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Aviva Life Insurance Company India Limited

Premium Quotation Version Number: 38.0 Prepared on: 20/2/2012

Age of the Life Insured:32 Gender: Male Product Features

1. 2. 3. 4. 5.

Name of the Product: Aviva LifeShield Platinum Unique Identification No.(UIN):122N089V01 Plan Option : Option C Premium Paying Frequency:Annual Cover Description and Premium:

Plan Base Plan

Sum Assured Coverage Term Premium Payment Term Modal Premium *Service Tax Total Amount 5000000 35 23 6600 680 Total Amount 7280 7280

6.

Base Plan - Option C

Death Benefit A lump sum benefit equal to Sum at Risk in-force as at the date of death. The Sum at Risk will be equal to: Sum Assured Minus (Sum Assured * No. of Policy Anniversaries Elapsed till the date of death) / Policy Term.

Notes:

*Service Tax or any other applicable taxes will be charged and/or deducted on/from the premium at the prevailing rate. Tax laws are subject to change. This illustration does not include any additional premium payable due to underwriting or effect of any ,applicable taxes on such premium. No survival Benefit/Maturity Benefit is payable under the policy. Policy will not acquire any surrender value or paid-up value during the premium payment term. After the premium payment term, if all premiums have already been paid in respect of Option-C then a special surrender value, as decided by the Company from time to time, shall be payable on premature surrender of the policy. For more details on risk factors and terms & conditions please read sales brochure carefully before concluding a sale.

I ______________________, having received the information with respect to the above, have understood the above statement before entering into the contract.

FPAs / FPCs Signature Company Seal

Policyholders Signature: Place: Date:

Aviva Life Shield Platinum

What is Aviva Life Shield Platinum?

Important points you must know about this policy

Aviva Life Shield Platinum protects your family for a certain period of time or term. If you die within that period of time, your family (the beneficiary) is paid the amount of the policy. Your base premium will not increase through the life of the policy if you continue paying all premiums on time. The service tax however is What is the guarantee under this plan? subject to change. You can select a term between 10-52 years subject to maturity ages defined for each option. 70 years last birthday (without Riders) What is the Term of this policy? 65 years last birthday (with Aviva DD Rider) 60 years last birthday (with ADB Rider / both riders) You have selected the policy term of 35 years. The Premium Paying Term depends upon the option selected by you : Option A: Same as the Policy Term What are the Premium Payment Term options Options B & C: Two third of policy term (rounded down to nearest integer) under this plan? The premium payment frequency allowed is Yearly, Half Yearly, Quarterly & Monthly for Regular Premium option. (For Quarterly & monthly mode ECS or Direct Debit is mandatory) You have to pay premiums regularly for 23 years at Annual frequency as opted by you. Death Benefit Option A: Sum Assured (SA) will be payable on death and the policy will terminate. Option B: A monthly amount chosen at inception duly inflated @ 5% compounding annually. Option C: A lump sum benefit equal to death cover applicable as on date of death is payable. Sum Assured under this option is reducing in What are the benefits under this plan? nature. Maturity Benefit: This being a pure insurance policy, there is no maturity benefit. Rider Benefits: Are applicable as per the riders opted by you. You have chosen Option C.
What happens if I stop paying my premiums? Should you discontinue paying premiums; the policy will be terminated without any benefit or value. Can I cash in (surrender) the policy during the Payment Term, if all due premiums have been paid in respect of Option-B or Option-C, then a Special Surrender Value, as decided by the term of the policy? What is not covered under this policy (Exclusions)? Do I have a right to review my purchase?

The policy will not acquire any surrender value or paid up value during Premium Payment Term under any of the options. After the Premium Company from time to time, shall be payable on premature surrender. Please refer to the Key Feature brochure for details. No benefit will be paid in case of death because of actual or attempted suicide within one year from the date of issuance of policy or date of revival. Please refer rider key features for rider exclusions. You have Freelook Period of 15 days from the date you receive your policy document. In case you do not agree with terms and conditions, you may cancel the policy where the premium you have paid will be refunded after deducting proportionate risk charges, stamp duty and cost of medical examination, if any.

We request you to personally fill the proposal form and provide accurate information to ensure that your claim is not reduced or declined because of non-disclosure or misrepresentation of information. Please note: Aviva is not liable for any claim until receipt of premium in full, completion of underwriting and acceptance of risk. This document does not contain the full terms and conditions of the Policy.Details of the terms and conditions, and exclusions of the insurance contract are contained in the Key Feature brochure. It is important that you read the entire Key Feature brochure. I confirm that I have read the Key Feature brochure along with this document and understand the features such as policy benefits, premium payable including the number of years for which premium is required to be paid. Signature of Life Assured Signature of the Proposer (In case different from Proposer) Proposer name Proposal number Name of Life Assured Proposal Date