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PART A
Welcome to Max Life Insurance
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Date 04-Jul-2024
To Mr. Mandala Ganesh Kumar
Plot No 331 Aeronagar Pragthi Nagar Kukatpally
Pragathi Nagar
Before Ullas Dhaba
Hyderabad 500090
Telangana India
Branch: WAH76
Policy no.: 161476668
Telephone: 9912345070
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Welcome Dear Mr. Mandala Ganesh Kumar,
Thank you for opting for Max Life Smart Wealth Advantage Guarantee Plan (A Non-Linked Non-Participating Individual Life
Insurance Savings Plan). We request you to go through the enclosed policy contract.
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What to do in On examination of the Policy, if you notice any mistake or error, proceed as follows:
case of errors 1. Contact our customer helpdesk or your agent immediately at the details mentioned below.
2. Return the Policy to Us for rectifying the same.
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Cancelling the In case You disagree with any of the terms and conditions of the Policy, you have the option to return the Policy for cancellation
Policy with a written request to Us, stating the reasons for objection, within the Freelook period of 30 days from the date of receiving the
Policy document for review of the terms and conditions.

Result: Upon return, the Policy will terminate forthwith and all rights, benefits and interests under the Policy will cease
immediately. You will be entitled for refund of the Premiums received by us after deducting the proportionate risk Premium for the
period of cover, stamp duty paid and the expenses incurred on medical examination of the Life Insured, if any.
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Long term We are committed to giving you honest advice and offering you long-term savings, protection and retirement solutions backed by
protection the highest standards of customer service. We will be delighted to offer you any assistance or clarification you may require about
your Policy or claim-related services at the address mentioned below. We look forward to being your partner for life.
Yours Sincerely,
Max Life Insurance Company Limited

Krishnakumar Ramasubramanian
Executive Vice President - Head of Operations

Digitally signed by DS MAX LIFE INSURANCE COMPANY LIMITED 1

Date: 2025.01.02 22:04:31 IST
Reason: Max Life Insurance
Location: 90C, Gurugram

Intermediary Name & Code: Policy Bazaar Ins Broker Pvt.Ltd

(IRDA/DB797/19)
Seller Name & Code: Head Office Policy Bazaar Capital Guarantee
Solutio (64753C)
Contact Number: 18601205577, 18002585970, Address: Plot No. 119,
Sector-44, Gurgaon, Gurgaon - 122001
NB13
Max Life Insurance Company Limited
Plot No. 90 C, Sector 18, Udyog Vihar, Gurugram-122015, Haryana, India
Phone 4219090 Fax 4159397 (From Delhi and Other cities: 0124) Customer Helpline: 1860 120 5577
Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144 533
Visit Us at: www.maxlifeinsurance.com E-mail: [email protected]
IRDAI Registration No: 104 Corporate Identity Number: U74899PB2000PLC045626 .

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Key Feature Document for Max Life Smart Wealth Advantage Guarantee
Plan- Wealth for milestones
Plan UIN A Non-Linked Non-Participating Individual Life Insurance Savings Plan UIN: 104N124V07
Unique Ref. No. 161476668
Variant Wealth for Milestones
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Introduction This document is the summary of important points in your policy. You must read this to understand your policy
better.
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Policy Benefits The table below explains the benefits if the Life Insured survives the Policy Term:
If the life insured
lives If you Then you receive
Pay all the Premiums applicable in your policy Guaranteed Sum Assured on Maturity Plus Accrued
Guaranteed Additions, if any, at the end of policy term.
The Policy terminates thereafter.
Do not pay the complete Annualised Premium* for first No benefits and the life cover ceases. However, you can
two Policy Years revive the Policy within five years from the due date of
the first unpaid Premium by paying the Premiums due
and late fee.
Do not pay the renewal premium in the third year or The Policy will continue in Reduced Paid up Mode.
thereafter and do not surrender the Policy Reduced Death Benefit or Reduced Maturity Benefits
and Reduced Income Benefits as the case may be in
terms of the Policy will be paid and the policy will
terminate thereafter.
Surrender the Policy after paying all due Premiums for
Surrender value and the Policy will terminate thereafter.
first 2 (Two) Policy Years

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If the life insured If the Life Insured expires during the policy term after having paid all due premiums, we will immediately pay
expires the Death Benefit as per below-

Policy Continuance
You opt for Then you receive
Benefit (PCB)****
Regular/Limited Without PCB Death Benefit shall be higher of:
Pay • Sum Assured on Death
• 105% of (Total Premiums Paid** plus underwriting extra
premiums*** plus loadings for modal premiums) as on the date
of death of life insured
• 125% of Surrender Value applicable as on date of death
With PCB With PCB, multiple benefits are applicable:
• Death Benefit higher of below components will be paid
immediately;
• Sum Assured on Death
• 105% of (Total Premiums Paid** plus underwriting extra
premiums*** plus loadings for modal premiums) as on the date
of death of life insured
• Plus, all premiums will be waived off in case they were due
• Plus, all future Survival Benefit and Maturity Benefit shall be paid
to your beneficiary, as and when due in future without any need
for the premium payment.
• Plus, any accrued income benefit and loyalty income boosters, if
applicable and not already paid shall be paid in addition to death
benefit to your beneficiary.
For all variants other than single pay Additional Accidental Death Benefit equal to 50% of the Sum
variants Assured on Death will be paid, incase Life Insured dies during
the Accidental Death Benefit Term, provided all due premiums are
paid.

Any accrued income benefit and loyalty income boosters, if not already paid shall be paid in addition to death
benefit. Please refer to the detailed policy contract for more details.

*Annualised Premium means Premium amount payable during a Policy Year chosen by Policyholder, excluding
Underwriting Extra Premium***, loading for modal premium, Rider Premiums and applicable taxes, cesses or
levies if any;

** Total Premiums Paid means the total of all Premiums received, excluding Underwriting Extra Premium***,
loading for modal premium, Rider Premiums, and applicable taxes, cesses or levies, if any.

***Underwriting Extra Premium means an additional amount charged by Us, as per Underwriting Policy, which
is determined on the basis of disclosures made by Policyholder in the Proposal Form or any other information
received by Us including medical examination report of the Life Insured

**** Policy Continuance Benefit, if opted for, ensures survival and maturity benefits continue to be paid, as and
when due in case of death of the Life Insured without any need of premium payment.

"Sum Assured on Maturity" means the amount which is guaranteed to become payable on maturity of the policy,
in accordance with the terms and conditions of the policy.

"Sum Assured on Death" means an assured amount, payable upon the death of the Life Insured. Sum Assured on
Death shall be equal to:
• For Single Pay - Death Benefit Multiple (1.25 or 10, as chosen by the policyholder) times Single Premium (plus
any underwriting extra premium***)
• For other than single pay - 11 times Annualised* Premium (plus any underwriting extra premium***)

Please note: Your Policy will be made available only without a medical examination in case it is sourced through
a Point of Sale person
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Managing Your Policy - Frequently Asked Questions
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What you need to You need to
do? • Pay Premiums on time for the entire Premium Payment Term. There are various easy and convenient payment
options for you to choose from. To know more about payment options, log on to www.maxlifeinsurance.com,
and
• Read the details of the Policy document, including the Proposal Form, to ensure the accuracy of information.
For any error you observe, contact us for correction
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How can you manage Manage your policy under the Customer Service section by visiting www.maxlifeinsurance.com to get easy access
your policy? to the following self-service options:
• Access Policy statements, receipts and Premium due information
• Update your contact details
• Pay renewal Premiums online
Note: For any support or claim-related query, you can reach us at 1860 120 5577 or (0124) 4219090 or
[email protected]
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Premium Payment This variant provides single, limited and regular pay options to the policyholder. In single and limited pay, policy
Term/ Policy Term term is different from premium payment term and in regular pay, policy term is equal to premium payment term.
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What happens if you To ensure continuous life insurance cover, please pay your Premium on time. If for any reason, you are unable
delay your premium to pay by the due date, you have a grace period of 15 days from the due date of the unpaid premium for monthly
payment? premium payment mode and 30 days from the due date of the unpaid premium for annual premium payment modes,
within which you can pay without any late fee.

Note: During the Grace Period, the insurance cover continues. If the Life Insured dies during this period, we will
pay the Death Benefit after deducting the unpaid Premium, if any.
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Can you take a loan Yes, you may take a loan under this Policy subject to a maximum of 80% of Surrender Value as per the applicable
against the policy? terms and conditions of the Policy contract.
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How can you cancel If your Policy does not meet your objective, you may contact us to understand the Policy benefits. If you still feel
your policy? the need to cancel your Policy, you have an option to cancel it within the free look period of 30 days from the
day you receive the Policy documents.

Note: If you have bought this Policy from the Distance Marketing or any electronic mode, you have a free look
period of thirty days.
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How can you revive You may Revive your Policy within five years from the due date of the first unpaid Premium, once you
your policy? • provide us with a written request to Revive the Policy
• pay all overdue Premiums (along with the applicable taxes, cesses and levies, if any) along with late fee, and
• produce evidence of insurability of the Life Insured.
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Taxes and Others - Frequently Asked Questions

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Tax benefits Tax benefits may be available as per the prevailing tax laws.
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Exclusions Suicide
In the event Life Insured commits suicide, within twelve months from the Date of Commencement or Revival,
all risks and benefits under this Policy shall cease and no benefits will be payable. We shall only pay either the
following to the Claimant:
• higher of the Surrender Value or total premiums paid** (plus underwriting extra premiums*** paid plus loadings
for modal premiums, if any) if the Policy has acquired a Surrender Value; or
• Total premiums paid** (plus underwriting extra premiums*** paid plus loadings for modal premium, if any),
if the Policy has not acquired a Surrender Value.
Waiting period
In case this policy is sourced through a Point of Sale person, in such cases, there is a waiting period of 90 days
from the Date of Acceptance of Risk of this Policy ("Waiting Period"). In case of death (for other than accidental
death only) during this Waiting Period, 100% of the total premiums paid** till the date of death will be payable
since the date of commencement of policy, excluding Goods and service tax or any other cess. The full Death
Benefit will not be payable.
In case of death of Life Insured due to accident, this Waiting Period is not applicable, and full Death Benefit shall
be payable. The Waiting Period is not applicable in case of revival of the Policy.

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 Exclusions applicable to Accidental Death Benefit
No benefits under this benefit will be payable if death occurs from, or is caused by, either directly or indirectly,
voluntarily or involuntarily due to or caused, occasioned, accelerated or aggravated by certain events detailed
out in your policy document. Please refer relevant section for details.
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Disclaimers The aim of this document is to summarize the key features of your policy and does not replace the policy, in any
way. In case of any discrepancy between the policy contract and this document, the terms and conditions of the
policy contract shall prevail.
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 POLICY PREAMBLE

MAX LIFE INSURANCE COMPANY LIMITED

Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144533

Max Life Smart Wealth Advantage Guarantee Plan

A Non-Linked Non-Participating Individual Life Insurance Savings Plan

UIN [104N124V07]

Max Life Insurance Company Limited has entered into this contract of insurance on the basis of the information given in the Proposal Form
together with the Premium deposit, statements, reports or other documents and declarations received from or on behalf of the Proposer for
effecting a life insurance contract on the life of the person named in the Schedule.

We agree to pay the benefits under the Policy on the happening of the insured event, while the Policy is in force subject to the terms and
conditions stated herein.

Max Life Insurance Company Limited

Place of Issuance :Gurugram, Haryana

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POLICY SCHEDULE

Policy: Max Life Smart Wealth Advantage Guarantee Plan Type of Policy: A Non-Linked Non-Participating Individual Life
Insurance Savings Plan
UIN: 104N124V07 Office: Policy Bazaar Ins Broker PVT.LTD Head Office
Policy No./ Proposal No.: 161476668 Client ID: 6003077397

Date of Proposal: 27-May-2024

Policyholder/Proposer : Mr. Mandala Ganesh Kumar Age Admitted: Yes

PAN: AVDPM5374K Date of Birth: 02-Jun-1986

Identification Source & ID No.: PAN , AVDPM5374K Gender: Male

Relationship with Life Insured: Same Person Tel No./Mobile No.: / 9912345070

Email: [email protected]

Address(For all communication purposes):

Plot No 331 Aeronagar Pragthi Nagar Kukatpally Pragathi Nagar
Before Ullas Dhaba
Hyderabad 500090 Telangana India

Life Insured: Mr. Mandala Ganesh Kumar Age Admitted: Yes

Identification Source & ID No.: PAN , AVDPM5374K Date of Birth: 02-Jun-1986

Age: 38 years

Gender: Male

Address(For all communication purposes): Plot No 331

Aeronagar Pragthi Nagar Kukatpally
Pragathi Nagar Before Ullas Dhaba
Hyderabad 500090
Telangana India

Nominee(s):
Nominee (s)Name Relationship of Nominee(s) Date of Birth Gender Age %
with Policyholder Of Nominee share
Ms. Ega Mounika Spouse 12-Mar-1989 Female 35 100

Appointee (if Nominee is minor):

Name: N.A.
Gender: N.A
Age: N.A
Relationship with nominee: N.A
Date of Commencement of Risk/Inception of Policy: 30-Jun-2024 Premium Payment variant: Limited
Premium Payment mode: Monthly
Date of Issuance of Policy: 30-Jun-2024 Policy Variant: Wealth for Milestones
Point of sale policy: No
Policy Continuance Benefit opted: Yes
Income Benefit Deferment Option opted: NA
Existing Customer/Staff/Seller/ Transgender/Agent lives
Discount (available for first policy year only): No
Option to avail income on a chosen date: No
Details of the Riders, if any: N.A Date on which first Survival Benefit is payable: NA
Premium Payment Method: Direct Bill Payment Date: NA
Bank Name: NA
Bank Account Number: NA
Bank Account Details for Pay outs: Bank Name: NA
Bank Account Number: NA
Intermediary Name & Code: Policy Bazaar Ins Broker Pvt.Ltd Seller Name & Code: Head Office Policy Bazaar Capital Guarantee
(IRDA/DB797/19) Solutio (64753C)

Address: Intermediary License No.: MAX64753C

Plot No. 119, Sector-44, Gurgaon
Gurgaon 122001 Contact Number: 18601205577, 18002585970

Email: [email protected]

Details of Sales Personnel (for direct sales only): N/A

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 List of Maturity Death Sum Sum Guaran- Age of Life Policy Income Income Income
Coverage Date Benefit Assured Assured on teed Insured at Term Benefit Benefit Benefit
Multiple on Maturity additions Maturity (in Period Payout
(Appli- Death as (INR) Date years) Frequency
cable on the (in
only for Date of years)
Single Commen-
Prem- cement
ium Policy) of Risk
(INR)
Max Life
Smart
Wealth 30-Jun- NA 11,41,404.33 9,09,094.00 2,90,910.00 58 20 0.00 NA NA
Advantage 2044
Guarantee
Plan

Income Income Income Premium Premium Annuali- Under- GST** and Modal Total Due Date
Benefit Benefit Benefit Payment Payment sed writing any other Factor Premium when
Deferment start years Period Term Mode Premium/ Extra taxes, (including Premium
Period start Date (in years) Single Premium cesses Underwr- is payable
(in years) Premium (INR) & levies iting /date when
(INR) (INR) Extra the last
Premium) premium
along with is payable
applicable
taxes,
cesses
and levies
payable
as per
premium
payment
mode
selected
(INR)
30th of
NA NA NA 5 Monthly 1,00,110.01 3,654.02 4,669.31 .0857 9,292.73 every
month; 31-
May-2029

**GST includes IGST, SGST, CGST, UGST (whichever is applicable) and applicable cesses.

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PART B selected by You. No Income Benefit is available under the Wealth For
DEFINITIONS Milestones Variant;
The words and phrases listed below will have the meaning attributed to them wherever 22. "Income Benefits Modal Factor" means the applicable factor, which is used
they appear in the Policy unless the context otherwise requires. by Us for determining the Income Benefits under this Policy as follows i) for
1. "Accident" means sudden, unforeseen and involuntary event caused by annual mode - (1.0); ii) for semi-annual mode - (0.49) iii) for quarterly mode
external, visible, violent means; - (0.24) and iv) for monthly mode - (0.08);
2. "Accidental Death" means death which is caused by an Accident provided such 23. "Income Benefit Period" means the period, as specified in the Schedule, during
death was caused directly by such Accident and independent of any physical or which the Income Benefit as per the Income Benefit Payout Frequency selected
mental illness within 180 days of the date of Accident; by You will be payable;
3. "Additional Accidental Death Benefit Term" shall mean the period, in case 24. "Income Benefit Start Year" means the year, as specified in the Schedule,
of non-Single Premium Payment Variant, starting from the end of Premium from when the Income Benefit as per the Income Benefit Payout Frequency
Payment term and lasting till the end of Policy Term or attainment of maximum selected by You will be payable;
maturity age of 80 years applicable for additional Accidental Death benefit, 25. "Income Benefit Deferment Option" means the Income Benefit deferment
whichever is earlier; option as selected by You at the time of Date of Commencement of Risk for
4. "Additional Accidental Sum Assured on Death" means an assured additional 'Regular Wealth Variant' or 'Long Term Wealth Variant' to defer the Income
amount which is guaranteed to become payable on the death of the Life Insured Benefit under the Policy for the Income Benefit Deferment Period.
due to Accident in accordance with the terms and conditions of the Policy. 26. "Income Benefit Deferment Period" means the period (in years) between 0 to
Additional Accidental Sum Assured on Death shall be equal to 50% of Sum 5 years, as chosen by You and as specified in the Schedule during which Income
Assured on Death. The maximum Additional Accidental Sum Assured On Death Benefit will not be payable;
shall not exceed Rs. 1 crore; 27. "Income Benefit Payout Frequency" means a frequency as specified in the
5. "Age" means Life Insured's age on last birthday as on the Date of Policy Schedule at which the Income Benefit Payouts under Income Benefit are
Commencement of Risk or on the previous Policy Anniversary, as the case may payable;
be; 28. "IRDAI" means the Insurance Regulatory and Development Authority of India;
6. "Annualised Premium" is the amount specified in the Schedule and means 29. "Lapsed Policy" means a Policy which has not acquired the Surrender Value
the Premium amount payable during a Policy Year chosen by You, excluding and where due Premium has not been received for at least the first two
Underwriting Extra Premiums, loadings for modal premiums, Rider Premiums consecutive Policy Years;
and applicable taxes cesses and levies, if any; 30. "Life Insured" means the person named in the Schedule, on whose life the
7. "Appointee" means the person named by You (as applicable and registered with Policy is effected;
Us in the Schedule) who is authorised to receive and hold in trust the benefits 31. "Limited Premium Payment Variant" means where the Premium is payable
under this Policy on behalf of the Nominee/(s), if the Nominee/(s) is/are less to Us during the Premium Payment Term which is limited compared to the
than Age 18 on the date of payment of such benefit; Policy Term (i.e. the Policy Term being greater than the Premium Payment
8. "Assignee" is the person to whom the rights and benefits are transferred by Term) and is paid in regular instalments in the manner and at the intervals
virtue of an Assignment; specified in the Schedule;
9. "Assignment" is the process of transferring the rights and benefits to an 32. "Loyalty Income Boosters" means an amount expressed as a percentage of
Assignee, in accordance with the provisions of Section 38 of Insurance Act, Income Benefit, which will accrue after the Premium Payment Term and will be
1938, as amended from time to time; payable every year during the Income Benefit Period, provided that all Premiums
10. "Auto Debit" means an automatic payment method whereby We are allowed have been paid during the Premium Payment Term;
to auto debit Premiums directly from bank account or credit/ debit card; 33. "Maturity Date" means the date specified in the Schedule, on which the Policy
11. "Auto Debit Boosters" means the additional amount payable by Us in Term expires;
accordance with Clause 1.2.5 of Part C of this Policy; 34. "Medical Practitioner" means a person who holds a valid registration from
12. "Claimant" means You (if You are not the Life Insured), Nominee(s) (if the Medical Council of any state or Medical Council of India or Council for
valid nomination is effected), Assignee(s) or their heirs, legal representatives or Indian Medicine or for Homeopathy set up by the Government of India or
holders of a succession certificates in case You or Nominee(s) or Assignee(s) a State Government and is thereby entitled to practice medicine within its
is/are not alive at the time of claim, as the case may be; jurisdiction and is acting within its scope and jurisdiction of license, provided
13. "Date of Commencement of Risk/ Inception of Policy" means the date as such Medical Practitioner shall not include Your spouse, father (including
specified in the Schedule, on which the insurance coverage / risk under the Policy step father), mother (including step mother), son (including step son), son's
commences; wife, daughter, daughter's husband, brother (including step brother/s) or sister
14. "Distance Marketing" includes every activity of solicitation (including lead (including step sister/s) or the Life Insured or You or employed by You/the Life
generation) and sale of insurance products through the following modes: (i) Insured.
Voice mode, which includes telephone-calling; (ii) Short Messaging service 35. "Modal Factor" means the applicable factor specified in the Schedule, which
(SMS); (iii) Electronic mode which includes e-mail, internet and interactive is used by Us for determining the Premium. The Modal Factors for this Policy
television; (iv) Physical mode which includes direct postal mail and newspaper are as follows: i) for annual Premium payment mode - (1); ii) for semi-annual
& magazine inserts; and (v) Solicitation through any means of communication Premium payment mode - (0.5075); iii) for quarterly Premium payment mode
other than in person; - (0.2558); iv) for monthly Premium payment mode - (0.0857);
15. "Death Benefit Multiple" (applicable in case of Single Premium Payment 36. "Money Back Benefit" means lump sum amount equal to 50% of the Sum
Variant only) means a multiplier as selected by You and as specified in the Assured on Maturity payable only in case of the Lifelong Wealth Variant at the
Schedule. The available Death Benefit Multiples under the Policy are 1.25 or 10; end of year when You attain Age of 85 years, subject to provisions of Clause
16. "Freelook" means a period during which, subject to the Clause 6 Part D of the 1.2.4 (c) of Part C;
Policy, You have an option to return the original Policy to Us by stating the 37. "Nomination" is the process of nominating a person(s) in accordance with
objections/reasons for disagreement in writing; provisions of Section 39 of the Insurance Act, 1938 as amended from time to
17. "Grace Period" means the time granted by Us from the due date for the time;
payment of Premium, without any penalty or late fee, during which time the 38. "Nominee" means the person named in the Policy Schedule who has been
Policy is considered to be in force with risk cover without any interruption, nominated by You (only if You are the Life Insured), in accordance with Section
as per the terms and conditions of the Policy. The grace period is a period of 39 of the Insurance Act, 1938 as amended from time to time to receive benefits
15 (Fifteen) days from the due date of the first unpaid Premium for monthly in respect of this Policy;
Premium payment mode and 30 (Thirty) days from the due date of the first 39. "Policy" means the contract of insurance entered into between You and Us as
unpaid Premium for annual, semi-annual or quarterly premium payment modes; evidenced by this document, the Proposal Form, the Schedule and any additional
18. "Guaranteed Additions" means an amount as specified in the Schedule. information/document(s) provided to Us in respect of the Proposal Form along
Guaranteed Additions are expressed as a percentage of Sum Assured on Maturity with any written instructions from You subject to Our acceptance of the same
and shall be equal to 8% of Sum Assured On Maturity each year. Guaranteed and any endorsement issued by Us;
Additions accrue at the end of the last four Policy Years in case of Wealth 40. "Policy Anniversary" means the annual anniversary of the Date of
For Milestones Variant provided the Policy is Premium paying or all Premiums Commencement of Risk;
under the Policy haves been fully paid and at the end of last four Premium 41. "Policy Continuance Benefit" means the benefit as specified in Clause 1.1.2 of
Payment Term in case of Early Wealth Variant, provided the Policy is Premium Part C. This option can be chosen (not available for the Single Premium Payment
paying on the date the accrued Guaranteed Addition becomes due. The Variant and Lifelong Wealth Variant) only at the Date of Commencement of
accrued value of Guaranteed Additions shall be payable on the Maturity Date Risk by the Policyholder and only if the Policyholder and Life Insured are same
in accordance with Clause 1.3 of Part C. In case of surrender, the applicable person and once opted cannot be opted out of during the Policy Term;
Surrender Value of accrued Guaranteed Additions shall be payable at the time 42. "Policy Term" means the term of this Policy as specified in the Schedule during
of surrender of the Policy in accordance with Clause 1 of Part D which the Policy coverage continues;
19. "Guaranteed Surrender Value" means an amount computed in accordance 43. "Policy Variants" means the 'Wealth For Milestones Variant', 'Regular Wealth
with Clause 1 of Part D, which is guaranteed by Us; Variant' or 'Long Term Wealth Variant' or 'Early Wealth Variant' or Lifelong
20. "Injury" means accidental physical bodily harm excluding any illness or Wealth Variant' of this Policy, as specified in the Schedule. Please note that the
disease, solely and directly caused by an external, violent, visible and evident choice of Policy Variants can only be made on the Date of Commencement of
means which is verified and certified by a Medical Practitioner; Risk and these cannot be changed at any point of time during the Policy Term;
21. "Income Benefit" means an amount, as specified in the Schedule, payable 44. "Policy Year" means a period of 12 (Twelve) months commencing from the
during the Income Benefit Period as per the Income Benefit Payout Frequency Date of Commencement of Risk and every Policy Anniversary thereafter;

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45. "Premium" means an amount specified in the Schedule, payable by You by PART C
the due dates to secure the benefits under the Policy, excluding applicable taxes, POLICY FEATURES, BENEFITS AND PREMIUM PAYMENT
cesses and levies, if any; 1. BENEFITS
46. "Premium Payment Term" means the term specified in the Schedule, during 1.1. Death Benefit
which the Premiums are payable by You; 1.1.1. Death during the Policy Term where the Policy Continuance
47. "Proposal Form" means the form filled in and completed by You for the Benefit not selected by You:
purpose of obtaining insurance coverage under the Policy; If the Life Insured dies during the Policy Term, provided the Policy is in
48. "Proposer" is a person, who proposes a life insurance proposal; force and is not a Lapsed Policy or in Reduced Paid Up Mode, on the date
49. "Reduced Paid Up Sum Assured on Death" means an amount equal to of death of the Life Insured and You have not opted for Policy Continuance
the Sum Assured on Death multiplied by the ratio of total period for which Benefit, We will pay lump sum guaranteed death benefit as follows:
Premiums have already been paid under the Policy to the maximum period for a. For Single Premium Payment Variant, higher of:
which Premiums were originally payable under the Policy; i. Sum Assured on Death;
50. "Reduced Paid Up Mode" means the Policy with reduced paid up benefits as 125% of the Surrender Value applicable as on the date of death
ii.
specified under Clause 3 of Part C; of the Life Insured.
51. "Reduced Paid Up Income Benefit" means the Policy with reduced paid up b. For Regular Premium Payment Variant and Limited Premium
Income Benefits as specified under Clause 3.5 of Part C; Payment Variant, highest of:
52. "Reduced Paid Up Sum Assured on Maturity" means an amount equal to i. Sum Assured on Death;
the Sum Assured on Maturity multiplied by the ratio of total period for which ii. 105% (One Hundred Five percent) of sum of (Total Premiums
Premiums have already been paid under the Policy to the maximum period for Paid plus loadings for modal premiums plus Underwriting
which Premiums were originally payable under the Policy; Extra Premium (if any)) received under the Policy, as on the
53. Reduced Paid Up Money Back" means an amount equal to the Money Back date of death of the Life Insured; or
Benefit multiplied by the ratio of total period for which Premiums have already iii. 125% of the Surrender Value applicable as on the date of death
been paid under the Policy to the maximum period for which Premiums were of the Life Insured.
originally payable under the Policy; Note - Any accrued Income Benefit and Loyalty Income Boosters, if not
54. "Regular Premium Payment Variant" means a Variant in which the Premium already paid shall be paid in addition to death benefit.
is payable to Us in regular installments throughout the Premium Payment Term, 1.1.2. Death during the Policy Term where the Policy Continuance
which is the same as the Policy Term, in the manner and at the intervals specified Benefit is selected by You:
in the Schedule; If the Life Insured dies during the Policy Term, provided the Policy is in
55. "Revival" means restoration of the Policy, which was discontinued due to force and is not a Lapsed Policy nor in Reduced Paid Up Mode, on the date
non-payment of Premium, by Us with all the benefits stated in the Policy, upon of death of the Life Insured and You have opted for Policy Continuance
the receipt of all the due Premiums and other charges / late fee as provided in Benefit, We will pay the following:
Clause 3 of Part D of the Policy; i. Death benefit being the higher of (i) Sum Assured on Death or (ii)
56. "Revival Period" means a period of 5 (Five) consecutive years from the due 105% of (Total Premiums Paid plus Underwriting Extra Premium
date of the first unpaid Premium, during which period You are entitled to revive plus loadings for modal premiums) as on the date of death of Life
the Policy which was discontinued due to the non-payment of Premium; Insured; plus
57. "Rider" means optional benefits which are in addition to basic benefits under ii. Policy Continuance Benefit
the Policy; Note for Policy Continuance Benefit:
58. "Rider Premium" means the premium amount payable in respect of a Rider a) Subject to Clause 1.1.4 of Part C, if You have opted for "Policy
applicable under the Policy and is the amount specified in the Schedule; Continuance Benefit", then on death of the Life Insured any time
59. "Schedule" means the policy schedule and any endorsements attached to and during the Policy Term, Sum Assured on Death shall be paid
forming part of the Policy and if any updated Schedule is issued, then, the immediately as a lump sum amount or if the settlement option is
Schedule latest in time; selected, the death benefit shall be paid in accordance with Clause 2
60. "Single Premium" means the premium amount paid to Us in a single instalment of Part C.
as specified in the Schedule excluding Underwriting Extra Premium (if any), b) The applicable future Survival Benefits and maturity benefit shall be
Rider Premium and applicable taxes, cesses and levies; paid to the Claimant as and when due, without payment of any future
61. "Single Premium Payment Variant" means Policy Variant in which the Premiums as would have been the case had the Life Insured been alive
Premium is received in lump sum before the Date of Commencement of Risk; and would have been paying the Premiums.
62. "Special Surrender Value" means an amount computed in accordance with c) Policy Continuance Benefit shall not be available in case the Policy is
Clause 1 of Part D; in Reduced Paid Up Mode. Thus, in case of death of the Life Insured
63. "Sum Assured on Death" means an assured amount which is guaranteed to while the Policy is in Reduced Paid Up Mode, Reduced Paid Up Sum
become payable on the death of the Life Insured as per Clause 1.1 of Part C and Assured on Death shall be paid and the Policy shall terminate.
will be equal to: d) If You have opted for Policy Continuance Benefit, then upon death
a) For Single Premium Payment Variant- Death Benefit Multiple times of the Policyholder, the Claimant shall have no right to discontinue
Single Premium (plus Underwriting Extra Premium, if any) the Policy.
b) For Regular Premium Payment Variant/ Limited Premium Payment e) Any accrued Income Benefit and Loyalty Income Boosters, if not
Variant- 11 times Annualised Premium (plus Underwriting Extra already paid shall be paid in addition to death benefit.
Premium, if any) f) If waiver of premium Rider is issued by Us and Policy Continuance
64. "Sum Assured on Maturity" means the guaranteed amount as specified in the Benefit is opted under Your Policy and, if the benefit under the Rider
Schedule calculated as per Clause 1.3 of Part C, payable on the Maturity Date, was triggered due to occurrence of any insured event as covered under
if the Life Insured is alive on the Maturity Date and all due Premiums have been
the Rider during the Premium Payment Term and is later followed
received by Us;
by death of Life Insured during the Premium Payment Term, then in
65. "Surrender Value" means an amount payable on surrender of this Policy, in
addition to the above, the present value of the future base Premium
accordance with Clause 1 of Part D;
(excluding Rider Premium, if any) to be waived, discounted at the rate
66. "Survival Benefit" means the benefit (including Income Benefit, Loyalty
applicable as per the Rider terms and conditions, will also be paid.
Income Booster, Money Back Benefit) payable as per the terms and conditions
1.1.3. Death due to Accident during the Additional Accidental Death
of this Policy as per the Survival Benefit option chosen You, until death of the
Benefit Term after the end of Premium Payment Term (only for
Life Insured or end of the Policy Term, whichever is earlier. One of the following
other than Single Premium Payment Variant Policy)
Survival Benefit options may be chosen by You:
If the Life Insured dies due to Accident during the Additional Accidental
i. "Regular Wealth Variant" as specified in Clause 1.2.1 of Part C
Death Benefit Term after the end of Premium Payment Term, provided
ii. "Long Term Wealth Variant" as specified in Clause 1.2.2 of Part C
the Policy is in force, on the date of death of the Life Insured, We will
iii. "Early Wealth Variant" as specified in Clause 1.2.3 of Part C
pay Additional Accidental Sum Assured on Death in addition to the death
iv. "Lifelong Wealth Variant" as specified in Clause 1.2.4 of Part C
benefit payable under Clause 1.1.1 or 1.1.2 above. If the Life Insured is
67. "Total Premiums Paid" means the total of all Premiums received under the
minor, additional Accidental Death benefit will not be available under the
Policy, excluding Underwriting Extra Premium, loadings for modal premiums,
Policy.
Rider Premium and applicable taxes, cesses or levies (if any).
Additional Accidental Death benefit coverage shall cease on Policy
68. "Underwriting Extra Premium" means an additional amount mentioned in the
maturity or at the end of the Policy Year in which Life Insured attains the
Schedule and charged by Us, as per Underwriting Policy, which is determined
Age of 80 years, whichever is earlier.
on the basis of disclosures made by You in the Proposal Form or any other
information received by Us including medical examination report of the Life
1.1.4. In case this Policy is sourced as a point of sale Policy, the
Insured, if any;
following conditions shall apply:
69. "Underwriting Policy" means the underwriting policy approved by Our board
(i) In case of death of the Life Insured, death benefit will be
of directors;
payable as noted in Clause 1.1.1 or 1.1.2 above, as the case
70. "Waiting Period" shall mean a period of 90 days from the Date of
may be. However, in case the Life Insured dies during the
Commencement of Risk/Inception of the Policy. It is applicable only in case the
Waiting Period due to any reason other than an Accident, We
Policy is sourced as a point of sale policy;
will refund 100% of the Total Premiums Paid till the date of
71. "We", "Us" or "Our" means Max Life Insurance Company Limited; and
72. "You" or "Your" or "Policyholder" means the policyholder as named in the death of the Life Insured excluding applicable taxes, cesses,
Schedule.

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 levies, if any, and no other benefit will be payable and the in lumpsum or in installment over a period of 5 years as detailed below. Under
Policy will terminate. this option, income payment frequency which may be chosen is either monthly
(ii) In the event of death of Life Insured due to an Accident, the or annual mode.
Waiting Period shall not be applicable and the death benefit A. Following two settlement options for the death benefit can be selected by
shall be payable in accordance with Clause 1.1.1 or 1.1.2 You under the Policy:
above, as the case may be. i. Lumpsum benefit: to take the entire death benefit as lumpsum.
(iii) The Waiting Period is not applicable on Revival of the Policy. ii. Regular monthly/annual income for 5 years: to take 22.10% of death
1.2. Survival Benefit benefit as annual income payable for 5 years, or 1.88% of death
During the Policy Term while the Life Insured is alive and upon expiry benefit as monthly income payable for 60 months. The income (for
of the Income Benefit Deferment Period, Survival Benefit payable shall both monthly and annual mode) will be payable from the monthly
depend on the Policy Variant chosen by You and shall be payable on the policy anniversary following the date of death of Life Insured. If the
due date as specified in the Schedule, provided the Policy is in-force. The date of death is same as the policy monthly anniversary date, then the
same shall be as under: monthly income will be payable from date of death.
1.2.1. In case You have chosen Regular Wealth Variant, We will pay the At any time during the income phase under death benefit, future remaining
following Survival Benefit: income payouts can be commuted by the Claimant at present value of all
a) Income Benefit, payable during the Income Benefit Period in future payouts discounted at the rate of 5.25% per annum as commuted
arrears , as per chosen Income Payout Frequency; and value.
b) Loyalty Income Boosters (equivalent to 10% of the Income B. Following two settlement options can be exercised by You only at least 15
Benefit) shall accrue after the completion of the Premium days prior to the Maturity Date of the Policy:
Payment Term and will be payable every year during the i. Lumpsum benefit: to take the entire maturity benefit as lumpsum.
Income Benefit Period ii. Regular monthly/annual income for 5 years: to take the maturity
1.2.2. In case You have chosen Long Term Wealth Variant, We will pay benefit as monthly income payable over 60 months or annual income
the following Survival Benefit: payable over 5 years. The income (for both monthly and annual mode)
a) Income Benefit, payable during the Income Benefit Period in will be payable from the monthly policy anniversary following the
arrears , as per chosen Income Payout Frequency; and, Maturity Date.
b) Loyalty Income Boosters (equivalent to 20% of the Income The terms of the settlement option will vary depending upon the
Benefit), shall accrue after the completion of the Premium prevailing investment conditions at the time of settlement and the then
Payment Term and will be payable every year during the interest rate at which the settlement option shall be valued will be
Income Benefit Period. based on the 5-year G-Sec yield prevailing at that time less 1%.
1.2.3. In case You have chosen Early Wealth Variant, We will pay the Each year, on April 1st, We will set the rate for settlement option
following Survival Benefit: equal to the yield on 5-year G-Sec as on March 31st of that year (basis
Income Benefit, payable during the Income Benefit Period in FBIL website) less 1%.
arrears , as per chosen Income Payout Frequency. The Income At any time during the income phase under maturity benefit, future
Benefit Period shall depend on the Income Benefit start year remaining payouts may be commuted by You, wherein the present
and Income Benefit Period shall be equal to the Policy Term value of all future payouts discounted at the rate applicable at the
less Income Benefit start year; time of exercising the settlement option shall be payable as commuted
1.2.4. In case You have chosen Lifelong Wealth Variant, We will pay the value.
following Survival Benefit: Once the settlement option is exercised, the discount rate declared
a) Income Benefit, payable during the Income Benefit Period will become guaranteed. The same rate shall also get applicable in
in arrears , as per chosen Income Payout Frequency. Income case commutation of remaining payouts is opted during the settlement
Benefit Period shall start immediately after the Premium period.
Payment Term and shall be equal to 100 less Entry Age less 3. REDUCED PAID UP BENEFITS
Premium Payment Term. The Income Benefit Period shall If this Policy has acquired a Surrender Value as specified under Clause 1 of
depend on the entry Age, Premium Payment Term chosen; Part D and for other than Single Premium Payment Variant, in the event of
b) Loyalty Income Boosters (equivalent to 20% of the Income non-payment of the due Premiums by You to Us on the expiry of the Grace
Benefit), shall accrue after the completion of the Premium Period this Policy, will not become a Lapsed Policy and will continue under
Payment Term and will be payable every year during the Reduced Paid Up Mode unless revived. If this Policy is under Reduced Paid Up
Income Benefit Period; and, Mode, the benefits payable shall be as follows:
c) Money Back Benefit at the end of Policy Year in case the Life 3.1. Reduced Paid Up Death Benefit
Insured has survived till the Age of 85 years. If the Life Insured dies during Policy Term, We will pay the Reduced Paid
Note: If the Income Benefit Payout Frequency is monthly, then the payout Up Death Benefit to the Claimant which shall be highest amongst:
will be done at the end of the month and in case it is annual, then the payout i. Reduced Paid Up Sum Assured on Death; or
will be done at the end of year during the Income Benefit Period. ii. 105% (One Hundred Five percent) of (Total Premiums Paid plus
1.2.5. Auto Debit Boosters loadings for modal premiums plus Underwriting Extra Premium (if
If the Policy is in-force and fully paid up and all due Premiums any) received under the Policy), as on the date of death of the Life
have been received by Us and the Life Insured has survived until the Insured; or
end of the Premium Payment Term, for all the Premiums received iii. 125% of Surrender Value as on date of death.
through Auto Debit mode, Auto Debit Booster equivalent to 1 % 3.2. Additional Reduced Paid Up Accidental Death Benefit: The Additional
(one percent) of the Premiums (including modal loadings) received Accidental Death benefit is payable, over and above the Reduced Paid Up
through Auto Debit mode will be paid Death Benefit, on death of the Life Insured due to Accident during the
1.3 Maturity Benefit Additional Accidental Death Benefit Term. Additional Reduced Paid Up
1.3.1. If the Life Insured has survived until the Maturity Date, provided Accidental Death Benefit will be equal to 50% of Reduced Paid Up Sum
the Policy is in-force and has been fully paid and is neither a Lapsed Assured on Death. The maximum Additional Reduced Paid Up Accidental
Policy nor in Reduced Paid Up Mode on the Maturity Date, We shall Death Benefit shall not exceed Rs. 1 crore;
pay the maturity benefit as under: 3.3. Reduced Paid Up Maturity Benefit
a. In case You have chosen Wealth For Milestones Variant, We If the Life Insured has survived until the Maturity Date, We shall pay
will pay Sum Assured on Maturity and accrued Guaranteed the Reduced Paid Up Sum Assured on Maturity plus accrued Guaranteed
Additions. Additions, if applicable.
b. In case You have chosen Regular Wealth Variant, We will not 3.4. Reduced Paid Up Money Back Benefit
pay any maturity benefit. If the Life Insured has survived until 85 years of Age, We shall pay the
c. In case You have chosen Long Term Wealth Variant, We will Reduced Paid Up Money Back.
pay the Sum Assured on Maturity which will be equal to the 3.5. Reduced Paid Up Income Benefit
Total Premiums Paid The Reduced Paid Up Income Benefit will be equal to and will be
d. In case You have chosen Early Wealth Variant, We will determined using the methodology for the below Policy Variants:
pay the Sum Assured on Maturity and accrued Guaranteed
Additions. Policy Variant Reduced Paid Up Income Benefit
e. In case You have chosen Lifelong Wealth Variant, We will Wealth For Milestones Variant Nil
pay the Sum Assured on Maturity which will be equal to the Regular Wealth Variant Income Benefit multiplied by the ratio
100% of the Total Premiums Paid but including the loadings of total period for which Premiums
Long Term Wealth Variant
for modal premiums have already been paid under the
1.3.2. Any accrued income benefit and Loyalty Income Boosters, if not Policy to the maximum period for
already paid, shall be paid in addition to the above maturity benefit. Lifelong Wealth Variant which Premiums were originally
payable under the Policy;
2. SETTLEMENT OPTION
You only at the time of receiving the benefits under the Policy may opt to
exercise the settlement option by giving a written request to Us. Under the Early Wealth Variant
Settlement option there will be flexibility to take the death and maturity benefit NIL

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 a. If Policy Year is less than the a. date. It may be noted that once this option is selected, no change will be allowed
Premium Payment Term during the Policy Term.
b. If Policy Year is equal to b. Income Benefit multiplied by the The Income Benefit and Loyalty Income Boosters (if applicable) applicable for
or higher than the Premium sum of the [(Policy Term minus the first year will be calculated by pro-rating the original payable income amount
Payment Term Income Benefit start year plus by the number of days between the chosen income benefit payout date and
1) multiplied by the ratio of the Policy Anniversary. As this benefit will be paid before the ensuing Policy
total period for which Premiums Anniversary when the income is due and hence will be lesser than the actual
have already been paid under payable Income Benefit and Loyalty Income Boosters (if applicable) in the first
the Policy to the maximum year.
period for which Premiums were Further, upon maturity of the Policy, an additional amount will be calculated for
originally payable under the the last Policy Year by pro-rating the original payable income amount by the
Policy minus the period for number of days between the chosen payout date and maturity date.
which income has already been 7. PREMIUMS
paid under the Policy] divided by 7.1. You can pay the Premium annually, semi-annually, quarterly or on monthly
(Policy Term minus Premium basis, as per the Premium payment mode chosen by You.
Payment Term plus 1) 7.2. You have an option to change the Premium payment mode by submitting
a written request to Us, provided the limits of minimum premium for the
chosen premium payment mode are adhered to and the Sum Assured on
3.6. Surrender Value for a Reduced Paid Up Policy Maturity remains unchanged. Any change in the Premium payment mode
The Surrender Value of Reduced Paid Up Policy will be determined using will result in a change in the Premium amount basis the applicable Modal
the methodology and Special Surrender Value scales as mentioned in Factors. A change in Premium payment mode will be effective only on the
Clause 1 of Part D. Any accrued Income Benefit and Loyalty Income Policy Anniversary following the receipt of such request.
Boosters, if not already paid, shall be paid in addition. 7.3. You can pay Premium at any of Our offices or through Our website
3.7. Policy Continuance Benefit www.maxlifeinsurance.com or by any other means, as informed by Us.
Policy Continuance Benefit shall not be available in Reduced Paid Up Any Premium paid by You will be deemed to have been received by Us
Mode and, the benefit on death of the Life Insured shall be higher of the only after the same has been realized and credited to Our bank account.
following and the Policy shall terminate. 7.4. The Premium payment receipt will be issued in Your name, which will be
i. Reduced Paid Up Sum Assured on Death subject to realization of cheque or any other instrument/medium.
ii. 105% of (Total Premiums Paid plus Underwriting Extra Premiums 8. GRACE PERIOD
plus loadings for modal premiums), as on the date of death of Life 8.1. The Premium is due and payable by the due date specified in the Schedule.
Insured If the Premium is not paid by the due date, You may pay the same during
iii. 125% of Surrender Value as on date of death the Grace Period without any penalty or late fees.
Any accrued Income Benefit and Loyalty Income Boosters, if not already paid 8.2. The insurance coverage continues during the Grace Period. However, if
shall be paid in addition. the overdue Premium is not paid in the Grace Period and the Life Insured
4. OPTION TO CHANGE FREQUENCY FOR PAYMENT OF INCOME dies, We will pay the Death Benefit under this Policy after deducting the
BENEFITS AND LOYALTY INCOME BOOSTERS due Premium (if any) till the date of death.
4.1. You may choose to receive the applicable Income Benefits and Loyalty
Income Boosters at annually, semi-annually, quarterly or on monthly PART D
frequency, in arrears after applying the applicable Income Benefits Modal POLICY SERVICING CONDITIONS
Factor only for Regular Wealth Variant, Long Term Wealth Variant, Early 1. SURRENDER
Wealth Variant and Lifelong Wealth Variant. 1.1. The Policy shall acquire Surrender Value ("Surrender Value"), subject to
4.2. The payment frequency of the Income Benefits and Loyalty Income the following criteria:
Boosters, can be chosen at inception or can be changed anytime only a) For Single Premium Payment Variant: Immediately upon receipt of
once during the Policy Term by submitting a request at least 30 days Single Premium
before the Policy Anniversary and shall be effective from the next Policy b) Limited Premium Payment Variant / Regular Premium Payment
Anniversary. Once changed, request for next change in the frequency can Variant: On receipt of complete Premiums for first two Policy Years.
be made only after completion of a Policy Year. 1.2. You may request in writing to surrender the Policy at any time but You
4.3. It may be noted that once the Policy Continuance Benefit is triggered, the will get the Surrender Value only if the Policy has acquired the Surrender
Claimant cannot change the frequency of payment of Income Benefit and Value. On receipt of such request, the Surrender Value prevailing on the
Loyalty Income Boosters. date of request for the surrender of this Policy shall be payable by Us and
5. ACCRUAL OF INCOME BENEFITS AND LOYALTY INCOME thereafter no other benefit under this Policy shall be payable. Once the
BOOSTERS Surrender Value is paid, the Policy shall terminate. If the Policy has not
5.1. You may choose an option to accrue the applicable Income Benefits and acquired Surrender Value, no amount shall be payable by Us.
Loyalty Income Boosters. 1.3. The Surrender Value payable will be subject to the condition that there are
5.2. This option may be exercised at inception or anytime during the Policy no statutory or other restrictions to the contrary.
Term. 1.4. The Surrender Value will be equal to the higher of Guaranteed Surrender
5.3. In order to opt in or opt-out of this option, You will have to submit a written Value or Special Surrender Value.
request to us 30 days before the Policy Anniversary and the same will 1.5. Once You have surrendered the Policy, the same cannot be reinstated.
be effective from the next Policy Anniversary. However, any change so 1.6. Any accrued Income Benefit and Loyalty Income Boosters, if not already
effected, will be applicable for a minimum of 1 (one) Policy Year. paid, shall be paid in addition to Surrender Value.
5.4. Interest rate equal to the reverse repo rate published by RBI on its website 1.7. Guaranteed Surrender Value
will apply on the Survival Benefits so accrued and this rate will be reviewed 1.7.1. Subject to Clause 1.1 of Part D, the Guaranteed Surrender Value
annually. The RBI reverse repo rate' for the financial year ending on 31st will be determined in the Policy Year in which the surrender is
March every year will be considered. As the interest rate will be reviewed effected and shall be an amount equal to the {Guaranteed Surrender
at the beginning of each financial year, any change in this interest rate will Value factors (as specified in the Table 1 below) multiplied by the
be applicable from 1st May to 30th April. The RBI reverse repo rate as on Total Premiums Paid and loadings for modal premiums (if any)}
31st March, 2021 is 3.35% per annum. less Survival Benefits (Income Benefit and Money Back Benefit)
5.5. You may withdraw the Income Benefit so accrued in full or in part, applicable till date of surrender for base Policy plus Guaranteed
any time during the Policy Term. The balance amount, if any, will keep Surrender Value of the accrued Guaranteed Additions, if any, which
accumulating and income, if any, will be payable upon termination of the will be an amount equal to the Guaranteed Surrender Value factors
Policy due to death of the Life Insured or maturity or surrender of this for accrued Guaranteed Additions (which is 30%) multiplied by the
Policy. accrued Guaranteed Additions (if any).
5.6. In case option to accrue the Income Benefits and Loyalty Income Boosters Applicable Surrender Value for accrued Guaranteed Additions shall
has been chosen, only annual frequency of payment of Survival Benefits be payable.
shall be applicable, irrespective of the payment frequency chosen earlier. Any accrued Income Benefits and Loyalty Income Boosters that are
It is clarified that once the option for accrual is withdrawn, then You may deducted from the calculation of Surrender Value and not paid yet
choose the frequency for payment of Survival Benefit, as per Clause 4.1 will be paid in full in addition to the Surrender Value.
of Part C.
6. SAVE THE DATE OPTION Table 1 - Guaranteed Surrender Value factors
The Income Benefit and Loyalty Income Boosters (if applicable) is payable on Regular Premium
the date of Policy Anniversary by default during the Income Period. Payment
Policy Year Single Premium
Income Benefit and Loyalty Income Boosters (if applicable) payment frequency Variant /Limited
of Surrender Payment Variant
is selected as annual at inception, however, You may choose to receive it on any Premium
date other than the Policy Anniversary. Pro-rated Income Benefit and Loyalty Payment Variant
Income Boosters (if applicable) shall be payable in first and last year of the 1 75% 0.00%
Income Benefit Period in case the chosen Income Benefit and Loyalty Income 2 75% 30.00%
Boosters (if applicable) receipt date is different from the Policy Anniversary 3

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 75% 35.00% No. of days
Currently
4-7 90% 50.00% between date of
Revival late fee basis applicable
Graduating linearly from Revival and date
Revival late fee*
8+ 90% 50% to 90% during the of lapse of Policy
last two Policy Years 0-60 Nil 0.00%
RBI Bank Rate
1.8. Surrender Value for a Reduced Paid Up Mode Policy: The Surrender + 1%per annum
61-180 5.65%
Value of Reduced Paid Up Mode Policy will also be determined using the compounded annually
above methodology and factors. on due Premiums
1.9. Special Surrender Value: Your Policy also acquires a Special Surrender RBI Bank Rate +
Value. Before making a request for Surrender, you may approach Us to 3% per annum.
>180 7.65%
know about the Surrender Value in respect of your Policy. compounded annually
1.9.1. Special Surrender Value on accrued Guaranteed Additions shall be on due Premiums
payable.
1.9.2. It may be noted that the Special Surrender Value factors and the *Note: The current applicable revival late fee effective as on 1st
basis for calculating the Special Surrender Value factors under the July 2020 and is based on RBI Bank rate of 4.65% p.a. prevailing
Policy may be revised by Us based on the experience, subject to as on 31st March 2020. The 'RBI Bank Rate' for the financial year
prior approval from IRDAI. ending 31st March (every year) will be considered for determining
1.10. In case Policy Continuance Benefit is chosen and triggered, surrender will the revival late fee and the same shall be made effective from the
not be allowed. following period of 1st July to 30th June till the next change. The
2. LOANS revival late fee is revised only if the 'RBI Bank Rate' changes by 1%
2.1. Once this Policy has acquired the Surrender Value and it is a Premium or more from the 'RBI Bank Rate' used to determine the prevailing
paying in-force Policy and if there's no existing outstanding loan on the revival late fee (reviewed on every 31st March). For further details
same Policy, then, You will be eligible for grant of loans from Us. and the revival late fee applicable as on date, please refer to our
2.2. The minimum amount of loan which can be granted by Us under this Policy website www.maxlifeinsurance.com.
is INR 10,000 (Rupees Ten Thousand). In no event shall the maximum 3.2. The Revival of the Lapsed Policy or a Policy under Reduced Paid Up
amount of loan which can be granted under this Policy during the Policy Mode will take effect only after We have approved the same in accordance
Term exceed 80% (Eighty percent) of the Surrender Value payable under with Our Underwriting Policy and communicated Our decision to You in
this Policy, subject to such terms and conditions as may be determined by writing. All original benefits such as unpaid accrued Survival Benefit (if
Us from time to time. any), death benefit and maturity benefit which were originally payable will
2.3. Upon grant of a loan under this Policy, this Policy shall automatically be restored on such Revival. However, no interest shall be payable by Us
be assigned in Our favour, till the time the entire loan amount including on such restoration.
interest, any fees or dues towards such loan has been repaid to Us. On 3.3. If a Lapsed Policy is not revived within the Revival Period, this Policy will
repayment of the entire loan and accumulated interest to Us, if any, this immediately and automatically terminate without value, on the expiry of
Policy will be reassigned to You. the Revival Period.
2.4. All benefits payable under the Policy (including surrender, death, survival 3.4 If a Policy under Reduced Paid Up Mode is not revived within the Revival
or maturity) shall be first adjusted against outstanding loan and interest Period, the Policy under Reduced Paid Up Mode cannot be revived and
accrued thereon, prior to being paid to You and then the balance loan will continue to be under Reduced Paid Up Mode for the remaining part
amount will be disbursed. For clarity, it may be noted that any such of the Policy Term.
adjustment will be done firstly to repay any accrued loan interest and the 3.5 For the avoidance of doubt, the Policy cannot be revived beyond the Policy
balance, if any, will be adjusted towards the principle loan outstanding Term.
amount. 3.6 In addition to the revival provisions stated above, You may also be eligible
2.5. If You have obtained a loan under this Policy, You are required to pay to avail of one or more of the following revival schemes to revive Your
interest on such loan. The interest on the loan will be compounded and Policy
applied annually on the Policy Anniversary at the rates as prescribed by 3.6.1. Reduction in the Sum Assured: You may be eligible to revive Your
Us at the time of taking the loan. Policy by reducing the Sum Assured. Please contact Us for details
2.6. The loan interest rate shall be equal to applicable 'RBI Bank Rate' plus on whether You are eligible for this revival scheme and, if so, the
3.0%. The current loan interest rate is 7.65% p.a. compounded annually extent to which the Sum Assured can be reduced, the total amount
and is based on 'RBI Bank Rate' of 4.65% p.a. prevailing as on 31st March required to be paid by You to revive the Policy and the applicable
2022. The 'RBI Bank Rate' for the financial year ending 31st March terms and conditions for utilizing this revival scheme;
(every year) will be considered for determining the loan interest rate and 3.6.2. Change in the Premium Payment Term: You may be eligible to
the same shall be made effective from the following period of 1st July to revive Your Policy by changing the Premium Payment Term. Please
30th June, till the next change. The loan interest rate is revised only if the contact Us for details on whether You are eligible for this revival
'RBI Bank Rate' changes by 1% or more from the 'RBI Bank Rate' used to scheme and if so, the extent to which the Premium Payment Term
determine the prevailing loan interest rate (reviewed on every 31st March). can be changed, the total amount required to be paid by You
For further details and the loan interest rate applicable as on date, please to revive the Policy and the applicable terms and conditions for
refer to our website www.maxlifeinsurance.com. Any change in the basis utilizing this revival scheme;
of determination of the above interest rate shall be with prior approval of 3.6.3. Special Revival Schemes: We may also introduce special revival
IRDAI. schemes from time to time which are available for a particular
2.7. The inforce polices or fully paid up polices will not be foreclosed for period. Please contact Us for details on whether such revival scheme
non-payment of outstanding loan balance even if the outstanding loan is available and, if You are eligible for the same, the total amount
balance and accumulated interest on such loan exceeds the Surrender required to be paid by You to revive the Policy and the applicable
Value. terms and conditions for utilizing such revival scheme.
2.8. For Reduced Paid Up Mode policies, if the outstanding loan amount 3.7. We may, from time to time, at Our sole discretion, introduce new
granted to You and accumulated interest on such loan exceed the Surrender revival schemes or modify or terminate existing revival schemes. Please
Value, the Policy will terminate immediately and automatically and no contact Us for details on [1860 120 5577] or visit Our website
amount shall be payable by us under the Policy. In case outstanding loan www.maxlifeinsurance.com.
amount including accumulated interest on such loan exceeds 95% of the
Surrender Value or the remaining Policy Term is 6 months or lesser
(whichever is earlier), We will send You a communication for repayment 4. PAYMENT OF BENEFITS
of loan along with the accrued interest. 4.1. The benefits under this Policy will be payable only on submission of
2.9. In case of repayment of loan through credit card, applicable credit card satisfactory proof to Us. The benefits under this Policy will be payable to
payment charges will be borne by the Policyholder. You/the Claimant as the case may be.
4.2. Once the benefits under this Policy are paid to You/the Claimant as the case
3. REVIVAL OF POLICY may be, the same will constitute a valid discharge of Our liability under
3.1. A Lapsed Policy or a Policy under Reduced Paid Up Mode can be revived this Policy.
as per Underwriting Policy, within the Revival Period: 5. TERMINATION OF POLICY
3.1.1. on receipt of Your written request to Revive the Policy by Us; This Policy will terminate upon the happening of any of the following events:
3.1.2. if You produce an evidence of insurability (in form of declaration 5.1. on the date on which We receive Freelook cancellation request;
of health condition and/or relevant medical reports) of Life Insured 5.2. the date of payment of death benefit on the death of the Life Insured (if
at Your own cost; and You have not opted for Policy Continuance Benefit);
3.1.3. on payment of all overdue Premiums (along with the applicable 5.3. on the expiry of the Revival Period, if the Lapsed Policy has not been
taxes, cesses and levies, if any) to Us with late payment fee as may revived;
be determined by Us from time to time (in the manner described 5.4. on the date of payment of Surrender Value;
herein below) as on the date of Revival. Currently the applicable 5.5. on the payment of the Maturity Benefit;
late fee is as below: 5.6. on payment of dues as per suicide clause (Clause 5 of Part-F); or

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 5.7. if the outstanding loan and accumulated interest exceeds the Surrender
Value payable in accordance with Clause 2.8 of part D.
6. FREELOOK CANCELLATION 3. DECLARATION OF THE CORRECT AGE
"Freelook" means a period (as mentioned in the forwarding letter appended in Declaration of the correct Age and/ or gender of the Life Insured is important for
the beginning of this Policy) to review the terms and conditions of the Policy, Our underwriting process and calculation of Premiums payable under the Policy.
where if You disagree with any of such terms and conditions, You have the If the Age and/or gender declared in the Proposal Form is found to be incorrect
option to return the Policy stating the reasons for objection. Upon return, the at any time during the Policy Term or at the time of claim, We may exercise Our
Policy will terminate forthwith and all rights, benefits and interests under the rights under Section 45 of the Insurance Act, 1938 as amended from time to time
Policy will cease immediately. You shall be entitled to a refund of the Premium or revise the Premium with interest and/or applicable benefits payable under
received by Us after deducting the proportionate risk premium for the period of the Policy in accordance with the Premium and benefits that would have been
cover, stamp duty paid and the expenses incurred by Us on medical examination payable, if the correct Age and/ or gender would have made the Life Insured
of the Life Insured, if any. eligible to be covered under the Policy on the Date of Commencement of Risk.
7. LAPSATION OF POLICY 4. FRAUD, MIS-STATEMENT AND FORFEITURE
If You discontinue the payment of Premium before paying Premiums for any of Fraud, mis-statement and forfeiture would be dealt with in accordance with
the first 2 (Two) Policy Years, the Policy will become a Lapsed Policy on the provisions of Section 45 of the Insurance Act, 1938 as amended from time to
expiry of the Grace Period and no benefit under the Policy shall be payable. time. [A leaflet containing the simplified version of the provisions of the above
8. RISK COVERAGE FOR MINOR AND VESTING ON ATTAINING section is enclosed in Annexure - 1 for reference]
MAJORITY 5. SUICIDE EXCLUSION
Risk coverage for minors will start from the Date of Commencement of Risk. Notwithstanding anything stated herein, if the Life Insured commits suicide,
In case the Life Insured is a minor, the Policy will automatically vest in him/her whether minor/major, whether sane or insane, within 12 (Twelve) months from
on his/her attaining the age of majority. However, the Life Insured on attaining the Date of Commencement of Risk or from the date of Revival of this Policy, as
the Age of majority, will be required to provide all the requisite information applicable, all risks and benefits under this Policy shall cease and the Policy shall
(including his address, contact details, bank account details, etc.) and other terminate immediately and We shall only pay the following to the Claimant,
documents as specified by Us to enable Us to pay the benefits under this Policy. provided that the Policy is in force:
5.1. Higher of the Surrender Value as on the date of death or the sum of (Total
PART E Premiums Paid plus loadings for modal premiums and Underwriting Extra
POLICY CHARGES Premium, if any, paid till the date of death), if the Policy has acquired a
APPLICABLE FEES/ CHARGES UNDER THE POLICY Surrender Value; or
This Policy is a non-linked non-participating individual life insurance savings plan 5.2. Total Premiums Paid plus loadings for modal premiums and Underwriting
and therefore, Part E is not applicable to this Policy. Extra Premium, if any, received by Us, if the Policy has not acquired a
Surrender Value.
PART F 6. EXCLUSIONS APPLICABLE TO ADDITIONAL ACCIDENTAL
GENERAL TERMS AND CONDITIONS DEATH BENEFIT:
1. TAXES No benefit under the additional Accidental Death benefit will be payable if
1.1. All Premiums are subject to applicable taxes, cesses, and levies, if any death occurs from or is caused by, either directly or indirectly, voluntarily or
which will entirely be borne by You and will always be paid by You along involuntarily due to or caused, occasioned, accelerated or aggravated by, any
with the payment of Premium. If any imposition (tax or otherwise) is levied one of the following:
by any statutory or administrative body under the Policy, We reserve the i. Intentional self-inflicted Injury, or attempted suicide, while sane or insane;
right to claim the same from You. Alternatively, We have the right to ii. Life Insured being under the influence of drugs, alcohol, narcotics or
deduct the amount from the benefits payable by Us under the Policy. psychotropic substances, unless taken in accordance with the lawful
1.2. Tax benefits may be available as per the prevailing tax laws. Tax laws directions and prescription of a Medical Practitioner;
and the benefits arising thereunder are subject to change. You are advised iii. War, invasion, act of foreign enemy, hostilities (whether war be declared
to seek an opinion of Your tax advisor in relation to the tax benefits and or not), armed or unarmed truce, civil war, mutiny, rebellion, revolution,
liabilities applicable to You. insurrection, military or usurped power, riot or civil commotion, strikes;
2. CLAIM PROCEDURE iv. Taking part in any naval, military or air force operation during peace time
2.1. For processing a claim request under this Policy, We will require all of the or during service in any police, paramilitary or any similar organisation;
following documents: v. Participation by the Life Insured in any flying activity, except as a bona
2.1.1. Death Claim documents: fide, fare-paying passenger of a recognized airline or a pilot and cabin crew
a) Claimant's statement in the prescribed form; of a commercial airline on regular routes and on a scheduled timetable;
b) Original Policy document; vi. Participation by the Life Insured in a criminal or unlawful act with illegal
c) A copy of police complaint/ first information report (in the case or criminal intent;
of death by accident or suicidal death of the Life Insured); vii. Any Injury incurred before the Date of Commencement of Risk;
d) All medical/ hospital records, in case of hospitalisation, viii. Engaging in or taking part in professional sport(s) or any hazardous
(including diagnostic records); pursuits, including but not limited to, diving or riding or any kind of
e) A copy of duly certified post mortem report (in the case of death race; underwater activities involving the use of breathing apparatus or not;
by Accident or suicidal death of the Life Insured); martial arts; hunting; mountaineering; parachuting; bungee-jumping;
f) A copy of death certificate issued by the local/municipal ix. Nuclear contamination; radioactive, explosive or hazardous nature of
authority duly attested by the Claimant; nuclear fuel materials or property contaminated by nuclear fuel materials
g) A self-attested copy of identity proof of the Claimants bearing or Accident arising from such nature.
their photographs and signatures; 7. TRAVEL AND OCCUPATION
h) Bank details of Claimant; There are no restrictions on travel or occupation under this Policy.
i) Any other document or information required by Us for assessing 8. NOMINATION
and approving the claim request. Nomination is allowed as per Section 39 of the Insurance Act, 1938 as amended
2.1.2. Maturity benefit claim documents: from time to time. [A leaflet containing the simplified version of the provisions
a) NEFT Form (if not provided earlier) of the above section is enclosed in Annexure - 2 for reference]
b) A cancelled cheque or copy of passbook with pre-printed name 9. ASSIGNMENT
and bank account number, for payout through NEFT (if not Assignment is allowed as per Section 38 of the Insurance Act, 1938 as amended
provided earlier); from time to time. [A leaflet containing the simplified version of the provisions
c) Any other document or information required by Us. of the above section is enclosed in Annexure - 3 for reference]
2.1.3. Survival Benefit documents: 10. POLICY CURRENCY
a) NEFT Form (if not provided earlier) This Policy is denominated in Indian Rupees. Any benefit/claim payments under
b) a cancelled cheque or copy of passbook with pre-printed name the Policy will be made in Indian Rupees by Us or in any other currency in
and bank account number, for payout through NEFT (if not accordance with the applicable guidelines issued by the Reserve Bank of India
provided earlier); from time to time.
c) Any other document or information required by Us.
2.2. A Claimant can download the claim request documents from Our website 11. ELECTRONIC TRANSACTIONS
www.maxlifeinsurance.com or can obtain the same from any of Our You will comply with all the terms and conditions with respect to all transactions
branches or offices. effected by or through facilities for conducting remote transactions including the
2.3. Subject to provisions of Section 45 of the Insurance Act, 1938 as amended internet, world wide web, electronic data interchange, call center, tele-service
from time to time, We shall pay the benefits under this Policy subject to operations or by other means of telecommunication established by Us or on Our
Our satisfaction: behalf, for and in respect of the Policy or services, which will constitute legally
2.3.1. that the benefits have become payable as per the terms and binding and valid transactions when executed in adherence to and in compliance
conditions of this Policy; and with the terms and conditions for such facilities.
2.3.2. of the bonafides and credentials of the Claimant. 12. AMENDMENT
2.4. Subject to Our sole discretion and satisfaction, in exceptional No amendments to the Policy will be effective, unless such amendments are
circumstances such as on happening of a force majeure event, We may expressly approved in writing by Us and/or by the IRDAI wherever applicable.
decide to waive all or any of the requirements set out in this Clause. 13. REGULATORY AND JUDICIAL INTERVENTION

14 of 68
 If any competent regulatory body or judicial body imposes any condition on 1.4. As per Rule 14 of the Insurance Ombudsman Rules, 2017, a complaint to
the Policy for any reason, We are bound to follow the same which may include the Insurance Ombudsman can be made only within a period of 1 (One)
suspension of all benefits and obligations under the Policy. year after receipt of Our rejection of the representation or after receipt of
14. COMMUNICATION AND NOTICES Our decision which is not to Your satisfaction or if We fail to furnish reply
14.1. All notices meant for Us should be in writing and delivered to Our address after expiry of a period of one month from the date of receipt of the written
as mentioned in Part G or such other address as We may notify from time to representation of the complainant, provided the complaint is not on the same
time. You should mention the correct Policy number in all communications matter, for which any proceedings before any court, or consumer forum or
including communications with respect to Premium remittances made by arbitrator is pending.
You.
14.2. All notices meant for You will be in writing and will be sent by Us
to Your address as shown in the Schedule or as communicated by You
and registered with Us. We may send You notices by post, courier,
hand delivery, fax or e-mail/electronic mode or by any other means as
determined by Us. If You change Your address, or if the address of the
Nominee changes, You must notify Us immediately. Failure in timely
notification of change of address could result in a delay in processing of
benefits payable under the Policy.
14.3. For any updates, please visit Our website www.maxlifeinsurance.com.
15. GOVERNING LAW AND JURISDICTION
The Policy will be governed by and enforced in accordance with the laws of
India. The competent courts in India will have exclusive jurisdiction in all
matters and causes arising out of the Policy.
16. ISSUANCE OF DUPLICATE POLICY
You may request for a duplicate copy of the Policy to Us along with relevant
documents. Additional charges, not exceeding Rs.250/- may be applicable for
issuance of the duplicate Policy.

PART G
GRIEVANCE REDRESSAL MECHANISM AND OMBUDSMAN DETAILS
1. DISPUTE REDRESSAL PROCESS UNDER THE POLICY
1.1. All consumer grievances and/or queries may be first addressed to Your
agent or Our customer helpdesk as mentioned below:
a. Max Life Insurance Company Limited, Plot No. 90 C,
Sector 18, Udyog Vihar, Gurugram-122015, Haryana, India,
Helpline No.- 1860 120 5577 or (0124) 4219090, Email:
[email protected], Or
b. To any office of Max Life Insurance Company Limited.
1.2 . If Our response is not satisfactory or there is no response within 15 (Fifteen)
days:
1.2.1. the complainant may file a written complaint with full details of the
complaint and the complainant's contact information to the following
official for resolution:
Grievance Redressal Officer,
Max Life Insurance Company Limited
Plot No. 90 C, Sector 18, Udyog Vihar,
Gurugram-122015, Haryana, India
Helpline No - 1860 120 5577 or (0124) 4219090
Email - [email protected]
1.2.2. the complainant may approach the Grievance Cell of the IRDAI on
the following contact details:
IRDAI Grievance Call Centre (IGCC)
Toll Free No:155255 or 1800 4254 732
Email ID: [email protected]
1.2.3. the complainant can also register Your complaint online at
http://www.igms.irdai.gov.in/
1.2.4. the complainant can also register Your complaint through fax/paper
by submitting Your complaint to:
Consumer Affairs Department
Insurance Regulatory and Development Authority of India
Sy No. 115/1, Financial District,
Nanakramguda,Gachibowli, Hyderabad - 500032
Ph: (040) 20204000
1.3. If the complainant are not satisfied with the redressal or there is no
response within a period of 1 (One) month, or within 1 year after
rejection of complaint by Us, the complainant may approach Insurance
Ombudsman at the address mentioned in Annexure Aor on the IRDAI
website www.irdai.gov.in or on Council of Insurance Ombudsmen website
at www.cioins.co.in, if the grievance pertains to:
1.3.1 delay in settlement of a claim beyond the time specified in
the regulations, framed under the Insurance Regulatory and
Development Authority of India Act, 1999;
1.3.2. any partial or total repudiation of a claim by Us;
1.3.3. dispute over Premium paid or payable in terms of the Policy; or
1.3.4. misrepresentation of Policy terms and conditions at any time in the
Policy document or Policy contract;

1.3.5. legal construction of the Policy in so far as such dispute relates to

claim;
1.3.6 Policy servicing by Us, Our agents or intermediaries;
1.3.7. issuance of insurance Policy, which is not in conformity with the
Proposal Form submitted by You;
1.3.8. non issuance of any insurance document after receipt of the Premium.
1.3.9. Any other matter resulting from non-observance of or non-adherence
to the provisions of any regulations made by the IRDAI with regard
to protection of policyholders' interests or otherwise, or of any
circulars, guidelines or instructions issued by the IRDAI or of the
terms and conditions of the Policy contract, in so far as they relate to
issues mentioned in this para 1.3 above.

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ENDORSEMENT

STAMP DUTY AMOUNT : `228.4

Paid by e-Stamps Certificate no. 203/Issue Date: 26-06-2024/Vide Treasury

(E-CHALLAN) GRN NO.117772871 for Rs. 45000000

Krishnakumar Ramasubramanian
Authorized Signatory

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 Annexure 1 the nature of his title. 14. If nominee(s) die after the policyholder but before his
Section 45 - Policy shall not be called in question on the ground of share of the amount secured under the policy is paid, the share of the expired
mis-statement after three years nominee(s) shall be payable to the heirs or legal representative of the nominee
Provisions regarding policy not being called into question in terms of Section 45 or holder of succession certificate of such nominee(s). 15.The provisions of
of the Insurance Act, 1938, as amended from time to time are as follows: 1. No sub-section 7 and 8 (13 and 14 above) shall apply to all life insurance policies
Policy of Life Insurance shall be called in question on any ground whatsoever maturing for payment after the commencement of Insurance Laws (Amendment)
after expiry of 3 yrs from a. the date of issuance of policy or b. the date of Act 2015.16.If policyholder dies after maturity but the proceeds and benefit of
commencement of risk or c. the date of revival of policy or d. the date of rider the policy has not been paid to him because of his death, his nominee(s) shall be
to the policy, whichever is later. 2.On the ground of fraud, a policy of Life entitled to the proceeds and benefit of the policy.17.The provisions of Section
Insurance may be called in question within 3 years from a. the date of issuance 39 are not applicable to any life insurance policy to which Section 6 of Married
of policy or b. the date of commencement of risk or c. the date of revival of Women's Property Act, 1874 applies or has at any time applied except where
policy or d. the date of rider to the policy, whichever is later. For this, the before or after Insurance Act, 1938 as amended from time to time, a nomination
insurer should communicate in writing to the insured or legal representative is made in favour of spouse or children or spouse and children whether or not
or nominee or assignees of insured, as applicable, mentioning the ground and on the face of the policy it is mentioned that it is made under Section 39. Where
materials on which such decision is based. 3. Fraud means any of the following nomination is intended to be made to spouse or children or spouse and children
acts committed by insured or by his agent, with the intent to deceive the insurer under Section 6 of MWP Act, it should be specifically mentioned on the policy.
or to induce the insurer to issue a life insurance policy: a. The suggestion, as In such a case only, the provisions of Section 39 will not apply.
a fact of that which is not true and which the insured does not believe to be [Disclaimer: This is only a simplified version prepared for general
true; b. The active concealment of a fact by the insured having knowledge or information. You are advised to refer to the Insurance Act 1938 as amended
belief of the fact; c. Any other act fitted to deceive; and d. Any such act or from time to time for complete and accurate details.]
omission as the law specifically declares to be fraudulent. 4.Mere silence is Annexure 3
not fraud unless, depending on circumstances of the case, it is the duty of the Section 38 - Assignment and Transfer of Insurance Policies
insured or his agent keeping silence to speak or silence is in itself equivalent Assignment or transfer of a policy should be in accordance with Section 38 of
to speak. 5. No Insurer shall repudiate a life insurance policy on the ground the Insurance Act, 1938 as amended from time to time. The extant provisions
of fraud, if the insured / beneficiary can prove that the misstatement was true in this regard are as follows:1.This policy may be transferred/assigned, wholly
to the best of his knowledge and there was no deliberate intention to suppress or in part, with or without consideration.2.An Assignment may be effected in a
the fact or that such mis-statement of or suppression of material fact are within policy by an endorsement upon the policy itself or by a separate instrument under
the knowledge of the insurer. Onus of disproving is upon the policyholder, if notice to the Insurer.3.The instrument of assignment should indicate the fact of
alive, or beneficiaries. 6.Life insurance Policy can be called in question within transfer or assignment and the reasons for the assignment or transfer, antecedents
3 years on the ground that any statement of or suppression of a fact material to of the assignee and terms on which assignment is made.4.The assignment must
expectancy of life of the insured was incorrectly made in the proposal or other be signed by the transferor or assignor or duly authorized agent and attested by at
document basis which policy was issued or revived or rider issued. For this, least one witness.5.The transfer or assignment shall not be operative as against
the insurer should communicate in writing to the insured or legal representative an insurer until a notice in writing of the transfer or assignment and either the
or nominee or assignees of insured, as applicable, mentioning the ground and said endorsement or instrument itself or copy there of certified to be correct by
materials on which decision to repudiate the policy of life insurance is based.7.In both transferor and transferee or their duly authorised agents have been delivered
case repudiation is on ground of mis-statement and not on fraud, the premium to the insurer.6.Fee to be paid for assignment or transfer can be specified by
collected on policy till the date of repudiation shall be paid to the insured or legal the Authority through Regulations.7.On receipt of notice with fee, the insurer
representative or nominee or assignees of insured, within a period of 90 days should Grant a written acknowledgement of receipt of notice. Such notice shall
from the date of repudiation.8.Fact shall not be considered material unless it has be conclusive evidence against the insurer of duly receiving the notice.8.If the
a direct bearing on the risk undertaken by the insurer. The onus is on insurer to insurer maintains one or more places of business, such notices shall be delivered
show that if the insurer had been aware of the said fact, no life insurance policy only at the place where the policy is being serviced.9.The insurer may accept
would have been issued to the insured. 9. The insurer can call for proof of age at or decline to act upon any transfer or assignment or endorsement, if it has
any time if he is entitled to do so and no policy shall be deemed to be called in sufficient reasons to believe that it is a. not bonafide; b. not in the interest of
question merely because the terms of the policy are adjusted on subsequent proof the policyholder; c. not in public interest; or d.is for the purpose of trading of
of age of life insured. So, this Section will not be applicable for questioning age the insurance policy.10.Before refusing to act upon endorsement, the insurer
or adjustment based on proof of age submitted subsequently. should record the reasons in writing and communicate the same in writing
[Disclaimer: This is only a simplified version prepared for general to policyholder within 30 days from the date of policyholder giving a notice
information. You are advised to refer to the Insurance Act 1938 as amended of transfer or assignment.11.In case of refusal to act upon the endorsement
from time to time for complete and accurate details.] by the insurer, any person aggrieved by the refusal may prefer a claim to
Annexure 2 IRDAI within 30 days of receipt of the refusal letter from the insurer.12.The
Section 39 - Nomination by Policyholder priority of claims of persons interested in an insurance policy would depend
Nomination of a life insurance policy is as below in accordance with Section 39 on the date on which the notices of assignment or transfer is delivered to the
of the Insurance Act, 1938 as amended from time to time. The extant provisions insurer; where there are more than one instruments of transfer or assignment,
in this regard are as follows: 1. The policyholder of a life insurance policy on the priority will depend on dates of delivery of such notices. Any dispute in this
his own life may nominate a person or persons to whom money secured by the regard as to priority should be referred to the Authority.13.Every assignment or
policy shall be paid in the event of his death. 2. Where the nominee is a minor, transfer shall be deemed to be absolute assignment or transfer and the assignee
the policyholder may appoint any person to receive the money secured by the or transferee shall be deemed to be absolute assignee or transferee, except a.
policy in the event of policyholder's death during the minority of the nominee. where assignment or transfer is subject to terms and conditions of transfer or
The manner of appointment is to be laid down by the insurer. 3. Nomination assignment OR b. where the transfer or assignment is made upon condition
can be made at any time before the maturity of the policy. 4. Nomination may that i. the proceeds under the policy shall become payable to policyholder or
be incorporated in the text of the policy itself or may be endorsed on the policy nominee(s) in the event of assignee or transferee dying before the insured; or
communicated to the insurer and can be registered by the insurer in the records ii. the insured surviving the term of the policy. Such conditional assignee will
relating to the policy. 5. Nomination can be cancelled or changed at any time not be entitled to obtain a loan on policy or surrender the policy. This provision
before policy matures, by an endorsement or a further endorsement or a will as will prevail notwithstanding any law or custom having force of law which is
the case may be. 6. A notice in writing of change or cancellation of nomination contrary to the above position.14In other cases, the insurer shall, subject to terms
must be delivered to the insurer for the insurer to be liable to such nominee. and conditions of assignment, recognize the transferee or assignee named in the
Otherwise, insurer will not be liable if a bonafide payment is made to the person notice as the absolute transferee or assignee and such persona shall be subject
named in the text of the policy or in the registered records of the insurer. 7. Fee to to all liabilities and equities to which the transferor or assignor was subject to at
be paid to the insurer for registering change or cancellation of a nomination can the date of transfer or assignment; b. may institute any proceedings in relation
be specified by the Authority through Regulations. 8. On receipt of notice with to the policy; and c. obtain loan under the policy or surrender the policy without
fee, the insurer should grant a written acknowledgement to the policyholder of obtaining the consent of the transferor or assignor or making him a party to the
having registered a nomination or cancellation or change thereof. 9. A transfer proceedings15.Any rights and remedies of an assignee or transferee of a life
or assignment made in accordance with Section 38 shall automatically cancel insurance policy under an assignment or transfer effected before commencement
the nomination except in case of assignment to the insurer or other transferee of the Insurance Laws (Amendment) Act, 2015 shall not be affected by this
or assignee for purpose of loan or against security or its reassignment after section.
repayment. In such case, the nomination will get affected to the extent of [Disclaimer: This is only a simplified version prepared for general
insurer's or transferee's or assignee's interest in the policy. The nomination will information. You are advised to refer to the Insurance Act, 1938 as amended
get revived on repayment of the loan.10.The right of any creditor to be paid from time to time for complete and accurate details.]
out of the proceeds of any policy of life insurance shall not be affected by the
nomination.11.In case of nomination by policyholder whose life is insured, if the
nominees die before the policyholder, the proceeds are payable to policyholder
or his heirs or legal representatives or holder of succession certificate.12.In case
nominee(s) survive the person whose life is insured, the amount secured by the
policy shall be paid to such survivor(s). 13. Where the policyholder whose life
is insured nominates his a. parents or b. spouse or c. children or d. spouse and
children e. or any of them, the nominees are beneficially entitled to the amount
payable by the insurer to the policyholder unless it is proved that policyholder
could not have conferred such beneficial title on the nominee having regard to

17 of 68
Annexure A: List of Insurance Ombudsman

AHMEDABAD - Office of the Insurance Ombudsman, 6th Floor, Jeevan Prakash Bldg, Tilak Marg, Relief Road, Ahmedabad-380
001. Tel.:- 079-25501201/02/05/06 Email: [email protected]. (State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman
and Diu.)
BENGALURU - Office of the Insurance Ombudsman, Jeevan Soudha Bldg., PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar, 1st Phase,
Bengaluru - 560 078. Tel.: 080-26652049/26652048 Email: [email protected]. (State of Karnataka)
BHOPAL - Office of the Insurance Ombudsman, 1st Floor, Jeevan Shikha, 60-B,Hoshangabad Road, Opp. Gayatri Mandir, Bhopal-462
011. Tel.:- 0755-2769201/2769202 Email: [email protected] (States of Madhya Pradesh and Chhattisgarh.)
BHUBANESHWAR - Office of the Insurance Ombudsman, 62, Forest Park, Bhubaneswar - 751 009. Tel.:- 0674-2596461/2596455 Email:
[email protected] (State of Odisha.)
CHANDIGARH - Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17-D, Chandigarh-160017. Tel.:- 0172
- 4646394/2706468 Email: [email protected] [States of Punjab, Haryana (excluding 4 districts viz, Gurugram, Faridabad, Sonepat and
Bahadurgarh) Himachal Pradesh, Union Territories of Jammu & Kashmir, Ladakh and Chandigarh]
CHENNAI - Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai-600 018. Tel.:- 044-24333668
/ 24333678 Email: [email protected] [State of Tamil Nadu and Union Territories - Puducherry Town and Karaikal (which are part of Union
Territory of Puducherry).]
DELHI - Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi-110 002. Tel.:- 011 - 23237539 Email:
[email protected] (State of Delhi, 4 districts of Haryana viz, Gurugram, Faridabad, Sonepat and Bahadurgarh)
ERNAKULAM - Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, M.G. Road, Ernakulam-682 011. Tel :
0484-2358759/2359338 Email: [email protected] (State of Kerala and Union Territory of (a) Lakshadweep (b) Mahe-a part of Union Territory
of Puducherry.)
GUWAHATI - Office of the Insurance Ombudsman, "Jeevan Nivesh", 5th Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati-781
001(ASSAM) Tel.:- 0361-2632204/2602205 Email: [email protected] (States of Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh,
Nagaland and Tripura.)
HYDERABAD - Office of the Insurance Ombudsman, 6-2-46, 1st Floor, Moin Court, Lane Opp. Saleem Function Palace, A.C. Guards, Lakdi-Ka-Pool,
Hyderabad-500 004. Tel : 040-23312122 Email: [email protected] (State of Andhra Pradesh, Telangana and Yanam and part of the Union
Territory of Puducherry.)
JAIPUR - Office of the Insurance Ombudsman, Ground Floor, Jeevan Nidhi II Bldg, Bhawani Singh Marg, Jaipur - 302005 Tel : 0141-2740363/ 2740798 Email:
[email protected] (State of Rajasthan)
KOLKATA - Office of the Insurance Ombudsman, Hindustan Building. Annexe, 7th Floor, 4, C.R. Avenue, Kolkata-700 072. Tel :
033-22124339/22124341 Email: [email protected] (States of West Bengal, Sikkim, and Union Territories of Andaman and Nicobar Islands.)
LUCKNOW - Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-2, Nawal Kishore Road, Hazratganj, Lucknow-226 001. Tel.:
0522 - 4002082 / 3500613 Email: [email protected] (Following Districts of Uttar Pradesh: Lalitpur, Jhansi, Mahoba, Hamirpur, Banda,
Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur,
Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar,
Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.)
MUMBAI - Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz(W), Mumbai 400054. Tel :
022- 69038821/23/24/25/26/27/28/29/30/31 Email: [email protected] (State of Goa and Mumbai Metreturn of premiumolitan Region excluding
areas of Navi Mumbai and Thane)
NOIDA - Office of the Insurance Ombudsman, 4th Floor, Bhagwan Sahai Palace, Main Road, Naya Bans, Sector-15, Distt: Gautam Buddh Nagar,
U.P. - 201301. Tel: 0120-2514252/2514253 Email: [email protected] (State of Uttarakhand and the following Districts of Uttar Pradesh:
Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit,
Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras,
Kanshiramnagar, Saharanpur.)
PATNA - Office of the Insurance Ombudsman, 2nd floor, Lalit Bhawan, Bailey Road, Patna - 800001 Tel No: 0612-2547068, Email id :
[email protected] (State of Bihar, Jharkhand.)
PUNE - Office of the Insurance Ombudsman, 3rd Floor, Jeevan Darshan Bldg, C.T.S. Nos. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune - 411030. Tel.:
020-24471175 Email: [email protected] (State of Maharashtra including Navi Mumbai and Thane and excluding Mumbai Metreturn of
premiumolitan Region.)

18 of 68
 Max Life Insurance Limited
Regd. Office : 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District
Nawanshahr, Punjab, 144533 Payor
Head Office: 11th & 12th Floor, DLF Square, Jacaranda Marg, DLF City Phase-II,
Proposer/ Joint Life
Gurugram - Haryana, 122002
Attach Recent
Attach Recent Photograph
Non Linked Proposal Form Photograph

PROPOSAL NUMBER:161476668 GO/CA/Broker Code: 64753C

Do you have a Max Life Insurance Policy or have currently applied simultaneous policies? Yes No. If yes give Policy/Proposal number 621784412

Purpose of Insurance Savings Child Future Pension Protection Tax Benefit

Objective of Insurance E/E MWPA HUF CEIP Keyman Partnership Individual

Product Solution ________________ Affinity Customer

Existing Customer

A. PERSONAL DETAILS

PROPOSER/ JOINT LIFE LIFE TO BE INSURED (if other than

proposer)
1. Title MR

First Mandala

2. Name Middle Ganesh

Last Kumar

First Kumara
3. Father's / Husband
Name
Last Swamy MANDALA

4. Date of Birth 02/06/1986

5. Gender Male Female Transgender Male Female Transgender

6. Nationality Indian NRI PIO Foreign

Indian NRI PIO Foreign National
National
6 a Residence for Tax purposes in (if Nationality other than Indian) No (if Nationality other than Indian) No
Jurisdiction(s) outside India:
7. Marital Status Married
8. Education Graduate
9. Relationship with Proposer/ Joint Life SELF

Others
10. Industry Type
healthcare

11. Organisation Type Pvt Ltd

12. Occupation / Job Title Salaried / MANAGER
13. Name of Entity / Employer Apollo Hospitals Enterprise Ltd
14. Annual Income (Rs) 1500000

15. Is the Life to be Insured / Proposer / Joint Life / Nominee / Payor a Politically Exposed Person ? Yes No

16. NOMINEE DETAILS Nominee 1 (Mandatory) Nominee 2 (Optional) Nominee 3 (Optional)

a. Title Ms. NA NA

First Ega NA NA

b. Name Middle NA NA

Last Mounika NA NA

c. Date of Birth 12/03/1989 NA NA

d. Gender Female NA NA

1 TRAD_STD_0523_5.10 19 of 68
e. Percentage of Share 100 % 0% 0%

f. Relationship with Proposer/ Joint Spouse Parents Spouse Parents Spouse

Life Others -------- Others NA Parents Others NA
g. Appointee Full Name (if nominee is
NA NA
under age 18)
h. Appointee relationship to
NA NA
Nominee

i. Appointee Gender Male Female

Male Female Transgender Male Female Transgender
Transgender
j. Appointee Date of Birth NA NA NA

17. CURRENT RESIDENTIAL ADDRESS

House No./Apt. Name plot no 331 aeronagar pragthi nagar kukatpally

Society Road/Area/Sector pragathi nagar

Landmark before ullas dhaba

Village/Town City / District HYDERABAD

Pin Code 500090 State / U.T. TELANGANA Country India

Mobile # 1 9912345070 Mobile # 2 STD Code Telephone #
E-mail ID [email protected]

18. PERMANENT RESIDENTIAL ADDRESS (optional)

House No./Apt. Name 83-50218/1/A YELLAREDDY GUDA A

Society Road/Area/Sector MEERPET
Landmark

Village/Town City/ District HYDERABAD

Pin Code 500073 State / U.T. TELANGANA Country India

19. Preferred Mailing Address Current Residential Permanent Residential

20. Do you wish to hold this Policy electronically under e-insurance ? Yes No

a. e-Insurance Account No. (if available): and Insurance Repository name:

b. Preferred Insurance Repository you would like to have your e-lnsurance Account CAMSRep Karvy CIRL NSDL

B. COVERAGE INFORMATION - Type of Coverage

Sum
Premium Income
Assured/ Premium
a. Base Plan Variant Back Payout Coverage Term Modal Premium GST
Income Payment Term
Option Frequency
Payout
Max Life Smart Wealth
Advantage Guarantee - Wealth Rs
No NA 20 5 Rs 8570 Rs 386
Wealth Milestones - Limited Milestones 913545.00
Pay PCB

Income Deferment Period Income Period Income Start Year

NA 0 NA

Modal Premium without GST* and Cess Rs 8570 GST* and applicable Cess Rs 386.0 Total Premium Paid Rs 8956

*GST shall comprise of CGST, SGST/UTGST or IGST (whichever is applicable) including cesses and levies, if any. All applicable taxes, cesses and levies, as per
prevailing laws, shall be borne by you.

c. Death Benefit Option Wealth Milestones d. Life Stage Benefit Yes No NA

f. Avail Income on a Special Date Yes NO NA (if yes),

e. Policy Continuance Benefit (PCB) Yes NO NA
please provide date

Bonus Options
(Not Applicable for plans that offer reversionary bonus) Paid to Policy holder Premium Offset Paid-up Addition

All Payouts will be credited to this account through Electronic mode of

2. NEFT BANK A/C DETAILS OF PROPOSER/ JOINT LIFE
payment. (This will be applicable at select cities as per facilities /

2 TRAD_STD_0523_5.10 20 of 68
 arrangements of Max Life Insurance).
Bank Account Number:- 068001501684 Account Holder's Name:- Mandala Ganesh Kumar
MICR Code:- 500229028 IFSC Code:- ICIC0000680
Bank Name & Branch: ICICI BANK LIMITED,ICICI BANK LTD., 68-3-231-W/73,MAIN ROAD, KRISHNA NAGAR, SRINAGAR COLONY,
HYDERABAD.500081

Type of Bank Account: Saving Current Others

3. PERMANENT ACCOUNT NUMBER (PAN) AVDPM5374K (for proposer ) (for insured)

Form 60
Form 60

TDS may be applicable, in accordance with Income Tax Act 1961, as amended from time to time.

4. MODE OF PAYMENT Annual Semi-Annual Quarterly Monthly

5. RENEWAL PREMIUM BY Cash Cheque/DD Direct Debit Credit Card List Billing

6. SOURCE OF FUNDS Salary Agriculture Professional Business Other Income Specify:

7. IS PAYOR DIFFERENT FROM THE PROPOSER? Yes No

8. Are you a Max Life Agent Advisor or an employee of a Max group company/ Corporate Agents? NA
9. EFFECTIVE DATE OF COVERAGE 27/05/2024

10. PREMIUM PAYMENT DETAILS Amount in Words: Eight Thousand Nine Hundred Fifty Six

Payment by Cash Cheque Demand Draft

Paid Rs: 8956
Credit Card Net Banking Net Banking
Cheque / Draft No. / Instrument No
Date: 27/05/2024 12:00:00 AM
20240527210600000001858874708044288
Bank Name and Branch: NA

Proposer/ Life to be
Joint Life Insured
C. INFORMATION OF LIFE TO BE INSURED
Yes No Yes No

1. Do you have any life or Critical Illness insurance policy issued, pending approval from any other insurance companies or has
your application for Life/ Health/ Critical Illness insurance or its reinstatement ever been offered at modified terms, rejected or
postponed ?

Issued or Pending LIFE: TOTAL Sum Assured:- CI / DD: TOTAL Sum Assured:-

Offered at modified terms, rejected or postponed

2. In the next 12 months you intend to travel or reside abroad other than on holiday of more than 4 weeks?

3. Do you participate or do you intend to participate in any hazardous activities as part of your Occupation/ Sports/ Hobby?
Details:

4. Have you ever been convicted or are you under investigation for any criminal charges?
Details:

5. FOR FEMALE LIFE TO BE INSURED

Spouse Are you pregnant? Yes

Occupation: Income: Insurance Amount:
Detail: No

If "Yes", how many months? Do you have any complications related to pregnancy? If "Yes", give details:

6. FOR MINOR LIFE TO BE INSURED (Age <18 yrs.)

Parent's Annual Income:- Parent's - Total insurance cover:-

Life to
Proposer/Joint
be
Life
D. MEDICAL INFORMATION Insured
Yes No
Yes No

1. FAMILY HISTORY : Has any two (2) or more of your family members (Parents & Siblings) ever been diagnosed with
Diabetes or Hypertension or Kidney Failure or Cancer or Heart Attack or any Hereditary Disorder before the age of 60 ?

3 TRAD_STD_0523_5.10 21 of 68
 2. Proposer Life To Be Insured

Height 165 cms feet inch cms feet inch

Weight 75 Kgs. kgs.

Life to
Proposer/
3. HAVE YOU EVER BEEN INVESTIGATED, TREATED OR DIAGNOSED WITH ANY OF THE FOLLOWING CONDITIONS. If
be
Joint Life
YES, PLEASE PROVIDE DETAILS : No Insured
Yes No
Yes No

i). Diabetes /High blood sugar levels

ii). Hypertension/ High Blood Pressure, High Cholesterol or Thyroid disorder

iii). Heart or vascular disorder including chest pain, stroke, heart attack or Angioplasty, CABG or any other heart surgery.

iv). Breathing or lung disorders including asthma, emphysema, tuberculosis.

v). Liver or digestive system related disorder including jaundice ,gall bladder, pancreas or Hepatitis B/C.

vi). Any abnormal growth like tumour,lump,cancer or blood disorder, including anemia or thalassaemia or Sexually transmitted disease ( STD )
including HIV or AIDS.

vii). Any kind of Kidney or bladder disorder, including kidney failure, renal stone, nephritis or prostrate disorder.

viii). Any neurological or mental health problem like paralysis, multiple sclerosis, Parkinson's, epilepsy, depression or anxiety.

ix). Muscular-skeletal or joint disorders, including any kind of arthritis, gout, osteoporosis.

x). Are you having history of any hospitalization, treatment or investigation?

xi). Have you advised now or in last 5 yrs tests like X-Ray/CT scan/MRI/ Ultrasonography/ ECG/Blood test or any other investigatory or
diagnostic tests, or any type of surgery.

Xii). Have you ever been diagnosed with any form of internal or external congenital anomaly or defect i.e. any condition(s) which is present
since birth, and which is abnormal with reference to form, structure or position?

Xiii). Have you had any genetic testing before?

4. TOBACCO / ALCOHOL / DRUGS CONSUMPTION: Do you consume any of the following ?

i). Tobacco ( Smoking /Chewing) currently or even occasionally in last 1 year ?

Are you smoking more than 20 cigarettes/ day or chew more than 10 sachet/day of tobacco ?

ii) Are you drinking any kind of liquor more than 3 days a week ?

Have you ever been advised to quit alcohol?

iii). Are you taking drugs like Cannabis/Marijuana/Ecstacy/Heroin/LSD/Amphetamines or any other illegal drugs?

E. DECLARATION AND AUTHORISATION

DECLARATION BY PROPOSER/ JOINT LIFE

I/We hereby declare that I/We fully understand the meaning and scope of the Proposal form and the questions contained above and I am submitting the completed
proposal form of my/our own volition, and confirm that I/We have not been induced by anyone to make the Proposal. I/We have been explained the nature of
questions and the importance of disclosing all material information.

I/We further declare that all the statements and declarations herein shall be the basis of a contract between me/us and the Company and that I/We have made
complete, true and accurate disclosure of all the facts and circumstances and have not withheld any information that may be relevant to enable the Company to
make an informed decision about the acceptability of the Proposal. I agree that in case of any fraud or misstatement, provisions of Section 45 of Insurance Act,

4 TRAD_STD_0523_5.10 22 of 68
1938, as amended from time to time will apply. I/We undertake to notify the Company, forthwith in writing, of any change in any of the statements made in the
Proposal subsequent to the signing of this proposal and before acceptance of risk and issuance of the Policy by the Company. The first and subsequent year
premium will be paid out of legally acquired source of income. I will provide information as and when required by the Company, acting on its own or under any order
or instruction received from Statutory Authorities, as regards to the sources of funds or utilizations or withdrawals. I agree that the Company may provide any
information related to me in respect of this proposal;as available to the Company at any time, to any Statutory Authority in relation to the any laws including the laws
governing prevention of money laundering, applicable in the country. To enable the Company to assess the risk under my/our proposal or for any other purpose in
relation to the policy, l/we, my/our heirs, administrators or executors or assignees hereby authorize my past or present employer(s)/business association/medical
practitioners /other agencies or governmental and/or any regulatory bodies, insurance repositories, CERSAI/ UIDAI, reinsurers / hospitals or diagnostic centres/
other insurance companies/ service providers to disclose and make available to the Company such details/records, as may be requested by the Company. I
understand that I have disclosed my personal information with Max life and I hereby provide consent to Max Life to share, store my information with its authorized
service providers for servicing this policy/proposal such as issuance, underwriting renewal and claims process with respect to this policy as per the regulation
applicable from time to time. I/We submit the mandate to credit My/Our account towards all payments against the above policy and agree and understand that
payouts would be processed through electronic mode of payment and will be affected at select cities as per facilities/ arrangements of Max Life Insurance. I/We
authorize Max Life to send all communications by E-mail, SMS or any other communication mode. I/We agree to receive regular reminders, updates / alerts from
Max life from time to time.

I do hereby certify that above stated information regarding the nationality and tax residential status is correct in all respects and may be used for all purposes,
including reporting to statutory authorities & compliances, and understand that it is my responsibility to report the changes, if any, to Max Life within 2 weeks of
occurrence of such change

Signature / Thumb Impression / Electronic Signature of Proposer/ Joint Life

Place:- HYDERABAD Date:- 27/05/2024

VERNACULAR /ILLITERATE DECLARATION

(Declaration to be made by a person unconnected with Max Life Insurance Company Limited but whose identify can be easily established.) I hereby declare that I
have fully explained the contents of this proposal to the proposer/Life to be Insured in ______________ language, as understood by him/her and that the left thumb
impression/signature of the proposer/Life to be Insured has been appended/affixed after fully understanding the contents thereof. I have truthfully recorded the
answers given by the Proposer/Life to be Insured. I have understood the content of the proposal form as explained to me in______________ language by the
declarant, Mr./Ms. _______________________________, filling in the proposal form and after the same, I am affixing my signature/thumb-impression.

Name of the Declarant: Address of the Declarant:

I hereby certify that I understood the content of the proposal form as explained to me in______________ language by the declarant, Mr./Ms.
_______________________________ , filling in the proposal form and after the same, I am affixing my signature/thumb-impression.

Signature / Thumb Impression / Electronic Signature of Proposer/

Signature / Thumb Impression / Electronic Signature of Declarant
Joint Life

DECLARATION BY PRINCIPAL OFFICER/AGENT ADVISOR/SPECIFIED PERSON

I _________________________ do declare and confirm that I have met and explained the Product features, benefits, premium paying term, nature of the questions
contained in this Proposal form and other relevant terms and conditions to the Proposer and the Life Insured. I have also explained that the answers to the
questions forms the basis of the contract of the Insurance between the Company and the Proposer / Life Insured, and if any untrue statement is contained therein
and / or any information that may be relevant to enable the Company make an informed decision, the Company shall have the right to vary the benefits which may
be payable and / or treat the policy voidable at the option of the Company subject to section 45 of the Insurance Act, 1938 as amended from time to time. I confirm
that to the best of my knowledge the Life Insured does not suffer from any physical or mental abnormality or handicap or has / had been hospitalised, undergone
any surgery or treatment, or he /she is involved in activities including any hazardous avocation or occupation or any other information material for underwriting this
proposal form, unless expressly stated in this Proposal. I also declare and represent to the Company that I am in full compliance with the regulatory requirements
applicable to agent / corporate agent / specified person / broker prescribed by the Insurance Act 1938, as amended from time to time and any other regulation,
circular, instruction issued by IRDAI from time to time. I confirm that I have verified the identity, current / permanent residential address of the Proposer/ Life
Insured, the nature of his/her business and his / her financial status basis the Max Life AML moral hazard checklist.

Is this a Replacement Sale? If yes, I have adequately explained the consequences of replacement sale to the customer. Yes No
Relationship of Principal Officer/Agent Advisor/Specified Person
with the Proposer/ Joint Life/ Life Insured
Name of Principal Officer/Agent Advisor/Specified Person Policybazaar Insurance Brokers Pvt Ltd.
Principal Officer/Agent Advisor/Specified Person Code
Phone No. with STD Code
Date:- Place:-

Signature / Thumb Impression / Electronic Signature of Principal Signature / Thumb Impression /Electronic Signature of Sales
Officer/Agent Advisor/Specified Person Manager

5 TRAD_STD_0523_5.10 23 of 68
We Confirm that we have made joint efforts in soliciting the prospect and will be jointly responsible for performing the service related to the policy. We further
confirm that the objective of sharing the commission is not for qualifying for any contest and/or reward & recognition programs of the company.
(Applicable only if more than one Agent Advisors share the commission.)

Name(S) of Principal Officer/AA/Spec Principal Officer/AA/Spec Person Principal Officer/AA/Spec Person's %

Person Code Signature Share

Important Notes:

(1) Any payment/s including initial payment accompanying this proposal, cash or by bearer instrument must be made at any of the Company's General Office only.
(2) Crossed cheque or bank drafts must be made in favour of MAX LIFE INSURANCE COMPANY LIMITED ACCOUNT (Proposal No. as above) may be handed
over to the Agent Advisor. (3) Receipt of the Completed Proposal and initial payment does not create any obligations upon the Company to underwrite the risk. The
Company shall not be liable until it has underwritten the risk and issued the Policy. If the Policy is sent by post it shall be deemed to have been delivered to and
received by you in the ordinary course within 3 (three) days of posting. We draw your attention to Section-39, 45 and 41 of the Insurance Act, 1938, which reads as
follows-
Section 39: In case nomination facility is availed, section 39 of the Insurance Act, 1938 as amended from time to time shall apply.
Section 45: No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of issuance of policy,
from the date of the Commencement of Risk or Revival of the policy or the date of the rider to the policy, whichever is later. However, Insurer may question the
Policy at any time within three years from the date of issuance of policy, from the date of Commencement of Risk or Revival of the policy or the date of the rider to
the policy, whichever is later, on the ground of fraud, in which case insurer shall inform Proposer/Life Insured/legal representatives in writing specifying the grounds
and materials on which such decision is based. For other details please refer to Section 45 of the Insurance Act, 1938 as amended from time to time.
Section 41: (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance in
respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the
policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published
prospectuses or tables of the insurer.

TRAD_STD_0523_5.10

CKYC Annexure
1. CENTRAL KYC REGISTRY | Know Your Customer(KYC) Application Form | Individual
Application Type: EXISTING
KYC Number: 10084999350196
2. PERSONAL DETAILS (Please refer instruction A at the end)
Prefix First Name Middle Name Last Name
Name(Same as ID proof) Mr Mandala Ganesh Kumar
Maidan Name(If any)
Father/ Spouse Name Kumara Swamy MANDALA
Mother Name Ms JAYASRI MANDALA
Date Of Birth* 02/06/1986
Gender Male
Marital Status Married
Nationality Indian
Resident Status India
Occupation Type Salaried
3.RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA
Tax Identification number or Equivalent
Country Code of Jurisdiction of Residence

Place/City of Birth* : Country Code of Birth :

4. PROOF OF IDENTITY/ADDRESS(Please refer instruction C at the end)

ID/Address proof name Aadhar/UID Card
ID/Address proof Number xxxxxxxx7428
ID/Address Expiry date
5. PROOF OF ADDRESS(PoA)*
Address proof name Aadhar/UID Card
Address Line1 plot no 331 aeronagar pragthi nagar kukatpally
Address Line2 pragathi nagar
Address Line3 before ullas dhaba
City HYDERABAD

6 TRAD_STD_0523_5.10 24 of 68
State TELANGANA
PIN 500090
Country INDIA
6. Address in the Jurisdiction details where Applicant is Resident Outside India for Tax Purposes
Overseas Address
7. Contact Details
Mobile Number 9912345070
Email -ID [email protected]
8. APPLICATION DECLARATION

■ I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any change
therein immediately. In case of the above Information is found to be false or untrue or misleading or misrepresenting. I am aware that I am be held liable for
it.
■ I hereby consent to receiving information from Canral KYC Registry through SMS/Email on the above registered number/email address

Name/Date/Place
Name of the applicant Mr Mandala Ganesh Kumar
Place HYDERABAD
Date 27/05/2024

Proposal Form Annexure- Additional Questions Annexure

Proposer Life to be Insured
Others
Industry Type
healthcare
Defence/CRPF
a. Are you currently posted in any
sensitive/border location
b. Your nature of job/role
Aviation
a. Exact Nature of duties
b. If in Flying role what do you fly?
Diving
a. Are you a professional diver?
Where do you dive?
Oil and Natural Gas
a. Are you based at offshore or your job
involves travelling to offshore?
Merchant Marine
a. Type of vessel where working?
Mining
a. Does your role involves going inside any kind
of mine?
Have you ever had any illness related to your
occupation?
Nature of Duties/Business healthcare

Are you/your Nominee a Politically Exposed Person (PEP)? Yes No

If above Question "Yes" then answer below:

a. Which of the following persons is PEP (Tick as applicable) Life insured Family member of life insured
Specify:
b. Please specify the extent of Political involvement:
i. Political Experience (Years) :
ii. Affiliation to Political Party :

ii. Role in Political Party : Social Worker MLA MP Others ------

iv. Portfolio Handled :

v. Whether Party in Power : Yes No

7 TRAD_STD_0523_5.10 25 of 68
c. Whether the concerned PEP has ever been posted in foreign office/portfolio? Yes No
Specify:
d. Please specify all sources of income of concerned PEP? :

e. Has the concerned PEP ever been convicted or is under any investigation for any crime punishable by 3 or more years of imprisonment? : Yes

No
Specify:

Insurance History Annexure

Do you have any Life, Disability, Critical Illness or Health Insurance policy issued/pending/lapsed with or any other insurance company? Yes No

Has any proposal/reinstatement for life or health Insurance ever been refused, modified, postponed or offered with extra premium ? Yes No

Medical and Travel Questions Annexure

In next 12 months you intend to travel or reside abroad other than on holiday of more than 4 weeks ? Yes No

Has any two (2) or more of your family members (Parents & Siblings) ever been diagnosed with Diabetes or Hypertension or Kidney Failure or Cancer or

Heart Attack or any Hereditary Disorder before the age of 60 ? Yes No

Have you ever been investigated/diagnosed or treated for any of the following? No

1. Heart or vascular disorder including chest pain, stroke, heart attack or Angioplasty, CABG or any other heart surgery.

Chest Pain NO Heart Attack NO

Angioplasty, CABG or any other heart
Stroke NO NO
surgery.
Any other heart conditions

2. Diabetes /High blood sugar levels

High Blood Sugar NO Diabetes NO

3. Breathing or lung disorders including asthma, emphysema, tuberculosis.

Asthma NO Tuberculosis NO
Any other respiratory Disorder NO Any other respiratory Disorder

4. Any abnormal growth like tumour, lump, cancer or blood disorder, including anemia or thalassaemia or Sexually transmitted disease (STD) including
HIV or AIDS

Cancer NO Tumour NO
Anemia or Thalassemia NO HIV Infection NO
AIDS/AIDS Related NO Any other sexually trasmitted diseases NO
Any blood disorder NO Provide Details

5. Liver or digestive system related disorder including jaundice ,gall bladder, pancreas or Hepatitis B/C

Liver or digestive system disorder NO Jaundice, Gall blader, Pancreas NO

Hepatitis B NO Hepatitis C NO
Provide Details

6. Any neurological or mental health problem like paralysis, multiple sclerosis, Parkinson's, epilepsy, depression or anxiety.

Any other nervous system related

Neurological or mental health problem NO NO
diseases

Provide Details :
7. Muscular-skeletal or joint disorders, including any kind of arthritis, gout, osteoporosis.

Any ailment of bones/joints/limbs NO Spine Related disorder NO

Any disorder of muscle NO Provide details

8. Any kind of Kidney or bladder disorder, including kidney failure, renal stone, nephritis or prostrate disorder.

Any Kidney disorder NO Provide Details

9. Hypertension/ High Blood Pressure, High Cholesterol or Thyroid disorder.

High Blood Pressure/ Hypertension NO Thyroid NO

Provide Details

10. Any other disorders.

Any Gynaecological disorder NO Any disorder of Eye/Ear/Nose/Throat NO

Any other hormonal disorder NO

11. Have you ever been hospitalised or been advised to under go any investigation (other than routine checkup) or treatment or surgery? NO
Provided Details:

8 TRAD_STD_0523_5.10 26 of 68
12. In the last 1 year, have you been absent from Work/Educational Institution due to an illness or injury for a continuous period of more than 10 days?
Provided Details:

13. Have you ever been diagnosed with any form of internal or external congenital anomaly or defect i.e. any condition(s) which is present since birth,
and which is abnormal with reference to form, structure or position? : NO
Provided Details:

14. Have you had any genetic testing before? : NO

Provided Details:

Tobacco/Alcohol/Drugs Consumption: (In case you consume or have ever consumed) Yes No
Give Details :

9 TRAD_STD_0523_5.10 27 of 68
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ALFPA3522P
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ALFPA3522P
 Face Match Report : 161476668C - MANDALA GANESH KUMAR
Face Similarity Score Of 96.42 %

Face - 1 Face - 2

Result Image

# 0000 0166 6475 # 24-Jun-2024 07:56:36 PM #

MLIC

Report Generation Time : 24-Jun-2024 07:56:37 PM

CIN : U72900PN2000PTC015558 IRDAI Registration No.: 005

MDIndia Health Insurance TPA Private Limited

(Formerly Known as MDIndia Healthcare Services (TPA) Pvt. Ltd.)

General & Claim Enquiry Helpline Cashless Enquiry Helpline

Fax No. : 1860-233-4449 Fax No. : 1860-233-4449
Toll Free: 1800-209-7777 Toll Free: 1800-209-7800
Email: [email protected] Email: [email protected]

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ACPFS5891L
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

Investigation Observed Value Unit Biological Reference Interval

Cholesterol-Total 162 mg/dL Desirable: < 200

(Serum,CHOD-PAP Polychromatic end point Borderline High: 200-240
CHOD-PAP) High: >= 240
Triglycerides level 145 mg/dL Normal: < 150
(Serum,Lipase/GlycerolKinase Bichromatic end Borderline High: 150-199
point) High: 200-499
Very High: >= 500
Creatinine 1.10 mg/dL 0.90-1.30
(Serum,Jaffes method(IDMS TRACEBLE))
Interpretation - Creatinine is a waste product formed in muscles from the high energy storage compound, creatine phosphate. The
amount of creatinine produced is constant (unlike Urea) and is primarily a function of muscle mass.
Physiological factors affecting serum creatinine concentration includes age, gender, race, muscularity, exercise, Pregnancy, certain
drugs, diet, dehydration and nutritional status.
Low serum Creatinine levels is seen in cases of low muscle mass like muscular atrophy, or aging.
High serum creatinine levels is seen in Acute and Chronic kidney disease, obstruction.
Since a rise in blood creatinine is observed only with marked damage of the nephrons, it is not suited to detect early stage kidney
disease.

BUN-Blood Urea Nitrogen 12 mg/dL 7-18

(Serum,Urease Bichromatic end point)
Remark: In blood, Urea is usually reported as BUN and expressed in mg/dl. BUN mass units can be converted to urea mass units
by multiplying by 2.14.

HDL Cholesterol 37 mg/dL Major risk factor for heart

(Serum,Detergent - Bichromatic end point) disease: < 40
Negative risk factor for heart
disease: >= 60
BilirubinTotal, Direct, IndirectSerum
(Serum)
Bilirubin-Total 0.29 mg/dL 0-1.2
(Diazo – Bichromatic end point)

Interpretation :

1. Total Bilirubin is the sum of the unconjugated and conjugated fractions. Total Bilirubin is elevated in hepatitis, cirrhosis,
haemolytic disorders , several inherited enzyme deficiencies, and conditions causing hepatic obstruction.
2. Neonatal Bilirubin quantitation is used to monitor diseases causing jaundice in the new-born, chiefly erythroblastosis fetalis
( also caused haemolytic disease of the newborn or HDN.)
3. Physiologic jaundice is seen at serum bilirubin concentrations from 7 to 17 mg/dl. Serum bilirubin concentrations greater
than 17 mg/dl may be pathologic. The primary concern is the potential for bilirubin encephalopathy or kernicterus.

Page 1 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

43 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

Investigation Observed Value Unit Biological Reference Interval

Bilirubin-Direct 0.09 mg/dL 0.0-0.3

(Diazo – Bichromatic end point)
Note: Direct Bilirubin is elevated in conditions causing hepatic obstruction , hepatitis, cirrhosis, several inherited enzyme
deficiencies, and inherited defects in canalicular excretion.

Bilirubin- Indirect 0.20 mg/dL 0.1-1.0

(Calculated)
Alkaline Phosphatase 97 IU/L 46-116
(Serum,Bichromatic rate technique with AMP)
Gamma GT (GGTP) 26 U/L 15-85
(Serum,Bichromatic rate technique)
Proteins
(Serum)
Total Protein 7.3 g/dL 6.4-8.2
(Biuret – Bichromatic end point)
Albumin 3.9 g/dL 3.4-5.0
(BCP Polychromatic end point)
Globulin 3.40 g/dL 1.8-3.6
A/G Ratio 1.15 1.1-2.2
(Calculated)
Interpretation:
• Total Proteins are useful in the diagnosis and treatment of disease involving liver, kidney, bone marrow ,metabolic and
nutritional disorders.
• The protein concentration of serum is an indicator of the hydration state of the body.
• Prolonged bed rest results in decreased total protein concentration.
• The A/G ratio measures the relative ratio of albumin to globulin
• Low A/G ratio may indicate viral infections, liver and kidney disease, or autoimmune disorders. These diseases increase
globulin and decrease albumin thus lowering the A/G ratio.
• A high A/G ratio may indicate diseases that make the body produce less globulin, such as genetic disorders or may result
from the use of immunosuppressive drugs.
Reference:
• Juraschek SP, Moliterno AR, Checkley W, Miller ER 3rd. The Gamma Gap and All-Cause Mortality. PLoS One. 2015 Dec
2;10(12):e0143494
• Busher JT. Serum Albumin and Globulin. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History,
Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 101.
• Pack Insert

Page 2 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

44 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

Investigation Observed Value Unit Biological Reference Interval

Glucose fasting 129 mg/dL Normal: 70-99

(Plasma-F,Hexokinase Bichromatic end point) Impaired Fasting Glucose(IFG):
100-125
Diabetes mellitus: >= 126
(on more than one occassion)
(American diabetes association
guidelines 2022)
Note: An individual may show higher fasting glucose level in comparison to post prandial glucose level due to following reasons :
The glycaemic index and response to food consumed, Changes in body composition, Increased insulin response and sensitivity,
Alimentary hypoglycemia, Renal glycosuria, Effect of oral hypoglycaemics & Insulin treatment.

Associated Tests: HbA1c (H0018), Diabetes Profile – Maxi (D0021),HOMA Index (H0275), Insulin (I0275).

SGOT (AST) 12 U/L 15-37

(Serum,Bichromatic rate technique with P5P)
SGPT (ALT) 20 U/L 16-63
(Serum,IFCC with P5P Bichromatic rate technique)

Page 3 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

45 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

BPB,ME,HBA1c, RUA
Routine Examination Urine
Investigation Observed Value Unit Biological Reference Interval

General Examination
Colour Pale Yellow Pale Yellow
Transparency (Appearance) Clear Clear
Deposit Absent Absent
Reaction (pH) 6.0 4.5-8
(Reagent Strip Dipstick)
Specific gravity 1.010 1.010-1.030
(Reagent Strip Dipstick)
Chemical Examination (Automated Dipstick Method)
Urine Protein (Albumin) Absent Absent
(Reagent Strip Dipstick/ Sulfosalicylic Acid )
Urine Glucose Absent Absent
(Reagent Strip Dipstick / Benedict)
Urine Ketones (Acetone) Absent Absent
(Reagent Strip Dipstick/ Dumm & Shipley powder)
BILIRUBIN Negative Negative
(Reagent Strip Dipstick/ Fouchet’s Reagent)
Bile pigments Absent Absent
Bile salts Absent Absent
Urobilinogen Normal mg/dL Normal
(Reagent Strip Dipstick/ Ehrlich’s Reagent )
Bile Salt and pigment Absent Absent
Nitrite Negative Negative
(Reagent Strip Dipstick)
Microscopic Examination
Red blood cells Nil cells/hpf 0-2
Dysmorphic Red Blood Cells Absent Absent
Pus cells (WBCs) 2-3 cells/hpf <= 5
Epithelial cells Nil cells/hpf 0-2
Crystals Absent Absent
Cast Absent Absent
Amorphous deposits Absent Absent

Page 4 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

46 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

Investigation Observed Value Unit Biological Reference Interval

Bacteria Absent Absent
Yeast cells Absent Absent
1. Urine routine and microscopy is a screening test.
2. Abnormal results of chemical examination are confirmed by manual methods.
3. Chemical examination through Dipstick includes test methods as Protein (Protein Error Principle), Glucose (Glucose
Oxidase-Peroxidase), Ketone (Legals Test), Bilirubin (Azo- Diazo reaction), Urobilinogen (Diazonium ion Reaction) Nitrite
(Griess Method).
4. All abnormal results of chemical examination are confirmed by manual methods. Manually pH checked by pH paper, Specific
gravity by Urinometer, Protein by sulfosalicylic acid method, Glucose by Benedict’s method, Ketone by Rothera's method,
Bile salt by Sulfur granule method, Bile pigment by Fouchet method, Urobilinogen by Ehrlich Method, Nitrite by Nitrate
reduction test.
5. Pre-test conditions to be observed while submitting the sample- First void, mid-stream urine, collected in a clean, dry, sterile
container is recommended for routine urine analysis, avoid contamination with any discharge from vaginal, urethra,
perineum, as applicable, avoid prolonged transit time & undue exposure to sunlight.
6. During interpretation, points to be considered are Negative nitrite test does not exclude the presence of the bacteria or
urinary tract infections.
7. Trace proteinuria can be seen with many physiological conditions like prolonged recumbency, exercise, high protein diet etc.
8. False reactions for bile pigments, proteins, glucose and nitrites can be caused by peroxidase like activity by disinfectants,
therapeutic dyes, ascorbic acid and certain drugs etc.
9. Physiological variations may affect the test results.
10. The Microscopic examination findings reported are in decimal numbers as they represent arithmetic mean of multiple fields
scanned using Microscopy.

Page 5 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

47 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

CBC Haemogram
Investigation Observed Value Unit Biological Reference Interval

Erythrocytes
Haemoglobin (Hb) 13.4 gm/dL 14-18
Erythrocyte (RBC) Count 5.50 mill/cu.mm 4.4-6.0
PCV (Packed Cell Volume) 44.6 % 42-52
MCV (Mean Corpuscular Volume) 81.1 fL 82-101
MCH (Mean Corpuscular Hb) 24.4 pg 27-34
MCHC (Mean Corpuscular Hb Concn.) 30.0 g/dL 31.5-36
RDW (Red Cell Distribution Width) 14.9 % 11.5-14.0
Leucocytes
Total Leucocytes (WBC) count 10,220 cells/cu.mm 4300-10300
Absolute Neutrophils Count 6541 /c.mm 2000-7000
Absolute Lymphocyte Count 2964 /c.mm 1000-3000
Absolute Monocyte Count 613 /c.mm 200-1000
Absolute Eosinophil Count 102 /c.mm 20-500
Absolute Basophil Count 0 /c.mm 20-100
Neutrophils 64 % 40-80
Lymphocytes 29 % 20-40
Monocytes 6 % 2.0-10
Eosinophils 1 % 1-6
Basophils 0 % 0-2
Platelets
Platelet count 443 10^3 / µl 140-440
MPV (Mean Platelet Volume) 8.2 fL 7.8-11
PCT ( Platelet crit) 0.36 % 0.2-0.5
PDW (Platelet Distribution Width) 8.0 % 9-17
Tests done on Automated five Part Cell Counter. RBC, WBC,PCV and Platelets are analysed by DC Detecction method,
Haemoglobin by NON- CYNAIDE method. Other parameters are calculated. All Abnormal Haemograms are reviewed and confirmed
microscopically.

Page 6 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

48 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

Investigation Observed Value Unit Biological Reference Interval

HbA1C- Glycated Haemoglobin 6.3 % Non-diabetic: <= 5.6

(HPLC) Pre-diabetic: 5.7-6.4
Diabetic: >= 6.5
Refer interpretation for
monitoring ranges.
Estimated Average Glucose (eAG) 134.11 mg/dL

Interpretation & Remark:

1. HbA1c is used for monitoring diabetic control. It reflects the estimated average glucose (eAG).
2. HbA1c has been endorsed by clinical groups & ADA (American Diabetes Association) guidelines 2017, for diagnosis of
diabetes using a cut-off point of 6.5%.
3. Trends in HbA1c are a better indicator of diabetic control than a solitary test.
4. Low glycated haemoglobin(below 4%) in a non-diabetic individual are often associated with systemic inflammatory diseases,
chronic anaemia(especially severe iron deficiency & haemolytic), chronic renal failure and liver diseases. Clinical correlation
suggested.
5. To estimate the eAG from the HbA1C value, the following equation is used: eAG(mg/dl) = 28.7*A1c-46.7
6. Interference of Haemoglobinopathies in HbA1c estimation.
A. For HbF > 25%, an alternate platform (Fructosamine) is recommended for testing of HbA1c.
B. Homozygous hemoglobinopathy is detected, fructosamine is recommended for monitoring diabetic status
C. Heterozygous state detected (D10/ Tosho G8 is corrected for HbS and HbC trait).

7. In known diabetic patients, following values can be considered as a tool for monitoring the glycemic control.
Excellent Control - 6 to 7 %,
Fair to Good Control - 7 to 8 %,
Unsatisfactory Control - 8 to 10 %
and Poor Control - More than 10 % .

Note : Hemoglobin electrophoresis (HPLC method) is recommended for detecting hemoglobinopathy.

ESR - Erythrocyte Sedimentation Rate 5 mm/hr 0-15

(EDTA Whole Blood)

Page 7 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

49 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

Investigation Observed Value Unit Biological Reference Interval

Method: Modified Westergren’s Method

Interpretation:

1. It indicates presence and intensity of an inflammatory process, never diagnostic of a specific disease. Changes are more
significant than a single abnormal test.
2. It is a prognostic test and used to monitor the course or response to treatment of diseases like tuberculosis, bacterial
endocarditis, acute rheumatic fever, rheumatoid arthritis, SLE, Hodgkins disease, temporal arteritis, polymyalgia rheumatica.
3. It is also increased in pregnancy, multiple myeloma, menstruation, and hypothyroidism.

Page 8 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist

50 of 68

AALCP8413E
 Mr. MANDALA GANESH KUMAR Reference: SELF VID: 240108102339009
.. Sample Collected At: Registered On:
Promiso Health Private Limited - Credit
11/06/2024 02:50 PM
B-23, H K Arcade 1st, Floor 1b,
PID NO: P33024525474121 Mahadeavapura Post, I T I Industrial Area, Collected On:
Age: 38 Year(s) Sex: Male Processing Location:SDRC,1-1-58/7/3 11/06/2024 2:49PM
Srinath Complex,SD Road, Reported On:
Secunderabad, Hyderabad - 500003
11/06/2024 05:21 PM

Investigation Observed Value Unit Biological Reference Interval

BPB,ME,HBA1c, RUA
HIV-DUO (IV th Generation test) Non Reactive,0.12 S/CO Non Reactive: < 1.0
(Serum,CMIA) Reactive: >= 1.0

Test Description : The HIV Ag/Ab Combo(HIV DUO) assay is a Screening test for simultaneous qualitative detection of HIV p24
antigen and antibodies to HIV type 1 and/or 2 in human serum or plasma. However, the HIV Ag/Ab Combo result does not
distinguish between the detection of HIV p24 antigen, HIV-1 antibody, or HIV-2 antibody separately.

Test Interpretation :
• All reactive samples are tested by 3 different methods as per NACO guidelines, 2015 (Strategy) /algorithm III).
• A single test result is not always indicative of a disease and diagnosis of HIV infection must be based on results of
supplemental, confirmatory tests performed on repeat sample & with clinical correlation for the patient’s immune status and
history.
• The test results obtained relate only to the sample given or received and tested
• Non Reactive results may not rule-out acute or early HIV infection in the window period. If acute HIV-1 infection is suspected,
detection of HIV-1 RNA or HIV proviral is recommended.
• Reactive results suggest possibility of preliminary infection with HIV-1 and/or HIV-2. All reactive samples should be verified
by submitting a second serum specimen for repeat testing with screening & supplemental or confirmatory HIV tests (by
serology-HIV 1 & 2 western blot or molecular- HIV 1 & 2 PCR).
• For the received samples, it is presumed that patient counselling is done at referring centre or by referring physician.

HBsAg Screening Non Reactive,0.18 IU/mL Non Reactive: < 1.0

(Serum,CMIA) Reactive: >= 1.00
All Reactive results must be confirmed by Neutralizing confirmatory test or by HBV DNA detection assay.

Interpretation note : Patients on Biotin supplement may have interference in some immunoassays. With individuals taking high dose
Biotin (more than 5mg per day) supplements, at least 8-hour wait time before blood draw is recommended.
Ref: Arch Pathol Lab Med—Vol 141, November 2017

Reports to follow - Kindly await following pending reports :

Investigation : Status
Glucose Random Recollect - Sample not received (S.N.R)

-- End of Report --

Tests marked with NABL symbol are accredited by NABL vide Certificate no MC-2715; Validity till 13-06-2025

Page 9 of 9

Dr. PRAMOD K REDDY

MD(Path),Pathologist
51 of 68

AALCP8413E
 52 of 68

ALFPA3522P
IN THE UNIT LINKED POLICIES, THE INVESTMENT RISK IN THE INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. This advertisement is designed for
combination of benefits of two or more individual and separate products namely Max Life Online Savings Plan, A Unit Linked Non Participating Individual Life
Insurance Plan (UIN: 104L098V05) and Max Life Smart Wealth Advantage Guarantee Plan, a Non Linked Non Participating Individual Life Insurance Savings
plan (UIN: 104N124V07). These products are also available for sale individually without the combination offered/suggested. This benefit illustration is the
arithmetic combination and chronological listing of combined benefits of individual products. The customer is advised to refer the detailed sales brochure of
respective individual products mentioned herein before concluding the sale.

This is a combination solution comprising of Max Life Online Savings Plan (UIN: 104L098V05) and Max Life Smart Wealth
Advantage Guarantee Plan (UIN: 104N124V07)

Proposal for: Mr.Mandala, aged 38 years

In this solution, the yearly premium paid by you will be invested in Max Life Online Savings Plan and Max Life Smart Wealth
Advantage Guarantee Plan in a predetermined ratio. While Max Life Online Savings Plan will provide market-linked returns,
Max Life Smart Wealth Advantage Guarantee Plan will generate Guaranteed Returns at Maturity which will ensure you do not
lose out on your investment. This plan provides 4 main benefits:

• Assured Benefits no matter what happens to the

• Build your corpus
market

• Secure your family’s financial future • Tax Benefits*

*As per prevailing tax laws that are subject to change

UNIT LINKED INSURANCE PRODUCTS DO NOT OFFER LIQUIDITY DURING THE FIRST FIVE YEARS OF THE CONTRACT. YOU WILL NOT BE ABLE
TO WITHDRAW THE MONEY INVESTED IN LINKED INSURANCE PRODUCTS COMPLETELY OR PARTIALLY TILL THE END OF THE FIFTH YEAR.
APPLICABLE TAXES, CESSES AND LEVIES AS IMPOSED BY THE GOVERNMENT FROM TIME TO TIME WILL BE DEDUCTED FROM THE
PREMIUMS RECEIVED.

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 Overview of Solution for Mr.Mandala

In this solution, you will purchase Max Life Online Savings Plan (UIN: 104L098V05) and Max Life Smart Wealth Advantage
Guarantee Plan (UIN: 104N124V07)

Age Gender PPT PT

38 Years Male 5 Years 20 Years

Premium Premium
Policy Installment Guaranteed Death
Product name Variant payment payment Annual Premium
term premium Benefit
term mode
Max Life Smart Wealth Advantage Wealth For
Guarantee Plan 20 5 Monthly Rs. 8,893 Rs. 1,00,110 Rs. 11,41,404
Milestones

Max Life Online Savings Plan Variant 2 20 5 Monthly Rs. 11,421 Rs. 1,37,047 Rs. 13,70,469

Overview of Solution

Annual Premium Paid Rs. 2,40,000

Premium Paid Over Premium payment term Rs. 12,00,000

Assured Benefits

Guaranteed Benefit* at maturity Rs. 12,00,004

Market Linked Returns

Market Linked Returns @ 8% Rs. 15,59,212

Market Linked Returns @ 4% Rs. 7,07,851

Total Possible Returns

Total Possible Returns @ 8% Total Possible Returns @ 4%

Rs. 27,59,216 Rs. 19,07,855

*For Max Life Smart Wealth Advantage Guarantee Plan, the applicable taxes, cesses and levies will be charged over and above
the policy premiums.
The guaranteed benefits are applicable only if all due premiums are paid. Please note that the returns, 4% and 8%, are only
assumed rates. These are not guaranteed and they are not the upper or lower limits of returns of the Funds selected in your
policy, as the performance of the Funds is dependent on number of factors including future investment performance. For
more information, please request for your policy specific illustration. Past performance is not necessarily indicative of future
performance

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Maturity Benefit:

Age : 38 years Maturity Benefit

PPT : 5 years Max Life Smart Wealth Advantage
PT : 20 years Guarantee Plan
Rs. 12,00,004
Annual Premium : Rs. 2,40,000 +
• Max Life Smart Wealth Advantage Guarantee
Online Savings Plan
Plan: Rs. 1,00,110
Illustrated @ 8% : Rs. 15,59,212
• Max Life Online Savings Plan : Rs. 1,37,047
Illustrated @ 4% : Rs. 7,07,851

Age 38 yrs Age 42 yrs Age 57 yrs

Year 1 Year 5 Year 20

Monthly premium = Rs. 20,314 for 5 yrs

Death Benefit:

Guaranteed Death Benefit Maturity Benefit

Age : 38 years Max Life Smart Wealth Advantage
PPT : 5 years Guarantee Plan
Max Life Smart Wealth Advantage
PT : 20 years Rs. 12,00,004
Guarantee Plan
+
Annual Premium : Sum Assured : Rs. 11,41,404 Online Savings Plan
Rs.2,40,000 + Illustrated @ 8% : Rs.
Online Savings Plan Sum Assured : 15,59,212
Rs. 13,70,469 Illustrated @ 4% : Rs.
7,07,851
*Monthly income =
(1%*(13,70,469))

Age 38 yrs Age 57 yrs

Year 1 Year 20
Unforeseen death of life
Monthly premium = Rs 20,314 insured
for 5 yrs
The company will fund all future outstanding premiums in case of death of life insured during the policy payment term

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Disclaimers

• Capital Guarantee Solution is a combination solution of Max Life Online Savings Plan, A Unit Linked Non Participating
Individual Life Insurance Plan (UIN: 104L098V05) and Max Life Smart Wealth Advantage Guarantee Plan, a Non-Linked Non
Participating Individual Life Insurance Savings plan (UIN: 104N124V07).
• It is NOT MANDATORY to purchase the Max Life Online Savings Plan and the Max Life Smart Wealth Advantage Guarantee
Plan together. This is only an illustrative document. It does not purport to be a contract of insurance and does not in any way
create any rights and/or obligations. Some of the 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 returns then
these will be clearly marked “guaranteed” in the illustrations. The actual experience on the contract may be different from
illustrated.
• The guaranteed and non-guaranteed benefits are applicable only if all due premiums are paid.
• Please note that the maturity benefits of Max Life Online Savings Plan are NOT GUARANTEED.
• All applicable taxes, cesses and levies as imposed by the Government will be charged over and above the policy premiums at
the time of purchase of Max Life Smart Wealth Advantage Guarantee Plan.
• This is not a product prospectus. For more details on the risk factors, terms and conditions, please read the respective
prospectus of Max Life Online Savings Plan and Max Life Smart Wealth Advantage Guarantee Plan carefully, available on
www.maxlifeinsurance.com, before concluding a sale.
• For Online Savings Plan, for the purposes of illustration, the Company has assumed 4% and 8% as the rates of investment
returns. The returns shown in the illustration are not guaranteed and they are not the upper or lower limits of what might be
received, as the value of the policy depends on a number of factors including future investment performance. 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.
• Life insurance coverage is available in Max Life Online Savings Plan and Max Life Smart Wealth Advantage Guarantee Plan.
• The benefits available under this solution shall be as per the product policy terms and conditions
The tax laws are subject to amendments from time to time
• This life insurance product is offered and underwritten by Max Life Insurance Co. Ltd.
• The life insurance contract is between the proposer and Max Life Insurance co. Ltd
• *Under Online savings plan variant 2, a Family Income Benefit equal to 1% of the Sum Assured will be paid each month
starting from the Policy anniversary date of every month following or coinciding with the date of death of the Life Insured till
the end of the Policy Term, subject to a minimum of 36 monthly payments and a maximum of 120 monthly payments.
• Under policy continuance benefit (PCB) option, in case of death of the life Insured, the policy continues as it would have in
case the life insured was alive with the survival benefits and maturity benefits payable in future as and when due, without
having to pay any future premiums.
• The premium shall be adjusted on due date even if it has been received in advance in the following scenarios
o Due to any benefit change of Smart Wealth Advantage Guarantee Plan owing to age or rate revision, there may be
change in ratio to allocate premium in both products to ensure capital guarantee.
o In case of a counter offer made for any reason, customer may have to pay extra premium for the same and we may not
adjust the Sum Assured in order to ensure Capital Guarantee of the policy
Customer Declaration
I, Mandala, hereby confirm that I have understood the features of Capital Guarantee Solution 1 to me, explained by the sales
representative and affixing my signature below.
Sign :
Date: 6/27/24 Mandala

This would be followed by individual, separate and complete benefit illustrations of SWAG and OSP, as are currently generated.

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 BENEFIT ILLUSTRATION
[Date and Time of Illustration – 27 June 2024, 12:47 AM]

Name of the Prospect/Policyholder: Mr. Mandala Proposal No:

Age & Gender: 38 Years, Male Name of the Product: Max Life Smart Wealth Advantage Guarantee Plan
Name of the Life Assured: Mr. Mandala Tag Line: A Non-linked Non Participating Individual Life Insurance Savings Plan
Age & Gender: 38 Years, Male Unique Identification No: 104N124V07
Policy Term: 20 Years GST Rate (Base Policy, First Year): 4.50%
Premium Payment Term: 5 Years GST Rate (Base Policy, Subsequent Year): 2.25%
Amount of Installment Premium: `9,293 GST Rate (Rider, First Year): NA
Mode of payment of premium: Monthly
GST Rate (Rider, Subsequent Year): NA
Income Amount: NA
Income Start Year, if applicable: NA
Income Period, if applicable: NA Max Life State: Haryana
Deferment Period, if applicable: NA Policyholder Residential State/Country: Telangana

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

Policy Details
Policy Option Wealth for Milestones Sum Assured on Maturity (in Rs.) 9,09,094
Death Benefit Multiple NA Sum Assured (at inception of the policy) upon Death (in Rs.) 11,41,404
Policy Continuance Benefit Option Yes Sum Assured (Inbuilt Additional Accidental Death Benefit) (in Rs.) 5,70,702
Special Date Option No Opted Special Date NA

Rider Details

Accidental Death & Dismemberment (ADD) Rider Term NA Accidental Death & Dismemberment (ADD) Rider Sum Assured (in Rs.) NA

Term Plus Rider Term NA Term Plus Rider Sum Assured (in Rs.) NA
Waiver of Premium (WOP) Plus Rider Term NA
Critical Illness and Disability Rider - Rider Premium Payment
NA Critical Illness and Disability Rider - Coverage Variant NA
Term and Rider Term
Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Accidental Death & Waiver of Premium Plus Critical Illness and Total Installment Premium
Base Plan Dismemberment Rider
Term Plus Rider Rider Disability Rider
Installment Premium without GST (in Rs.) 8,893 0 0 0 0 8,893
Installment Premium with first year GST (in Rs.) 9,293 0 0 0 0 9,293
Installment Premium with GST 2nd year onwards (in Rs.) 9,093 0 0 0 0 9,093

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UIN: 104N124V07 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 1 of 3
 (Amount in Rupees)
Non Guaranteed
Guaranteed
Single/
Total Annual Other Benefits, if Inbuilt
Policy Annualized Money Back Accrued Minimum
Premium (BOY) Auto Debit any (Sum Additional Special
Year Premium (BOY) Base Income Loyalty Income (In case of Life Total Survival Guaranteed Total Maturity Guaranteed
Booster Assured on Death Benefit Accidental Surrender Value
(EOY) (EOY) Long Income) Benefit (EOY) Additions (if Benefit (EOY) Surrender Value
(EOY) Maturity) (EOY) Death Benefit (EOY)
any) (EOY) (EOY)

1 1,00,110 1,06,711 - - - - - - - - 11,41,404 - - -

2 1,00,110 1,06,711 - - - - - - - - 11,41,404 - 61,772 61,673
3 1,00,110 1,06,711 - - - - - - - - 11,41,404 - 1,08,101 1,00,855
4 1,00,110 1,06,711 - - - - - - - - 11,41,404 - 2,05,906 1,64,873
5 1,00,110 1,06,711 5,062 - - - - - - - 11,41,404 - 2,57,383 2,49,546
6 - - - - - - - - - - 11,41,404 5,70,702 2,57,383 2,72,001
7 - - - - - - - - - - 11,41,404 5,70,702 2,57,383 2,96,546
8 - - - - - - - - - - 11,41,404 5,70,702 2,74,540 3,23,183
9 - - - - - - - - - - 11,41,404 5,70,702 2,91,697 3,52,274
10 - - - - - - - - - - 11,41,404 5,70,702 3,08,854 3,84,001
11 - - - - - - - - - - 11,41,404 5,70,702 3,26,011 4,18,547
12 - - - - - - - - - - 11,41,404 5,70,702 3,43,174 4,56,274
13 - - - - - - - - - - 11,41,404 5,70,702 3,60,331 4,97,274
14 - - - - - - - - - - 11,41,404 5,70,702 3,77,493 5,42,093
15 - - - - - - - - - - 11,41,404 5,70,702 3,94,650 5,90,820
16 - - - - - - - - - - 11,41,404 5,70,702 4,11,812 6,44,002
17 - - - - - - - 72,728 - - 11,41,404 5,70,702 4,50,788 7,58,163
18 - - - - - - - 1,45,455 - - 11,41,404 5,70,702 4,89,768 8,87,614
19 - - - - - - - 2,18,183 - - 11,41,404 5,70,702 5,28,744 10,34,164
20 - - - - - - - 2,90,910 9,09,094 12,00,004 11,41,404 5,70,702 5,50,562 12,00,004

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UIN: 104N124V07 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 2 of 3
 Notes:
• EOY: End of Year, BOY = Beginning of Year
• Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Service Tax.
• Total Annual Premium includes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any but excludes Goods and Service Tax.
• The Surrender Value payable shall be higher of ‘Minimum Guaranteed Surrender Value’ and ‘Special Surrender Value’. Any additional Surrender Value over and above the ‘Minimum Guaranteed Surrender Value’ is not
guaranteed.
• The above benefits are assuming income payment mode as Annual and with the assumption that no special date is opted by you. For details on other income payment modes and special date options, please refer the Policy
Document.
• The Net Rate of Return has been calculated based on the total survival (including auto-debit booster) and total maturity benefit, assuming that all premiums have been paid as and when due (excluding applicable taxes, cesses
and levies and rider premiums, if any).
• Refer Sales literature (Prospectus) and Policy Document for explanation of terms used in this illustration.
• Surrender value (both GSV and SSV) shown above is before payment of survival benefit applicable during the year of surrender.
• The above benefit illustration assumes that all premiums (excluding the first premium) are paid via auto debit mode of premium payment. Note that auto debit boosters are applicable only on the premiums paid via auto debit
mode of premium payment. Auto debit booster shall be payable only to the fully paid-up policies where all due premiums have been paid.

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

Place: Signature / Thumb Impression / Electronic Signature of Date:6/27/24 Signature / Thumb Impression / Electronic Signature of
Date: 6/27/24 Agent/ Intermediary / Official Prospect/ Policyholder
This system generated benefit illustration shall be treated as signed by me.

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UIN: 104N124V07 Max Life Insurance Company Limited having its Corporate Office at 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurugram – 122002 Page 3 of 3
 Proposal No:

Name of the Prospect/Policyholder: Mr. Mandala Name of the Product: Max Life Online Savings Plan
Tag Line: A Unit Linked Non Participating Individual Life Insurance Plan
Age & Gender: 38 Years, Male
Policy Option: Variant 2
Name of the Life Assured: Mr. Mandala Unique Identification No: 104L098V05
GST Rate: 18.00%
Age & Gender: 38 Years, Male Max Life State: Haryana
Policyholder Residential State/Country: Telangana
Sum Assured: `13,70,469 Investment Strategy Opted for: NA
Policy Term & Premium Payment Term: 20 Years & 5 Years
Funds opted for along with their risk level
Amount of Installment Premium: `11,421 [Please specify the customer specific fund
Mode of payment of premium: Monthly option):

Nifty Alpha 50 Fund (Risk Rating-Very High) : 100%

How to read and understand this benefit illustration?

This benefit illustration is intended to show what charges are deducted from your premiums and how the unit fund, net of charges and taxes, may grow over the years of the policy term if the fund earns a gross
return of 8% p.a. or 4% p.a. These rates, i.e., 8% p.a. and 4% p.a. are assumed only for the purpose of illustrating the flow of benefits if the returns are at this level. It should not be interpreted that the returns
under the plan are going to be either 8% p.a. or 4% p.a.
Net Yield mentioned corresponds to the gross investment return of 8% p.a., net of all charges but does not consider mortality, morbidity charges, underwriting extra, if any, guarantee charges and cost of riders, if
deducted by cancellation of units. It demonstrates the impact of charges 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 break-up of the charges, and other values.
Note: Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. If your policy offers guaranteed benefits then
these will be clearly marked “guaranteed” in the illustration table on this page. If your policy offers variable benefits then the illustration on this page will show two different rates of assumed future investment
returns. 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 actual
future investment performance.

Rider Details

Critical Illness and Disability-Secure Rider - Rider Premium Payment Term and Rider Term NA Critical Illness and Disability Rider - Coverage Variant NA

Critical Illness and Disability Rider - Rider Sum Assured NA

Premium Summary
Max Life Critical Illness and Disability-Secure Rider
Base Plan Total Installment Premium

Installment Premium without GST (in Rs.) 11,421 0 11,421

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Installment Premium with first year GST (in Rs.) 11,421 0 11,421

Installment Premium with GST 2nd year onwards (in Rs.) 11,421 0 11,421

UIN: 104L098V05 Page 1 of 5

 Part A

(Amount in Rupees.)
At 4% p.a. Gross Investment Return At 8% p.a. Gross Investment Return
Commission
Policy Annualized
payable to
Year Premium Mortality, Morbidity Fund at End Surrender Mortality, Fund at End Surrender
Other Charges* GST Death Benefit Other Charges* GST Death Benefit intermediary
Charges of Year Value Morbidity Charges of Year Value

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 1,37,047 5,945 895 1,231 1,31,764 1,24,684 13,70,469 5,945 908 1,234 1,34,503 1,27,423 13,70,469 -
2 1,37,047 6,155 2,574 1,571 2,66,528 2,60,628 13,70,469 6,155 2,658 1,586 2,77,370 2,71,470 13,70,469 -
3 1,37,047 6,411 4,291 1,926 4,04,311 3,99,591 13,70,469 6,411 4,516 1,967 4,29,080 4,24,360 13,70,469 -
4 1,37,047 6,699 6,046 2,294 5,45,149 5,42,789 13,70,469 6,699 6,489 2,374 5,90,160 5,87,800 13,70,469 -
5 1,37,047 6,963 7,840 2,665 6,89,147 6,89,147 13,70,469 6,963 8,584 2,798 7,61,242 7,61,242 13,70,469 -
6 - 7,464 8,730 2,915 6,97,228 6,97,228 13,70,469 7,464 9,850 3,117 8,00,917 8,00,917 13,70,469 -
7 - 8,218 8,827 3,068 7,04,607 7,04,607 13,70,469 8,218 10,361 3,344 8,42,215 8,42,215 13,70,469 -
8 - 9,131 8,913 3,248 7,11,075 7,11,075 13,70,469 9,131 10,891 3,604 8,85,044 8,85,044 13,70,469 -
9 - 10,163 8,987 3,447 7,16,469 7,16,469 13,70,469 10,163 11,440 3,889 9,29,358 9,29,358 13,70,469 -
10 - 11,315 9,047 3,665 7,20,620 7,20,620 13,70,469 11,315 12,008 4,198 9,75,107 9,75,107 13,70,469 -
11 - 12,431 9,091 3,874 7,23,538 7,23,538 13,70,469 12,431 12,594 4,504 10,22,426 10,22,426 13,70,469 -
12 - 13,329 9,121 4,041 7,25,455 7,25,455 13,70,469 13,329 13,203 4,776 10,71,681 10,71,681 13,70,469 -
13 - 14,188 9,138 4,199 7,26,391 7,26,391 13,70,469 14,188 13,837 5,045 11,23,044 11,23,044 13,70,469 -
14 - 14,983 9,144 4,343 7,26,401 7,26,401 13,70,469 14,983 14,499 5,307 11,76,728 11,76,728 13,70,469 -
15 - 15,651 9,138 4,462 7,25,612 7,25,612 13,70,469 15,651 15,193 5,552 12,33,038 12,33,038 13,70,469 -
16 - 16,166 9,124 4,552 7,24,187 7,24,187 13,70,469 16,166 15,922 5,776 12,92,328 12,92,328 13,70,469 -
17 - 16,500 9,103 4,609 7,22,328 7,22,328 13,70,469 16,500 16,691 5,974 13,55,010 13,55,010 13,70,469 -
18 - 17,303 9,073 4,748 7,19,463 7,19,463 13,70,469 17,303 17,500 6,265 14,20,728 14,20,728 13,70,469 -
19 - 18,807 9,024 5,010 7,14,729 7,14,729 13,70,469 18,807 18,344 6,687 14,88,823 14,88,823 13,70,469 -
20 - 20,502 8,950 5,301 7,07,851 7,07,851 13,70,469 20,502 19,216 7,149 15,59,212 15,59,212 13,70,469 -
*See Part B for details

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

I ALSO UNDERSTAND THAT WHILST 100% OF MY FIRST YEAR PREMIUM WILL BE INVESTED IN UNIT LINKED INVESTMENT FUNDS THERE ARE CHARGES DURING THE FIRST POLICY
YEAR AS GIVEN IN THE BENEFIT ILLUSTRATION.

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UIN: 104L098V05 Page 2 of 5
 I, ……………………………………………. (name), have explained the premiums, charges and I, Mandala (name), having received the information with respect to the above, have understood
benefits under the policy fully to the prospect / policyholder. the above statement before entering into the contract.

Place:
Date: 6/27/24 Signature / OTP Confirmation Date / Thumb Impression / Date:6/27/24 Signature / OTP Confirmation Date / Thumb Impression /
Electronic Signature of Agent/ Intermediary / Official Electronic Signature of Prospect/ Policyholder

This system generated benefit illustration shall be treated as signed by me.

Part B
Gross Yield 8% p.a. Net Yield 6.65% Amount in Rupees
Premium Annualized Premium - Policy
Policy Annualized Mortality Guarantee Other Additions to the Fund before Fund at End of Surrender Death
Allocation Premium Allocation GST Admin. FMC
Year Premium (AP) Charge Charge Charges* fund* FMC the Year Value Benefit
Charge (PAC) Charges Charge
1 1,37,047 - 1,37,047 5,945 1,234 - - - - 1,34,670 908 1,34,503 1,27,423 13,70,469
2 1,37,047 - 1,37,047 6,155 1,586 - - - - 2,77,713 2,658 2,77,370 2,71,470 13,70,469
3 1,37,047 - 1,37,047 6,411 1,967 - - - - 4,29,611 4,516 4,29,080 4,24,360 13,70,469
4 1,37,047 - 1,37,047 6,699 2,374 - - - - 5,90,891 6,489 5,90,160 5,87,800 13,70,469
5 1,37,047 - 1,37,047 6,963 2,798 - - - - 7,62,184 8,584 7,61,242 7,61,242 13,70,469
6 - - - 7,464 3,117 - - - - 8,01,909 9,850 8,00,917 8,00,917 13,70,469
7 - - - 8,218 3,344 - - - - 8,43,257 10,361 8,42,215 8,42,215 13,70,469
8 - - - 9,131 3,604 - - - - 8,86,140 10,891 8,85,044 8,85,044 13,70,469
9 - - - 10,163 3,889 - - - - 9,30,509 11,440 9,29,358 9,29,358 13,70,469
10 - - - 11,315 4,198 - - - - 9,76,314 12,008 9,75,107 9,75,107 13,70,469
11 - - - 12,431 4,504 - - - - 10,23,692 12,594 10,22,426 10,22,426 13,70,469
12 - - - 13,329 4,776 - - - - 10,73,008 13,203 10,71,681 10,71,681 13,70,469
13 - - - 14,188 5,045 - - - - 11,24,434 13,837 11,23,044 11,23,044 13,70,469
14 - - - 14,983 5,307 - - - - 11,78,185 14,499 11,76,728 11,76,728 13,70,469
15 - - - 15,651 5,552 - - - - 12,34,565 15,193 12,33,038 12,33,038 13,70,469
16 - - - 16,166 5,776 - - - - 12,93,928 15,922 12,92,328 12,92,328 13,70,469
17 - - - 16,500 5,974 - - - - 13,56,687 16,691 13,55,010 13,55,010 13,70,469
18 - - - 17,303 6,265 - - - - 14,22,487 17,500 14,20,728 14,20,728 13,70,469
19 - - - 18,807 6,687 - - - - 14,90,666 18,344 14,88,823 14,88,823 13,70,469
20 - - - 20,502 7,149 - - - - 15,61,142 19,216 15,59,212 15,59,212 13,70,469

62 of 68
UIN: 104L098V05 Page 3 of 5
 Gross Yield 4% p.a. Amount in Rupees
Premium Annualized Premium - Policy
Policy Annualized Mortality Guarantee Other Additions to the Fund before Fund at End of Surrender Death
Allocation Premium Allocation GST Admin. FMC
Year Premium (AP) Charge Charge Charges* fund* FMC the Year Value Benefit
Charge (PAC) Charges Charge
1 1,37,047 - 1,37,047 5,945 1,231 - - - - 1,31,927 895 1,31,764 1,24,684 13,70,469
2 1,37,047 - 1,37,047 6,155 1,571 - - - - 2,66,858 2,574 2,66,528 2,60,628 13,70,469
3 1,37,047 - 1,37,047 6,411 1,926 - - - - 4,04,811 4,291 4,04,311 3,99,591 13,70,469
4 1,37,047 - 1,37,047 6,699 2,294 - - - - 5,45,824 6,046 5,45,149 5,42,789 13,70,469
5 1,37,047 - 1,37,047 6,963 2,665 - - - - 6,90,000 7,840 6,89,147 6,89,147 13,70,469
6 - - - 7,464 2,915 - - - - 6,98,091 8,730 6,97,228 6,97,228 13,70,469
7 - - - 8,218 3,068 - - - - 7,05,479 8,827 7,04,607 7,04,607 13,70,469
8 - - - 9,131 3,248 - - - - 7,11,955 8,913 7,11,075 7,11,075 13,70,469
9 - - - 10,163 3,447 - - - - 7,17,356 8,987 7,16,469 7,16,469 13,70,469
10 - - - 11,315 3,665 - - - - 7,21,512 9,047 7,20,620 7,20,620 13,70,469
11 - - - 12,431 3,874 - - - - 7,24,434 9,091 7,23,538 7,23,538 13,70,469
12 - - - 13,329 4,041 - - - - 7,26,353 9,121 7,25,455 7,25,455 13,70,469
13 - - - 14,188 4,199 - - - - 7,27,290 9,138 7,26,391 7,26,391 13,70,469
14 - - - 14,983 4,343 - - - - 7,27,300 9,144 7,26,401 7,26,401 13,70,469
15 - - - 15,651 4,462 - - - - 7,26,510 9,138 7,25,612 7,25,612 13,70,469
16 - - - 16,166 4,552 - - - - 7,25,084 9,124 7,24,187 7,24,187 13,70,469
17 - - - 16,500 4,609 - - - - 7,23,222 9,103 7,22,328 7,22,328 13,70,469
18 - - - 17,303 4,748 - - - - 7,20,354 9,073 7,19,463 7,19,463 13,70,469
19 - - - 18,807 5,010 - - - - 7,15,614 9,024 7,14,729 7,14,729 13,70,469
20 - - - 20,502 5,301 - - - - 7,08,727 8,950 7,07,851 7,07,851 13,70,469

*There are no charges included in other charges. There are no additions included on Additions to the fund.
Notes: 1. Refer the sales literature for explanation of terms used in this illustration.
2. Fund management charge is based on the specific fund option(s) chosen.
3. In case rider charges are collected explicitly through collection of rider premium, and not by way of cancellation of units, then, such charges are not considered in this illustration. In other cases, rider charges are included in
other charges.

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UIN: 104L098V05 Page 4 of 5
 I, ……………………………………………. (name), have explained the premiums, charges and I, Mandala (name), having received the information with respect to the above, have understood
benefits under the policy fully to the prospect / policyholder. the above statement before entering into the contract.

Place:
Date: 6/27/24 Signature / OTP Confirmation Date / Thumb Impression / Date:6/27/24 Signature / OTP Confirmation Date / Thumb Impression /
Electronic Signature of Agent/ Intermediary / Official Electronic Signature of Prospect/ Policyholder

This system generated benefit illustration shall be treated as signed by me.

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UIN: 104L098V05 Page 5 of 5
 Premium Receipt
Receipt No.: 161476668JUN2401 | Receipt Date: 30-JUN-2024
Personal Details
Policy Number: 161476668 Email ID: [email protected]
Policyholder Name: Mr. Mandala Ganesh Kumar PAN Number: AVDPM5374K
Address: plot no 331 aeronagar pragthi nagar kukatpally pragathi nagar Customer GSTIN: Not Available
before ullas dhaba Current Residential State: Telangana
HYDERABAD- 500090
Telangana India
Mobile Number: 9912345070
Policy Details

Plan Name: Max Life Smart Wealth Advantage Guarantee Plan Policy Commencement Date: 30-JUN-2024
Life Insured: Mr. Mandala Ganesh Kumar Policy Term: 20 Years Premium Payment Term: 5 Years
Premium Payment Frequency: Monthly Date of Maturity: 30-JUN-2044 Modal Premium (incl. GST): ` 9,292.74
Late Payment Fee (incl GST): ` 0.00 Premium Received (incl. GST): ` 9,292.74
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (`) Rate Amount (`) Rate Amount (`) Rate Amount (`) M/S. Head Office Policy Bazaar Capital
Base 2,223.11 NA 0.00 NA 0.00 18% 400.16 Guarantee Solutio
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Total GST Value: ` 400.16
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132 1860 120 5577 or (0124) 4219090

Mudrank: Paid by e-Stamps Certificate no. 52/Issue Date: 18/04/2024/ Vide Treasury (E-CHALLAN) GRN NO.115370783

Minimum Guaranteed
Death Benefit (of base plan
and term rider (if any))
30-JUN-2024 to
` 11,41,404.33 ` 9,292.74 29-JUL-2024 30-JUL-2024
*Important Note:
1.For payment mode other than in cash, this receipt is conditional upon the credit in our account. Payment of premium amount does not constitute commencement of risk. The risk
commencement starts after acceptance of risk by us.
2.Amount received would be adjusted against the due premium as per terms and conditions of the policy.
3.Premiums may be eligible for tax benefits under section 80C/80CCC/80D/37(1) of the income Tax Act 1961. Kindly consult your tax advisor for more information. Tax benefits are liable
to change due to changes in legislation or government notification.
4.GST shall comprise CGST, SGST / UTGST or IGST (whichever is applicable) including cesses and levies, if any as per prevailing laws and shall be borne by you. For GST purposes, this premium
receipt is Tax invoice. Assessable Value in GST is premium as reduced by amount allocated for investment (if applicable). In other scenarios, assessable value for Endowment First Year is
25%, Renewal Year is 12.5%, Single Premium Annuity is 10%, Term and Health is 100%. Currently base GST rate is 18% apart from Cess in some states.
5.I/We hereby declare that though our turnover is more than the turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the said sub-rule.

Authorised Signatory
PRM20 PRODUCT UIN: 104N124V07
E.&O.E

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