Personalised proposal for securing your life goals

with

Hi
Congratulations on taking the first step towards
fulfilling your life goals with a regular income for
whole of life and a lump sum on maturity along
with the security of a life insurance cover.

Please go through your personalised ICICI Pru Gold

proposal and reach out to your financial planner in
case you need any further details.
 ICICI Pru Gold belongs to 'Participating' category of products. In this category of products, your
benefits are partially guaranteed and partially dependent on bonuses. Below is a detailed
explanation of how your plan will work. For your clarity, we have shown the split of your
benefits into guaranteed and bonus linked benefits.

Snapshot of your plan

You pay

Yearly premium of 36 years / Male

` 2,00,000/- for 7 years

Jun 2025 Jun 2065

Year

Jun 2026
You get
Lump sum
Income every year till you turn 76 years of age on maturity

Income Lump sum Total Benefits

Guaranteed Income: ` 15,000/- Guaranteed lump sum Total Guaranteed benefits:

+ (Sum Assured on Maturity): ` 20,00,000/-
Bonus based income (Cash Bonus): ` 14,00,000/-
+
+
+ =
At 8% ARR: ` 39,000/- Total bonus based benefits:
At 4% ARR: ` 10,000/- Bonus based lump sum At 8% ARR: ` 44,19,512/-
(Terminal Bonus): At 4% ARR: ` 14,92,938/-
Total Income: At 8% ARR: ` 28,59,512/-
Total benefits:
At 8% ARR: ` 54,000/- At 4% ARR: ` 10,92,938/-
At 8% ARR: ` 64,19,512/-
At 4% ARR: ` 25,000/-
Total Lump sum (Maturity Benefit): At 4% ARR: ` 34,92,938/-
(every year At 8% ARR: ` 42,59,512/-
from Jun 2026 to Jun 2065) At 4% ARR: ` 24,92,938/-

#
Also, get a life insurance cover of ` 23,80,000/- throughout the policy term
 Snapshot of Additional Coverage

You have made the right choice by enhancing your financial protection
with extra safety net of additional coverage.

Waiver of all future premiums if the life assured of the

base policy is totally and permanently disabled due to
accident or diagnosed with covered critical illnesses any
time during the premium payment term. Here the life
assured of base policy refers to . This ensures that your
savings goal remains protected even if you are unable to
pay future premiums.
 Premium details Payment term Premium Amount

Premium to be paid every year 7 years ` 2,01,849/-

Detailed break-up of premium amount

Yearly Applicable Total

Premium taxes amount
Yearly Premium
` 2,00,000/- ` 9,001/- ` 2,09,001/-
during 1 year st

Rider Yearly Premium

` 1,849/- ` 333/- ` 2,182/-
during 1st year
Total Yearly premium
` 2,01,849/- ` 9,334/- ` 2,11,183/-
during 1st year
Yearly Premium
from 2 year onwards
nd ` 2,00,000/- ` 4,501/- ` 2,04,501/-

Rider Yearly Premium

` 1,849/- ` 333/- ` 2,182/-
from 2 year onwards
nd

Total Yearly premium

` 2,01,849/- ` 4,834/- ` 2,06,683/-
from 2 year onwards
nd

Additional Flexibility through Savings wallet

You can choose to accumulate your guaranteed income and let it grow, with an
option to withdraw the accumulated amount anytime, partially or completely,
as per your preference during the policy term. With this feature, your policy
acts like a wallet giving you complete freedom to accumulate or withdraw
income as per your requirement.
 Why choose us:

9.17 Cr ` 3.24 Lakh Cr

Lives covered as on Benefits paid till
March 31, 2025 March 31, 2025

24 hrs claim settlement

` 3.09 Lakh Cr
Assets under management as on Quick claim settlement
March 31, 2025 process available

Tax Saving
Get tax benefits on premium
paid & benefits

*ARR stands for Assumed rate of return. If the policy offers guaranteed returns, then these will be clearly marked "guaranteed" in the Benefit Illustration. Since the policy offers variable
returns, the given illustration shows two different rates of assumed future investment returns. The returns shown above are not guaranteed and they are not the upper or lower limits of
what you might get back, as the maturity value of policy depends on a number of factors including future investment performance.
#Life insurance cover shown is the Sum Assured on Death (at policy inception). Death Benefit is equal to: Sum Assured on Death, plus Balance in Savings Wallet (if any), plus Interim
Survival Benefit (if any), plus Terminal Bonus (if declared) Where, the Sum Assured on Death is the highest of: 7 times the Annualized Premium or 105% of the Total Premiums Paid as on

the Date of Death or Death Benefit multiple times Annualized Premium.

^The values and the income start date mentioned here are indicative based on the date on which you applied for this policy. The exact values and income start date will be as per the
date of issuance of your policy and are specified in the Policy Certificate attached in your welcome kit.

ICICI Prudential Life Insurance Company. IRDAI Regn No. 105. CIN:L66010MH2000PLC127837. ICICI Prudential Life Insurance Company Limited. Registered Address:1089 Appasaheb
Marathe Marg, Prabhadevi, Mumbai - 400025. ICICI Pru Gold UIN: 105N190V04. ICICI Pru Non-Linked Accidental Death and Disability Rider UIN: 105B042V02.
ICICI Pru Waiver of Premium Rider UIN: 105B044V02 For more details on the risk factors, term & conditions please read the. policy document COMP/DOC/Apr/2023/54/2728.
 Benefit Illustration - ICICI Pru GOLD

Name of Prospect/Policyholder : Mr. Name of the Product : ICICI Pru GOLD

Age of the Policyholder at inception : 11-Jun-1989 (36 years) Tag Line : A Participating Non-Linked
Life Individual
Savings Product
Gender of the Policyholder : MALE
Name of the Life Assured : Mr. Unique Identification Number : 105N190V04
Age of the Life Assured at inception : 11-Jun-1989 (36 years) GST Rate for Year 1 : 4.5%
Gender of the Life Assured : MALE GST Rate For Year 2 Onwards : 2.25%
Policy Term : 40 years Sales Channel : Agency
Premium Payment Term : 7 years
Amount of Instalment Premium (Without : Rs. 200,000/-
GST)
Mode of payment of premium : Yearly

How to read and understand this benefit illustration?

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8%
p.a. and 4% p.a.
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, 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 dependent on a number of factors including future investment performance.

Policy Details
Plan Option Immediate Income Sum Assured on Maturity Rs. 1,400,000
Deferment Period Not Applicable Sum Assured on Death (at inception of the policy) Rs. 2,380,000
Bonus Type Simple Bonus Save The Date feature Not Applicable

Premium Summary
Base Plan ICICI Pru Non-Linked ICICI Pru Non-Linked ICICI Pru Non-Linked Total Instalment
Accidental Death and Accidental Death and Waiver of Premium Premium
Disability Rider Disability Rider Rider (Critical Illness &
(Accidental Death (Accidental Total & Accidental Disability
Benefit option) Permanent Disability option)
Benefit option)
Instalment Premium without GST Rs. 200,000/- - - Rs. 1,849/- Rs 201,849/-
Instalment Premium with first year GST Rs. 209,001/- - - Rs. 2,182/- Rs. 211,183/-
Instalment Premium with GST 2nd year onwards Rs. 204,501/- - - Rs. 2,182/- Rs. 206,683/-
*Please refer to the details of Rider attached with this document for more information.

Summary of Benefits payable over the course of the Policy Term

Guaranteed Benefits payable as Survival Benefits during the Income Term
Guaranteed Income as per frequency chosen by you: Rs. 15,000 Guaranteed Booster as per frequency chosen by you: Not Applicable
Frequency of Guaranteed Income: Annual (arrears) Frequency of Guaranteed Booster: Not Applicable
Guaranteed Income payable in a year: Rs. 15,000 Guaranteed Booster payable in a year, when due: Not Applicable
Total Guaranteed Income payable (A) Rs. 600,000
Benefit payable at the end of policy term (Maturity Benefit)
Benefits at 4% p.a. Benefits at 8% p.a.
Estimated Cash Bonus as per frequency chosen by you: Rs. 10,000 Rs. 39,000
Frequency of Cash Bonus: Annual (arrears) Annual (arrears)
Estimated Cash Bonus payable in a year Rs. 10,000 Rs. 39,000
Estimated Total Cash Bonus payable over the Income Term (B) Rs. 400,000 Rs. 1,560,000
Estimated Terminal Bonus at Maturity Rs. 1,092,938 Rs. 2,859,512
Estimated Total Maturity Benefit (C) Rs. 2,492,938 Rs. 4,259,512
Total Benefits payable till Maturity (A + B + C) Rs. 3,492,938 Rs. 6,419,512
 Guaranteed Benefits Non-Guaranteed Benefits @ 4% p.a. Non-Guaranteed Benefits @ 8% p.a. Total Benefits including Guaranteed and Non-Guaranteed Benefit
Survival Benefit Maturity Benefit Death Benefit
Policy Annualiz Guarant Guarant Guarantee Death Maturity Reversion Cash Guarantee Special Surrender Reversion Cash Guarantee Special Surrender Total Total Total Total Total Total
Year ed eed eed d Benefits Benefits ary Bonus Bonus d Surrender Benefit ary Bonus Bonus d Surrender Benefit Survival Survival Maturity Maturity Death Death
Premiu Income Booster Surrender Surrender Value Higher of Surrender Value Higher of Benefit @ Benefit @ Benefit @ Benefit @ Benefit @ Benefit @
m Value Value (5 + 10, 11) Value (5 + 15, 16) 4% p.a.(3 + 8% p.a.(3 + 4% p.a. (7 8% p.a. (7 4% p.a.(6 + 8% p.a.(6 +
4 + 9) 4 + 14) +Terminal + Terminal Interim/Ter Interim/Ter
Bonus, if Bonus, if minal minal
declared) declared) Bonus, if Bonus, if
declared) declared)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
1 200,000 15,000 0 0 2,380,000 0 0 10,000 5,000 25,988 25,988 0 39,000 0 2,133 2,133 25,000 54,000 0 0 2,380,000 2,380,000
2 200,000 15,000 0 12,000 2,380,000 0 0 10,000 58,000 54,570 70,000 0 39,000 0 23,320 23,320 25,000 54,000 0 0 2,380,000 2,380,000
3 200,000 15,000 0 48,000 2,380,000 0 0 10,000 87,000 85,986 135,000 0 39,000 0 71,606 71,606 25,000 54,000 0 0 2,380,000 2,380,000
4 200,000 15,000 0 184,000 2,380,000 0 0 10,000 116,000 120,505 300,000 0 39,000 0 4,505 184,000 25,000 54,000 0 0 2,380,000 2,380,000
5 200,000 15,000 0 230,000 2,380,000 0 0 10,000 145,000 380,158 380,158 0 39,000 0 296,287 296,287 25,000 54,000 0 0 2,380,000 2,380,000
6 200,000 15,000 0 276,000 2,380,000 0 0 10,000 174,000 612,674 612,674 0 39,000 0 502,135 502,135 25,000 54,000 0 0 2,380,000 2,380,000
7 200,000 15,000 0 322,000 2,380,000 0 0 10,000 203,000 932,204 932,204 0 39,000 0 795,720 795,720 25,000 54,000 0 0 2,380,000 2,380,000
8 0 15,000 0 285,500 2,380,000 0 0 10,000 232,000 945,660 945,660 0 39,000 0 803,873 803,873 25,000 54,000 0 0 2,380,000 2,380,000
9 0 15,000 0 249,000 2,380,000 0 0 10,000 261,000 959,881 959,881 0 39,000 0 822,397 822,397 25,000 54,000 0 0 2,380,000 2,380,000
10 0 15,000 0 212,500 2,380,000 0 0 10,000 290,000 974,883 974,883 0 39,000 0 842,661 842,661 25,000 54,000 0 0 2,380,000 2,380,000
11 0 15,000 0 176,000 2,380,000 0 0 10,000 319,000 990,682 990,682 0 39,000 0 864,446 864,446 25,000 54,000 0 0 2,380,000 2,380,000
12 0 15,000 0 139,500 2,380,000 0 0 10,000 348,000 1,007,292 1,007,292 0 39,000 0 887,860 887,860 25,000 54,000 0 0 2,380,000 2,380,000
13 0 15,000 0 103,000 2,380,000 0 0 10,000 377,000 1,024,723 1,024,723 0 39,000 0 913,024 913,024 25,000 54,000 0 0 2,380,000 2,380,000
14 0 15,000 0 66,500 2,380,000 0 0 10,000 406,000 1,042,988 1,042,988 0 39,000 0 940,067 940,067 25,000 54,000 0 0 2,380,000 2,380,000
15 0 15,000 0 30,000 2,380,000 0 0 10,000 435,000 1,062,099 1,062,099 0 39,000 0 969,137 969,137 25,000 54,000 0 0 2,380,000 2,380,000
16 0 15,000 0 0 2,380,000 0 0 10,000 457,500 1,082,073 1,082,073 0 39,000 0 1,000,399 1,000,399 25,000 54,000 0 0 2,380,000 2,380,000
17 0 15,000 0 0 2,380,000 0 0 10,000 450,000 1,102,938 1,102,938 0 39,000 0 1,034,042 1,034,042 25,000 54,000 0 0 2,380,000 2,380,000
18 0 15,000 0 0 2,380,000 0 0 10,000 442,500 1,124,729 1,124,729 0 39,000 0 1,070,280 1,070,280 25,000 54,000 0 0 2,380,000 2,380,000
19 0 15,000 0 0 2,380,000 0 0 10,000 435,000 1,147,495 1,147,495 0 39,000 0 1,109,360 1,109,360 25,000 54,000 0 0 2,380,000 2,380,000
20 0 15,000 0 0 2,380,000 0 0 10,000 427,500 1,171,293 1,171,293 0 39,000 0 1,151,558 1,151,558 25,000 54,000 0 0 2,380,000 2,380,000
21 0 15,000 0 0 2,380,000 0 0 10,000 420,000 1,196,198 1,196,198 0 39,000 0 1,197,187 1,197,187 25,000 54,000 0 0 2,380,000 2,380,000
22 0 15,000 0 0 2,380,000 0 0 10,000 412,500 1,222,292 1,222,292 0 39,000 0 1,246,596 1,246,596 25,000 54,000 0 0 2,380,000 2,380,000
23 0 15,000 0 0 2,380,000 0 0 10,000 405,000 1,249,666 1,249,666 0 39,000 0 1,300,172 1,300,172 25,000 54,000 0 0 2,380,000 2,380,000
24 0 15,000 0 0 2,380,000 0 0 10,000 397,500 1,278,421 1,278,421 0 39,000 0 1,358,347 1,358,347 25,000 54,000 0 0 2,380,000 2,380,000
25 0 15,000 0 0 2,380,000 0 0 10,000 390,000 1,308,661 1,308,661 0 39,000 0 1,421,600 1,421,600 25,000 54,000 0 0 2,380,000 2,380,000
26 0 15,000 0 0 2,380,000 0 0 10,000 382,500 1,340,498 1,340,498 0 39,000 0 1,490,462 1,490,462 25,000 54,000 0 0 2,380,000 2,380,000
27 0 15,000 0 0 2,380,000 0 0 10,000 375,000 1,374,044 1,374,044 0 39,000 0 1,565,530 1,565,530 25,000 54,000 0 0 2,380,000 2,380,000
28 0 15,000 0 0 2,380,000 0 0 10,000 367,500 1,409,422 1,409,422 0 39,000 0 1,647,478 1,647,478 25,000 54,000 0 0 2,380,000 2,380,000
29 0 15,000 0 0 2,380,000 0 0 10,000 360,000 1,446,761 1,446,761 0 39,000 0 1,737,070 1,737,070 25,000 54,000 0 0 2,380,000 2,380,000
30 0 15,000 0 0 2,380,000 0 0 10,000 352,500 1,486,202 1,486,202 0 39,000 0 1,835,182 1,835,182 25,000 54,000 0 0 2,380,000 2,380,000
31 0 15,000 0 0 2,380,000 0 0 10,000 345,000 1,527,901 1,527,901 0 39,000 0 1,942,825 1,942,825 25,000 54,000 0 0 2,380,000 2,380,000
32 0 15,000 0 0 2,380,000 0 0 10,000 337,500 1,572,041 1,572,041 0 39,000 0 2,061,174 2,061,174 25,000 54,000 0 0 2,380,000 2,380,000
33 0 15,000 0 0 2,380,000 0 0 10,000 330,000 1,618,829 1,618,829 0 39,000 0 2,191,605 2,191,605 25,000 54,000 0 0 2,380,000 2,380,000
34 0 15,000 0 0 2,380,000 0 0 10,000 322,500 1,668,514 1,668,514 0 39,000 0 2,335,735 2,335,735 25,000 54,000 0 0 2,380,000 2,380,000
35 0 15,000 0 0 2,380,000 0 0 10,000 315,000 1,721,386 1,721,386 0 39,000 0 2,494,945 2,494,945 25,000 54,000 0 0 2,380,000 2,494,945
36 0 15,000 0 0 2,380,000 0 0 10,000 307,500 1,777,796 1,777,796 0 39,000 0 2,668,999 2,668,999 25,000 54,000 0 0 2,380,000 2,668,999
37 0 15,000 0 0 2,380,000 0 0 10,000 300,000 1,838,168 1,838,168 0 39,000 0 2,859,226 2,859,226 25,000 54,000 0 0 2,380,000 2,859,226
38 0 15,000 0 0 2,380,000 0 0 10,000 292,500 1,903,014 1,903,014 0 39,000 0 3,067,252 3,067,252 25,000 54,000 0 0 2,380,000 3,067,252
39 0 15,000 0 0 2,380,000 0 0 10,000 285,000 1,972,957 1,972,957 0 39,000 0 3,294,887 3,294,887 25,000 54,000 0 0 2,380,000 3,294,887
40 0 15,000 0 0 2,380,000 1,400,000 0 10,000 260,000 2,048,757 2,048,757 0 39,000 0 3,544,147 3,544,147 25,000 54,000 2,492,938 4,259,512 2,380,000 3,544,147

Note: Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods & Service Tax, if any.
Important points to note:
1. Example to understand when does Survival Benefits become payable: If the date of risk commencement of your policy is Jan 15, 2023, then Survival Benefits will start from:
• For Annual mode: Jan 14, 2024 • For Monthly mode: Feb 14, 2023, under 'Immediate Income' or 'Immediate Income with Booster' variants
• For Annual mode: Jan 14, 2029 • For Monthly mode: Feb 14, 2028, under 'Deferred Income' variant with deferment of 5 years (for example)
• For Annual mode: 1 June of policy year when it is first due to be paid • For Monthly mode: Not Applicable, under all variants when Special Date chosen is 1 June under 'Save The Date' feature
These pay out dates are indicative and the applicable date will be mentioned in the Policy Schedule of your policy document.
2. The Survival Benefits are payable during the policy year when they are due as per the frequency or date chosen at inception. The payments will continue to be paid on the due date(s) as applicable till the last policy
year, provided the Life Assured is alive. The payments will stop once the policy matures.
3. If Save the date is opted, the survival benefit values mentioned here are indicative based on the date on which this benefit illustration was generated for this policy.The chosen Save the Date may change basis the date
of issuance of your policy. The final date and survival benefit values will be as per the date of issuance of your policy and are specified in the Policy Schedule attached in your welcome kit.
4. The Surrender Value (benefit amount payable on policy surrender) and Death Benefit (benefit amount payable on death of the Life Assured) mentioned above are illustrated assuming that the event occurs at the end of
the respective year and after the payment of any survival benefit due at the end of respective year. The Maturity Benefits mentioned are payable at the end of the policy term. Post payment of this benefit (whichever is the
earliest) the policy terminates and no further benefit is payable. The surrender values may be different than those illustrated above if surrender takes place before the end of the policy year or if all the instalment premiums
payable in that policy year have not been paid.
5. Savings Wallet: At any point during the policy term, you will have the option to accumulate Survival Benefit instead of taking as payment and withdraw the accumulated Survival Benefit partially or completely. If not
withdrawn, any balance left will be paid out along with death, surrender or maturity payment, whichever hapepns first. For more details, please refer to the policy document.
6. Please refer to your sales brochure and policy document for more details. In case of any discrepancy between this document and policy document, the latter shall prevail.
7. For any further clarifications, policyholder can contact their advisor or the Company.
I __________________________________(Name), have explained I ______________________________(Name), having received
the premiums, and benefits under the product fully to the the information with respect to the above, have understood the
prospect / policyholder. above statement before entering into the contract.

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

ICICI Prudential Life Insurance Company Limited.

1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400025
Email: [email protected]
www.iciciprulife.com
 Rider Details

Name of the Policyholder : Mr.

Age of the Policyholder at Rider policy : 11-Jun-1989 (36 years)
inception
Name of the Life Assured : Mr.
Age of the Life Assured at Rider policy : 11-Jun-1989 (36 years)
inception
Gender of the Life Assured : MALE
Name of the product : ICICI PRU GOLD

Rider Details
Rider Name and Rider option Rider Tagline Rider Sum Instalment GST Instalment Frequency Premium Coverage /
UIN Assured Premium without Rate Premium with GST of premium Payment Rider Term
GST and Cesses, if and Cesses, if any payment Term
any
ICICI Pru Non- Health option A Non–Participating Rs. 200,000/- Rs. 1,849/- 18% Rs. 2,182/- Yearly 7 years 7 years
Linked Waiver of Non–Linked Health
Premium Rider Individual Pure Risk
(105B044V02) Rider
 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 Title Description Policy Clause

No Number
(Please refer to applicable Policy Clause
Number in next column)
1 Name of Insurance Policy schedule
ICICI Pru Gold
Product and Unique
Identification Number UIN: 105N190V04
(UIN)
2 Policy number Policy schedule

3 Type of Insurance A Participating Non-Linked Life Individual Policy schedule

Policy Savings Product

4 Basic Policy details Sum Assured on : 23,80,000/- Policy schedule

Death (at inception of the policy) (in ₹)
Premium Instalment (in ₹): 2,00,000/-
Premium Payment frequency : Yearly
Premium payment term : 7 years
Policy term: 40 years
Date of Maturity : Jun 2065
5 Policy Benefits payable on maturity- Part C-Clause
Coverage/benefits , on survival of the Life Assured till the end of 2b,1,2a of
payable the Policy term, for a fully-paid Policy, the Part D -Clause
following will be payable: . This Maturity Benefit 2
will be sum of
•Sum Assured on Maturity, plus
•
•Terminal Bonus (if declared)

For more information, refer to Part C , Clause 2b

of policy document.

Benefits payable on death-

(i)On death of the Life Assured during the Policy
term, for a Premium Paying or Fully Paid Policy,
Death Benefit shall be payable to the Claimant.
Benefits shall be payable as per the plan
chosen by you at inception.

Death Benefit is equal to:

•Sum Assured on Death, plus
•
•Interim Survival Benefit (if any), plus
 •Terminal Bonus (if declared) For more
information, refer to Part C , Clause 1 of policy
document.

Surrender benefits-
You can surrender the policy any time after
payment of at least one full policy year’s
premium(s). Prior to receipt of one full year’s
premium, no surrender value is payable.
On policy surrender, a Surrender Value equal to
the higher of the following will be payable:
• Guaranteed Surrender Value (GSV)
• Special Surrender Value (SSV)

For more information related to surrender, refer

to Part D, Clause 2 of policy document.

Survival Benefits excluding that payable on

maturity- On survival of the Life Assured, the
Survival Benefit amount will be payable
depending upon the Plan variant chosen.
For more information, refer to Part C , Clause 2a
of policy document.

Options to policyholders for availing benefits, if

any, covered under the policy-
Savings Wallet is available for the customer
For more information, refer to Part C , Clause 2a
viii of policy document.

Other benefits/options payable, specific to the

policy, if any- Not applicable.

6 Options available (in Not applicable

case of Linked Insurance
Products)
7 Option available (in case Not applicable
of Annuity product)
8 Riders opted, if any Name of Rider –

ICICI Pru Non-Linked Waiver of Premium Rider

Rider option Opted -

Critical Illness & Accidental Disability option

9 Exclusions (events Suicide: In case of death due to suicide within Part F, Clause
where insurance 12 months from the date of commencement of 11
coverage is not risk under the Policy or from the date of revival
payable), if any of the Policy, as applicable, the Claimant shall
be entitled to at least 80% of the Total
Premiums Paid till the date of death or the
Surrender Value available as on the date of
death whichever is higher, provided the Policy
is in force.
In case any Survival Benefits have already been
paid out, such amount already paid out shall be
deducted from the amount payable on such
death.
The Policy will terminate on making such a
payment and all rights, benefits and interests
under the Policy will stand extinguished.
For more information, refer to Part F, Clause 11
of policy document

10 Waiting /lien Period, if Not Applicable

any
11 Grace Period 15 days-For monthly frequency of premium Part C-Clause 5
payment of Policy
30 days- For other frequencies of premium Document
payment

For more information, refer to Part C, Clause 5

of policy document
12 Free Look Period 30 days Part D -Clause
1
For more information, refer to Part D, Clause 1
of policy document
13 Lapse, paid-up and Lapse: The Policy shall lapse with all benefits Part C-Clause
revival of the Policy and the cover shall cease, if premium payment 3,6
is discontinued by You before acquiring a Part D -Clause
Surrender value(i.e during the first Policy Year). 5
If the Policy is not revived within the Revival
Period, then the Policy shall foreclose and all
rights and benefits under the Policy shall stand
 extinguished.
For more details, refer to Part C, Clause 6 of
policy document

Paid up: If any premium remains unpaid after

the expiry of the grace period and the policy
has acquired a surrender value, the policy’s
status shall be altered to paid-up status with
reduced benefits payable under specified
contingencies.

For more details, refer to Part C, Clause 3 of

policy document

Revival:
A Policy which has discontinued payment of
Premium may be revived subject to Board
Approved Underwriting Policy and certain
condition.
The application for revival is made within 5
years from the due date of the first unpaid
premium or the policy term, whichever is
earlier. Revival will be based on the prevailing
Board approved underwriting policy.
For more details, refer to Part D, Clause 5 of
policy document

14 Policy Loan, if Loans are available provided a positive Part D -Clause

applicable surrender value is payable under the policy at 4
the time of disbursement of the same. Loan
amount of up to 80% of Surrender Value can
be availed.

For more information, refer to Part D, Clause 4

of policy document
15 Claims/Claims Turn around Time – For TAT details for death Part F-Clause
Procedure claim refer to 10
https://www.iciciprulife.com/contact-us/our-
services-turn-around-times.html

For any assistance on Claims, you can call Us

on 18002660 (for calls within India) or +91
8069385555 (for calls outside India). You can
also register a health or a death claim by
sending us an email at
[email protected]
 The claim form can be downloaded from the
following links:
Digital Claim Form Link:
https://buy.iciciprulife.com/buy/Claim-
Intimation.htm?execution=e2s1

Physical Claim Form Link:

https://www.iciciprulife.com/insurance-
library/life-insurance-claims-related-
faqs.html#linked_content

For information on documents required to

process claims, please refer to the policy
document (Part F, Clause 10) under the
section ‘Specimen Policy Document’ available
on our website at
https://www.iciciprulife.com/services/downloa
d-centre.html
16 Policy Servicing Turn around Time – For TAT details for policy Part G of Policy
servicing - refer to Document
https://www.iciciprulife.com/contact-us/our-
services-turn-around-times.html

For any clarification or assistance, You may

contact Our advisor or call Our customer
service representative (between 10.00 a.m. to
7.00 p.m, Monday to Saturday; excluding
national holidays) on 18002660 or visit Our
website: www.iciciprulife.com.
Alternatively, You may communicate with Us
at any of our branches or the customer service
helpline number 18002660 or email at
[email protected]. For updated contact
details, We request You to regularly check Our
website.
17 Grievances /Complaints i. You may write to gro by visiting the Part G of Policy
grievance redressal page of our Document
website:https://www.iciciprulife.co
m/services/grie vance-
redressal.html. Alternatively, you
can contact the Grievance redressal
officer at our branches or write to us
at [email protected]
ii. https://www.iciciprulife.com/service
s/grie vance-redressal.html
iii. Kindly refer the Insurance
Ombudsman details under part G
 under the ‘Specimen Policy
Document’ available at Download
Centre | ICICI Prulife . This is subject
to change from time to time
Additionally, the contact details of
Ombudsman can be accessed through
https://www.cioins.co.in/Ombudsman The
concerns of senior citizens will be resolved
on priority ensuring there is a speedy
disposal of the grievances.

Note: In case of any conflict, the terms and conditions mentioned in the policy
document shall prevail.

Declaration by the Policyholder

I have read the above and confirm having noted the details.

Place: (Signature of the Policyholder)

Date
 HOW TO READ YOUR 'BI'
The benefit Illustration provides a year-by-year summary of how your benefits will look like. ICICI Pru Gold belongs to 'Participating'
category of products. In this category of products, your benefits are partially guaranteed and partially dependent on bonuses.
Therefore, all the benefits will be shown at an assumed rate of returns of 4% and 8%. The guaranteed benefits are shown in sub-
section 'Guaranteed Benefits' and the bonus based benefits are shown under sub-section 'Non-Guaranteed Benefits'.

Here are a few pointers which will help you read the table in the Benefit Illustration better:

1 Policy year:
This refers to the number of years you stay invested or the term chosen by you. Policy year is shown in column 1.

2 Annualized premium:
This is the premium you need to pay for the premium payment duration selected by you. The annualized
premium is shown in column 2.

3 Survival benefit (Income):

This refers to the income amount paid to the life assured throughout the income term. Total Income is a combination of
'guaranteed income' and 'bonus-based income (cash bonus). The guaranteed part of income is shown in column 3. The
bonus based income is shown at 8% and 4% ARR respectively in column 10 and 8. Therefore, to refer to the total income
payable every year, please refer to column 13 (@8% ARR) and column 12(@4% ARR). In case you have opted for
'Immediate Income with Booster' plan option, over and above income you will receive a guaranteed booster every 5th
policy year. The guaranteed booster is shown in column 4.

4
Maturity benefit:
This is a lump sum payable on maturity and is a combination of 'guaranteed lump sum (sum assured on maturity)' and
'bonus-based lump sum (Terminal bonus)'. The guaranteed lump sum is shown in column 7. Total maturity benefit is shown
in column 15 (@8% ARR) and column 14 (@4% ARR).

5 Death benefit (Life cover):

This refers to the lump sum that will be paid to the nominee on death of the life assured. It is a combination of guaranteed
life cover and bonus-based cover (Interim/terminal bonus). The guaranteed life cover is shown in column 6 and total life
cover is shown in column 17 (@8% ARR) and column 16 (@4% ARR).

6
Surrender benefit:
This is the amount paid to you if you exit the plan. The final surrender value is calculated as higher of (the guaranteed
surrender value and bonus-based surrender value). The final surrender value is shown in the last two columns i.e. column
19 (@8% ARR) and column 18 (@4% ARR).

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COMP/DOC/Apr/2023/264/2914
 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 Title Description Policy

No Clause
Number
1 Name of Insurance ICICI Pru Non-Linked Waiver of Premium Rider Schedule
Product/Policy Rider

Benefit Option: Health Option

2 Policy Number / Rider Schedule
Application Number
3 Type of Insurance Benefit Rider Schedule
Product/ Policy A Non-Participating Non- Linked Health
Individual Pure Risk Rider
4 Sum Insured (Basis) Sum Assured (in ₹): 2,00,000/- Rider Schedule
(Along with amount)
5 Policy Coverage A. This WoP Rider can be attached to Part C, Clause
(What the policy Your Base Policy or other Subsisting A
covers?) Rider(s) if any. Depending on the
manner of attachment, the following
benefit is applicable on the
occurrence of the contingent event:
a. If attached with the Base
Policy: all future premiums
payable under the Base Policy
including any Underwriting
Extra Premiums will be waived
off;
b. If attached with Subsisting
Rider(s) if any: all future
premiums payable under the
Subsisting Rider(s) including
any Underwriting Extra
Premiums shall be waived off.

B. The Rider benefit will be applicable on

the first occurrence of the event of:
Accidental Total and Permanent
Disability of the Life Assured named
under the WoP rider.
Or,
Diagnosis with any of the covered
Critical Illnesses.

C. Accidental Total and Permanent

Disability (ATPD): The Rider Benefit
will be applicable if the Life Assured
named under the WoP rider has
become totally, continuously and
permanently disabled as a result of an
Accident i.e. Accidental Total
Permanent Disability and should
mandatorily satisfy at least one
condition outlined within the following
three conditions:
Condition 1:
The Life Assured named under the
WoP rider suffers any of the following
disabilities due to an Injury/Accident
due to which there is total and
irrecoverable disability:
 Loss of Use of at least two
limbs
 Loss of Sight of both eyes
 Loss of hearing and loss of
speech
 Loss of Use of four fingers
and Thumb of both hands
 Loss of Use of one limb and
sight of one eye
 Loss of Use of one limb and
hearing
 Loss of Use of one limb and
speech
 Loss of sight of one eye and
speech
 Loss of sight of one eye and
hearing
 Loss by severance of two or
more limbs at or above
wrists or ankles
 Loss by severance of four
Fingers and Thumb of both
hands
 Loss by severance of one
limb and sight of one eye
 Loss by severance of one
limb and hearing
 Loss by severance of one
limb and speech

The loss of sight, loss of

hearing and loss of speech are
defined as follows:

1. Loss of sight means total,

permanent and irreversible
loss of all vision in at least
one eye as a result of
accident.
a. The Blindness is
evidenced by:
i. Corrected visual
acuity being 3/60 or
less in at least one
eye or;
ii. The field of vision
being less than 10
degrees in at least
one eye; and
b. The diagnosis of
blindness must be
confirmed and must not
be correctable by aids or
surgical procedure.

2. Loss of hearing means total

and irreversible loss of
hearing in both ears as a
result of accident. This
diagnosis must be
supported by pure tone
audiogram test and
certified by an Ear, Nose
and Throat (ENT)
specialist. Total means “the
loss of hearing to the extent
that the loss is greater than
90 decibels across all
frequencies of hearing” in
both ears.

3. Loss of speech means total

and irrecoverable loss of
the ability to speak as a
result of Injury to the vocal
cords due to an Accident.
The inability to speak must
be established for a
continuous period of 12
months. This diagnosis
must be supported by
medical evidence furnished
by an Ear, Nose, Throat
(ENT) specialist.

Or,
 Condition 2:
The Life Assured named under
the WoP rider must be totally
incapable of being employed
or engaged in any work or any
occupation whatsoever for
remuneration or profit.

Or,

Condition 3:
The Life Assured named under
the WoP rider must be unable
to perform (whether aided or
unaided) at least 3 of the
following 6 “Activities of Daily
Work”:
a. Mobility: The ability to walk
a distance of 200 meters on
flat ground.
b. Bending: The ability to bend
or kneel to touch the floor
and straighten up again
and the ability to get into a
standard saloon car, and
out again.
c. Climbing: The ability to
climb up a flight of 12 stairs
and down again, using the
handrail if needed.
d. Lifting: The ability to pick up
an object weighing 2kg at
table height and hold for 60
seconds before replacing
the object on the table.
e. Writing: The manual
dexterity to write legibly
using a pen or pencil, or type
using a desktop personal
computer keyboard.
f. Blindness: permanent and
irreversible – Permanent
and irreversible loss of sight
to the extent that even
when tested with the use of
visual aids, vision is
measured at 3/60 or worse
in the better eye using a
Snellen eye chart.

D. In addition to the aforementioned

conditions, in order for the Rider
Benefit to be applicable for
Accidental Total Permanent
Disability following additional
conditions shall have to be satisfied:
a) Accidental Total
Permanent Disability
must be caused within
180 days from the date of
Accident. Accidental Total
and Permanent Disability
will be applicable if the
Accident occurs within
the Rider Term set under
the benefit option, but
disability occurs beyond
the Rider Term (however
within 180 days from date
of the Accident).
b) The disabilities as stated
above must have
continuously lasted,
without interruption, for
at least 180 days and
must in the opinion of a
Medical Practitioner, be
deemed permanent.
These disabilities, as
stated above, must also
be verified by a Medical
Practitioner appointed by
the company. However,
for the disabilities
mentioned in condition 1
under sub points j to n (i.e.,
physical severance), such
180 days period would
not be applicable.
c) The Company shall not be
liable to pay the benefit, in
the event of the
Accidental Total and
Permanent Disability of
the Life Assured named
under the WoP rider
occurs after 180 days
from the date of Accident.
d) The WoP rider must be in
force at the time of
 Accident.

E. Critical Illness (CI): The Rider Benefit

will be applicable on the Life Assured
named under the WoP rider being
diagnosed with any of the covered
critical illnesses within the Rider Term
by a Medical Practitioner. List of CIs
covered are as follows:
 Cancer of Specified
Severity
 Myocardial Infarction or
First Heart Attack of
Specified Severity
 Open Chest CABG
 Stroke resulting in
permanent symptoms.
 Kidney Failure Requiring
Regular Dialysis
 Major Organ/ Bone Marrow
Transplant
 Multiple Sclerosis with
Persisting Symptoms
 Alzheimer's Disease
 Heart Valve Surgery (Open
Heart Replacement or
Repair of Heart Valves)
 Apallic Syndrome
 Benign Brain Tumour
 Brain Surgery
 Coma of Specified Severity
 Major Head Trauma
 Major Burns
6 Exclusions 1. For Accidental Total Permanent Part C, Clause
Disability, following exclusions shall B
(what the policy apply:
a. Disability arising out of a Pre-existing
does not cover)
Disease or any complication arising
therefrom. Pre-existing Disease
means any condition, aliment, Injury
or disease:
i. That is/are diagnosed by a
physician not more than 36
months prior to the Date of
Commencement of Risk of the
benefit option issued or its date
of reinstatement; or
 ii. For which medical advice or
treatment was recommended
by, or received from, a
Physician not more than 36
months Prior to the Date of
Commencement of Risk of the
benefit option issued or its date
of reinstatement.
Coverage under this Rider after the
expiry of 36 months for any pre-
existing disease is subject to the
same being declared at the time of
application and specifically accepted
by the Company.
b. Disability caused due to attempted
suicide, intentional self-inflicted Injury
or acts of self-destruction.
c. Disability caused due to any
congenital external diseases, defects,
or anomalies or in consequence
thereof.
d. Disability caused by or arising from
bacterial / viral infections (except
pyogenic infection which occurs
through an Accidental cut or wound)
e. Disability arising out of or attributable
to foreign invasion, act of foreign
enemies, hostilities, warlike
operations (whether war be declared
or not or while performing duties in
the armed forces of any country
during war or at peace time),
participation in any naval, military or
air-force operation, civil war, riot,
public defense, rebellion, revolution,
insurrection, military or usurped
power.
f. Disability caused by treatment
directly arising from or consequent
upon any Life Assured named under
the WoP rider committing or
attempting to commit a breach of law
with criminal intent.
g. Disability caused by alcohol or solvent
abuse or taking of drugs, narcotics or
psychotropic substances unless taken
 in accordance with the lawful
directions and prescription of a
registered Medical Practitioner.
h. Disability caused by participation of
the Life Assured named under the
WoP rider in any flying activity, except
as a bona fide, fare-paying passenger
of a recognized airline on regular
routes and on a scheduled timetable.
i. Disability of the Life Assured named
under the WoP rider whilst engaging
in a speed contest or racing of any
kind (other than on foot), bungee
jumping, parasailing, ballooning,
parachuting, skydiving, paragliding,
hang gliding, mountain or rock
climbing necessitating the use of
guides or ropes, potholing, abseiling,
deep sea diving using hard helmet
and breathing apparatus, polo, snow
and ice sports in so far as they involve
the training for or participation in
competitions or professional sports, or
involving a naval, military or air force
operation.
j. Disability caused by engaging in
hazardous sports / pastimes, i.e.,
taking part in (or practicing for)
boxing, caving, climbing, horse racing,
jet skiing, martial arts,
mountaineering, off piste skiing, pot
holing, power boat racing,
underwater diving, yacht racing or
any race, trial or timed motor sport.
k. Disability arising from or caused by
ionizing radiation or contamination by
radioactivity from any nuclear fuel
(explosive or hazardous form) or
resulting from or from any other cause
or event contributing concurrently or
in any other sequence to the loss,
claim or expense from any nuclear
waste from the combustion of nuclear
fuel, nuclear, chemical or biological
attack.
i. Chemical attack or weapons
 means the emission, discharge,
dispersal, release or escape of
any solid, liquid or gaseous
chemical compound which,
when suitably distributed, is
capable of causing any Illness,
incapacitating disablement or
death.
ii. Biological attack or weapons
means the emission, discharge,
dispersal, release or escape of
any pathogenic (disease
producing) microorganisms
and/or biologically produced
toxins (including genetically
modified organisms and
chemically synthesized toxins)
which are capable of causing
any Illness, incapacitating
disablement or death.
l. Certification by a Medical Practitioner
who is either the insured person(s)
himself or related to the insured
person(s) by blood or marriage or
shares the same residence as the Life
Assured.

2. Exclusions for Critical Illness cover:

The Rider Benefit shall not be
applicable for any listed Critical
Illness conditions arising directly or
indirectly from, though, in
consequence of or aggravated by
any of the following:
a) Pre-Existing Diseases or
conditions connected to a Pre-
Existing Condition will be
excluded. Pre-existing Disease
means any condition, ailment,
Injury or disease:
i. that is/are diagnosed by a
physician not more than 36
months prior to the effective
date of the policy issued by
the Company or its
reinstatement or
 ii. For which medical advice or
treatment was
recommended by, or
received from, a physician
not more than 36 months
prior to the effective date of
the policy or its
reinstatement.
b) Existence of any Sexually
Transmitted Disease (STD) and
its related complications.
c) Self-inflicted Injury, suicide,
insanity and deliberate
participation of the Life Assured
in an illegal or criminal act with
criminal intent.
d) Use of intoxicating drugs /
alcohol / solvent, taking of drugs
except under the direction of a
qualified Medical Practitioner.
e) War – whether declared or not,
civil commotion, breach of law
with criminal intent, invasion,
hostilities (whether war is
declared or not), rebellion,
revolution, military or usurped
power or willful participation in
acts of violence.
f) Aviation other than as a fare
paying passenger or crew in a
commercial licensed aircraft.
g) Taking part in any act of a
criminal nature with criminal
intent.
h) Treatment for Injury or illness
caused by avocations / activities
such as hunting,
mountaineering, steeple
chasing, professional sports,
racing of any kind, scuba diving,
aerial sports, activities such as
hand-gliding, ballooning,
deliberate exposure to
exceptional danger.
i) Radioactive contamination due
to nuclear accident.
 j) Failure to seek or follow medical
advice, the Life assured named
under the WoP rider has
delayed medical treatment in
order to circumvent the waiting
period or other conditions and
restriction applying to this
policy.
k) Any treatment of a donor for the
replacement of an organ.
l) Any illness due to a congenital
defect or disease which has
manifested or was diagnosed
before the Insured attains aged 17.
7 Waiting period a. The benefit shall not apply in respect
of any Critical Illness for which care,
treatment, or advice was
recommended by or received from a
Physician, or which first manifested
itself or was contracted during the
first six months from the Date of
Commencement of Risk or 3 months
from the Rider revival date where the
WoP rider has lapsed for more than 3
months.
b. No waiting period applies where
Critical Illness is due to Accident.
8 Financial limits of Not Applicable
coverage
9 Claims / Claims Turn around Time – For TAT details for Part F, Clause
Procedure death claim refer to 9
https://www.iciciprulife.com/contact-
us/our-services-turn-around-times.html

For any assistance on Claims, you can

call Us on 1800-2660 (for calls within
India) or +91 8069385555 (for calls
outside India). You can also register a
health or a death claim by sending us an
email a
[email protected]

The claim form can be downloaded from

the following links:
 Digital Claim Form Link:
https://buy.iciciprulife.com/buy/Claim-
Intimation.htm?execution=e2s1

Physical Claim Form Link:

https://www.iciciprulife.com/insurance-
library/life-insurance-claims-related-
faqs.html#linked_content

For information on documents required to

process claims, please refer to the policy
document (Part F, Clause 10) under the
section ‘Specimen Policy Document’
available on our website at
https://www.iciciprulife.com/services/dow
nload-centre.html

10 Policy Servicing Turn around Time – For TAT details for Part G , Clause
policy servicing - refer to 1
https://www.iciciprulife.com/contact-
us/our-services-turn-around-times.html

For any clarification or assistance, You

may contact Our advisor or call Our
customer service representative (between
10.00 a.m. to 7.00 p.m, Monday to
Saturday; excluding national holidays) on
1800-2660or visit Our website:
www.iciciprulife.com.
Alternatively, You may communicate with
Us at any of our branches or the customer
service helpline number 1800-2660 or
email at [email protected]. For
updated contact details, We request You
to regularly check Our website.
11 Grievances/Complaint Grievance Redressal Officer:
s

If You do not receive any resolution from

Us or if You are not satisfied with Our
resolution, You may get in touch with Our
designated grievance redressal officer
(GRO) at [email protected] or
18002660

Address: ICICI Prudential Life Insurance

Company Limited,
Ground Floor & Upper Basement,
Unit No. 1A & 2A, Raheja Tipco Plaza,
Rani Sati Marg, Malad (East),
Mumbai-400097

The concerns of senior citizens will be

resolved on priority ensuring there is a
speedy disposal of the grievances.

For more details please refer to the

“Grievance Redressal” section on
www.iciciprulife.com.

 IRDAI/(IGMS/Call Centre):
If you are not satisfied with the
response or do not receive a response
from us within 15 days, 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 (or) 1800
4254 732
Email ID: [email protected]

You can also register your complaint

online at igms.irda.gov.in
Address for communication for
complaints by fax/paper:
Consumer Affairs Department
 Insurance Regulatory and
Development Authority of India
Survey No. 115/1, Financial District,
Nanakramguda, Gachibowli,
Hyderabad, Telangana State –
500032

Ombudsman list: Please refer to the policy

document (Part G) under the section under
the ‘Specimen Policy Document’ available
at
https://www.iciciprulife.com/services/dow
nload-centre.html

This is subject to change from time

time. Refer
https://www.iciciprulife.com/services/griev
ance-redressal.html

for more details.

12 Things to Remember Free Look: 30 days Part D, Clause
1
For more information, refer to Part D,
Clause 1 of policy document

13 Insured’s Obligations Please disclose all pre-existing disease/s

or condition/s before buying a policy. Non-
disclosure may affect the claim
settlement.
Material information includes:
Age, Gender, Education, Income, Occupation
Nationality & country of residence, Question
on criminal charges, Avocation/dangerous
hobbies, Address, Details of existing &
applied insurance policies with other
companies & terms of acceptance , Personal
details like habits, Height & weight and
Health Questions
Note: In case of any conflict, the terms and conditions mentioned in the policy
document shall prevail.

Declaration by the Policyholder

I have read the above and confirm having noted the details.

Place: (Signature of the Policyholder)

Date