BENEFIT ILLUSTRATION

Tata AIA Life Insurance Sampoorna Raksha Supreme

Name of the Prospect/Policyholder : Uppuluri Venkata Sri Harsha Proposal No: 70004500247
Age (years) : 22 Name of the Product: Tata AIA Life Insurance Sampoorna Raksha Supreme
Gender : Male Tag Line: Non-Linked, Non-Participating Life Insurance Plan
Name of the Life Assured : Uppuluri Venkata Sri Harsha Unique Identification Number: 110N160V03
Age (years) : 22 GST Rate : 18.00%
Gender : Male
Policy Term : 60 Years 00 Months
Premium Payment Term : 12 Years 00 Months
Amount of Instalment Premium (Rs.) : 30,798
Mode of Payment of Premium : Annual
Smoker: No
Income Start Age (years): NA
Income Rate: NA
Credit Interest Rate: NA

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.
Policy Details
Policy Option: Life option Lumpsum(Rs): 1,00,00,000
Sum Assured (Rs): 1,00,00,000 Income p.a (Rs): 0
Sum Assured on Death (at inception of the policy) 1,00,00,000 Income Duration (months): 0
(Rs):

Rider Details
Tata AIA Vitality (Wellness Program): No
Details of Life Insured/Partner under the Benefit Option Benefit Payout Return Benefit Premium Sum Premium Year 1
Rider Name / UIN^(Benefit Option / Benefit Payout Income Income of p.a. Discount
Option) Name Age(yrs) Gender Lumpsum p.a. Duration premium Option Payment Assured without
(Rs.)
(Rs.) (yrs) option Term Term (Rs.) GST (Rs.) (Rs.)

Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium without GST (Rs.) 26,100 0 26,100
Instalment Premium with First year GST (Rs.) 30,798 0 30,798
Instalment Premium post applicable discount with First year GST (Rs.) 30,798 0 30,798
Instalment Premium with GST 2nd year onwards (Rs.) 30,798 0 30,798
 (Amount in Rupees).

Guaranteed# Non - Guaranteed

Policy Year Single/ Annualized Premium
Survival Benefit / Loyalty Additions Other Benefits, if any Maturity Benefit Death Benefit Min Guaranteed Surrender Value Special Surrender Value
1 26,100 0 0 0 1,00,00,000 0 0
2 26,100 0 0 0 1,00,00,000 20,880 0
3 26,100 0 0 0 1,00,00,000 31,320 0
4 26,100 0 0 0 1,00,00,000 41,760 0
5 26,100 0 0 0 1,00,00,000 52,200 0
6 26,100 0 0 0 1,00,00,000 62,640 0
7 26,100 0 0 0 1,00,00,000 73,080 0
8 26,100 0 0 0 1,00,00,000 83,520 0
9 26,100 0 0 0 1,00,00,000 93,960 0
10 26,100 0 0 0 1,00,00,000 1,04,400 0
11 26,100 0 0 0 1,00,00,000 1,14,840 0
12 26,100 0 0 0 1,00,00,000 1,25,280 0
13 0 0 0 0 1,00,00,000 1,12,752 0
14 0 0 0 0 1,00,00,000 1,03,356 0
15 0 0 0 0 1,00,00,000 93,960 0
16 0 0 0 0 1,00,00,000 87,696 0
17 0 0 0 0 1,00,00,000 78,300 0
18 0 0 0 0 1,00,00,000 72,036 0
19 0 0 0 0 1,00,00,000 68,904 0
20 0 0 0 0 1,00,00,000 62,640 0
21 0 0 0 0 1,00,00,000 59,508 0
22 0 0 0 0 1,00,00,000 53,244 0
23 0 0 0 0 1,00,00,000 50,112 0
24 0 0 0 0 1,00,00,000 46,980 0
25 0 0 0 0 1,00,00,000 43,848 0
26 0 0 0 0 1,00,00,000 40,716 0
27 0 0 0 0 1,00,00,000 37,584 0
28 0 0 0 0 1,00,00,000 34,452 0
29 0 0 0 0 1,00,00,000 34,452 0
30 0 0 0 0 1,00,00,000 31,320 0
31 0 0 0 0 1,00,00,000 28,188 0
32 0 0 0 0 1,00,00,000 28,188 0
33 0 0 0 0 1,00,00,000 25,056 0
34 0 0 0 0 1,00,00,000 25,056 0
35 0 0 0 0 1,00,00,000 21,924 0
36 0 0 0 0 1,00,00,000 21,924 0
37 0 0 0 0 1,00,00,000 18,792 0
38 0 0 0 0 1,00,00,000 18,792 0
39 0 0 0 0 1,00,00,000 15,660 0
 (Amount in Rupees).

Guaranteed# Non - Guaranteed

Policy Year Single/ Annualized Premium
Survival Benefit / Loyalty Additions Other Benefits, if any Maturity Benefit Death Benefit Min Guaranteed Surrender Value Special Surrender Value
40 0 0 0 0 1,00,00,000 15,660 0
41 0 0 0 0 1,00,00,000 15,660 0
42 0 0 0 0 1,00,00,000 12,528 0
43 0 0 0 0 1,00,00,000 12,528 0
44 0 0 0 0 1,00,00,000 12,528 0
45 0 0 0 0 1,00,00,000 9,396 0
46 0 0 0 0 1,00,00,000 9,396 0
47 0 0 0 0 1,00,00,000 9,396 0
48 0 0 0 0 1,00,00,000 9,396 0
49 0 0 0 0 1,00,00,000 6,264 0
50 0 0 0 0 1,00,00,000 6,264 0
51 0 0 0 0 1,00,00,000 6,264 0
52 0 0 0 0 1,00,00,000 6,264 0
53 0 0 0 0 1,00,00,000 3,132 0
54 0 0 0 0 1,00,00,000 3,132 0
55 0 0 0 0 1,00,00,000 3,132 0
56 0 0 0 0 1,00,00,000 3,132 0
57 0 0 0 0 1,00,00,000 3,132 0
58 0 0 0 0 1,00,00,000 0 0
59 0 0 0 0 1,00,00,000 0 0
60 0 0 0 0 1,00,00,000 0 0

Note: "Annualized Premium” shall be the premium payable in a year under a non-single pay option chosen by the policyholder, excluding the taxes, rider premiums, underwriting extra premiums, loading for
modal premiums, if any.
"Single Premium” shall be the premium payable under a single pay option chosen by the policyholder, excluding the taxes, rider premiums, underwriting extra premiums, if any.
#The benefits illustrated are as at the end of the policy year.

I, …...................... (name), have explained the premiums and benefits under the product fully to the I, Uppuluri Venkata Sri Harsha, having received the information with respect to the above, have
prospect / policyholder. understood the above statement before entering into the contract.

Place:
Date: 14 Dec 2022 Date: 14 Dec 2022
Signature of Agent / Intermediary / Official Signature of Prospect / Policyholder
Unique Reference Number - L&C/Advt/2022/Jun/1419 (Rider - L&C/Advt/2020/Dec/1539)

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013
Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license.
For more information, Call the Tata AIA Life Insurance Company Ltd Helpline number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com