Life Partner Plus

UIN- 104N029V01
Participating
Policy/Proposal No:[ _________________ ]
Date of Illustration - Nov 4, 2011 3:38:46 PM
Insured
Age at inception of Policy

22

Sex

Male

Class

Standard

Face Amount

Rs 4,90,838

Bonus Option

Paid Up Additions

Payment Mode

Annual Billed

Premium Payment Term

20 Pay

PREMIUM SUMMARY
Basic Premium

Rs

30,000.02

Annual - Billed

TOTAL

Rs

30,000.02

Annual - Billed

Service Tax on base premium and all rider premiums.

Rs

463.50

Annual - Billed

Total Premium (inclusive of Service Tax)

Rs

30,463.52

Annual - Billed

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 1 of 5

YEARLY DETAIL
The following ledger provides year by year illustrative figures for premiums required, for the policy that you have chosen.
General Details
Year

Guaranteed

Age

Non Guaranteed Lower Rate 6%:

Annual
Premium

Death
Benefit

Surrender
Value

Money
Back
Payments

Net
Outlay

( Rs )

( Rs )
(BOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )

22

30,000

4,90,838

23

30,000

24

30,000

25

26

Non Guaranteed Higher Rate 10%:

Death
Benefit

Annual
Bonus

Surrender
value of PUA

Total
Surrender
Value

Net
Outlay

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )

(BOY)

30,000

4,90,838

4,90,838

30,000

4,90,838

29,799

30,000

4,90,838

4,90,838

5,090

30,000

4,90,838

39,930

30,000

4,90,838

50,164

30,000

5,24,195

30,000

5,46,314

27

30,000

4,90,838

60,501

30,000

28

30,000

4,90,838

29

30,000

4,90,838

70,941

81,484

30

30,000

4,90,838

92,130

10

31

11

32

30,000

4,90,838

30,000

4,90,838

12
13

33

30,000

34

30,000

14

35

15
16

Death
Benefit

Annual
Bonus

Surrender
value of PUA

Total
Surrender
Value

(BOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )
(EOY)

30,000

4,90,838

30,000

29,799

30,000

3,506

5,287

45,217

4,455

9,136

59,299

5,73,364

5,435

14,123

30,000

6,05,123

6,447

30,000

6,41,371

7,488

30,000

6,81,862

1,02,885

30,000

1,13,752

30,000

4,90,838

1,24,722

4,90,838

1,35,800

30,000

4,90,838

1,46,996

36

30,000

4,90,838

37

30,000

4,90,838

17

38

30,000

18

39

19

40

20
21

4,90,838

4,90,838

10,175

29,799

30,000

5,57,520

7,308

10,570

50,500

30,000

6,03,624

9,432

18,574

68,737

74,623

30,000

6,60,901

11,693

29,103

89,604

20,328

91,269

30,000

7,29,232

14,095

42,403

1,13,344

27,836

1,09,321

30,000

8,08,477

16,658

58,738

1,40,222

8,568

36,734

1,28,864

30,000

8,98,558

19,387

78,405

1,70,535

7,26,419

9,688

47,121

1,50,005

30,000

9,99,373

22,298

1,01,717

2,04,602

7,74,855

10,838

59,095

1,72,847

30,000

11,10,850

25,405

1,29,006

2,42,758

30,000

8,26,945

12,033

72,750

1,97,472

30,000

12,32,947

28,721

1,60,629

2,85,351

30,000

8,82,536

13,264

88,203

2,24,003

30,000

13,65,638

32,269

1,96,988

3,32,788

30,000

9,41,440

14,543

1,05,554

2,52,550

30,000

15,08,940

36,052

2,38,490

3,85,487

1,58,300

30,000

10,03,523

15,866

1,24,926

2,83,226

30,000

16,62,843

40,095

2,85,582

4,43,883

1,69,717

30,000

10,68,635

17,229

1,46,443

3,16,160

30,000

18,27,390

44,429

3,38,749

5,08,466

4,90,838

1,81,247

30,000

11,36,613

18,644

1,70,220

3,51,467

30,000

20,02,687

49,061

3,98,508

5,79,755

30,000

4,90,838

1,92,894

30,000

12,07,345

20,112

1,96,387

3,89,282

30,000

21,88,813

54,005

4,65,398

6,58,292

30,000

4,90,838

2,04,655

30,000

12,80,722

21,622

2,25,085

4,29,740

30,000

23,85,846

59,314

5,40,002

7,44,657

41

30,000

4,90,838

2,06,702

30,000

13,56,600

23,195

2,56,439

4,63,140

30,000

25,93,995

64,986

6,22,955

8,29,657

42

4,90,838

2,08,768

14,34,908

23,969

2,90,641

4,99,410

28,13,393

69,361

7,15,022

9,23,790

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 2 of 5

General Details
Year

Guaranteed

Age

Non Guaranteed Lower Rate 6%:

Annual
Premium

Death
Benefit

Surrender
Value

Money
Back
Payments

Net
Outlay

( Rs )

( Rs )
(BOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )

Non Guaranteed Higher Rate 10%:

Death
Benefit

Annual
Bonus

Surrender
value of PUA

Total
Surrender
Value

Net
Outlay

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )

(BOY)

Death
Benefit

Annual
Bonus

Surrender
value of PUA

Total
Surrender
Value

(BOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )
(EOY)

22

43

4,90,838

2,10,859

15,12,765

24,775

3,26,955

5,37,814

30,38,694

74,078

8,15,161

10,26,020

23

44

4,90,838

2,12,965

15,90,202

25,615

3,65,484

5,78,449

32,70,231

24

45

4,90,838

2,15,095

16,67,253

26,496

4,06,298

6,21,393

35,08,261

79,133

9,24,009

11,36,974

84,577

10,42,127

12,57,222

25

46

4,90,838

2,17,245

17,43,969

27,406

4,49,511

6,66,756

26

47

4,90,838

2,19,419

18,20,371

28,346

4,95,198

7,14,617

37,53,149

90,411

11,70,224

13,87,469

40,05,194

96,692

13,08,957

15,28,376

27

48

4,90,838

2,21,613

18,96,477

29,336

5,43,448

7,65,062

42,64,797

1,03,414

14,59,088

16,80,701

28

49

4,90,838

2,23,832

19,72,355

30,362

5,94,370

29

50

4,90,838

2,39,333

20,48,035

31,440

6,48,074

8,18,202

45,32,280

1,10,690

16,21,386

18,45,218

8,87,407

48,08,183

1,18,434

17,96,793

20,36,125

30

51

4,90,838

2,57,258

21,23,580

32,557

7,04,691

9,61,949

50,92,758

1,26,805

19,86,189

22,43,447

31

52

4,90,838

2,76,592

21,99,012

32

53

4,90,838

2,97,482

22,74,402

33,734

7,64,340

10,40,932

53,86,559

1,35,764

21,90,639

24,67,231

34,951

8,27,181

11,24,663

56,89,969

1,45,391

24,11,253

27,08,735

33

54

4,90,838

3,20,075

34

55

4,90,838

3,44,549

23,49,762

36,237

8,93,362

12,13,437

60,03,460

1,55,681

26,49,256

29,69,331

24,25,164

37,569

9,63,062

13,07,611

63,27,404

1,66,792

29,05,909

32,50,458

35

56

4,90,838

3,71,098

25,00,622

38,974

10,36,486

14,07,584

66,62,409

1,78,729

31,82,802

35,53,900

36

57

4,90,838

3,99,945

37

58

4,90,838

4,31,348

25,76,194

40,433

11,13,851

15,13,796

70,08,971

1,91,485

34,81,530

38,81,475

26,51,892

41,972

11,95,582

16,26,930

73,67,470

2,05,304

38,04,428

42,35,776

38

59

4,90,838

4,65,584

27,27,758

43,594

12,81,845

17,47,429

77,38,564

2,20,135

41,53,237

46,18,821

39

60

40

61

4,90,838

4,66,159

36,813

28,03,833

45,279

13,72,786

18,38,944

81,22,717

2,36,131

45,29,597

49,95,755

4,90,838

4,66,807

36,813

-36,813

28,80,123

45,612

14,68,622

19,35,428

-36,813

85,20,572

2,50,386

49,35,637

54,02,443

41

62

42

63

4,90,838

4,67,533

36,813

-36,813

29,54,329

45,980

15,68,135

20,35,668

-36,813

89,27,923

2,65,836

53,70,626

58,38,159

4,90,838

4,68,348

36,813

-36,813

30,26,562

46,384

16,71,524

21,39,872

-36,813

93,45,542

2,82,406

58,36,932

63,05,280

43

64

4,90,838

4,69,271

36,813

-36,813

30,96,928

46,826

17,79,073

22,48,344

-36,813

97,73,956

3,00,240

63,37,213

68,06,484

44

65

4,90,838

4,70,316

36,813

-36,813

31,65,520

47,284

18,91,134

23,61,450

-36,813

1,02,13,764

3,19,529

68,74,595

73,44,911

45

66

4,90,838

4,71,484

36,813

-36,813

32,32,396

47,794

20,09,013

24,80,498

-36,813

1,06,65,683

3,40,455

74,56,126

79,27,610

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 3 of 5

General Details
Year

Guaranteed

Age

Non Guaranteed Lower Rate 6%:

Annual
Premium

Death
Benefit

Surrender
Value

Money
Back
Payments

Net
Outlay

( Rs )

( Rs )
(BOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )

Non Guaranteed Higher Rate 10%:

Death
Benefit

Annual
Bonus

Surrender
value of PUA

Total
Surrender
Value

Net
Outlay

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )

(BOY)

Death
Benefit

Annual
Bonus

Surrender
value of PUA

Total
Surrender
Value

(BOY)

( Rs )
(EOY)

( Rs )
(EOY)

( Rs )
(EOY)

46

67

4,90,838

4,72,824

36,813

-36,813

32,97,617

48,373

21,32,057

26,04,881

-36,813

1,11,30,278

3,63,048

80,81,825

85,54,649

47

68

4,90,838

4,74,365

36,813

-36,813

33,61,299

48,963

22,61,004

27,35,370

-36,813

1,16,08,217

3,87,643

87,56,937

92,31,303

48

69

4,90,838

4,76,147

36,813

-36,813

34,23,460

49,620

23,96,568

28,72,715

-36,813

1,21,00,350

4,14,152

94,87,409

99,63,557

49

70

4,90,838

4,78,219

36,813

-36,813

34,84,179

50,344

25,39,790

30,18,008

-36,813

1,26,07,138

4,43,186

1,02,80,438

1,07,58,657

50

71

4,90,838

4,80,633

36,813

-36,813

35,43,513

51,126

26,92,032

31,72,666

-36,813

1,31,29,467

4,74,798

1,11,45,501

1,16,26,135

51

72

4,90,838

4,83,475

36,813

-36,813

36,01,488

52,001

28,55,017

33,38,493

-36,813

1,36,67,872

5,09,700

1,20,94,146

1,25,77,621

52

73

4,90,838

4,86,838

36,813

-36,813

36,58,145

52,957

30,30,923

35,17,761

-36,813

1,42,23,210

5,48,147

1,31,41,056

1,36,27,893

53

74

4,90,838

5,27,651

36,813

-36,813

37,13,485

54,021

32,22,647

37,50,298

-36,813

1,47,96,022

5,91,111

1,43,05,184

1,48,32,835

Rs 5,27,651

Maturity Value:

Rs 38,04,319

Rs 1,54,23,946

NOTES:
(BOY)

Beginning of Year Value

(EOY)

End of Year Value

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 4 of 5

Important Notes:
-- This is only an illustrative document. It does not purport to be a contract of insurance and does not in any way create any rights and/or obligations. Bonuses (if applicable and shown in the illustration) are not guaranteed, and bonus rates will be based on
the actual company experience from time to time. Some of the benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. 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 illustrations on this page will show the 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 dependent on a number of factors including future investment performance.
-- Policy benefits are payable provided all premiums are paid, when they are due. The illustrative benefits above assume that all premiums that are due will be paid on the due dates.
-- Please refer to the product brochures, for understanding the product features and explanation of the terms used in this illustration.
-- Service Tax and Education Cess would be levied as per applicable laws and would be to the account of the policyholder.
-- This plan may entitle you to certain tax benefits on your premiums as well as on your maturity value:
-- U/s 80C of the Income Tax Act 1961 on your premiums.
-- U/s 10(10D) of the Income Tax Act 1961 on your maturity proceeds of the policy.
-- U/s 80D of the Income Tax Act 1961, on your premiums towards Health insurance.
(Please note that if the premium paid in a financial year exceeds 20% of the Sum Assured, under section 10 (10D) benefit will not be available and 80C benefit will not be available for the premium exceeding 20% of the Sum Assured under the current tax
laws.)
-- The company reserves the right to revise the premium rates at portfolio level in plans for health insurance based upon the actuarial review of the claims experience subject to prior approval of IRDA and shall be communicated to you at least 30 days
prior to such change.

I ________________________________________________________ (Name), having received the information with respect to the above, have understood the above statement before entering into the contract.

Signature of Agent/Specified Person/Principal Officer:

Policy Holders Signature:

Name and ID:

Policy Holders Name:

Place:

Date:

Date:
Company Seal:

MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002
2010.1.2.8.6.56.40agency1221490838112383 100000001000000 10000018001000000 0 1

Page 5 of 5