Max Life Platinum Protect II UIN No:104N060V02 Non-Participating Regular Pay Term Insurance Plan Policy/Proposal No:[_________________] Date

of Illustration : Jan 23, 2014 7:11:23 PM

Personal Details Policyholder Life Insured Age of Life Insured at Policy Inception Gender Risk Class 28 Years Male Non-Smoker Policy Term (Years) Premium Paying Term (Years) Premium Paying Mode Sum Assured State Product Features 30 30 Annual Rs 25,00,000 Other

Premium Summary
Modal Premium Service Tax including Cess on Modal Premium Total Modal Premium (Inclusive of Service Tax & Cess) Total Annualised Premium (exclusive of Service Tax and Cess) Total Annualised Premium (inclusive of Service Tax and Cess) Rs 5,850.00 Rs 723.06 Rs 6,573.06 Rs 5,850.00 Rs 6,573.06

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 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 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 future investment performance.

MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

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YEARLY ILLUSTRATIVE DETAILS (This shall form a part of the policy document)
All cash flows are in Rs General Details Policy Year Age of Life Insured Annualised Premium Base Death Benefit Guaranteed Benefits** Reduced Insurance Cover (Payable on Death if applicable)* 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,25,000 7,08,333 7,91,667 8,75,000 9,58,333 10,41,667 11,25,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49

6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573

MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

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YEARLY ILLUSTRATIVE DETAILS (This shall form a part of the policy document)
General Details Policy Year Age of Life Insured Annualised Premium Base Death Benefit Guaranteed Benefits** Reduced Insurance Cover (Payable on Death if applicable)* 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 25,00,000 12,08,333 12,91,667 13,75,000 14,58,333 15,41,667 16,25,000 17,08,333 17,91,667

23 24 25 26 27 28 29 30

50 51 52 53 54 55 56 57

6,573 6,573 6,573 6,573 6,573 6,573 6,573 6,573

* A policy becomes eligible for a "Reduced Insurance Cover " from policy year 16 onwards in case policyholder discontinues premium payment after paying premiums for first 15 years at least.This feature is only available for policy terms 20, 25 or 30 years.For eligible policies, the "Reduced Insurance Cover " increases with the number of premiums paid before the policyholder discontinues paying the premiums. ** There is no surrender or maturity value available under this plan.

MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

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Important Notes: -- Please refer to the product brochures, for the 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/ your nominee. I ________________________________________________________ (Name), have explained the terms and conditions and the benefits of the policy to the prospect/policyholder. Signature of Agent/Specified Person: Name and ID: Place: Date: Company Seal: I _____________________________________________________________________________________ (Name), having received the information with respect to the above, have understood the above statement before entering into the contract. I understand and intend to continue paying the above said premium amount for the complete Premium Payment Period and as per the opted frequency. Policy Holders Signature: Policy Holders Name: Date:

2010.1.2.8.6.59.21pnmgdm10428125000001122000 100000001000000 10000018001000000 0

MAX LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

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