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Proposal No.

: Illustration of benefits for Bharti AXA Life Aajeevan Sampatti UIN : 130N050V01 Product Code : WLP15R

Policy No.:

Illustration generated by: online Illustration Date: 19-04-2013

Benefits and Premium Details Plan Name Bharti AXA Life Aajeevan Sampatti Policy Benefit Period 75 years Premium Payment Term 15 years Premium Mode Annual Proposer Details Sum Assured (Rs.) 500000 Proposer Name : RAVIKIRAN POTTIMURTHY Death Benefit (Rs.) 500500 Benefit Up to age 100 years Proposer Gender : Male Annual Regular Premium (Rs.) 45500 Age as on last birthday : 25 years Modal Premium Payable (Rs.) 45500 Service Tax Plus Educational Cess payable in the 1st year 1406 Service Tax Plus Educational Cess payable 2nd year onwards 705 Total Premium Payable By You in first year (Rs.) 46906 Total Premium Payable By You 2nd year onwards(Rs.) 46205 Illustration summary with statement growth of the Fund expected over the duration of the policy with assumed gross investment rate of 6% & 10% per annum

Personal Details Life To Be Insured : RAVIKIRAN POTTIMURTHY Age as on last birthday : 25 years Gender : Male

Guaranteed Benefits End of Policy Year 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Annual Premium 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500 Death 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 Survival/Maturity 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500

Non Guaranteed Benefits at 6% Gross Investment Rate Per Annum Annual Cash Bonus 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 Surrender 58500 82000 107000 134500 164500 197500 233000 272000 284500 298500 313000 329500 347000 348000 349000 350000 351000 352500 353500 355000

Non Guaranteed Benefits at 10% Gross Investment Rate Per Annum Annual Cash Bonus 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 Surrender 58500 82000 107000 134500 164500 197500 233000 272000 284500 298500 313000 329500 347000 348000 349000 350000 351000 352500 353500 355000

Name of the Proposer: __________________________________________________

Signature of the Proposer: ________________________________

Insurance is the subject matter of the solicitation. Bharti AXA Life Insurance Company Limited, Regd. Office-Unit 601 & 602, 6th Floor, Raheja Titanium, Off Western Express Highway,Goregaon (E), Mumbai-400 063,

Regn no.-130 . Website: www.bharti-axalife.com Abacus Ver. 3.5 Page: 1 of 5

Guaranteed Benefits End of Policy Year 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 Annual Premium Death 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 500500 Survival/Maturity 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500 27500

Non Guaranteed Benefits at 6% Gross Investment Rate Per Annum Annual Cash Bonus 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 Surrender 356500 357500 359000 361000 362500 364000 366000 367500 369500 371500 374000 376000 378500 381000 383500 386000 388500 391500 394500 397500 400500 403500 406500 409500 412500 416000 419000 422000 425000 428000 430500 433500 436000 438500 441000 443500 445500 447500 449500 451500 453500 455500 457500 459500 461500

Non Guaranteed Benefits at 10% Gross Investment Rate Per Annum Annual Cash Bonus 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 32750 Surrender 356500 357500 359000 361000 362500 364000 366000 367500 369500 371500 374000 376000 378500 381000 383500 386000 388500 391500 394500 397500 400500 403500 406500 409500 412500 416000 419000 422000 425000 428000 430500 433500 436000 438500 441000 443500 445500 447500 449500 451500 453500 455500 457500 459500 461500

Name of the Proposer: __________________________________________________

Signature of the Proposer: ________________________________

Insurance is the subject matter of the solicitation. Bharti AXA Life Insurance Company Limited, Regd. Office-Unit 601 & 602, 6th Floor, Raheja Titanium, Off Western Express Highway,Goregaon (E), Mumbai-400 063,

Regn no.-130 . Website: www.bharti-axalife.com Abacus Ver. 3.5 Page: 2 of 5

Guaranteed Benefits End of Policy Year 68 69 70 71 72 73 74 75 Annual Premium Death 500500 500500 500500 500500 500500 500500 500500 500500 Survival/Maturity 27500 27500 27500 27500 27500 27500 27500 500000

Non Guaranteed Benefits at 6% Gross Investment Rate Per Annum Annual Cash Bonus 6000 6000 6000 6000 6000 6000 6000 Surrender 463500 466000 469000 472500 478000 486500 500000 -

Non Guaranteed Benefits at 10% Gross Investment Rate Per Annum Annual Cash Bonus 32750 32750 32750 32750 32750 32750 32750 Surrender 463500 466000 469000 472500 478000 486500 500000 -

This illustration is applicable only to employees of 'Bharti' and 'AXA' group of companies in India.

Name of the Proposer: __________________________________________________

Signature of the Proposer: ________________________________

Insurance is the subject matter of the solicitation. Bharti AXA Life Insurance Company Limited, Regd. Office-Unit 601 & 602, 6th Floor, Raheja Titanium, Off Western Express Highway,Goregaon (E), Mumbai-400 063,

Regn no.-130 . Website: www.bharti-axalife.com Abacus Ver. 3.5 Page: 3 of 5

EXPLANATION AND INFORMATION ------------------------------------------------------------------------------------------------------------------------Explanation Aajeevan Sampatti ------------------------------------------------------------------------------------------------------------------------1. This benefit illustration explains the benefits and features of the proposed policy and is not a contract of insurance. 2 .The illustrated values based on the assumption of 6% and 10% gross investment rates per annum are not guaranteed and are for illustration purpose only. 3. The illustration is based on the standard risk class , without taking in to consideration your own circumstances. They will be determined according to our underwriting decision. 4. Some benefits are guaranteed and some are variable with returns based on the future performance of the insurance company. If your policy offers guaranteed returns then these will be clearly marked as "guaranteed" in the illustration table. If your policy offers variable returns then the illustrations 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 dependant on a number of factors including future investment returns. 5. Guaranteed Benefits include Guaranteed Survival Benefit. Non Guaranteed benefits include Annual Cash Bonuses. 6. Guaranteed Surrender Value(GSV) at any time is 30%(Thirty percent)of all premiums paid to that point excluding the premium paid in the first policy year, all extra premiums and any taxes. The GSV is paid only if at least three full years' premium has been paid. Survival benefits already paid would be deducted from the GSV. 7. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale. 8. Tax benefits are as per the current tax legislations and are subject to change in tax laws. Neither the company nor its agents can offer legal or tax advice. 9. Bharti AXA Life Insurance Company Ltd., Bharti AXA Life Aajeevan Sampatti, is the name of the Insurance Company, Product and does not in any way indicate the quality of the contract, its future prospects or returns.

------------------------------------------------------------------------------------------------------------------------Explanation Hospi Cash Rider (if applicable) ------------------------------------------------------------------------------------------------------------------------1. This benefit illustration explains the benefit and features of the proposed rider and is not a contract of insurance. 2. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale. 3. Tax benefits are as per Income Tax Act 1961 and are subject to amendments from time to time. Service tax and education cess will be levied as per prevailing rates. Neither the company nor its agents can offer legal or tax advice. 4. The illustration is based on the standard risk class, without taking in to consideration your own circumstances. They will be determined according to our underwriting decision. 5. Daily Hospital Cash benefit (DHCB) is the guaranteed benefit payable on a minimum Hospitalization of 48 hours of the Life Insured during the policy Benefit Period subject to the Policy being in effect. 6. The Premium rates will be subject to revision after every three years (upwards or downwards) subject to experience and will be guaranteed for a period of three years. 7. Bharti AXA Life Insurance Company Ltd., Bharti AXA Life Hospi Cash is the name of the Insurance Company, Rider and does not in any way indicate the quality of the contract, its future prospects or returns. 8. All benefits payable under the rider are subject to the Waiting Period and other exclusions as applicable. Please read sales brochure in conjunction with this benefit illustration carefully before concluding a sale.

Declaration by Proposer
I confirm that before entering in to the contract of insurance I have read and understood the product brochure and the information provided in this Illustration of benefits and understand that the policy Bond will be issued to me on this basis. However, if my final choice of sum assured results in the actual premium paid (payable) being different to that illustrated above, the Company shall issue a revised illustration with the Policy bond. Name of Proposer : ___________________________ Place: ___________________ Signature of proposer : ____________________________ Date: ___________________

Declaration by Advisor / Sales Person


I certify that I have explained the product brochure and this benefit illustration to the proposer and have made no statements that are inconsistent with the same __________________________________ Name of the advisor/sales person _________________________________ Signature of the advisor/sales person

Insurance is the subject matter of the solicitation. Bharti AXA Life Insurance Company Limited, Regd. Office-Unit 601 & 602, 6th Floor, Raheja Titanium, Off Western Express Highway,Goregaon (E), Mumbai-400 063,

Regn no.-130 . Website: www.bharti-axalife.com Abacus Ver. 3.5 Page: 4 of 5

Bharti AXA Life Aajeevan Sampatti Key Feature Document


1. 2. Aim of the policy Type of policy Lifelong Guaranteed Annual Payouts with protection incase of death and benefits on maturity. Participating whole life policy. Participating policy participates in the performance of the participating insurance fund and the surplus if any is distributed as bonus. This is a limited premium payment policy while the cover continues till you reach the age of 100 years. 1. Benefits on maturity: The policy matures when the Life Insured reaches 100 years of age. On maturity the Sum Assured is payable as a lump sum subject to the policy being in-force 2. Benefits in case of survival: a) Guaranteed Annual Payouts: 5.5% of Sum Assured is paid every year starting from the end of the 10th policy year till maturity or death of the life insured (whichever is earlier) b) Annual Cash Bonuses: Bonuses (if declared) are payable from end of 6th policy year onwards till maturity or death of the life insured, whichever is earlier. 3. 4. Benefits in case of death: The Sum Assured is payable as a lump sum in case of death of the life insured. Additional Benefits: This is the optional benefit that can be added to your basic plan for extra protection Premium Waiver rider: This rider allows premium payments to be waived incase of an unfortunate event of death of the policyholder during the Premium payment term. Additional premium is required to be paid for these benefits. For more details on rider premium, please refer the rider brochure If the Life Insured commits suicide: 1. Within one year of the date of issuance of the Policy: Only the premiums paid till date will be payable and the policy will cease to exist. 2. Within one year of the date of reinstatement of the Policy: Surrender value will be paid and the policy will cease to exist. Policy acquires a surrender value if premiums have been paid for at least first three policy years. Minimum surrender value guaranteed: 30% of total amount of the premiums paid excluding premiums for the first year and all extra premiums. The company may declare surrender value that is higher than the guaranteed surrender value. No surrender value will be payable if you exit the policy in first three policy years. If you are not satisfied with the terms and conditions of the policy, you may return the policy within 15 days from the date of receipt of the policy document. 6. Free look Option The Policy will accordingly be cancelled and an amount equal to premiums paid less stamp duty and underwriting expenses incurred by the Company will be refunded. Loans (upto maximum of 70% of acquired surrender value) can be availed under the policy subject to policy provisions, if all premiums due under the policy are paid and the policy has acquired a surrender value. Refer your benefit illustration to know The premium payable to receive your Guaranteed Annual Payouts Frequency of Premium Payment, as selected by you. Premium Payment Term Number of years you need to pay the premiums. Service tax and education cess are applicable on the premium as per the prevailing rates. To know more about these charges please refer the Policy brochure.

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Policy Benefits

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Policy Exclusions

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Policy surrender

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Loans

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Benefit illustration

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Service tax

I confirm that I have understood the questions in the proposal form especially those related to personal, health, family history, occupation and income and answered them accordingly. I also understand that if there are any misstatements or non-disclosure in my answers, it might result in repudiation of claims. I am aware that under the Union Budget 2012-13, I would be eligible for Tax benefit under section 10(10D) of the IT Act, 1961and u/s 80C of the Income Tax Act 1961only if the annual premium payable under Bharti AXA Life Aajeevan Sampatti is upto 10% of the Base Sum Assured.I am fully aware of this fact and would like to proceed with purchasing this policy.

__________________________ Signature Of the Customer


For more details on risk factors, terms and conditions and detailed information please read sales brochure carefully.

Bharti AXA Life Insurance Company Limited, Registered Office: Unit no 601 & 602, 6th floor Raheja Titanium, Off Western Express Highway, Goregaon (E), Mumbai-400 063 www.bharti-axalife.com, Regn. No. 130, Comp-July-2012-2033, UIN: 130N050V01 Insurance is the subject matter of the solicitation

Abacus Ver. 3.5

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