Benefit Illustration

(This shall form a part of the policy document)

Name of Prospect/Policyholder: N M Proposal No:

Age: 49 Name of the Product: SUD Life Guaranteed Pension Plan
Name of Life Assured: N M Individual Non Linked Non Participating Deferred Pension
Tag Line:
Age: 49 plan

Policy Term: 10 Unique Identification Number: 142N052V01

Premium Payment Term: 5 1st Year 4.50%

GST Rate and applicable Cess, if any
Amount of Instalment Premium: 1,00,000 2nd Year Onwards 2.25%
Mode of Premium Payment: Annual
Vesting Age 59

Policy Details
Sum Assured Rs. 1,05,000
Policy Option NA
Sum Assured on Death(at inception of the policy) Rs. 1,05,000

Premium Summary
Base Plan Riders Total Instalment Premium
Instalment Premium w ithout GST 1,00,000 0 1,00,000
Instalment Premium w ith First Year GST 1,04,500 0 1,04,500
Instalment Premium w ith GST 2nd year Onw ards 1,02,250 0 1,02,250

(Amount in Rupees)
Guaranteed Non Guaranteed
Policy Year Annualized Premium
Survival Benefits Other Benefit, if any Vesting Benefit Death Benefit Guaranteed Surrender Value (GSV) Special Surrender Value (SSV) Surrender Benefit Max(GSV,SSV)

1 1,00,000 0 0 0 1,06,000 0 0 0
2 1,00,000 0 0 0 2,18,360 60,000 52,691 60,000
3 1,00,000 0 0 0 3,37,462 1,05,000 98,382 1,05,000
4 1,00,000 0 0 0 4,63,709 2,00,000 2,00,007 2,00,007
5 1,00,000 0 0 0 5,97,532 2,50,000 2,66,948 2,66,948
6 0 0 0 0 6,33,384 3,00,000 3,42,461 3,42,461
7 0 0 0 0 6,71,387 3,50,000 4,27,271 4,27,271
8 0 0 0 0 7,11,670 4,00,000 5,22,142 5,22,142

1
 (Amount in Rupees)
Guaranteed Non Guaranteed
Policy Year Annualized Premium
Survival Benefits Other Benefit, if any Vesting Benefit Death Benefit Guaranteed Surrender Value (GSV) Special Surrender Value (SSV) Surrender Benefit Max(GSV,SSV)

9 0 0 0 0 7,54,370 4,50,000 6,28,156 6,28,156

10 0 0 0 7,67,500 7,99,632 5,00,000 7,46,286 7,46,286
Annuity Option selected(The option can be changed any time before vesting) Annuity Option 1 - Life Annuity
Annuity payable p.a. based on prevailing annuity rates(Rs.) 68,125

Notes:
1. The values shown above are for illustrative pupose only.The actual annuity amount receivable depends on the prevailing annuity rates at the time of vesting.
2.Annualized Premium excludes Underwriting extra premium ,frequency loadings on premiums ,the premiums paid towards the riders ,if any and Goods and Service Tax.
3. Refer the sales literature of explaination of terms used in this illustration.

Terms and Conditions

1. Surrender Benefit
Surrender of the policy is allowed after 2 consecutive full years’ premiums have been paid. During the Policy Term, Surrender Value payable will be higher of Guaranteed Surrender Value and Special Surrender
Value.
2. Quantum of benefits in respect of Non-Guaranteed category may vary.
3. Policy values are as of year end.
4. Tax Benefits
Premiums payable and benefits receivable under this plan are eligible for tax benefits as per the prevailing tax laws. w.e.f. from April 01, 2012, to qualify for tax benefit on premium(s) paid under section 80 C &
for tax benefit on maturity/survival proceeds under section 10 (10 D) of the IT Act, 1961, the sum assured should not be less than 10 times the annualised/single premium. Please consult your tax advisor for details
5. Proposal Deposit
The proposal deposit receipt given in respect of the consideration amount paid to the company does not bind the company to accept the risk on the life of the life proposed under the proposal for insurance.
6. About Star Union Dai-ichi Life Insurance Company Limited
Star Union Dai-ichi Life insurance is the name of the company and 'SUD Life Guaranteed Pension Plan' is only the name of the Plan and does in no way indicate the quality of the policy, its future prospects or
returns.
7. Goods & Services Tax and applicable cess,if any will be charged on premiums as per prevailing tax laws.This is subject to any change in the tax rate.
8. For more details on risk factor, terms and conditions, please read the Sales brochure of the plan carefully before concluding a sale.
In case you require any clarification, please consult your insurance advisor or call our office.

I, ___________________________ (Name), have explained the premiums, and benefits under the I ___________________________ (Name), having received the information with respect to the
product fully to the prospect / policyholder. above, have understood the above statement before entering into the contract.

Place:
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect / Policyholder