALUE AS AT 20 /01/2022

Fund Value Regular Top Up Net Asset Regular/ Single Premium Top-up Premium Account Surrender
/Single Premium Value (`) Account Value (`)
Premium Account Units Fund Value Units Fund Value
Account (`) (`)
Allocation Allocation (A) (B) C=(A*B) (D) E=(A*D) (F)
India Consumption Fund (ULIF 061 15/07/14 10.00% 0.00% 32.4733 13.514179 438.85 0.000000 0.00 393.27
ICF 110)
Large Cap Equity Fund (ULIF 017 07/01/08 10.00% 0.00% 46.0452 9.530853 438.85 0.000000 0.00 406.71
TLC 110)
Multi Cap Fund (ULIF 060 15/07/14 MCF 110) 10.00% 0.00% 36.2464 12.107410 438.85 0.000000 0.00 398.02
Super Select Equity Fund (ULIF 035 16/10/09 10.00% 0.00% 55.9743 7.840562 438.87 0.000000 0.00 412.43
TSS 110)
Top - 200 Fund (ULIF 027 12/01/09 ITT 110) 10.00% 0.00% 97.3916 4.506036 438.85 0.000000 0.00 423.65
Top - 50 Fund (ULIF 026 12/01/09 ITF 110) 10.00% 0.00% 59.6380 7.358564 438.85 0.000000 0.00 414.03
Whole Life Aggressive Growth Fund (ULIF 010 10.00% 0.00% 58.0141 7.564541 438.85 0.000000 0.00 413.34
04/01/07 WLA 110)
Whole Life Income Fund (ULIF 012 04/01/07 5.00% 0.00% 32.1007 6.835677 219.43 0.000000 0.00 196.37
WLI 110)
Whole Life Mid Cap Equity Fund (ULIF 009 10.00% 0.00% 88.2711 4.971616 438.85 0.000000 0.00 422.08
04/01/07 WLE 110)
Whole Life Short Term Fixed Income Fund 5.00% 0.00% 28.6222 7.666427 219.43 0.000000 0.00 193.58
(ULIF 013 04/01/07 WLF 110)

Section II : PREMIUM INFORMATION IN THE CURRENT POLICY YEAR (2022-2022)

Premium Details Regular/Single Premium Top-up Premium
Current Policy Year(`) Since Inception (`) Current Policy Year (`) Since Inception (`)
Total Premium(s) Paid 4831.00 4831.00 0.00 0.00
Total Premium(s) Invested 4488.97 4488.97 0.00 0.00

BREAKUP OF TOTAL CHARGES DEDUCTED IN THE CURRENT POLICY YEAR

Charge Details Regular/ Single Premium Top-up Premium Account

Account
Amount (`) Amount (`)
Total Premium Allocation Charges 289.86 0.00
Service Tax on Premium Allocation Charge 52.17 0.00
Total Mortality Charges on Sum Assured (48.86) 0.00
Service Tax on Mortality Charges on Sum Assured (8.80) 0.00
Total Monthly Policy Administration charges (36.25) 0.00
Service Tax on Monthly Policy Administration (6.53) 0.00
Charge(s)
 Section III : COVERAGE INFORMATION DETAILS
Benefit Type Sum Assured (`) Effective Date Expiry Date
Basic Sum Assured 609000.00 Jan 20, 2022 Jan 20, 2043
Total Top-up Sum Assured 0.00

Current Death Benefit (Regular / Single Premium Account) as at 20 /01/2022 (`) 609000.00
Current Death Benefit (Top-up Premium Account) as at 20 /01/2022 (`) .00
Total Death Benefit as at 20 /01/2022 * (`) 609000.00

* Please refer to the Policy Contract on Death Benefit. It does not include any Supplementary Benefit with Death Coverage.

Unit Pricing methodology under Unit Linked Life insurance products has undergone changes pursuant to IRDA of India Circular ref: IRDA/F&I/
CIR/INV/173/08/2011 dated 29th July, 2011. Policyholders are informed that effective from 16th August, 2011 we have started calculating unit
prices as per the procedure prescribed in the above Circular as amended/modified by IRDA of India from time to time. There is no change in the
number of units to the credit of any policyholder on account of this change.

**In case of Complete Withdrawal within the first five years of the policy, the proceeds of the Discontinued Policy shown in the Unit Statement shall
be paid to the policyholder post completion of the lock-in period of five years from the inception of the policy or on death of the insured, if earlier.

“Proceeds of the Discontinued Policy” means the fund value as on the date of discontinuance plus entire income earned after deduction of the fund
management charges, subject to a minimum guarantee of interest @ 4% p.a. or as prescribed by IRDA of India from time to time.

Contact Us
SMS Website Email Call Center Write to us
'HELP' to 5676799 for list of www.tataaia.com customercare@tataaia.com Helpline Nos- Tata AIA Life Insurance
services offered via SMS Log on to the Customer 1800-267-9966(Toll Free) Company Ltd.
'SERVICE' to 58888 to Portal 1860-266-9966(Local Charges
receive call back from our Apply) 14th Floor, Tower A,
Customer Service Executives Callers Outside India Peninsula Business Park,
080-67603700 (Charges apply) Senapati Bapat Marg, Lower
Parel,
Mumbai - 400013

Kindly Note:

· Investment Risk in the investment portfolio shall be solely borne by the policyholder. The premium paid in Unit Linked Life Insurance policies
are subject to investment risks associated with capital markets and the NAVs of the units may go up or down based on the performance of the
fund and factors influencing the capital market and the insured shall be responsible for his or her decision.

l The underlying Fund’s Unit Price will be affected by interest rates and the performance of the underlying stocks. The Fund’s Unit Price may go
up or down reflecting the market value of the underlying assets.

l Please know the associated risks and the applicable charges, from your insurance agent or the Intermediary or policy document issued by the
insurance company.

l Whilst every care has been taken in the preparation of this statement, it is subject to correction and this statement should be read along with the
policy document and does not individually confer any legal rights. For policy terms and conditions, please refer to the policy document.

l This statement shall form a part of the policy document.

l As this is a computer generated statement, no signature is required.

l Service tax is applicable as per governing laws and the same shall be borne by the policyholder. Tata AIA Life Insurance Company Limited
reserves the right to recover from the Policyholder, any levies and duties (including service tax), as imposed by the goverment from time to
time.

l Insurance cover is available under this product.

l For policy terms and conditions, please refer to the policy document.

(Unique Reference No: L&C/Advt/2014/Mar/159)

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No.110) CIN - U66010MH2000PLC128403
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.
For more information, Call the Tata AIA Life Insurance Company Ltd Helpline numbers at 1800-267-9966 (toll free) and 1860-266-9966 (where local charges apply)
or Visit us at: www.tataaia.com or SMS 'LIFE' to 58888
 FIRST PREMIUM RECEIPT
Date: 20/01/2022
PERSONAL DETAILS
Policy Number U224373351 Plan Name Tata AIA Life Insurance Fortune Pro (110L112V04)
Policy Owner Name AMARDEEP KUMAR Life Assured Name AMARDEEP KUMAR
Email ID AMARDEEPBAR_2008@YAHOO.COM Distributor/Agent Name POLICYBAZAAR INSURANCE BROKERS PRIVATE
Contact no. 9928499152 Distributor/Agent Contact number 18002585970
PAN details BGYPK6630F

PREMIUM DETAILS
Premium Amount Due (In Rs.) 4831.00 Payment Mode Monthly
Goods & Service Tax (GST) 0.00 Next Premium Due on 20/02/2022
Total Amount (In Rs.) (a) 4831.00 Excess Amount (In Rs.) (b-a) : 0.00
Amount Received (In Rs.) (b) 4,831.00

TAX BENEFIT DETAILS

Sec 80 C Sec 80 CCC Sec 80 D
4831.00 .00 .00

PAYMENT DETAILS
Receipt Number Receipt Date Amount (In Rs.) Payment Method
PP1202817 15/01/2022 4,831.00 Online Payment

Please note:
• This document can be used as a proof for claiming deduction while filling your tax returns and tax benefits would be applicable
as per the prevailing tax laws.
• Payments made through modes other than cash are subject to clearance including through electronic mode payments.
• Any excess premium will be adjusted towards premium due in the current financial year or due in the next three months, whichever is
later. Else premium will be auto refunded post 15 days.
• Applicable govt taxes, surcharge, cess including GST would be charged in accordance with applicable Laws and Company will have the
right to recover the same from the policyholder.
• Please refer to the policy document for detailed terms and conditions and our website for FAQ on applicable tax benefits.

GST Details
Base Premium Taxable Value CGST .00% SGST/UTGST .00% IGST .00% Reverse Charge
` 4831.00 ` .00 ` .00 ` .00 ` .00
Tata AIA Life Insurance State HARYANA Tata AIA Life Insurance GST IN 06AABCT3784C1ZH SAC Description Life Insurance
Policy Owner's GST State RAJASTHAN Policy Owner's GSTIN NOT REGISTERED SAC Code 997132

#RakshakaranHero

PAN: AABCT3784C. Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110) GIN: U66010MH2000PLC128403. Registered & Corporate Office: 14th
Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is
used by Tata AIA Life Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor /
Intermediary or visit Tata AIA Life's nearest branch office or call 1-860-266-9966 or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com.

BEWARE OF SPURIOUS/ IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public receiving
FRAUD PHONE CALLS! such phone calls are requested to lodge a police complaint.

Contact us

0 0
e0
www.tataaia.com Chat on WhatsApp (7045669966) � Chat on our website

G
18602669966 - 24*7 Interactive Voice
SMS HELP to 5676799 • customercare@tataaia.com Response (IVR) [Customer Service Executive
available from 10am to 7pm, Mon-Sat]

Customer Service Department: 9th Floor, Tower B, I- Think Lodha Techno Campus, Off Pokharan Road Number 2, Thane r:y,Jest) - 400604.