Name of the Prospect / ANUSHKA B R Proposal No: Q17199269516667

Policyholder:
Name of the Product: Tata AIA Life Insurance Fortune Guarantee
Age (years) : 26 Gender: Female Plus

Tag Line : Individual, Non-Linked Non-Participating

Name of the Life Assured 1 : ANUSHKA B R Life Insurance Savings Plan
Age (years) : 26 Gender: Female Unique Identification No.: 110N158V12

i GST Rate: 4.5% for first year

Name of the Life Assured 2 : NA
am
red 2.25% second year onwards
Age (years) : NA Gender: NA

Policy Term (years) : 17

Premium Payment Term (years) : 12

Amount of Instalment Premium 97209

(Rs.):

Mode of Payment of Premium : Annual

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Policy Details
Basic Sum Assured (First Death) Rs. 1200000
Policy Option Regular Income
Basic Sum Assured (Second Death, if any) Rs. NA

Income Period (years) 20

Sum Assured on First Death (at inception of the policy) Rs. 1200000
Income starts from Year 18

Income ends on Year 37

Sum Assured on Second Death, if any (at inception of the policy) Rs. NA
Guaranteed Annual Income (GAI)* Annual

*GAI shall commence from the end of the Policy Year, following Date of Maturity of Policy. In case of monthly frequency, GAI shall commence from the end
of the policy month following Date of Maturity of Policy.

Rider Details

Tata AIA Vitality

(Wellness No
Program)

Details of Life
Rider Name/UIN^ Insured/Partner under the Benefit Payout
Benefit Option Return of Benefit Premium Sum Premium p.a. Year 1
(Benefit
premium Option Payment Assured without GST Discount
Option/Benefit Income option Term Term (Rs.) (Rs.) (Rs.)
Payout Option) Name Age(yrs) Gender Lumpsum Income Duration
(Rs.) p.a.(Rs.)
(yrs)

Premium Summary
Base Plan Riders Total Instalment Premium

Instalment Premium without GST (Rs.) 93023 0 93023

Instalment Premium with First year GST (Rs.) 97209 0 97209

Instalment Premium post applicable discount with First year GST

97209 0 97209
(Rs.)

Instalment Premium with GST 2nd year onwards (Rs.) 95116 0 95116
 (Amount in Rupees)
Guaranteed Non - Guaranteed
Death
Policy Single/ Annualised Survival Death
Other Maturity Benefit
Year Premium Benefit / Benefit #Min Guaranteed #Special Surrender
Benefits, if (Second
Loyalty
any Benefit ## (First
Death,
Surrender Value Value
Additions Death)
if any)
1 93023 NA NA 0 1200000 NA 0 0

2 93023 NA NA 0 1200000 NA 55814 93684

3 93023 NA NA 0 1200000 NA 97674 149043

4 93023 NA NA 0 1200000 NA 186046 215758

5 93023 NA NA 0 1200000 NA 232558 290989

6 93023 NA NA 0 1200000 NA 279069 374737

7 93023 NA NA 0 1200000 NA 325581 467002

8 93023 NA NA 0 1200000 NA 401859 579139

9 93023 NA NA 0 1200000 NA 493952 702632

10 93023 NA NA 0 1200000 NA 586045 837480

11 93023 NA NA 0 1200000 NA 695812 983684

12 93023 NA NA 0 1200000 NA 803719 1158278

13 0 NA NA 0 1200000 NA 859533 1260479

14 0 NA NA 0 1200000 NA 904184 1345646

15 0 NA NA 0 1200000 NA 959997 1464881

16 0 NA NA 0 1200000 NA 1004648 1584115

17 0 NA NA 0 1200000 NA 1004648 1703350

18 0 NA NA 153004 0 NA 0 0

19 0 NA NA 153004 0 NA 0 0

20 0 NA NA 153004 0 NA 0 0

21 0 NA NA 153004 0 NA 0 0

22 0 NA NA 153004 0 NA 0 0

23 0 NA NA 153004 0 NA 0 0

24 0 NA NA 153004 0 NA 0 0

25 0 NA NA 153004 0 NA 0 0

26 0 NA NA 153004 0 NA 0 0

27 0 NA NA 153004 0 NA 0 0

28 0 NA NA 153004 0 NA 0 0

29 0 NA NA 153004 0 NA 0 0

30 0 NA NA 153004 0 NA 0 0

31 0 NA NA 153004 0 NA 0 0

32 0 NA NA 153004 0 NA 0 0

33 0 NA NA 153004 0 NA 0 0

34 0 NA NA 153004 0 NA 0 0

35 0 NA NA 153004 0 NA 0 0

36 0 NA NA 153004 0 NA 0 0

37 0 NA NA 1269280 0 NA 0 0

Note: "Annualised Premium" shall be the premium payable in a year under a non-single pay option chosen by the policyholder, excluding the taxes, rider
premiums, underwriting extra premiums, loading for modal premiums, if any.
"Single Premium" shall be the premium payable under a single pay option chosen by the policyholder, excluding the taxes, rider premiums, underwriting
extra premiums, if any.
##The policyholder shall also be given the option to receive the Guaranteed Annual Income (GAI) on a monthly basis. This option has to be chosen at
inception and cannot be altered once chosen. The GAI illustrated above is the total amount payable in a year on selection of monthly mode.

#Surrender value illustrated above is the end of the policy year value.

#Special Surrender Value may be revised depending upon the prevailing marketing conditions.
#Surrender value will be higher of Guaranteed Surrender Value and Special Surrender Value.
 I _______________________________ (name), have explained I _______________________________ (name), having received the information
the premiums and benefits under the product fully to the prospect / with respect to the above, have understood the above statement before entering
policyholder. into the contract.

Place: i am red
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect/ Policyholder

Unique Reference Number - L&C/Advt/2024/Apr/1101 (Rider - L&C/Advt/2022/Sep/2271)

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

(I)V.99.00/FY2024-2025_Q2/RELEASE 01-07-24/EXPIRY 30-09-2024 AW 02-07-2024,06:59 PM