Proposal No.

: Illustration of benefits for Bharti AXA Life Family Income Secure

UIN : 130N038V01 Product Code : FISH20 Personal Details Life To Be Insured : MAHENDER KUNTLURU Age as on last birthday : 29 years Gender : Male Occupation : Salaried - Private Education : Post Graduate Annual Income : Rs 1 lakh - Rs 2.99 lakh Proposer Details Proposer Name : Proposer Gender : Age as on last birthday : YOUR BENEFIT AND PREMIUM PAYABLE BENEFIT NAME BENEFIT UP TO AGE Total Annual Income Annual Regular Premium 11548.75

Policy No.:

Illustration generated by: netambit Illustration Date: 05-09-2011 Illustration Details Policy Benefit Period : 20 years Premium Payment Term : 20 years Premium Mode : Semi Annual

- Bharti AXA Life Family Income Secure - Service Tax Plus Educational Cess YOUR TOTAL PREMIUM PAYABLE IS Explanation
1. 2. 3. 4. 5. 6. 7.

49 years

2500000.00

Premium as Maturity per the Mode Benefit(Rs.) Chosen By You 5774.38 230975.00 89.50 5863.88

8.

This benefit illustration explains the benefit and feature of the proposed product and is not a contract of insurance. For more details on risk factors,terms and conditions please read sales brochure carefully before concluding a sale. 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. 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. The annual income is the guaranteed benefit payable to the nominee on the death of the Life Insured for the next 20 years subject to the Policy being in effect. The Surrender Value payable is 30% of total premiums paid till the reciept of surrender request excluding first years' premium and extra premium 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. Bharti AXA Life Insurance Company Ltd., Bharti AXA Life Family Income Secure, 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.

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. 3.0 Page: 1 of 2

Bharti AXA Life Family Income Secure (UIN: 130N038V01)

Bharti AXA Life Family Income Secure is a traditional non participating term plan, under this product: (a) The premium is paid on a regular basis as per premium mode chosen by you. (b) 100% of the total premiums paid, returned on maturity subject to the policy being in force. (c) A yearly annual income is paid to the nominee for the next 20 years in case of unfortunate event of death of the Life Insured. What you need to know about your policy 1. Premium Payment Term: This is a regular premium payment policy and you need to pay the premium through out the policy term in order to achieve the desired goals. 2. Grace Period: You have a grace period of 30 days to pay your premiums incase you have missed the premium due date. 3. Benefit Illustration: It is strongly recommended that you ask your sales representative for the customised benefit illustration, which clearly reflects: Total Annual Income chosen by you at inception. The Total Annual income is the aggregate of the annual income payable to the nominee over 20 years incase of the unfortunate demise of the Life insured. Premium payable as per your Annual Income and policy term chosen by you. Premium mode -Frequency of Premium Payment. Premium Payment Term Number of years you need to pay the premiums. What happens on the death of the Life Insured? In case of the unfortunate event of death of the Life Insured an annual income payout will be made to the nominee, every year for the next 20 years, irrespective of the term of the policy. What happens on Maturity? 100% of the premiums paid under the policy are returned on Maturity subject to the policy being in force. Information Important to know Discontinuance of Premium/ Reinstatement We suggest you pay all your regular premiums on time, in order to meet your original objective of buying this product. However, even if due to some reason, you stop paying premium after the grace period of 30 days, The benefits under the Policy will be stopped and the policy will lapse. You can apply for reinstatement of the lapsed Policy within two years from the date of the first unpaid premium. This can be done by resuming premium payment and paying all the unpaid premiums. Free Look Option: If you disagree with any of the terms and conditions of the Policy, you will have the option to return the original Policy Bond along with a letter stating reasons for the objection within 15 days of receipt of the Policy Bond. Surrender Value : The policy acquires a surrender value if premiums have been paid for the first three policy years. The Surrender Value payable is 30% of total premiums paid till the receipt of surrender request excluding first years' premium and extra premium (if any) Termination of the Policy : The Policy will terminate on the earliest of the following: a) The Maturity Date of the Policy; b) At the end of period allowed for reinstatement of the Policy in case the Policy is not reinstated c) The date of intimation of death of the Life Insured. Service Tax: 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.

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.

__________________ Signature of the Customer

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

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 UIN :130N038V01, Advt. No. II -Sept2010-106 Abacus Ver. 3.0 Page: 2 of 2