Bajaj Allianz Life Insurance Company Ltd.

Registration No: 116 Statement Date: 16/04/2016 Annexure III

Policy No. 0051269333 Premium Frequency Annual

Name of Policyholder RAM MOHAN S
Address NO.8,VEENA GARDENS,VALLUVAR STREET EXTEN
JAI NAGAR,ARUMBAKKAM
CHENNAI
PART - A
Product UIN Transaction Type Premium Amount Premium Allocation Funds Allocated (Rs) Units as per Policy Admin Product Value (Rs)
Charge(Rs) System (PAS)
Capital Unit Gain 75 1st Year Premium 10000 500 9500 744.2808 107421.02
2nd Year Premium 10000 500 9500 919.0287
3rd Year Premium 10000 500 9500 632.2164
4th Year Premium 10000 500 9500 639.4852
5th Year Premium 10000 500 9500 346.8812
6th Year Premium 10000 500 9500 346.8812
7th Year Premium 10000 500 9500 346.8812
8th Year Premium 10000 500 9500 346.8812
9th Year Premium 10000 500 9500 314.9752
Total 90000 4500 85500 4637.5111
PART - B
Particulars ULIF02924/07/06EQ Total
GROWFUND116

Name of the Fund EQUITY GROWTH F

Total Amount collected 90000 90000
Percentage of Allocation (as on Statement Date 95 % 95 %
Funds Allocated ( in Rs ) 85500 85500
Funds Allocated ( in Units ) 4637.5111 4637.5111
Partial Withdrawal Amount 0 0

Withdrawals- Charges
Switch charge 0 0
Policy Administration charge 6644.01 6644.01
Mortality charges 1333.21 1333.21
Other charges (specify) 270.304 270.304
Service Tax 1193.45 1193.45
Available units in Segregated funds 3745.0719 3745.0719
Current NAV 28.6833
Fund value as on Statement Date 107421.02 107421.02

PART - C (Product Statistics)

Insurance Cover or Sum Assured 100000

Total Premium Paid from inception(D) 90000

Total Risk premium from inception, for insurance cover(E) 1333.21

Total Charges and deductions other than Mortality including Allocation charges till Login Dt. (including Service Charges)(F) 12607.764

Net invested amount =D-E-F 76329.33

Difference between (B) (B(1)) (unrealised Gain / Loss) 41%

Fund Performance
Fund Name SFIN NAV as on Login Date NAV as on Statement Date Percentage (%)
EQUITY GROWTH FUND ULIF02924/07/06EQGROWFUND116 12.764 28.6833 124.72

NOTE:
1. Product Porfolio value would be aggregate of all fund values in a product.
2. Product value per unit would be arrived at post dividing aggregate fund value by initial units
3. Consolidated Product Value would be a derived by aggregating the product values and divding the same by consolidated initial units
4. Product Value would be in addition to all the existing disclosures and calculations
5. Current prescribed practices shall continue