IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER

Product Proposal for achieving your Life Goals

Bajaj Allianz Life
Invest Protect Goal III
A Unit-linked Non-Participating Individual Life Savings Insurance Plan
UIN: 116L205V01

Hi Mr. Cus Cus,

Congratulations on taking the first step towards fulfilling your Life Goals with Bajaj Allianz Life Insurance.

You have opted for Bajaj Allianz Life Invest Protect Goal III , a high insurance cover savings plan, which provides:

Key Features

High life insurance Growth of your savings Wide range of funds Fund Maintenance Return of charges and Tax Benefits
cover throughout through market linked available to plan your Booster to ensure life Loyalty Additions to
policy term returns investments cover continuity enhance your corpus
Here's your illustration of Bajaj Allianz Life Invest Protect Goal III

(10 years)

Age 34 43 73

Policy Term
(40 years)

You Pay You Get

Premium Lumpsum Maturity Benefit
Excluding GST At Age 73

First year ₹ 80,000 Yearly Assumed rate of return

Second year onwards ₹ 80,000 Yearly @8% ₹ 67,53,271
@4% ₹ 15,68,734

Total Premium Total Benefits

₹ 8,00,000 @8% ₹ 67,53,271 @4% ₹ 15,68,734

Give-Get Life Insurance Cover(At Inception)

@8% 8.44 x @4% 1.96 x ₹ 24,00,000

Additional Coverages ( signifies Opted | signifies Not-opted )

Accidental Death Benefit Accidental Total Permanent Disability Critical Illness Benefit
From age 34 to 70 Benefit
From age 34 to 70

Care Plus 2

^ P r e m ium s a r e p a y a b l e a t t he b e g inning o f y e a r ; ^ ^ B e ne f it s t o b e r e c e iv e d a t t he e nd o f y e a r
T he a s s um e d r a t e o f r e t ur ns ind ic a t e d a t 4 % a nd 8 % a r e il l us t r a t iv e a nd no t g ua r a nt e e d a nd d o no t ind ic a t e t he up p e r o r l o w e r l im it s o f r e t ur ns und e r t he p o l ic y .
T he a b o v e b e ne f it s / r e t ur ns s ho w n in t he d o c um e nt a r e f o r il l us t r a t iv e p ur p o s e o nl y & m us t b e r e a d in c o nj unc t io n w it h t he B e ne f it I l l us t r a t io n. Fo r m o r e d e t a il s
o n r is k f a c t o r s , t e r m s a nd c o nd it io ns p l e a s e r e a d s a l e s b r o c hur e & p o l ic y d o c um e nt ( a v a il a b l e o n w w w .b a j a j a l l ia nz l if e .c o m ) c a r e f ul l y b e f o r e c o nc l ud ing a s a l e .
 Why Bajaj Allianz Life

Total Asset Under AAA; Stable Number of Lives

Managment (AUM) Rating by CARE Covered

Claim settlement Get 1 Day Claim Solvency Ratio

Ratio Approval

Individual Death Claim Settlement Ratio for FY 2023-2024. | ^Solvency ratio 432% as at 31 March 2024 against IRDAI mandated 150%
| % 96.70% of non-investigative individual claims approved in one working day for FY 2023-24. 1 day is counted from date of
intimation of claim before 3 PM on a working day (excluding Non-NAV days for ULIP) at Bajaj Allianz Life offices | $For details refer to
press release published by CARE | **All figures as on 31 March, 2024 | #Individual & Group.

For more details please refer to Company Factsheet

https://www.bajajallianzlife.com/content/dam/balic/pdf/financialinformation/Factsheet/none/Q1/Factsheet-FY-2023-2024.pdf

3
Bajaj A llianz L ife Insurance Co.L td., CIN : U66010P N 2001P L C015959 | IRDA I Reg.N o. 116 BEW ARE OF SPURIOUS PHONE CALLS AND FICTITIOUS /
Mail us: [email protected] | Call on: T oll free no. 1800 209 7272 FRAUDULENT OFFERS -
Registered O ffice A ddress: Bajaj A llianz House, A irport Road, Yerawada, P une - 411006, IRDAI or its officials do not involve in activities like selling
Maharashtra insurance policies, announcing bonus or investment of
T he L ogo of Bajaj A llianz L ife Insurance Co. L td. is provided on the basis of license given premiums. Public receiving such phone calls are requested to
by Bajaj Finserv L td.to use its "Bajaj" L ogo and A llianz SE to use its "A llianz" logo. lodge a police complaint.
Quotation No : 60074053314

Bajaj Allianz Life Invest Protect Goal III

A Unit-linked Non-Participating Individual Life Savings Insurance Plan

Customer Details
Name of the Prospect / Policyholder Cus Cus
Age (in years) 34
Gender of the Prospect / Policyholder M
Name of the Life Assured Cus Cus
Age (in years) 34
Gender of the Life Assured M

Product / Riders Details

Base Plan / Sum Policy Premium Payment Premium Payment Instalment Premium Instalment Premium
Rider Name of Product / Rider Option Chosen UIN Assured Term Term (Years) Mode Without GST GST Rate with GST
(Years)
Base Plan Bajaj Allianz Life Invest Protect Not Applicable 116L205V01 24,00,000 40 10 Annual 80,000 18% on 80,000
Goal III Charges
Rider Bajaj Allianz Life Linked Accident Accidental Death Benefit 116A057V01 72,00,000 37 10 Annual 8,323 18% on 9,821
Protection Rider II Premium
Rider Bajaj Allianz Life Linked Accident Accidental Total Permanent 116A057V01 24,00,000 37 10 Annual 1,666 18% on 1,966
Protection Rider II Disability Benefit Premium
Total 89,989 91,787

Investment Strategy Opted for Investor Selectable Portfolio Strategy

Fund opted for along with risk levels
Sr.No Fund Name SFIN Risk Level Fund Management Charge Investment%
1 Liquid Fund ULIF02510/07/06LIQUIDFUND116 Low 0.95% 0%
2 Bond Fund ULIF02610/07/06BONDFUNDLI116 Moderate 0.95% 0%
3 Individual Short Term Debt Fund ULIF08817/01/23INDSTRMDBT116 Moderate 0.95% 0%
4 Asset Allocation Fund II ULIF07205/12/13ASSETALL02116 High 1.25% 0%
5 Bluechip Equity Fund ULIF06026/10/10BLUECHIPEQ116 High 1.25% 0%
6 Dynamic Asset Allocation Fund ULIF08617/01/23DYNASALLOC116 High 1.35% 0%
7 Equity Growth Fund II ULIF05106/01/10EQTYGROW02116 Very High 1.35% 100%
8 Accelerator Mid-Cap Fund II ULIF05206/01/10ACCMIDCA02116 Very High 1.35% 0%
9 Pure Stock Fund II ULIF07709/01/17PURSTKFUN2116 Very High 1.30% 0%
10 Pure Stock Fund ULIF02721/07/06PURESTKFUN116 Very High 1.35% 0%
11 Flexi Cap Fund ULIF07917/11/21FLXCAPFUND116 Very High 1.35% 0%
12 Sustainable Equity Fund ULIF08017/11/21SUSEQUFUND116 Very High 1.35% 0%
13 Small Cap Fund ULIF08717/01/23SMALLCAPFU116 Very High 1.35% 0%
14 Midcap Index Fund ULIF08919/10/23MIDCPINDFD116 Very High 1.35% 0%
15 Smallcap Quality Index Fund ULIF09103/01/24SMCPQYINDF116 Very High 1.35% 0%
16 Nifty Alpha 50 Index Fund ULIF09221/05/24NYAPA50IND116 Very High 1.35% 0%
17 Nifty 200 Alpha 30 Index Fund ULIF09321/05/24N200AP30IN116 Very High 1.35% 0%
18 Nifty 200 Momentum 30 Index Fund ULIF09429/10/24N200MO30IN116 Very High 1.35% 0%
19 Nifty 500 Multicap Momentum Quality 50 Index Fund ULIF09527/12/24N500MM50IN116 Very High 1.35% 0%
20 Focused 25 Fund ULIF09606/02/25FOCUSED25F116 Very High 1.35% 0%

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 illustrations 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 dependent on a
number of factors including future investment performance.
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 returns of 8% p.a. and 4% p.a. These rates, i.e. 8% p.a. and 4% p.a. are assumed only for the purpose of illustrating the flow of benefits if the returns are at this level. It should not be interpreted that the
returns under the plan are going to be either 8%p.a. or 4% p.a.
Net Yield mentioned corresponds to the gross investment return of 8% p.a., net of all charges but does not consider mortality, morbidity charges, underwriting extra, if any, guarantee charges and cost of riders,
if deducted by cancellation of units. It demonstrates the impact of charges exclusive of taxes on the net yield. Please note that the mortality charges per thousand sum assured in general, increases with age.
The actual returns can vary depending on the performance of the chosen fund, charges towards mortality, morbidity, underwriting extra, cost of riders, etc. The investment risk in this policy is borne by the
policyholder, hence, for more details on terms and conditions please read sales literature carefully.
Part A of this statement presents a summary view of year-by-year charges deducted under the policy, fund value, surrender value and the death benefit, at two assumed rates of return. Part B of this statement
presents a detailed breakup of the charges, and other values.

O.X.X
Quotation No : 60074053314

Part A (Amount in Rupees)

At 4% p.a. Gross Investment Return At 8 % p.a. Gross Investment Return

Policy Year Annualised Premium
Mortality Charge Other Charges# GST FV at End of year Surrender Value Death Benefit Mortality Charge Other Charges# GST FV at End of year Surrender Value Death Benefit
1 80,000 2,653 6,651 1,675 71,885 67,572 24,00,000 2,651 6,672 1,678 74,725 70,242 24,00,000
2 80,000 2,709 7,635 1,862 1,45,394 1,42,194 24,00,000 2,703 7,715 1,875 1,54,089 1,50,889 24,00,000
3 80,000 2,779 8,640 2,056 2,20,552 2,18,152 24,00,000 2,763 8,824 2,086 2,38,374 2,35,974 24,00,000
4 80,000 2,857 9,669 2,255 2,97,386 2,95,786 24,00,000 2,825 10,001 2,309 3,27,885 3,26,285 24,00,000
5 80,000 2,944 10,720 2,460 3,75,927 3,75,927 24,00,000 2,889 11,252 2,545 4,22,951 4,22,951 24,00,000
6 80,000 3,031 9,784 2,307 4,58,742 4,58,742 24,00,000 2,943 10,570 2,432 5,26,616 5,26,616 24,00,000
7 80,000 3,123 10,917 2,527 5,48,421 5,48,421 24,00,000 2,990 12,019 2,702 6,41,686 6,41,686 24,00,000
8 80,000 3,210 12,144 2,764 6,35,084 6,35,084 24,00,000 3,015 13,626 2,996 7,59,025 7,59,025 24,00,000
9 80,000 3,310 13,329 2,995 7,23,669 7,23,669 24,00,000 3,034 15,266 3,294 8,83,724 8,83,724 24,00,000
10 80,000 3,412 14,541 3,232 8,23,223 8,23,223 24,00,000 3,028 17,009 3,607 10,27,096 10,27,096 24,00,000
11 0 3,686 14,806 3,329 8,33,906 8,33,906 24,00,000 3,160 17,893 3,789 10,83,475 10,83,475 24,00,000
12 0 4,027 14,949 3,416 8,44,433 8,44,433 24,00,000 3,326 18,679 3,961 11,43,199 11,43,199 24,00,000
13 0 4,422 15,090 3,512 8,54,736 8,54,736 24,00,000 3,501 19,512 4,142 12,06,466 12,06,466 24,00,000
14 0 4,881 15,227 3,619 8,64,733 8,64,733 24,00,000 3,685 20,395 4,334 12,73,490 12,73,490 24,00,000
15 0 5,413 15,359 3,739 9,19,534 9,19,534 24,00,000 3,870 21,330 4,536 13,86,755 13,86,755 24,00,000
16 0 5,841 16,106 3,950 9,29,910 9,29,910 24,00,000 3,870 22,913 4,821 14,64,896 14,64,896 24,00,000
17 0 6,501 16,242 4,094 9,39,741 9,39,741 24,00,000 3,982 24,003 5,037 15,47,818 15,47,818 24,00,000
18 0 7,235 16,370 4,249 9,48,927 9,48,927 24,00,000 4,036 25,162 5,256 16,35,890 16,35,890 24,00,000
19 0 8,032 16,489 4,414 9,57,377 9,57,377 24,00,000 4,005 26,393 5,472 17,29,541 17,29,541 24,00,000
20 0 8,885 16,597 4,587 10,46,794 10,46,794 24,00,000 3,861 27,702 5,681 19,05,966 19,05,966 24,00,000
21 0 9,215 17,819 4,866 10,56,136 10,56,136 24,00,000 3,029 30,175 5,977 20,17,800 20,17,800 24,00,000
22 0 10,067 17,939 5,041 10,64,679 10,64,679 24,00,000 2,465 31,743 6,157 21,37,357 21,37,357 24,00,000
23 0 10,937 18,048 5,217 10,72,384 10,72,384 24,00,000 1,681 33,420 6,318 22,65,393 22,65,393 24,00,000
24 0 11,821 18,146 5,394 10,79,213 10,79,213 24,00,000 647 35,218 6,456 24,02,745 24,02,745 24,02,745
25 0 12,721 18,232 5,571 11,39,889 11,39,889 24,00,000 0 37,145 6,686 25,57,357 25,57,357 25,57,357
26 0 13,064 19,059 5,782 11,46,824 11,46,824 24,00,000 0 39,306 7,075 27,13,877 27,13,877 27,13,877
27 0 13,957 19,147 5,959 11,52,855 11,52,855 24,00,000 0 41,493 7,469 28,80,244 28,80,244 28,80,244
28 0 14,900 19,221 6,142 11,57,901 11,57,901 24,00,000 0 43,818 7,887 30,57,080 30,57,080 30,57,080
29 0 15,914 19,281 6,335 11,61,854 11,61,854 24,00,000 0 46,289 8,332 32,45,042 32,45,042 32,45,042
30 0 17,026 19,326 6,543 12,74,221 12,74,221 24,00,000 0 48,916 8,805 35,39,684 35,39,684 35,39,684
31 0 16,613 20,867 6,747 12,80,078 12,80,078 24,00,000 0 53,033 9,546 37,58,011 37,58,011 37,58,011
32 0 17,810 20,937 6,974 12,84,643 12,84,643 24,00,000 0 56,084 10,095 39,90,077 39,90,077 39,90,077
33 0 19,167 20,988 7,228 12,87,694 12,87,694 24,00,000 0 59,327 10,679 42,36,743 42,36,743 42,36,743
34 0 20,717 21,016 7,512 12,88,964 12,88,964 24,00,000 0 62,774 11,299 44,98,931 44,98,931 44,98,931
35 0 22,495 21,018 7,832 13,84,942 13,84,942 24,00,000 0 66,438 11,959 47,77,615 47,77,615 47,77,615
36 0 22,356 22,333 8,044 13,86,544 13,86,544 24,00,000 0 70,332 12,660 50,73,834 50,73,834 50,73,834
37 0 24,390 22,337 8,411 13,85,754 13,85,754 24,00,000 0 74,472 13,405 53,88,692 53,88,692 53,88,692
38 0 26,732 22,306 8,827 13,82,146 13,82,146 24,00,000 0 78,872 14,197 57,23,360 57,23,360 57,23,360
39 0 29,437 22,234 9,301 13,75,221 13,75,221 24,00,000 0 83,548 15,039 60,79,087 60,79,087 60,79,087
40 0 32,577 22,112 9,844 15,68,734 15,68,734 24,00,000 0 88,520 15,934 67,53,271 67,53,271 67,53,271

# includes all charges other than mortality charge, See Part B for details
The Benefits shown above (Death Benefit, Surrender Value) are payable assuming Death / Surrender occur at the end of the year.

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

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

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

Part B

Amount( in Rs.)

Gross Yield 8% Net Yield 6.58 % Death

Benefit

Policy Annualised Premium Annualised Premium - Mortality GST (Excl On Policy Admin. Guaranteee Other Return of Mortality Loyalty Addition + FMB + ROAC+ Fund Before FMC Incl. Fund at End Surrender Lumpsum
Year Premium Allocation Charge Allocation Charge Charge FMC) Charge Charge Charges* Charge Family Benefit FMC GST of year Value
1 80,000 4,800 75,200 2,651 1,497 864 0 0 0 0 75,915 1,189 74,725 70,242 24,00,000
2 80,000 4,800 75,200 2,703 1,506 864 0 0 0 0 1,56,510 2,421 1,54,089 1,50,889 24,00,000
3 80,000 4,800 75,200 2,763 1,517 864 0 0 0 0 2,42,102 3,729 2,38,374 2,35,974 24,00,000
4 80,000 4,800 75,200 2,825 1,528 864 0 0 0 0 3,33,003 5,118 3,27,885 3,26,285 24,00,000
5 80,000 4,800 75,200 2,889 1,540 864 0 0 0 0 4,29,544 6,593 4,22,951 4,22,951 24,00,000
6 80,000 0 80,000 2,943 1,178 3,600 0 0 0 0 5,34,841 8,225 5,26,616 5,26,616 24,00,000
7 80,000 0 80,000 2,990 1,186 3,600 0 0 4,941 0 6,46,679 9,934 6,41,686 6,41,686 24,00,000
8 80,000 0 80,000 3,015 1,191 3,600 0 0 0 0 7,70,856 11,831 7,59,025 7,59,025 24,00,000
9 80,000 0 80,000 3,034 1,194 3,600 0 0 0 0 8,97,490 13,766 8,83,724 8,83,724 24,00,000
10 80,000 0 80,000 3,028 1,193 3,600 0 0 0 10,819 10,32,098 15,822 10,27,096 10,27,096 24,00,000
11 0 0 0 3,160 1,217 3,600 0 0 0 0 11,00,341 16,866 10,83,475 10,83,475 24,00,000
12 0 0 0 3,326 1,247 3,600 0 0 0 0 11,60,992 17,794 11,43,199 11,43,199 24,00,000
13 0 0 0 3,501 1,278 3,600 0 0 0 0 12,25,242 18,777 12,06,466 12,06,466 24,00,000
14 0 0 0 3,685 1,311 3,600 0 0 0 0 12,93,308 19,818 12,73,490 12,73,490 24,00,000
15 0 0 0 3,870 1,345 3,600 0 0 18,250 24,000 13,65,426 20,921 13,86,755 13,86,755 24,00,000
16 0 0 0 3,870 1,345 3,600 0 0 0 0 14,87,685 22,789 14,64,896 14,64,896 24,00,000
17 0 0 0 3,982 1,365 3,600 0 0 0 0 15,71,894 24,076 15,47,818 15,47,818 24,00,000
18 0 0 0 4,036 1,375 3,600 0 0 0 0 16,61,333 25,443 16,35,890 16,35,890 24,00,000
19 0 0 0 4,005 1,369 3,600 0 0 0 0 17,56,436 26,895 17,29,541 17,29,541 24,00,000
20 0 0 0 3,861 1,343 3,600 0 0 42,946 33,761 18,57,701 28,441 19,05,966 19,05,966 24,00,000
21 0 0 0 3,029 1,193 3,600 0 0 0 0 20,49,158 31,358 20,17,800 20,17,800 24,00,000
22 0 0 0 2,465 1,092 3,600 0 0 0 0 21,70,566 33,208 21,37,357 21,37,357 24,00,000
23 0 0 0 1,681 951 3,600 0 0 0 0 23,00,580 35,188 22,65,393 22,65,393 24,00,000
24 0 0 0 647 764 3,600 0 0 0 0 24,40,054 37,309 24,02,745 24,02,745 24,02,745
25 0 0 0 0 648 3,600 0 0 7,822 0 25,89,119 39,583 25,57,357 25,57,357 25,57,357
26 0 0 0 0 648 3,600 0 0 0 0 27,56,009 42,133 27,13,877 27,13,877 27,13,877
27 0 0 0 0 648 3,600 0 0 0 0 29,24,958 44,714 28,80,244 28,80,244 28,80,244
28 0 0 0 0 648 3,600 0 0 0 0 31,04,537 47,457 30,57,080 30,57,080 30,57,080
29 0 0 0 0 648 3,600 0 0 0 0 32,95,415 50,373 32,45,042 32,45,042 32,45,042
30 0 0 0 0 648 3,600 0 0 0 94,853 34,98,303 53,472 35,39,684 35,39,684 35,39,684
31 0 0 0 0 648 3,600 0 0 0 0 38,16,342 58,331 37,58,011 37,58,011 37,58,011
32 0 0 0 0 648 3,600 0 0 0 0 40,52,008 61,931 39,90,077 39,90,077 39,90,077
33 0 0 0 0 648 3,600 0 0 0 0 43,02,501 65,758 42,36,743 42,36,743 42,36,743
34 0 0 0 0 648 3,600 0 0 0 0 45,68,756 69,825 44,98,931 44,98,931 44,98,931
35 0 0 0 0 648 3,600 0 0 0 0 48,51,764 74,149 47,77,615 47,77,615 47,77,615
36 0 0 0 0 648 3,600 0 0 0 0 51,52,578 78,744 50,73,834 50,73,834 50,73,834
37 0 0 0 0 648 3,600 0 0 0 0 54,72,320 83,629 53,88,692 53,88,692 53,88,692
38 0 0 0 0 648 3,600 0 0 0 0 58,12,181 88,821 57,23,360 57,23,360 57,23,360
39 0 0 0 0 648 3,600 0 0 0 0 61,73,426 94,339 60,79,087 60,79,087 60,79,087
40 0 0 0 0 648 3,600 0 0 0 2,96,075 65,57,400 1,00,205 67,53,271 67,53,271 67,53,271

The Benefits s hown a bove (Dea th Benefit, Surrender Va lue) a re pa ya ble a s s uming Dea th / Surrender occur a t the end of the yea r.

O.X.X
Quotation No : 60074053314

Amount( in Rs.)

Death
Gross Yield 4%
Benefit

Policy Annualised Premium Annualised Premium - Mortality GST (Excl On Policy Admin. Guaranteee Other Return of Mortality Loyalty Addition + FMB + ROAC+ Fund Before FMC Incl. Fund at End Surrender
Lumpsum
Year Premium Allocation Charge Allocation Charge Charge FMC) Charge Charge Charges* Charge Family Benefit FMC GST of year Value
1 80,000 4,800 75,200 2,653 1,497 864 0 0 0 0 73,049 1,165 71,885 67,572 24,00,000
2 80,000 4,800 75,200 2,709 1,507 864 0 0 0 0 1,47,720 2,325 1,45,394 1,42,194 24,00,000
3 80,000 4,800 75,200 2,779 1,520 864 0 0 0 0 2,24,064 3,512 2,20,552 2,18,152 24,00,000
4 80,000 4,800 75,200 2,857 1,534 864 0 0 0 0 3,02,112 4,725 2,97,386 2,95,786 24,00,000
5 80,000 4,800 75,200 2,944 1,549 864 0 0 0 0 3,81,892 5,966 3,75,927 3,75,927 24,00,000
6 80,000 0 80,000 3,031 1,194 3,600 0 0 0 0 4,66,038 7,297 4,58,742 4,58,742 24,00,000
7 80,000 0 80,000 3,123 1,210 3,600 0 0 5,024 0 5,52,030 8,634 5,48,421 5,48,421 24,00,000
8 80,000 0 80,000 3,210 1,226 3,600 0 0 0 0 6,45,165 10,081 6,35,084 6,35,084 24,00,000
9 80,000 0 80,000 3,310 1,244 3,600 0 0 0 0 7,35,149 11,480 7,23,669 7,23,669 24,00,000
10 80,000 0 80,000 3,412 1,262 3,600 0 0 0 9,005 8,27,129 12,910 8,23,223 8,23,223 24,00,000
11 0 0 0 3,686 1,312 3,600 0 0 0 0 8,47,129 13,223 8,33,906 8,33,906 24,00,000
12 0 0 0 4,027 1,373 3,600 0 0 0 0 8,57,825 13,392 8,44,433 8,44,433 24,00,000
13 0 0 0 4,422 1,444 3,600 0 0 0 0 8,68,295 13,558 8,54,736 8,54,736 24,00,000
14 0 0 0 4,881 1,527 3,600 0 0 0 0 8,78,453 13,720 8,64,733 8,64,733 24,00,000
15 0 0 0 5,413 1,622 3,600 0 0 21,204 24,000 8,88,206 13,876 9,19,534 9,19,534 24,00,000
16 0 0 0 5,841 1,699 3,600 0 0 0 0 9,44,667 14,757 9,29,910 9,29,910 24,00,000
17 0 0 0 6,501 1,818 3,600 0 0 0 0 9,54,659 14,918 9,39,741 9,39,741 24,00,000
18 0 0 0 7,235 1,950 3,600 0 0 0 0 9,63,996 15,069 9,48,927 9,48,927 24,00,000
19 0 0 0 8,032 2,094 3,600 0 0 0 0 9,72,586 15,209 9,57,377 9,57,377 24,00,000
20 0 0 0 8,885 2,247 3,600 0 0 62,724 19,064 9,80,343 15,337 10,46,794 10,46,794 24,00,000
21 0 0 0 9,215 2,307 3,600 0 0 0 0 10,72,914 16,778 10,56,136 10,56,136 24,00,000
22 0 0 0 10,067 2,460 3,600 0 0 0 0 10,81,599 16,920 10,64,679 10,64,679 24,00,000
23 0 0 0 10,937 2,617 3,600 0 0 0 0 10,89,433 17,049 10,72,384 10,72,384 24,00,000
24 0 0 0 11,821 2,776 3,600 0 0 0 0 10,96,378 17,164 10,79,213 10,79,213 24,00,000
25 0 0 0 12,721 2,938 3,600 0 0 54,761 0 11,02,394 17,266 11,39,889 11,39,889 24,00,000
26 0 0 0 13,064 2,999 3,600 0 0 0 0 11,65,067 18,242 11,46,824 11,46,824 24,00,000
27 0 0 0 13,957 3,160 3,600 0 0 0 0 11,71,200 18,345 11,52,855 11,52,855 24,00,000
28 0 0 0 14,900 3,330 3,600 0 0 0 0 11,76,334 18,433 11,57,901 11,57,901 24,00,000
29 0 0 0 15,914 3,513 3,600 0 0 0 0 11,80,357 18,504 11,61,854 11,61,854 24,00,000
30 0 0 0 17,026 3,713 3,600 0 0 74,861 34,789 11,83,127 18,556 12,74,221 12,74,221 24,00,000
31 0 0 0 16,613 3,638 3,600 0 0 0 0 13,00,453 20,376 12,80,078 12,80,078 24,00,000
32 0 0 0 17,810 3,854 3,600 0 0 0 0 13,05,101 20,458 12,84,643 12,84,643 24,00,000
33 0 0 0 19,167 4,098 3,600 0 0 0 0 13,08,212 20,518 12,87,694 12,87,694 24,00,000
34 0 0 0 20,717 4,377 3,600 0 0 0 0 13,09,516 20,551 12,88,964 12,88,964 24,00,000
35 0 0 0 22,495 4,697 3,600 0 0 96,802 0 13,08,694 20,553 13,84,942 13,84,942 24,00,000
36 0 0 0 22,356 4,672 3,600 0 0 0 0 14,08,650 22,105 13,86,544 13,86,544 24,00,000
37 0 0 0 24,390 5,038 3,600 0 0 0 0 14,07,864 22,110 13,85,754 13,85,754 24,00,000
38 0 0 0 26,732 5,460 3,600 0 0 0 0 14,04,219 22,073 13,82,146 13,82,146 24,00,000
39 0 0 0 29,437 5,947 3,600 0 0 0 0 13,97,208 21,988 13,75,221 13,75,221 24,00,000
40 0 0 0 32,577 6,512 3,600 0 0 1,35,493 68,861 13,86,224 21,844 15,68,734 15,68,734 24,00,000

O.X.X
Quotation No : 60074053314

Family Benefit
Benefit Benefit
@8% @4%
Fund value at the end of year-with family benefit 68,12,486 15,82,506
Fund value at the end of year-without family benefit 67,53,271 15,68,734

The Benefits shown above (Death Benefit, Surrender Value) are payable assuming Death / Surrender occur at end of the year.

Notes:
1. Refer the salesliterature for explanation of terms used in this illustration.
2. Fund Management Charge is based on the specific fund option(s) chose
3. In case rider charges are collected explicitly through collec on of rider premium, and not by way of cancella on of units, then such charges are not considered in this illustra on other cases, rider charges are included in
other charges.
4. Other charges include morbidity and rider Charges , if any

I, ________ , have explained the premiums and benefits under the policy fully to the prospect / I, ____________ , having received the informa on with respect to the above, have understood the above
policyholder. statement before entering into the contract.

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

Notes: Bajaj Allianz Life Invest Protect Goal III

1. Please consult our 'Insurance Consultant' for any clarifications on this illustration.
2. Unit Linked Life Insurance Products are different from the traditional insurance products and are subject to the risk factors.
3. All benefits payable under the Policy are subject to the tax laws and other financial enactments, as they exist from time to time.
4. The Regular Premium and Top Up Premium, if any, paid is subject to investment risks associated with capital markets and Unit Prices may go up and down based on the performance of the underlying assets in the Funds
and the factors influencing the Capital market and the Life Assured/ Policyholder is responsible for his/ her decisions.
5.Bajaj Allianz Life Insurance is the name of the company & Bajaj Allianz Life Invest Protect Goal III is only the name of the Insurance Plan and does in no way indicate the quality of the policy, its future prospects or
returns.
6. On death of the life assured, Higher of (Prevailing Sum Assured or Regular Premium Fund Value) plus Higher of (Top up Sum Assured or Top up Premium Fund Value) is payable, provided all due premiums are paid up to
date.The total death benefit shall be at least the Guaranteed Benefit of 105% of Total premiums paid
7. The plan provides Loyalty Advantage, as detailed below. These will be added into the fund provided all due premiums under the policy are paid up to the date of each Loyalty Advantage. The Loyalty Advantage
available in the product are:
i) Return Of Premium Allocation Charge (ROAC) :At the end of the 15th policy year, the total of all the premium allocation charges w.r.t. regular/limited premiums deducted under the policy will be added into the fund
ii) Return Of Premium Mortality Charge (ROMC) :The mortality charges deducted will be added to the Fund value including to the Top-up Fund Value (in amount and timing) as per the table given below-

At the end of Policy Year Return of Mortality Charge of

7 25% of Mortality charge deducted till 7th year
15 50% of total Mortality charge deducted till 15th year Less Mortality charge already returned
20 100% of Mortality charge deducted till the end 20th Policy Year Less Mortality charge already returned
25 or at Maturity whichever is earlier 100% of Mortality charges deducted from 21st Policy Year to (end of the 25th Policy Year or at Maturity, whichever is earlier)
30 or at Maturity whichever is earlier 100% of Mortality charges deducted from 26th Policy Year to (end of the 30th Policy Year or at Maturity ,whichever is earlier)
35 or at Maturity whichever is earlier 100% of Mortality charges deducted from 31st Policy Year to ( end of the 35th Policy Year or at Maturity, whichever is earlier)
40 or at Maturity whichever is earlier 100% of Mortality charges deducted from 36th Policy Year to ( end of the 40th Policy Year or at Maturity, whichever is earlier)

iii) Loyalty Addi on (LA): At the end of 10th Policy Year and end of every 10th Policy Year therea er, ll the end of the Policy term (as applicable in the policy), Loyalty Addi ons as a propor on (as given in the table
below) of the average of the daily Regular Premium Fund Values during the previous 3 years (including the current year) will be added into the fund.

End of Policy Year 10th year 20th year 30th year 40th year
LA% 1.25% 2.00% 3.00% 5.00%

iv) Fund Maintenance Booster (FMB): From the 4th policy year, if the Fund Value is below one (1) Annualized Premium (will be checked at the start of each Policy month), then, Fund Maintenance Booster will be added to
the fund

Bajaj Allianz Life Insurance Co. Ltd.

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116.
Tel: (020) 66026777.
Email: [email protected]
www.bajajallianzlife.com

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

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

Policy
Sr. Description in Simple Words
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
Name of the
Insurance
Product and Bajaj Allianz Life Invest Protect Goal III Policy
1
Unique (UIN - 116L205V01) Schedule
Identification
Number (UIN)
Quotation Policy
2 60074053314
number Schedule
Type of
3 Insurance Linked -
Policy
Installment Premium(including Rider and GST)(Rs): 91,787
Mode of Premium Payment: Annual
Basic Policy Sum Assured on Death (Rs): 24,00,000 Policy
4 Details Sum Assured on Maturity (Rs): Not Applicable Schedule
Premium Payment Term (Years): 10
Policy Term (Years): 40
Benefits payable on maturity: Part C

Fund Value as on date of maturity Section 5

Benefits payable on death:

Death Benefit payable will be:

Higher of (Prevailing Sum Assured or Regular Premium Fund Value) + Part C

Higher of (Top-up Sum Assured or Top-up Premium Fund Value) Section 5

Subject to the Guaranteed Benefit of 105% of Total Premiums paid till date
of death.
Survival Benefits excluding that payable on maturity: Not Applicable -
Surrender benefits:
Policy Part D
5 Coverage/ben During the first 5 policy year: Discontinuance value at the end of the
efits payable lock-in period will be payable as surrender value. Section 9
After first 5 policy year: Fund value as on the date of surrender.
 Options to policyholders for availing benefits, if any, covered under
the policy: -
Not Applicable
Other benefits/options payable, specific to the policy, if any:
-
Not Applicable
Lock-in period for Linked Insurance products: Part B

Five (5) Years Section 1

Partial Withdrawal: Available

Top-up Premium: Available

Switch Funds (only under Investor Selectable Portfolio Strategy):

Available
Options Part D
available (in Settlement Option: Not Available
6 case of Linked Section
Insurance Increase or Decrease sum assured: Available 11
Products) Premium Apportionment (Only if investor selectable strategy is
selected): Available

Change Premium Payment Frequency:Available

Switch Portfolio strategies: Available

Option
available(in
7 case of Not Applicable -
Annuity
product)

Sum Assured
Rider Name Rider Benefit UIN
(Rs.)
Bajaj Allianz Life
Linked Accidental
Linked Accident 116A057V01 ₹ 72,00,000
Death Benefit
Riders Opted if Protection Rider II Policy
8
Any Bajaj Allianz Life Linked Accidental Schedule
Linked Accident Total Permanent 116A057V01 ₹ 24,00,000
Protection Rider II Disability Benefit

For details on the rider, please refer the customer information sheet of the
respective rider.
 Suicide claim provision: In case of death due to suicide within 12 months
Exclusions from the Date of Commencement of Risk or from the date of latest revival of
(events where the Policy, whichever is later, the Claimant shall be entitled to the Fund Part F
insurance Value, as available on the date of intimation of death.
9 Section
coverage is
not payable), if There is no other exclusion applicable w.r.t death other than suicide clause. 23
any
No other exclusions in the product
Waiting
10 Period/ /lien Not Applicable -
Period, if any

Thirty (30) days for premium payment frequencies other than monthly and Part B
11 Grace Period
fifteen (15) days for monthly frequency. Section 1

Free Look Part D

12 Thirty (30) Days
Period Section 6
Lapse

If premiums have not been paid

Part D
During the first five (5) policy years: Policy will be converted to a
discontinued life policy at the end of the grace period Section 7
After first five (5) policy years: Policy will be, immediately &
automatically, converted to a paid-up policy at the end of the grace
Lapse, paid-up
period.
13 and Revival of
the Policy Paid-up
Part D
If premiums have not been paid, after the lock-in period, policy will be
immediately & automatically converted to a paid-up policy at the end of the Section 7
grace period
Revival Part B

Three (3) years from the date of first unpaid premium Section 1
Policy Loan If
14 Not Applicable -
Applicable
 1. Turn Around Time (TAT) for claims settlement and brief
procedure:
Link for Brief Procedure : https://www.bajajallianzlife.com/life-
insurance-claim-assistance.html
Link for Turn Around Time (TAT) for claims settlement:
https://www.bajajallianzlife.com/content/dam/balic-
web/pdf/customer-services/services-tat.pdf

2. Helpline/Call Centre Numbers:

1800-209-7272 (Toll Free)

Claims / Mail Us : [email protected] Part F
15 Claims Section
Procedure 3. Contact details of the insurer:
34
Bajaj Allianz Life Insurance Company Limited
House, Ground Floor, Bajaj Allianz, Airport Rd, Yerawada, Pune,
Maharashtra 411006

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

including bank account details:

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

WhatsApp- 8806727272

1. Turn Around Time (TAT):

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

2. Helpline/Call Centre number: 1800 209 7272

3. Contact details of the insurer: In case you have any query, you may
communicate with the Company: Part G
Policy 1. By post at: Customer Care Desk, Bajaj Allianz Life Insurance
16 Section
Servicing Company Ltd., Bajaj Allianz House, 5th floor, Airport Road,
Yerawada, Pune - 411006 37
2. By Email: [email protected]

4. Link for downloading applicable form and list of documents

required including bank account details:
https://bajajallianzlifeonline.co.in/online/portal/logon/serviceRequest.do
?user_name=WEBSITE&p_flag=0
 1. Contact details of Grievance Redressal Officer of the insurer:
Grievance Redressal Officer of the insurer - In case you do not receive
a response within 14 days or if you are not satisfied with the resolution,
you may approach Grievance Redressal Officer at
[email protected]
Part G
2. Link for registering the grievance with the insurer’s
Grievances portal:Insurance company grievance portal - Section
17 37 and
/Complaints https://webpartner.bajajallianz.com/GrvOnlineApi/indexOnlineGrv.jsp#_
ga=2.7272630.541013491.1717475077- Section
1601763320.1694668355&_gac=1.52751388.1715749803.EAIaIQobC 38
hMIy_eqivKOhgMVdWsPAh0NFQrEEAAYASAAEgJObPD_BwE

3. Contact details of Ombudsman: Find your nearest Ombudsman

office at http://www.cioins.co.in/ombudsman
 Declaration by the policyholder

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

Web-link for the product where sample policy document can be downloaded:
https://www.bajajallianzlife.com/ulip-plans/invest-protect-goal-product-page.html
Disclaimer:
In case of conflict in the content mentioned hereinabove, the terms and conditions mentioned in the policy
document shall prevail.
 CUSTOMER INFORMATION SHEET / KNOW Y OUR POLICY.

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

Policy
Sr. Description in Simple Words
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
Name of Bajaj Allianz Life Linked Accident Protection Rider II Policy
1 Insurance
Schedule
Product/ Policy (UIN - 116A057V01)
Quotation Policy
2 60074053314
number Schedule
Type of As per
Benefit (Where an Insurance Policy pays a fixed amount under the policy on
3 Insurance base
the occurrence of a covered event)
Product/ Policy policy
Benefit Option Sum Assured (Rs.)
Accidental Death benefit (ADB) / Accidental Death benefit ₹ 72,00,000
Sum Insured (ADB) with ROP
Accidental Total Permanent Disability (ATPD) / Accidental Policy
4 (Basis) (Along Total Permanent Disability (ATPD) with ROP
₹ 24,00,000
Schedule
with amount) Maturity Benefit (In case Accidental Death benefit with ROP
and / or Accidental Total Permanent Disability with ROP Not Applicable
variant is opted)
The rider has the following options to choose from:

1. Accidental Death benefit (ADB) / Accidental Death benefit (ADB)

Part C –
with ROP: In the event of death due to an accident, higher of
Section
Guaranteed Benefit (i.e. 105% of Total Premiums Paid) or ADB Sum
3
Assured will be paid as a lumpsum and the ADB benefit will terminate.

2. Accidental Total Permanent Disability (ATPD) / Accidental Total

Policy Permanent Disability (ATPD) with ROP: In the event of Total Permanent Part C –
Coverage Disability of the Life Assured due to an accident, higher of Guaranteed Section
(What the Benefit (i.e. 105% of Total Premiums Paid) or ATPD Sum Assured will be 3
5 paid as a lumpsum and the ATPD benefit will terminate.
policy covers)
(Policy Clause In case Accidental Death benefit (ADB) with ROP and / or Accidental
Number/s) Total Permanent Disability (ATPD) with ROP variant is opted) – Total Part C –
Premiums paid under the Rider will be paid out on the Rider Maturity Date, Section
provided the Rider is in-force. The Rider will terminate immediately & 3
automatically on payment of the Maturity Benefit.
 Accidental Death Benefit & Accidental Death Benefit with ROP

i)Death occurs as a result of the Rider Life Assured committing any breach
of law with criminal intent.

ii) Death as a consequence of the Rider Life Assured being under the
influence of alcohol or drugs other than in accordance with the directions of
a registered medical practitioner.

iii) Death as a result of self-inflicted injuries.

iv) Death occurs as a result of the Rider Life Assured taking part in any
naval, military or air force operation during peace time.

v) Death occurs as a result of the Rider Life Assured participating in or

training for any dangerous or hazardous sport or competition or riding or
driving in any form of race or competition.

vi) Death occurs as a result of suicide.

Part D –
vii) Death occurs as a result of aviation, gliding or any form of aerial flight Section 5
other than as a fare paying passenger of a recognised airline on regular
routes and on a scheduled timetable.

viii) Death occurs as a result of war, invasion, civil war, rebellion, riots.

ix) Poison, gas or fumes (voluntary or involuntarily, accidentally or otherwise

taken, administered, absorbed or inhaled).

x) Service in the armed forces, or any police organization, of any country at

war or service in any force of an international body.

xi) Nuclear Contamination: the radioactive, explosive or hazardous nature of

nuclear fuel materials or property contaminated by nuclear fuel materials or
accident arising from such nature.

xii) Death as a result of any disease or infection.

Exclusions
(what the
6 policy does not Accidental Total Permanent Disability Benefit & Accidental Total
cover) Permanent Disability Benefit with ROP

i) Disability as a result of the Rider Life Assured committing any breach of

law with criminal intent.

ii) Disability of Rider Life Assured as a result of war, invasion, civil war,
rebellion or riot.

iii) Disability as a consequence of the Rider Life Assured being under the
influence of alcohol or drugs other than drugs prescribed by and taken in
accordance with the directions of a registered medical practitioner.

iv) Disability as a result of the Rider Life Assured taking part in any naval,
military or air force operation.

v) Disability as a result of the Rider Life Assured participating in or training

for any dangerous or hazardous sport or competition or riding or driving in
any form of race or competition.

vi) Disability of Rider Life Assured as a result of aviation, gliding or any form
of aerial flight other than as a fare paying passenger on a civilian airline
plying on regular routes and according to a scheduled timetable.

vii) Disability of Rider Life Assured as a result of attempted self-injury.

Part D –
viii) Any condition that is pre-existing at the time of inception of the policy. Section 5
Pre-existing condition means any condition, ailment, injury or disease: -

a. That is/are diagnosed by a physician within 48 months prior to the Date

of Commencement of Rider Cover or latest revival, whichever is later, or

b. For which medical advice or treatment was recommended by, or received

from, a physician within 48 months prior to the Date of Commencement of
Rider Cover or latest revival, whichever is later.

This exclusion will not be applicable to conditions, ailments or injuries or

related condition(s) which are underwritten and

accepted by the insurer at inception or at reinstatement.

ix) Poison, gas or fumes (voluntary or involuntarily, accidentally or otherwise

taken, administered, absorbed or inhaled).

x) Service in the armed forces, or any police organization, of any country at

war or service in any force of an international body.

xi) Nuclear Contamination: the radioactive, explosive or hazardous nature of

nuclear fuel materials or property contaminated by nuclear fuel materials or
accident arising from such nature.

xii) Disability as a result of any disease or infection.

 Waiting Period
Time
period
during
which
specified
diseases /
treatment Not
7 s are not Not Applicable Applicabl
covered e
It is
counted
from the
beginning
of the
policy
coverage
 Financial limits
of coverage

i. Sub-limit (It is
a pre-defined
limit and the
insurance
company will
not pay any
amount in
excess of this
limit)

ii. Co-payment
(It is a
specified
amount/percen
tage of the
admissible
claim amount i) Sub limit – Not Applicable
to be paid by
policyholder/in ii) Co-payment – Not Applicable Not
8 sured) Applicabl
iii) Deductible – Not Applicable e
iii. Deductible
(It is a iv) Any other limit (as applicable) – Not Applicable
specified
amount: - up to
which an
insurance
company will
not pay any
claim, and -
which will be
deducted from
total claim
amount (if
claim amount
is more than
the specified
amount)
iv. Any other
limit (as
applicable)
 Turn Around Time (TAT) for claims settlement and brief procedure:

· Link for Brief Procedure: https://www.bajajallianzlife.com/life-

insurance-claim-assistance.html

· Link for Turn Around Time (TAT) for claims settlement:

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

Helpline/Call Centre Numbers:

Claims/ Claims Part F –
9 1800-209-7272 (Toll Free) Section
Procedure
Mail Us : [email protected] 13

Contact details of the insurer: Bajaj Allianz Life Insurance Company

Limited House, Ground Floor, Bajaj Allianz, Airport Rd, Yerawada, Pune,
Maharashtra 411006

Link for downloading claim form and list of documents required

including bank account details: https://www.bajajallianzlife.com/life-
insurance-claim-assistance.html

Turn Around Time (TAT):

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

Helpline/Call Centre number: 1800 209 7272

Part G –
Contact details of the insurer: In case you have any query, you may
Policy As per
10 communicate with the Company:
Servicing Base
1. By post at: Customer Care Desk, Bajaj Allianz Life Insurance Company Policy
Ltd., Bajaj Allianz House, 5th floor, Airport Road, Yerawada, Pune – 411006

2. By Email: [email protected]

Link for downloading applicable forms and list of documents required

including bank account details:
https://bajajallianzlifeonline.co.in/online/portal/logon/serviceRequest.do?
user_name=WEBSITE&p_flag=0
 Contact details of Grievance Redressal Officer of the insurer:
Grievance Redressal Officer of the insurer - In case you do not receive a
response within 14 days or if you are not satisfied with the resolution, you
may approach Grievance Redressal Officer at [email protected]

Link for registering the grievance with the insurer’s portal: Insurance Part G –
Grievances/Co company grievance portal As per
11 -https://webpartner.bajajallianz.com/GrvOnlineApi/indexOnlineGrv.jsp#_ga= Base
mplaints
2.7272630.541013491.1717475077- Policy
1601763320.1694668355&_gac=1.52751388.1715749803.EAIaIQobChMIy
_eqivKOhgMVdWsPAh0NFQrEEAAYASAAEgJObPD_BwE

Contact details of Ombudsman:

Find your nearest Ombudsman office at: http://www.cioins.co.in/ombudsman

Free look cancellation – 30 days
Policy Renewal – Not applicable Part D
Things to
12 Migration and Portability – Not applicable –Secti
remember
Change in sum insured – Not applicable on 7
Moratorium Period – Not applicable
Please disclose all pre-existing disease/s or condition/s before buying a
rider. Non-disclosure may affect the claim settlement. Disclosure of material
Your Proposal
13 information while applying for the rider and changes during the rider period
obligations form
should be communicated to Bajaj Allianz Life Insurance customer care ID via
registered email id of the customer.
 Declaration by the policyholder

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

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