Benefit Illustration

Name of the Prospect Proposal No:

Mr. SYAMPRAKASH DUKKA
/Policyholder IndiaFirst Life Long
Name of the Product:
Age: 43 Guaranteed Income Plan
Name of the Life Assured: Mr. SYAMPRAKASH DUKKA Tag Line:
Age: 43 Unique Identification
Number: 143N054V06
Policy Term: 15
Premium Paying Term: 12 1st Year - 4.50% p.a
Amount of Installment GST Rate : 2nd Year onwards - 2.25%
Premium: 100,000 p.a
Premium Payment Yearly
Frequency:
Gender of Life Assured: Male
This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.
Policy Details
Policy Option Whole of Life Income option Income Period (years) 42
Riders Opted NA Sum Assured Rs. 1,293,319
WOP Rider Option NA Sum Assured on Death (at inception 1,142,000
of the policy) Rs.

Premium Summary
Base Plan Rider Total Instalment Premium
Instalment Premium without GST (Rs.) 100,000 0 100,000
Instalment Premium with First year 104,500 0 104,500
GST (Rs.)
Instalment Premium with GST 2nd 102,250 0 102,250
year onwards (Rs.)

(Amounts in Rupees)
Guaranteed Non
Guaranteed Surrender
Policy Year Annualized Value
Premium* (Rs.) Survival Other Maturity Death Min Guaranteed Special
Benefits/Loyalty Benefits, if Benefit Benefit Surrender Value Surrender Payable (Rs.)
Additions (Rs.) any (Rs.) (Rs.) (Rs.) (Rs.) Value** (Rs.)
(BOY) (EOY) (EOY) (EOY) (EOY) (EOY) (EOY) (EOY)
1 100,000 0 0 0 1,142,000 0 36,456 36,456
2 100,000 0 0 0 1,142,000 60,000 78,286 78,286
3 100,000 0 0 0 1,142,000 105,000 126,075 126,075
4 100,000 0 0 0 1,142,000 200,000 180,539 200,000
5 100,000 0 0 0 1,142,000 250,000 242,319 250,000
6 100,000 0 0 0 1,142,000 300,000 312,325 312,325
7 100,000 0 0 0 1,142,000 350,000 391,432 391,432
8 100,000 0 0 0 1,142,000 480,000 480,637 480,637
9 100,000 0 0 0 1,142,000 585,000 580,947 585,000
10 100,000 0 0 0 1,142,000 700,000 693,709 700,000
11 100,000 0 0 0 1,155,000 825,000 820,808 825,000
12 100,000 0 0 0 1,260,000 960,000 965,436 965,436
13 0 0 0 0 1,260,000 1,020,000 1,037,879 1,037,879
14 0 0 0 0 1,260,000 1,080,000 1,116,305 1,116,305
15 0 0 107,000 0 1,260,000 1,080,000 1,201,108 1,201,108
16 0 0 107,000 0 0 0 0 0
17 0 0 107,000 0 0 0 0 0
18 0 0 107,000 0 0 0 0 0
19 0 0 107,000 0 0 0 0 0
20 0 0 107,000 0 0 0 0 0
 (Amounts in Rupees)
Guaranteed Non
Guaranteed Surrender
Policy Year Annualized Value
Premium* (Rs.) Survival Other Maturity Death Min Guaranteed Special
Benefits/Loyalty Benefits, if Benefit Benefit Surrender Value Surrender Payable (Rs.)
Additions (Rs.) any (Rs.) (Rs.) (Rs.) (Rs.) Value** (Rs.)
(BOY) (EOY) (EOY) (EOY) (EOY) (EOY) (EOY) (EOY)
21 0 0 107,000 0 0 0 0 0
22 0 0 107,000 0 0 0 0 0
23 0 0 107,000 0 0 0 0 0
24 0 0 107,000 0 0 0 0 0
25 0 0 107,000 0 0 0 0 0
26 0 0 107,000 0 0 0 0 0
27 0 0 107,000 0 0 0 0 0
28 0 0 107,000 0 0 0 0 0
29 0 0 107,000 0 0 0 0 0
30 0 0 107,000 0 0 0 0 0
31 0 0 107,000 0 0 0 0 0
32 0 0 107,000 0 0 0 0 0
33 0 0 107,000 0 0 0 0 0
34 0 0 107,000 0 0 0 0 0
35 0 0 107,000 0 0 0 0 0
36 0 0 107,000 0 0 0 0 0
37 0 0 107,000 0 0 0 0 0
38 0 0 107,000 0 0 0 0 0
39 0 0 107,000 0 0 0 0 0
40 0 0 107,000 0 0 0 0 0
41 0 0 107,000 0 0 0 0 0
42 0 0 107,000 0 0 0 0 0
43 0 0 107,000 0 0 0 0 0
44 0 0 107,000 0 0 0 0 0
45 0 0 107,000 0 0 0 0 0
46 0 0 107,000 0 0 0 0 0
47 0 0 107,000 0 0 0 0 0
48 0 0 107,000 0 0 0 0 0
49 0 0 107,000 0 0 0 0 0
50 0 0 107,000 0 0 0 0 0
51 0 0 107,000 0 0 0 0 0
52 0 0 107,000 0 0 0 0 0
53 0 0 107,000 0 0 0 0 0
54 0 0 107,000 0 0 0 0 0
55 0 0 107,000 0 0 0 0 0
56 0 0 107,000 0 0 0 0 0
57 0 0 1,200,000 0 0 0 0 0

'BOY' refers to cashflows payable at the 'Beginning Of the Year', 'EOY' refers to cashflows payable in arrears (end of period) as per the benefit
payout frequency chosen, if applicable

Notes:
1. Please consult our 'Insurance Consultant' for any clarifications on this illustration.
*2. Annualized Premium excludes taxes, rider premiums, underwriting extra premiums and loadings for modal premiums.
3. Refer Sales Literature for explan on of terms used in illustra on and more details on risk factors, exclusions and other terms and condi ons
about the product.
4. Premiums payable are eligible for tax benefits as per Income Tax Act, 1961 amended from time to time.
5. All benefits payable under the Policy are subject to the tax laws and other financial enactments, as applicable from time to time.
**6. Special Surrender Value in the above table is based on current prevailing market environment condi ons and underlying experience. It shall be
reviewed annually and may be revised in the future.
Special Surrender Value shown in the first year shall become payable a er comple on of first policy year provided one full year premium has been
received.
Please check with the Company on the Special Surrender Value to be payable at the time of surrender.
7. 'Surrender value', shown in the table above is the higher of 'Min Guaranteed Surrender Value' and 'Special Surrender Value'.
8. Death Benefit amount payable on death shall be Death Benefit as shown above or Surrender Value as on date of death, whichever is higher.
9. The Company declares that it may charge extra premium subject to underwriting of proposal before the acceptance of risk.
10. This benefit illustra on has been generated basis my suitability assesment and on my confirma on the same has been proposed to me.
 I, ____________(name) , have explained the premiums, and benefits I, SYAMPRAKASH DUKKA , having received the information with
under the product fully to the prospect / policyholder. respect to the above, have understood the above statement before
Place: entering into the contract.
Date: 18 Aug 2025 Signature of Agent / Intermediary / Official
Date: 18 Aug 2025 Signature of Prospect / Policyholder

Request you to submit the following mandatory requirements along

with the application form:
1) Address Proof
2) Age Proof
3) CDF
4) Cancelled Cheque Copy
5) General Correspondence
6) ID Proof
7) PAN Card
8) Partnership Declaration Document
9) Photograph
10) Physical ECS Mandate
11) Suitability
12) TIN Document

Disclaimer - IndiaFirst reserves the right to call for any addi onal documents/requirements basis the informa on provided by you in the applica on
form. The requirements stated herein are applicable only in case of the current applica on. Any simultaneous applica on or previous applica ons
may necessitate addi onal requirements by the Company. Please get in touch with your BDM for scheduling of medicals if any. Self-a ested AML /
KYC documents for the proposer / premium payor only are to be submitted.

IndiaFirst Life Insurance Company Ltd , 12th & 13th floor, North ( C ) Wing, Tower 4, Nesco IT Park, Nesco Centre, Western Express Highway,
Goregaon (East), Mumbai – 400 063. Website: www.indiafirstlife.com , Toll Free No. : 1800 209 8700. IRDAI Regn No. 143. CIN:
U66010MH2008PLC183679
 CUSTOMER INFORMATION SHEET/ KNOW YOUR POLICY
This document provides key information about your policy. You are also advised to go through your policy document.

Sl Description Policy
No Title (Please refer to applicable Policy Clause Number in next column) Clause
Number

Name of Insurance
1 Product and Unique IndiaFirst Life Long Guaranteed Income Plan (143N054V06)
Identification
Number

Policy
2 Number/Application
Number

3 Type of Insurance Non-Linked other than Pure Risk & Pension

Policy

Instalment Premium: INR 1,00,000

Mode of Premium Payment: Yearly

Sum Assured on Death: INR 11,42,000

Sum Assured on Maturity INR 12,93,319

Premium Payment Term: 12 years

4 Basic Policy Details
Policy Term: 15 years

Riders opted

IndiaFirst Life Waiver of Premium Rider (UIN: 143B017V01) Not Applicable

Rider Instalment Premium:
Rider Sum Assured:
Rider Premium Payment Term:
Rider Policy Term:
 Part C
Benefits payable on death: Clause
1.1
Upon the Life Assured’s death highest of the following benefits are payable by us to the Nominee(s)/
Appointee/ Legal Heir during the policy term provided the life cover is in force:
Sum Assured on Death (SAD)
105% of Total Premiums Paid (TPP) till the date of death
Sum Assured on Maturity, minus the survival benefits paid to date
Surrender Value as on date of death
Where Sum Assured on Death (SAD) is Death Benefit Multiple (DBM) times of Annualized Premium.

Benefits payable on maturity:

Definite Income Option Part C

Maturity Benefit is paid in the form of Guaranteed Income which is defined as X% of Annualized Clause
Premium, for a period of 20 or 30 years along with Y% of return of premium at the end of the income 1.2
benefit period payable upon payment of all due premiums.

5 Policy Coverage/ Whole of Life Income Option

benefits payable Maturity Benefit in the form of Guaranteed Income which is defined as X% of Annualized Premium, up
to Age 99 years along with Y% of return of premium at the end of the income benefit period are payable
upon payment of all due premiums.

Please refer Part C of the Policy Document for more details on X% and Y%.

On maturity date for both the above income options, the policyholder will have an option to receive a
lumpsum amount which shall be the present value of future guaranteed income as well as Y% of return
of premium, discounted at the rate of 9% p.a. This benefit shall not be less than the total premiums
paid under the policy.

Survival Benefits excluding that payable on maturity:

Not Applicable

Surrender Benefits:
Please refer to Part D, of your policy document for more details

Lock-in period for Linked Insurance products:

NA Part C
Clause 5

Partial Withdrawal
NA

Switches
Options available NA
6 (in case of Linked
Insurance products) Settlement option
NA

Premium redirection
NA

7 Riders opted, if any Pls refer details under Point 4 above.

Suicide Exclusions:
Exclusions (events In case of death due to suicide within 12 months from the date of commencement of risk under the
where insurance policy or from the date of revival of the policy, as applicable, the nominee or beneficiary of the Part F
8 coverage is not policyholder shall be entitled to 80% of the total premiums paid till the date of death or the surrender Clause
payable), if any value available as on the date of death whichever is higher, provided the policy is in force. 14

For exclusions under applicable rider policy, please refer the rider policy document.

Waiting /lien Waiting period of first 90 days from the date of acceptance of risk shall be applicable. For deaths (other
9 Period, if any than accidental deaths) during the said waiting period, 100% of Premiums Paid shall be paid as Death
Benefit. In case of accidental death, entire death benefit shall be payable.
 You are provided a Grace Period of 15 days under monthly mode and 30 days for other premium
payment modes, in case you miss paying your Premium on the due dates. All your Policy benefits
continue during the Grace Period. Part C
10 Grace Period Clause 6
In case of the Life Assured's death during the Grace Period, we will pay the death benefit deducting
unpaid due premiums till such date and the Policy will terminate.

You have a free look period of 30 days from date of receipt of your policy document whether received
electronically or otherwise, to review the terms and conditions of the policy, in case you disagree to any part D
11 Free Look Period of those terms and conditions, you shall have an option to return the policy to us for cancellation, clause
stating the reasons for your objection, then you shall be entitled to a refund of the premium paid 10
subject only to a deduction of a proportionate risk premium for the period of cover and the expenses
incurred by us on medical examination of the life to be assured and stamp duty charges.

12 Lapse, paid-up and Please refer to Part C, of your policy document for more details. Part C
revival of the Policy Clause 4

You can avail a loan up to 90% of the acquired Surrender Value, if any. The minimum loan amount which
can be availed is INR 1,000. A loan disbursement letter will be issued informing about the loan details
including the applicable interest rate and relevant terms thereof.
For in-force and fully paid-up policies, if the outstanding loan along with interest exceeds 90% of
the Surrender Value, the Company will send a notice to the Policyholder to repay the loan partially
or completely. If the loan is not repaid subsequent to receipt of the notice, then we will adjust the
outstanding loan along with interest before any payment of benefits. After recovering the
outstanding loan along with interest, remaining benefit, if any, will be payable.
For other than in-force and fully paid-up policies, as and when the outstanding loan along with
Policy Loan, if interest exceeds the Surrender Value for paid-up cases, the Company will send a notice to the Part D
13 applicable Policyholder to repay the loan partially or completely. If loan is not repaid within a stipulated Clause
period, the Policy will be compulsorily surrendered and the outstanding loan along with interest 11
will be recovered from the Surrender proceeds or paid-up value.
The basis used for the calculation of interest rate on loan is 10-year G-Sec rate as at the end of
last financial year plus the absolute margin of 250 basis points rounded up to the nearest 50
basis points. The derived interest rate will be applicable in the succeeding financial year.
Currently, the interest rate on loan for FY 2024-25 is 10.00% p.a. (simple). It is arrived by adding a
margin of 250 basis points on the effective annual 10-year G-Sec and rounding up to the nearest
50 basis points (10.00% 7.18% + 2.50%).
Any change in the methodology of calculating the loan interest rate shall be subject to the
applicable regulations.

Death Claim:
In case of natural death
i. Proof of Age of the Life Assured, if the Age of the life assured has not been admitted by us.
ii. Claimant’s statement and claim in ma on report completely filled and signed by
claimant/nominee.
iii. Valid QR Code Scannable Death cer ficate issued under sec on 12/17 of registra on of Births
and Deaths Act 1969 (only in case of death of the Life Assured).
iv. Original Policy document.
v. A self-a ested copy of Pan Card of Nominee/Claimant. In case Nominee/Claimant does not have
a pan card issued on his/her name then please submit duly filled and signed Form 60.
vi. Self-a ested copy of photo-iden ty proof and address proof of the Nominee(s)/Claimant (e.g.
driving license, PAN card, passport, Voter ID card etc.)
vii. Self-a ested copy of bank passbook of Nominee(s)/Claimant along with cancelled cheque with
Printed Nominee name, Account Number and IFSC code available on the same.
Any other document or information that we may need for validating and processing the claim.

In case of unnatural death

Following additional documents will be required apart from ones mentioned above:
i. Clear Readable copies of Medico Legal Cer ficate, First Informa on Report, Panchnama, Inquest
report final viscera report, final police inves ga on closure report and postmortem report (Only if
Death), duly a ested by the police (only in case of Accident leading to unnatural death or
Permanent Disability of the Life Assured).
ii. All Hospitaliza on documents including discharge summary, Admission Notes, and all
inves ga on reports (only mandatory in case the Life Assured was treated for any illness related
to the cause of death).
Any other document or information that we may need for validating and processing the claim.

Maturity Claim:
 i. Maturity Claim Intimation form duly filled and signed by Policy Holder.
ii. Original Policy Document(s)
iii. Self-Attested Copy of Pan Card of the Policy Holder
iv. Cancelled Cheque or Self Attested Copy of Pass book of the Policy Holder
v. Self-Attested Copy of Address Proof (if change in Address). Part
14 Claims/Claims F Clause
Procedure vi. Duly filled and signed NRI Declaration form applicable only for NRIs.
vii. Any other document or information that we may need for validating and processing the claim. 13

Claims can be intimated through.

Courier – Intimation with supporting documents can be sent to claims department at head office by
courier to the below address.
Claims Department, IndiaFirst Life Insurance Company Ltd, 12th Floor, North (C) wing, Tower 4, Nesco
IT Park, Nesco Center, Western Express Highway, Goregaon (East), Mumbai – 400063
Email – Intimation with supporting documents can be sent to [email protected]
Website - Visit IndiaFirst website for online claim intimation at
https://www.indiafirstlife.com/claims/register-claim-online and follow few simple steps to complete
the claim intimation.
WhatsApp – Say Hi on +91 22 6274 9898 and follow few simple steps to complete the claim intimation

Turn Around Time for various servicing request and claims processing are as mentioned below:

Maturity/Survival/Death Claims

Processing of Maturity claim / Due

penal interest not paid date

Raising claim requirements 15 Days

after lodging the Death claim

Death claim decision without 15 Days

investigation requirement

Death claim decision with 45 Days

Investigation requirement

The claim form can be downloaded from the following link:

https://www.indiafirstlife.com/download-forms/claims

You may contact us at any of our branches or at Customer Care, IndiaFirst Life Insurance Company Ltd,
12th & 13th floor, North (C) Wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway,
Goregaon (East), Mumbai – 400 063. Contact No.: 1800 209 8700, Email id:
[email protected]
Turn Around Time for various servicing request and claims processing are as mentioned below:
Policy Servicing TAT's

Full Surrender 7 Days

Freelook Cancellation 7 Days

Request for Refund of

Proposal Deposit 15 days
Part F
15 Policy Servicing Refund of outstanding Clause
proposal deposit 30 days 22

The policy servicing form can be downloaded from the following link:
https://www.indiafirstlife.com/download-forms/policy-serving

You may contact us at any of our branches or at Customer Care, IndiaFirst Life Insurance Company Ltd,
12th & 13th floor, North (C) Wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway,
Goregaon (East), Mumbai – 400 063. Contact No.: 1800 209 8700, Email id:
[email protected]
 You may contact us in case of any grievance at any of our branches or at Customer Care, IndiaFirst Life
Insurance Company Ltd, 12th & 13th floor, North (C) Wing, Tower 4, Nesco IT Park, Nesco Center,
Western Express Highway, Goregaon (East), Mumbai – 400 063. Contact No.: 1800 209 8700, Email id:
[email protected]
a. An acknowledgment to all such grievances received will be sent immediately from the date of
receipt of the grievance.
b. A written communication giving reasons of either redressing or rejecting the grievance will be
sent to you within 14 days from the date of receipt of the grievance. In case We don't receive a
revert from You within 8 weeks from the date of registration of grievance, then We will treat the
complaint as closed.
However, if you are not satisfied with our resolution provided or have not received any response
within 14 days, then, you may approach our Grievance Officer at any of our branches or you may
write to our Grievance Redressal Officer at [email protected].
c. If you are not satisfied with the resolution or have not received any response within 14 days, then
you can contact the insurance ombudsman. For the list of ombudsman office please refer
Grievance/ Annexure B of your policy document.
16 Complaints Part G
d. Further, you may approach the Grievance Cell of the Insurance Regulatory and Development
Authority of India (IRDAI) on the following contact details.
IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: 155255
Email ID: [email protected]

You can also register your complaint online at

https://bimabharosa.irdai.gov.in/

Address for communication for complaints by fax/paper:

Policyholder Protection & Grievance Redressal Department (PPGR),
Insurance Regulatory and Development Authority of India,
Sy. No. 115/1, Financial District, Nanakramguda
Gachibowli, Hyderabad- 500032, Telangana
IRDAI TOLL FREE NO: 18004254732

For more details on Insurance Ombudsman, refer to your policy document Part G

Note: Customer Information Sheet contains brief information about the key features of the Product. The same shall not be construed as terms and
conditions of the Policy or part thereof. For detailed terms and conditions governing the Policy, please read all parts of the Policy document. In case
of any conflict between the information given in the Customer Information Sheet and the terms and conditions of the policy, the terms and
conditions of the Policy shall prevail.

Declaration by the Policy Holder

I, SYAMPRAKASH DUKKA , have read the above and confirm having noted the details.

Place:
Date: 18 Aug 2025

(Signature of the Policy Holder)

Note: The product related documents can be downloaded from below link:
https://www.indiafirstlife.com/download-forms