Lip

Life Partner Plus
UIN- 104N029V01
A Non- Linked, Participating Life Insurance Plan
Policy/Proposal No:[ _________________ ]
Date of Illustration - Dec 3, 2012 1:07:14 PM
Insured
Age at inception of Policy
Sex
Female
Class
Standard
Face Amount
Rs 1,49,775
Bonus Option
Paid Up Additions
Payment Mode
Annual Billed
Payor Name
Payor Age
35
Payor Sex
Male
Premium Payment Term
20 Pay
PREMIUM SUMMARY
First Year Premium
Renewal Premium
Basic Premium
Rs
9,548.16
9,548.16
Payor Benefit Rider (UIN NO: 104B013V02) -Rating 1.00
Rs
452.09
452.09
TOTAL
Rs
10,000.25
10,000.25
Service Tax on Base Premium & Rider Premium(s), if any
Rs
350.92
203.40
Total Premium (inclusive of Service Tax)
Rs
10,351.17
10,203.65
Signature of Agent/Specified Person/Principal officer:___________________________________________
Policy Holders Signature:___________________________________________
This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 6% and 10% are used as an illustration.
MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002
Page 1 of 5
YEARLY ILLUSTRATIVE DETAILS

The following ledger provides year by year illustrative figures for premiums required, for the policy that you have chosen.
General Details
Year
Guaranteed
Age
Non Guaranteed (Assumed Rate of return on investment of funds at 6% p.a.)
Annual
Premium
Death
Benefit
Surrender
Value
Money
Back
Payments
Net
Outlay
( Rs )
( Rs )
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
10,000
9,548
10,000
10,000
5
6
Non Guaranteed (Assumed Rate of return on investment of funds at 10%p.a.)
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
Net
Outlay
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(BOY)
10,000
9,548
19,383
10,000
29,512
8,766
10,000
19,383
29,512
1,433
10,000
39,946
11,747
10,000
60,970
10,000
50,692
14,756
10,000
61,761
17,796
10,000
10,000
10,000
73,162
20,868
10,000
10,000
84,905
10,000
97,001
23,970
27,102
10
10
10,000
11
11
10,000
1,49,775
30,265
1,49,775
33,461
12
12
10,000
1,49,775
13
14
13
10,000
14
10,000
15
15
16
17
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
10,000
9,548
10,000
8,766
10,000
988
1,489
13,236
85,664
1,254
2,574
1,13,763
1,529
3,982
1,45,132
1,813
10,000
1,79,636
10,000
2,17,128
10,000
10,000
36,689
1,49,775
39,948
1,49,775
43,240
10,000
1,49,775
16
10,000
17
10,000
18
18
19
19
20
19,383
29,512
2,868
8,766
10,000
82,014
2,059
2,979
14,726
17,330
10,000
1,21,837
2,655
5,237
19,993
21,778
10,000
1,68,970
3,289
8,209
26,005
5,732
26,601
10,000
2,23,329
3,964
11,961
32,829
2,104
7,849
31,819
10,000
2,84,843
4,682
16,567
40,537
2,407
10,359
37,460
10,000
3,53,440
5,446
22,113
49,215
2,97,816
2,717
13,288
43,553
10,000
4,69,376
6,261
28,687
58,952
3,28,084
3,039
16,652
50,114
10,000
5,39,130
7,129
36,362
69,823
10,000
3,60,620
3,369
20,477
57,166
10,000
6,15,466
8,052
45,228
81,917
10,000
3,95,313
3,711
24,775
64,723
10,000
6,98,371
9,032
55,353
95,301
10,000
4,32,094
4,064
29,590
72,830
10,000
7,87,882
10,086
66,880
1,10,120
46,567
10,000
4,70,870
4,428
34,948
81,515
10,000
8,84,115
11,202
79,926
1,26,492
1,49,775
49,925
10,000
5,11,554
4,809
40,881
90,806
10,000
9,87,039
12,396
94,611
1,44,535
1,49,775
53,317
10,000
5,54,108
5,196
47,436
1,00,753
10,000
10,96,742
13,677
1,11,098
1,64,415
9,548
1,49,775
56,742
9,548
5,98,396
5,601
54,638
1,11,380
9,548
12,13,322
15,041
1,29,529
1,86,272
9,548
1,49,775
60,204
9,548
6,44,384
6,018
62,533
1,22,737
9,548
13,36,821
16,502
1,50,078
2,10,282
20
9,548
1,49,775
60,806
9,548
6,91,987
6,450
71,165
1,31,971
9,548
14,67,342
18,058
1,72,931
2,33,736
21
21
1,49,775
61,414
7,41,133
6,660
80,584
1,41,998
16,04,923
19,268
1,98,293
2,59,707
22
22
1,49,775
62,028
7,90,007
6,882
90,586
1,52,614
17,46,320
20,559
2,25,895
2,87,923
23
23
1,49,775
62,648
8,38,648
7,106
1,01,209
1,63,857
18,91,622
21,949
2,55,912
3,18,560
24
24
1,49,775
63,274
8,87,015
7,345
1,12,495
1,75,769
20,41,014
23,431
2,88,584
3,51,858
25
25
1,49,775
63,906
9,35,147
7,590
1,24,489
1,88,395
21,94,570
25,045
3,24,120
3,88,026
26
26
1,49,775
64,546
9,83,031
7,852
1,37,221
2,01,766
23,52,575
26,786
3,62,757
4,27,303
Page 2 of 5
General Details
Year
Guaranteed
Age
Annual
Premium
Death
Benefit
Surrender
Value
Money
Back
Payments
Net
Outlay
( Rs )
( Rs )
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
Net
Outlay
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(BOY)
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
27
27
1,49,775
65,191
10,30,712
8,124
1,50,755
2,15,946
25,15,233
28,662
4,04,801
4,69,992
28
28
1,49,775
65,843
10,78,182
8,403
1,65,136
2,30,978
26,82,721
30,684
4,50,535
5,16,378
29
29
1,49,775
66,502
11,25,423
8,691
1,80,417
2,46,918
28,55,227
32,861
5,00,292
5,66,794
30
30
1,49,775
67,167
11,72,423
8,999
1,96,655
2,63,822
30,32,930
35,203
5,54,431
6,21,597
31
31
1,49,775
67,838
12,19,220
9,317
2,13,910
2,81,748
32,15,993
37,753
6,13,305
6,81,143
32
32
1,49,775
68,516
12,65,801
9,645
2,32,211
3,00,728
34,04,740
40,497
6,77,261
7,45,777
33
33
1,49,775
69,202
13,12,154
9,994
2,51,597
3,20,799
35,99,372
43,446
7,46,665
8,15,867
34
34
1,49,775
69,894
13,58,328
10,355
2,72,142
3,42,036
38,00,093
46,653
8,21,979
8,91,873
35
35
1,49,775
70,593
14,04,312
10,738
2,93,875
3,64,469
40,07,272
50,099
9,03,619
9,74,212
36
36
1,49,775
71,299
14,50,154
11,134
3,16,863
3,88,162
42,21,141
53,799
9,92,070
10,63,369
37
37
1,49,775
72,012
14,95,847
11,543
3,41,162
4,13,174
44,41,927
57,814
10,87,846
11,59,858
38
38
1,49,775
72,732
15,41,390
11,976
3,66,816
4,39,548
46,70,035
62,122
11,91,495
12,64,228
39
39
1,49,775
73,459
15,86,823
12,423
3,93,881
4,67,339
49,05,712
66,743
13,03,555
13,77,014
40
40
1,49,775
74,194
16,32,148
12,883
4,22,417
4,96,611
51,49,221
71,746
14,24,642
14,98,836
41
41
1,49,775
74,935
16,77,357
13,372
4,52,470
5,27,405
54,00,997
77,106
15,55,412
16,30,347
42
42
1,49,775
75,684
17,22,503
13,876
4,84,180
5,59,864
56,61,314
82,903
16,96,782
17,72,467
43
43
1,49,775
76,442
17,67,577
14,411
5,17,600
5,94,042
59,30,602
89,167
18,49,518
19,25,960
44
44
1,49,775
77,206
18,12,619
14,961
5,52,812
6,30,018
62,09,302
95,875
20,14,490
20,91,696
45
45
1,49,775
77,979
18,57,621
15,544
5,89,839
6,67,817
64,97,691
1,03,115
21,92,380
22,70,359
46
46
1,49,775
78,758
19,02,628
16,145
6,28,766
7,07,524
67,96,254
1,10,860
23,84,158
24,62,916
47
47
1,49,775
79,546
19,47,636
16,762
6,69,631
7,49,177
71,05,306
1,19,209
25,90,657
26,70,203
48
48
1,49,775
80,341
19,92,640
17,418
7,12,489
7,92,829
74,25,364
1,28,131
28,12,888
28,93,229
49
49
1,49,775
81,145
20,37,693
18,093
7,57,414
8,38,559
77,56,778
1,37,815
30,51,854
31,32,999
50
50
1,49,775
81,955
20,82,791
18,806
8,04,483
8,86,438
81,00,294
1,48,084
33,08,847
33,90,802
51
51
1,49,775
82,776
21,27,978
19,542
8,53,793
9,36,569
84,56,112
1,59,210
35,85,015
36,67,791
52
52
1,49,775
84,400
21,73,256
20,318
9,05,427
9,89,826
88,24,995
1,71,090
38,81,814
39,66,214
53
53
1,49,775
90,774
22,18,664
21,120
9,59,509
10,50,284
92,07,352
1,83,857
42,00,723
42,91,497
54
54
1,49,775
97,668
22,64,204
21,967
10,16,152
11,13,820
96,03,784
1,97,478
45,43,408
46,41,076
55
55
1,49,775
1,05,136
23,09,913
22,841
10,75,489
11,80,625
1,00,14,700
2,12,197
49,11,549
50,16,685
Page 3 of 5
General Details
Year
Guaranteed
Age
Annual
Premium
Death
Benefit
Surrender
Value
Money
Back
Payments
Net
Outlay
( Rs )
( Rs )
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
Net
Outlay
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(BOY)
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
56
56
1,49,775
1,13,237
23,55,789
23,764
11,37,686
12,50,923
1,04,40,900
2,27,997
53,07,339
54,20,577
57
57
1,49,775
1,22,040
24,01,868
24,717
12,02,910
13,24,950
1,08,82,995
2,44,840
57,32,935
58,54,974
58
58
1,49,775
1,31,622
24,48,143
25,722
12,71,549
14,03,171
1,13,41,384
2,63,118
61,91,646
63,23,268
59
59
1,49,775
1,42,069
24,94,637
26,783
13,43,700
14,85,769
1,18,16,979
2,82,713
66,85,775
68,27,844
60
60
1,49,775
1,42,244
11,233
25,41,376
27,880
14,19,439
15,61,683
1,23,10,336
3,03,829
72,17,414
73,59,659
61
61
1,49,775
1,42,442
11,233
-11,233
25,88,350
28,427
14,98,919
16,41,361
-11,233
1,28,22,255
3,25,227
77,89,393
79,31,835
62
62
1,49,775
1,42,664
11,233
-11,233
26,34,598
29,012
15,81,714
17,24,377
-11,233
1,33,51,363
3,48,396
84,03,471
85,46,134
63
63
1,49,775
1,42,912
11,233
-11,233
26,80,175
29,635
16,68,014
18,10,927
-11,233
1,38,98,682
3,73,196
90,63,142
92,06,054
64
64
1,49,775
1,43,194
11,233
-11,233
27,25,132
30,298
17,58,093
19,01,287
-11,233
1,44,64,825
3,99,864
97,72,312
99,15,506
65
65
1,49,775
1,43,513
11,233
-11,233
27,69,514
30,975
18,52,286
19,95,799
-11,233
1,50,50,569
4,28,671
1,05,35,607
1,06,79,119
66
66
1,49,775
1,43,869
11,233
-11,233
28,13,322
31,713
19,51,847
20,95,717
-11,233
1,56,56,850
4,59,916
1,13,63,585
1,15,07,454
67
67
1,49,775
1,44,278
11,233
-11,233
28,56,599
32,522
20,56,130
22,00,409
-11,233
1,62,84,465
4,93,622
1,22,56,072
1,24,00,350
68
68
1,49,775
1,44,749
11,233
-11,233
28,99,413
33,347
21,65,835
23,10,584
-11,233
1,69,34,301
5,30,287
1,32,20,835
1,33,65,584
69
69
1,49,775
1,45,292
11,233
-11,233
29,41,749
34,239
22,81,629
24,26,921
-11,233
1,76,07,528
5,69,790
1,42,66,650
1,44,11,942
70
70
1,49,775
1,45,924
11,233
-11,233
29,83,647
35,204
24,04,483
25,50,408
-11,233
1,83,04,765
6,13,030
1,54,04,146
1,55,50,070
71
71
1,49,775
1,46,661
11,233
-11,233
30,25,137
36,237
25,35,667
26,82,328
-11,233
1,90,27,269
6,60,113
1,66,47,307
1,67,93,968
72
72
1,49,775
1,47,528
11,233
-11,233
30,66,229
37,371
26,76,780
28,24,308
-11,233
1,97,75,815
7,12,095
1,80,13,172
1,81,60,701
73
73
1,49,775
1,48,554
11,233
-11,233
31,06,946
38,602
28,29,836
29,78,390
-11,233
2,05,51,670
7,69,369
1,95,23,389
1,96,71,944
74
74
1,49,775
1,61,008
11,233
-11,233
31,47,285
39,960
29,97,510
31,58,518
-11,233
2,13,55,659
8,33,398
2,12,05,884
2,13,66,892
Rs 1,61,008
Maturity Value:
Rs 31,98,478
Rs 2,22,00,290
NOTES:
(BOY) - Beginning of Year Value (EOY) - End of Year value
Page 4 of 5
Important Notes:
-- 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. Bonuses (if applicable and shown in the illustration) are not guaranteed, and bonus rates will be based on
the actual company experience from time to time.
-- 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 illustration table on this page. If your policy offers variable returns then the illustrations on this page will show the 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 future investment performance.
-- Benefits secured under your Policy shall become payable provided all contractual premiums are paid as and when they are due. The illustrative benefits above assume that all the contractual premiums will be paid on the due dates.
-- Please refer to the product brochures, for understanding the product features and explanation of the terms used in this illustration.
-- Service Tax and Education Cess would be levied as per applicable laws.
-- You may be entitled to certain applicable tax benefits on your premiums and Policy benefits. Please note that all the tax benefits are subject to tax laws prevailing at the time of payment of premium or receipt of benefits by you. As per the recent Union
Budget 2012 proposals, effective April 1, 2012, your Policy may be entitled to certain tax benefits or subject to deductions. We request you to please consult with your tax consultant for more information before concluding the sale.
I ________________________________________________________ (Name), having received the information with respect to the above, have understood the above statement before entering into the contract.
Signature of Agent/Specified Person/Principal Officer:
Policy Holders Signature:
Name and ID:
Policy Holders Name:
Place:
Date:
Date:
Company Seal:
2010.1.2.8.6.57.39agency111149775112383 100000001000000 10000018001000000 10000 2
Page 5 of 5

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Life Partner Plus

Premium Payment Term

Payor Benefit Rider (UIN NO: 104B013V02) -Rating 1.00

Service Tax on Base Premium & Rider Premium(s), if any

Total Premium (inclusive of Service Tax)

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

YEARLY ILLUSTRATIVE DETAILS

Non Guaranteed (Assumed Rate of return on investment of funds at 6% p.a.)

Non Guaranteed (Assumed Rate of return on investment of funds at 10%p.a.)

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

Non Guaranteed (Assumed Rate of return on investment of funds at 6% p.a.)

Non Guaranteed (Assumed Rate of return on investment of funds at 10%p.a.)

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

Non Guaranteed (Assumed Rate of return on investment of funds at 6% p.a.)

Non Guaranteed (Assumed Rate of return on investment of funds at 10%p.a.)

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

Signature of Agent/Specified Person/Principal Officer:

Policy Holders Signature:

Name and ID:

Policy Holders Name:

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