This shall form a part of the policy document

Benefit Illustration of RELIANCE'S GUARANTEED MONEY BACK PLAN

Name of the life insured
Proposal No :
: T raja
Age of the Policyholder:
Policy No
:
: 30
Prepared on
: 09/12/2014
Name of the Insurance Advisor : rAJA
Sex
: Male
Unique Identification No.
: 121N084V02

Basic Cover
Policy Term

Mode of Premium Payment

Yearly

Annualised Premium

54777

Total Installment premium (excluding service tax) 54777

15

Total Installment premium payable^ Year 1:

56470

Total Installment premium payable^ Year 2

onwards :

55623

Sum Assured

500000

Frequency

Premium Payment Term

10

Age Proof

Standard

Note :Some benefits are guaranteed and some benefits are variable with returns based on the future performance of Reliance Life Insurance. 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 illustration on this page will show two different rates of assumed 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. Statement of various charges alongwith growth of the fund expected
over the duration of the policy with assured rate of interest as mentioned.
(all figures are in rupees)
Benefit illustration table

Years

Age of
Policyholder

Annualised
premium
excluding service
tax

Service Tax
on
Premium

30

54777

1693

56470

500000

10000

31

54777

846

55623

500000

20000

32

54777

846

55623

500000

30000

33

54777

846

55623

500000

34

54777

846

55623

500000

35

54777

846

55623

36

54777

846

37

54777

846

38

54777

10

39

54777

Benefit Paid
on Death due
to accident

Money back
benefit at the
end of year

Maturity
Benefit

Guaranteed
Surrender Value
(GSV)*

547770

1047770

10955

547770

1047770

32866

32866

547770

1047770

82166

30387

82166

40000

547770

1047770

109554

48081

109554

50000

547770

1047770

136943

71314

136943

500000

60000

547770

1047770

164331

101530

164331

55623

500000

70000

547770

1047770

203223

140514

203223

55623

500000

80000

547770

1047770

245401

190472

245401

846

55623

500000

90000

547770

1047770

295796

254123

295796

846

55623

500000

100000

575159

1075159

345095

334812

345095

Premium
(inclusive of
Service tax)

Basic
Sum
Assured

Guaranteed Loyalty
Addition accrued at
the end of the year

Guaranteed
Maturity
Addition

Death
Benefit

Special
Surrender
Value (SSV)*

Surrender
value (SV)**
10955

11

40

500000

110000

575159

1075159

75000

292006

326775

326775

12

41

500000

120000

575159

1075159

75000

238917

317130

317130

13

42

500000

130000

575159

1075159

75000

185828

305556

305556

14

43

500000

140000

575159

1075159

75000

138216

291667

291667

15

44

500000

150000

75000

575159

1075159

200000

225000

^ Total installment premium payable is inclusive of services tax & cess and extra premium for non standard age proof (NSAP), if any.
*Guaranteed Surrender Value & Special Surrender value is calculated at year end after paying survival benefits
** Acquired surrender value is payable only after completion of first three policy years.
Insurance is the subject matter of solicitation. Reliance Life Insurance Company Limited is a fully licensed life insurance company registered with the Insurance Regulatory and Development Authority (Registration No: 121) in
accordance with the provisions of the Insurance Act 1938.
The premium amount shown above is calculated assuming that the life Proposed/Assured is a normal healthy person.
In the event the Life Proposed/Assured is suffering from any sickness/ medical problems or in the event of any past medical history, the premium will be adjusted accordingly, as per the underwriting guidelines of Reliance Life
Insurance Company Limited.
The main objective of the illustration is that the client is able to appreciate the features of the product and the flow of benefits in different circumstances with some level of quantification.
The above amounts assume that all premiums are paid when due. Further, the above death and surrender values are illustrated assuming that all the modal/installment premium payable in a policy year are paid (i.e. the event
occurs at the end of the policy year). If death or surrender occur and only some of the modal/ installment premium are paid, then the death or surrender values will only consist of that premium that has been paid. Accordingly, the
death or surrender values at a time other than at the end of the policy year will be lower than those illustrated above.
Disclaimers:-

1. This premium quotation is indicative. The premium rate charged to the customers may be different depending upon the factors such as health, occupation of the customer and other intrinsic factors such as non submission of
documentary evidences like age proof.
2. The current rate of service tax along with education cess is 3.09% and 1.545% on first year premiums and renewal premiums respectively on base policy premium and a service tax along with education cess of 12.36% is levied
on rider premiums. The service tax rate will be revised as and when notified by the Government.
3. Rider premium rates, (if applicable) have not been taken into account in calculating the base premium.
4. For authoritative details of the rates and the terms and conditions applicable to the particular person/policy, kindly refer to the specifications in the policy document after issuance.
5. For more details on risk factor, terms and conditions, please read Sales brochure of the particular plan carefully before concluding a sale.
6. Subject to the guaranteed minimum surrender value, the company may however pay a special surrender value calculated according to the basis and method in use from time to time.
7. The policy acquires Guaranteed surrender value after one year full premiums are paid.
8. If Premium paying term is less than 10 years, the policy acquires Special Surrender Value after two years full premiums are paid and If Premium paying term is greater than or equal to 10 years, the policy acquires Special
Surrender Value after three years full premiums are paid.
9. Special Surrender Value (SSV) is a non guaranteed benefit. It is calculated as SSV Factor multiplied by the Paid Up Sum Assured. The SSV Factor is dependent on the benefits payable for the paid up policy and is expressed as
percentage of Paid Up Sum Assured. The company reserves the rights to change the SSV Factor from time to time depending on the economic environment, experience and other factors, subject to IRDA approval.
0. Guaranteed Surrender Value is GSV factor multiplied by the total premiums paid , excluding rider premiums and extra premium paid, if any, less any survival benefits already paid. Policy will acquire GSV only if first annualized
premium have been paid. For GSV factors, kindly refer to the Policy document.
11. For policies with premium paying term less than 10, the policy acquires a paid up value after two years full premiums are paid. Please refer to sales brochure for more details.
2. For policies with premium paying term greater than or equal to 10, the policy acquires a paid up value after three years full premiums are paid. Please refer to sales brochure for more details.
3. Taxes, duties or surcharges of whatever description levied by any statutory authority will be applicable.

I rAJA have explained the information with respect to the above, to the prospect before entering entering into the contract.
Intermediary's Signature:

Place:
Date:
I T raja having received the information with respect to the above, have understood the above statement before entering into the contract.

Policyholders' Signature:

Place:
Date:

Marketing officials' Signature:

Company Seal:

Place:
Date:

For more details on risk factors , terms and conditions please read sales brochure carefully before concluding a sale.

Policyholder's Signature: