HNB ASSURANCE PLC

Iceland Business Centre, Level-03

No:30, Sri Uttarananda Mawatha, Colombo 03,
Tel : 0114793700 / Hot Line : 011-4384384 / Fax : 0114713800

HNB Assurance PrivilegedLife Product Quotation No: 202401KLT0008782 - 1

Details of The Main life Assured Details of Spouse and Children

Name Mr. S M JAYATHILAKA Age - Spouse (Years) 31
Date of Birth 1991-04-24 Age - Child 01 (Years) Not Selected
Age - Life Assured (Years) 33 Age - Child 02 (Years) Not Selected
Age at Maturity (Years) 53 Age - Child 03 (Years) Not Selected
Occupation Custom Age - Child 04 (Years) Not Selected
Age - Child 05 (Years) Not Selected

Details of the Main Cover Details of the Main Cover

Basic Annual Premium
Sum Assured Multiplier
Basic Sum Assured
Life Insurance Need
BA 120,000
10
1,200,000
Savings
Term of the policy
Basic Premium Paying Term
Mode
20
20
Monthly

Additional Rider Benefits

Life Assured Spouse
Guaranteed Additional Rider Benefits Annual Premium Annual
Sum Assured (Rs.) Sum Assured (Rs.)
N
(Rs.) Premium (Rs.)
Additional life Benefit N/A N/A N/A N/A
Accidental Death Benefit N/A N/A N/A N/A
Total Permanent Disability Benefit N/A N/A N/A N/A
Permanent Partial Disability Benefit N/A N/A N/A N/A
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Hospitalisation Benefit Covering Private Hospital 5,000 5,000

180 days per year (Amount per 3,432 3,409
day) Government Hospital 5,000 5,000
Critical Illness Benefit N/A N/A N/A N/A
Surgery Benefit N/A N/A N/A N/A
Supreme Health Unlimited Benefit (Medical Reimbursement)
Extra Benefits :
300,000 18,420 300,000 20,189
Covered countries :Sri Lanka, India, Singapore, Thailand and
Malaysia
Monthly Income Benefit N/A N/A N/A N/A
Cancer Rider Benefit N/A N/A N/A N/A
Super CI Rider N/A N/A N/A N/A
Sum Assured (Rs.)
Annual
Guaranteed Additional Rider Benefits - Children Government
Private Hospital Premium (Rs.)
Hospital
Child 1 N/A N/A N/A
Child 2 N/A N/A N/A
Hospitalisation Benefit Covering 180 days (Amount per day)
Child 3 N/A N/A N/A
Child 4 N/A N/A N/A
Child 1 N/A N/A
Child 2 N/A N/A
Critical Illness Benefit (Covering 15 Critical Illnesses)
Child 3 N/A N/A
Child 4 N/A N/A

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 Child 1 N/A N/A
Child 2 N/A N/A
Surgery Benefit
Child 3 N/A N/A
Child 4 N/A N/A
Waiver of
Waiver of Premium Benefit Monthly Annual Premium
Premium
Waiver of Basic Premium due to death of Life Assured N/A N/A
Waiver of Spouse & Childrens Rider Premium due to death of Life Assured N/A N/A
Waiver of Basic Premium due to total permanent disability of Life Assured N/A N/A
Waiver of Insured's additional life,Critical Illness Rider, Spouse and Childrens Rider
N/A N/A
Premium due to total permanent disability of Life Assured

Guaranteed Death Benefit Payable

Loss of Life due to Natural Causes 1,200,000 or fund value at the date of death whichever is higher
Loss of Life due to an accident 1,200,000 or fund value at the date of death whichever is higher
* With Waiver of Premium on death
[Link] Basic sum assured is higher than the investment account balance at the time of death, difference between Basic sum assured and investment
account balance shall be paid. Investment account continues to build up and maturity benefit shall be paid at the maturity date to the beneficiary.
[Link] Basic sum assured is less than the investment account balance at the time of death, Investment account continue to be built up and maturity
benefit shall be paid at the maturity date to the beneficiary.

Basic Premium

Additional Rider Premium

Renewal Policy Fee
BA
Extra Premium due to Occupation loading for Basic Benefit
Premium
10,000
0
3,787
10
Total Monthly Premium during first 20 years of the policy (Rs.) 13,797
Rs. 500.00 is charged as Policy fee with 1 st premium in addition to above mentioned installment premium
N
Non Guaranteed Fund Values as at Expiry based on premium paying frequency
Premium Paying Frequency Assumed Rate of Dividend - 7% Assumed Rate of Dividend - 9% Assumed Rate of Dividend - 11%
Yearly 4,269,169 5,289,468 6,589,154
Half Yearly 4,208,102 5,190,202 6,436,689
Quarterly 4,177,786 5,141,055 6,361,358
H

Monthly 4,157,652 5,108,462 6,311,456

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 Non Guaranteed Maturity Benefit Options - Based on Monthly Premium payment Mode
Option Assumed Rate of Dividend - 7% Assumed Rate of Dividend - 9% Assumed Rate of Dividend - 11%
Lump Sum 4,157,652 5,108,462 6,311,456
Withdraw upto 50% of the fund at the maturity and balance is kept as a health fund for health claims until death of life assured or fund
Health Fund
is exhausted whichever occurs earlier

*Monthly annuity are based on the 100% of Retirement fund. Above annuity amounts are only for illustration purposes. The annuity amounts will be decided at the
time of the maturity.

Non Guaranteed Illustration of Fund buildup - Based on Monthly Premium payment mode
Assumed Rate of Dividend - Assumed Rate of Dividend - Assumed Rate of Dividend -
7% 9% 11%
Age Basic Rider
Policy Illustrative Illustrative Illustrative
Nearest Annual Annual Illustrative Illustrative Illustrative
Year Surrender Surrender Surrender
B'day Premium Premium fund value at fund value at fund value at
value at the value at the value at the
the year end the year end the year end
year end year end year end
1 34 120,000 45,449 32,707 0 33,046 0 33,382 0
2 35 120,000 45,449 104,488 0 106,226 0 107,969 0
3 36 120,000 45,449 205,365 0 210,304 0 215,307 0
4 37 120,000 45,449 330,935 182,014 341,540 187,847 352,401 193,820
5 38 120,000 45,449 464,198 278,519 483,467 290,080 503,423 302,054
6 39 120,000 45,449 605,521 393,589 636,805 413,923 669,595 435,237
7
8
9
10
11
40
41
42
43
44
120,000
120,000
120,000
120,000
120,000
45,449
45,449
45,449
45,449
45,449
BA
755,471
914,600
1,083,665
1,262,980
1,584,166
528,830
685,950
866,932
1,073,533
1,425,750
802,588
981,858
1,175,989
1,385,635
1,745,548
561,812
736,393
940,791
1,177,790
1,570,993
852,588
1,054,145
1,276,495
1,520,874
1,925,621
596,812
790,609
1,021,196
1,292,743
1,733,059
12 45 120,000 45,449 1,797,453 1,617,707 2,004,722 1,804,250 2,238,946 2,015,051
13 46 120,000 45,449 2,023,860 1,821,474 2,285,148 2,056,633 2,584,344 2,325,910
14 47 120,000 45,449 2,263,555 2,037,200 2,587,606 2,328,846 2,963,738 2,667,365
N
15 48 120,000 45,449 2,517,650 2,265,885 2,914,339 2,622,906 3,381,207 3,043,087
16 49 120,000 45,449 2,787,014 2,508,312 3,267,304 2,940,574 3,840,586 3,456,528
17 50 120,000 45,449 3,073,049 2,765,744 3,649,374 3,284,437 4,347,218 3,912,496
18 51 120,000 45,449 3,375,796 3,038,217 4,061,381 3,655,243 4,903,627 4,413,264
H

19 52 120,000 45,449 3,696,745 3,327,070 4,506,497 4,055,847 5,515,949 4,964,354

20 53 120,000 45,449 4,157,652 4,157,652 5,108,462 5,108,462 6,311,456 6,311,456

* Please note that the above quoted maturity values are only for illustrative purposes. Illustrated dividend rates are not guaranteed.

* Guaranteed minimum interim dividend rate for 2024 - 7.5%

Note : Loyalty rewards of Basic Annualized premium shall be added every 10th policy anniversary subject to policy conditions.

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Notes on above Illustration & Quotation

(1.) The illustrative fund value at maturity is calculated assuming 7%,9% and 11% dividend rates. Illustrated dividend rates are not guaranteed and the final maturity
value will be subject to actual dividends declared, timely premium payment, top up premiums, partial withdrawal and future policy alterations (If any). These
assumed dividend rates are not an indicator of the lower or upper limits of actual dividend rates.

(2.) Maturity option annuity figures quoted will depend on the annuity factors determined by the company at policy maturity and the balance retirement fund.

(3.) Surrender values shown above are not guaranteed but would depend upon the balance of the investment account at the time of surrender.

(4) At the beginning of each calendar year the Company shall declare an interim dividend rate which will be guaranteed as a minimum dividend rate for the year.

( 5) This quotation valid only for 14 days from the date of issuance & Life Insurance contract will come in to effect if and when the risk is accepted by the company
under standard underwriting guidelines followed by HNB Assurance considering the medical, financial and other material information provided by the proposer and
subject to reinsurance consideration (If required).

(6) Premium rates applicable to medical reimbursement benefit, Hospitalization benefit, Surgery benefit, Cancer benefit are non-guaranteed and can be revised at
every policy anniversary with 30 days’ notice.

(7) You should only invest in this plan if you intend to pay the premiums for the entire premium paying term. In the event of terminate this policy early or stop
paying premiums early, you may suffer a significant loss.

(8) If due premium is not paid for Basic policy / Rider Benefits within the grace period of 30 days, the Basic policy/Rider benefits will lapse and you will not be
entitled for any of the above benefits.

(9) Maximum four Top up premiums are allowed per policy year after 12 months from the policy start date. Minimum Top Premium Should beis Rs.10,000.00.

Basic Medical Requirements

Main Life

Spouse
BA
(10) Any alterations made on this quotation are invalid and this document for illustration purpose only and does not form part of the policy document.

Assuring you of our very best services at all times.

HNB ASSURANCE PLC,
N
..........................................
Authorized Signatory Date : 18/02/2024

Confirmation from Life to be Assured

This is to confirm that Mr/ Mrs ..................................…................. Sales Advisor have come to meet me and clearly explained the terms and conditions
H

enumerated in the insurance policy along with the benefits as per details mentioned in the above quotation. I further hereby declare and confirm that
Sales Advisor provided me the advice in a manner that enable me to make an informed decision and I fully understood the benefits mentioned in this
quotation and decided to purchase this product since it meets my life insurance needs.

Mr. S M JAYATHILAKA ...................................................................................

Customer Name Customer Signature
NIC No : 917290083V Date : 18/02/2024

Confirmation from the Sales Advisor

I hereby confirm that policy benefits were clearly explained to Mr/Mrs............................................ as per details mentioned in the quotation along with the
terms and conditions enumerated in the insurance policy whilst assuring that the accurate advice were provided in a manner that enables the said
customer to make an informed decision in order to facilitate him/her to decide on the product which is suitable for his/her needs.

MS. PIYUMALI PRABODANI GAMAGE ....................................... J9721 18/02/2024

Sales Advisor's Name Signature Code Date

Main life sum at risk 1,200,000 , Spouse : 0

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