Duplicate

PART A
Welcome to Max Life Insurance
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Date 27-Jun-2022
To MS. PARVEEN SAINI IMPORTANT
FLAT NO 21 PLOT NO 102
Premium Payment Term (in years) 5
SITA RAM APARTMENT I P EXTN
KARKARDOOMA, PATPARGANJ EAST DELHI Total Premium Payable (Inclusive of 5,000.00
GST and Rider premium) Monthly
NEW DELHI 110092
DELHI Policy Maturity Date 27-Jun-2032
Guaranteed Benefit No
Branch: ADEL1
Policy no.: 609819495
Telephone: 9999669623, --
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Welcome Dear MS. PARVEEN SAINI,
Thank you for opting for Max Life Fast Track Super (A Unit Linked Non-Participating Individual Life Insurance Plan). We
request you to go through the enclosed policy contract.
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What to do in On examination of the Policy, if you notice any mistake or error, proceed as follows:
case of errors 1. Contact our customer helpdesk or your agent immediately at the details mentioned below.
2. Return the Policy to us for rectifying the same.
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Free Look In case you are not satisfied with the Policy, you have the option to cancel it by returning the original copy with a written request,
Cancellation stating the objections/reasons for such disagreement, to us within the Freelook period of 15 days from the date of receiving the
Policy document.

Result: Upon return, the Policy will terminate forthwith and all rights, benefits and interests under the Policy will cease
immediately. We will refund only an amount which will be equal to unallocated Premium plus charges levied by cancellation of
Units plus Fund Value at the date of cancellation less mortality charges (including applicable GST) for the period of cover, rider
charges (including applicable GST), expenses incurred on medical examination of the Life Insured, if any and stamp duty.
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Long term We are committed to giving you honest advice and offering you long-term savings, protection and retirement solutions backed by
protection the highest standards of customer service. We will be delighted to offer you any assistance or clarification you may require about
your Policy or claim-related services at the address mentioned below. We look forward to being your partner for life.
Yours Sincerely,
Max Life Insurance Company Limited

R Krishnakumar
Executive Vice President - Operations Digitally signed by DS MAX LIFE INSURANCE COMPANY LIMITED 1
Date: 2025.03.12 10:55:52 IST
Reason: Max Life Insurance
Location: 90C, Gurugram

AGENT NAME : MRS. PARVEEN SAINI TULI (438732), PH NO.:

9999669623, ADDRESS: D- 230, Vivek Vihar, Delhi,
NB13
Max Life Insurance Company Limited
Plot No. 90A, Sector 18, Gurugram, 122015, Haryana, India
Phone 4219090 Fax 4159397 (From Delhi and Other cities: 0124) Customer Helpline: 1860 120 5577
Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144 533
Visit Us at: www.maxlifeinsurance.com E-mail: [email protected]
IRDAI Registration No: 104 Corporate Identity Number: U74899PB2000PLC045626 .

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 Key Feature Document for Max Life Fast Track Super
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Introduction This document is the summary of important points in your policy. You must read this to understand your policy
better.
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Your policy details The table below gives an overview of the details of this policy:
Life Insured Name:(name of the Ms. Parveen Saini Policyholder Name:(person in Ms. Parveen Saini
person whose life is insured) whose name the policy is issued)
Policy No. (please use this for any 609819495 Premium Payment Due Date: 27th of every month
communication with us)
Date of Commencement: 27-Jun-2022 ECS Draw Date: 27th of Every Month
(date when the policy starts)
Premium Payment Term in 5 Policy Term: (period of 10
years (period for which premium coverage- in years)
is to be paid):
Last Premium Due Date : 27-May-2027 Maturity Date: 27-Jun-2032
Premium Amount : ` 5,000.00 Maturity Amount: Fund value as on maturity date
Sum Assured: (minimum amount ` 6,00,000.00 Fund(s) invested in: Regular: Growth Fund
payable if the life insured expires)
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Important points of These are the important points of your policy:
your policy • A Unit Linked Non-Participating Individual Life Insurance Plan
- is a long term life insurance and savings plan
- provides flexibility to invest in equity or debt or a combination based on your willingness to take risk, and
- gets you long term benefits and protection, so we encourage you to continue with the policy for the complete
policy term.
• Policy performance - The performance of your policy is related to the performance of markets; the total value
of your policy may fall, rise or remain constant, depending on the market ups and downs and the performance
of the fund(s). We do not assure guarantee of returns.
• Investment in funds - The entire premium amount is not invested in the markets. We invest the premium after
deducting the applicable charges, including the life insurance cover charge,
• Withdrawal of money - If you need, you will able to withdraw the money invested in this policy as follows:
If you wish to wish to withdraw money Then you
in the initial 5 years cannot withdraw money.
after the initial 5 years can withdraw money.
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Policy Benefits
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If the life insured On the maturity date, if we have received all the due premiums, we will pay the sum of the following:
lives • the fund value as on maturity date, or
• periodic payments, if you have chosen the settlement option.

Note: Under the settlement option you can continue to stay invested with us after maturity.
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If the life insured If the life insured expires during the policy term and we have received all the due premiums, we will pay the
expires highest of the following values:
• sum assured (after adjusting the policy benefits already availed, if any), or
• fund value as on the date of death, or
• 105% of premium(s) paid as on the date of death
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A. Managing Your Policy - Frequently asked questions
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What you need to do You need to
• pay premiums on time for the entire premium payment term. There are various easy and convenient payment
options for you to choose from. To know more about payment options, log on to www.maxlifeinsurance.com.
• read the details of the policy document, including the proposal form, to ensure the accuracy of information. For
any error you observe, contact us for correction.
• periodically, review the investment fund(s) based on your willingness to take risks. In this policy, the market
risks of the funds you choose reside with you.
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Can you change the You can
fund(s) you have • you have an option to exercise switching option during the settlement period
invested in? • switch fund(s) - change existing fund(s) to available fund(s):
- the minimum amount of change should be ` 5,000, and
- you can change funds 12 times, at no cost, in a year, and
• redirect funds - allocate future premiums, in full or parts, to available fund(s):
- for a maximum of 6 times in a year, at no cost,
- while the existing money you invested would continue as per fund(s) you selected earlier.
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What are the charges These are the charges applicable to your policy:
applicable to your • Premium Allocation Charge - This charge is levied for the allocation of the premium to the fund(s). The charge
policy? is deducted before the premium is invested in the chosen fund.
• Policy Administration Charge - The charge is levied towards the management of the policy over the lifetime.
This charge is levied through deduction of units every month.
• Mortality Charge - This charge is deducted to provide life cover under the policy. This charge is levied through
deduction of units every month.
• Fund Management Charge - This is the charge levied for the management of funds. This charge is levied by
adjusting the Net Asset Value (NAV) of the fund on a daily basis.
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How can you manage Manage your policy under the Customer Service section by visiting www.maxlifeinsurance.com to get easy access
your policy? to the following self-service options:
• Access policy statements, receipts and premium due information
• Update your personal details
• Change the premium payment mode to any of these - annual, semi-annual, quarterly or monthly modes
• Pay renewal premiums online
• Switch existing fund(s)
• Redirect premium (allocation of future premium to another fund of your choice)
• Option to reduce your annualised premium up to 50% once during the entire policy term post completion of 5
policy years
Note: For any support or claim-related query, you can reach us at 1860 120 5577 or (0124) 4219090 or
[email protected]
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How can you cancel If your Policy does not meet your objective, you may contact us to understand the Policy benefits. If you still feel
your policy? the need to cancel your Policy, you have an option to cancel it within the free look period of 15 days from the
day you receive the Policy documents.
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What happens if you To ensure continuous life insurance cover, please pay your premium on time.
delay your premium
payment? Non-payment by the due date
If for any reason, you are unable to pay by the due date, you have a grace period within which you can pay without
any late fee or interest.
Note: During the grace period, the insurance cover continues and your fund(s) will continue to participate in the
market. If the life insured dies during this period, we will pay the due amount.
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Continued on next page

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A. Managing Your Policy - Frequently asked questions, continued
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What happens if you Non-payment within the grace period
delay your premium If you are unable to pay the premium by the grace period, you can choose as follows:
payment?
If, during the lock-in period, you wish to Then
opt for
reviving the policy within three years you need to
• Give a written request to the company
• pay all due premiums; and
• produce evidence of insurability of the life insured
Withdraw/ surrender completely from the • we will transfer your existing value of the policy to the
policy discontinuance policy fund after deducting the applicable
charges (discontinuance/surrender charges), and
• all charges except the fund management charges will cease to
apply.
• post completion of the lock in period, we shall pay you the fund
value as on the date.
Note: There will be no risk cover once your fund(s) move
discontinuance policy fund
After the lock-in period
You can choose as follows Then
reviving the policy within three years you need to
• Give a written request to the company
• pay all due premiums; and
• produce evidence of insurability of the life insured
surrender the policy Proceeds of the Policy Fund shall be payable
If you do not exercise any of the above Your policy will move to paid up status post expiry of grace
options, period and proceedings will be paid at the end of 3 years revival
period
Note: Your policy has a lock-in period of 5 (five) years.
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B. Taxes and Others - Frequently asked questions
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Tax benefits Premium under the policy are tax deductible subject to fulfilling conditions prescribed under the Section
80C/80CCC/80D of Income Tax Act 1961. The benefits you receive in the policy will be exempt, subject to
fulfilling conditions prescribed under the Section 10(10D) else it will subject to TDS as per applicable rate. Please
note that tax benefits are as per prevailing provisions of Income Tax Act 1961 at the time of payment of premium
or receipt of benefits by you. Consult your tax advisor for further details.
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Are there any In the event of death of the life insured due to suicide within twelve months from the date of start or revival of
exclusions under the policy:
the policy? • all risks and benefits under this policy shall cease and no benefits will be payable under this policy, and
• we will pay you the fund value prevailing on the date of intimation of death of the life insured and terminate
the policy.
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Disclaimers Please read the following carefully:
• The actual returns of the policy may be different from what is shown in the benefit illustration, enclosed in the
policy document. In the benefit illustration, the benefits are illustrated at investment returns of 4% and 8% p.a,
which are not guaranteed.
• The past performance of a fund is no indicator of future performance.
• The aim of this document is to summarize the key features of your policy and does not replace the policy, in
any way. In case of any discrepancy between the policy contract and this document, the terms and conditions
of the policy contract shall prevail.
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"If this Key Feature Document has been issued in any language in addition to English, the English version shall
prevail in case of any inconsistency between the two languages."

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PREAMBLE TO THE POLICY
MAX LIFE INSURANCE COMPANY LIMITED
Regd. Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144533

Max Life Fast Track Super

A Unit Linked Non-Participating Individual Life Insurance Plan

UIN [104L082V04]

Max Life Insurance Company Limited has entered into this contract of insurance on the basis of the information given in the Proposal Form
together with the Premium deposit, statements, reports or other documents and declarations received from or on behalf of the proposer for
effecting a life insurance contract on the life of the person named in the Schedule.

We agree to pay the benefits under the Policy on the happening of the insured event, while the Policy is in force subject to the terms and
conditions stated herein.

Max Life Insurance Company Limited

Place of Issuance : Gurugram, Haryana

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 Max Life Fast Track Super
A Unit Linked Non-Participating Individual Life Insurance Plan
Plan UIN: 104L082V04

SCHEDULE

In this Policy, the investment risk in the investment portfolio is borne by You

I. DETAILS OF POLICY
BASE POLICY - Max Life Fast Track Super TYPE OF POLICY - A Unit Linked Non-Participating Individual
Life Insurance Plan
OFFICE - Delhi 1
POLICY NO : 609819495 PROPOSAL NO: 609819495
DATE OF PROPOSAL: 27-Jun-2022
DATE OF COMMENCEMENT OF RISK/EFFECTIVE DATE: 27-Jun-2022
DATE OF ISSUANCE OF POLICY: 27-Jun-2022
NAME OF THE INSURANCE MRS. PARVEEN SAINI TULI
BROKER/AGENT/INTERMEDIARY:
LICENSE NO.: 9041363
INSURANCE AGENT/INTERMEDIARY CODE: 438732
ADDRESS: D- 230, Vivek Vihar,
Delhi 110095
Delhi
MOBILE NO.: 9999669623
EMAIL: [email protected]
Details of Sales Personnel (for direct sales only): N/A

II. DETAILS OF POLICYHOLDER

POLICYHOLDER/PROPOSER: Ms. Parveen Saini
CLIENT ID: 5000439032
DATE OF BIRTH: 04-Feb-1972
AGE: 50
GENDER: Female
RELATIONSHIP WITH THE LIFE INSURED: Same Person
ADDRESS (For all communication purposes): GUARDIAN (IF NOMINEE IS A MINOR):
FLAT NO 21 PLOT NO 102 N.A.
SITA RAM APARTMENT I P EXTN KARKARDOOMA,
PATPARGANJ EAST DELHI
NEW DELHI 110092
DELHI
MOBILE NO.: 9999669623
EMAIL: [email protected]
BANK ACCOUNT NUMBER: 51017237625
PERMANENT ACCOUNT NUMBER: AYNPS0404M
Bank A/C no. : 51017237625 Bank Name : STATE BANK OF INDIA

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III. DETAILS OF LIFE INSURED
LIFE INSURED: Ms. Parveen Saini
DATE OF BIRTH: 04-Feb-1972
AGE: 50
AGE ADMITTED: Yes
GENDER: Female
ADDRESS: FLAT NO 21 PLOT NO 102SITA RAM APARTMENT I P EXTN
KARKARDOOMA, PATPARGANJ EAST DELHINEW DELHI
110092DELHI

IV. DETAILS OF POLICY COVERAGE

SUM ASSURED: 6,00,000.00
MATURITY DATE: 27-Jun-2032
DATE OF PAYMENT OF SURVIVAL BENEFIT: N.A.
POLICY TERM: 10
PREMIUM PAYABLE (in `): 5,000.00
PREMIUM FREQUENCY: Monthly
PREMIUM PAYMENT TERM: 5
DUE DATES WHEN REGULAR PREMIUM IS PAYABLE/ 27th of every month; 27-May-2027
DATE WHEN THE LAST INSTALMENT OF REGULAR
PREMIUM IS PAYABLE:
BILL DRAW DATE: 27TH
ANNUALISED PREMIUM: 60,000.00
Systematic Transfer Plan Option: N
Dynamic Fund Allocation Option: N
PREMIUM PAYMENT METHOD: ECS

V. ALLOCATION PROPORTION AT THE EFFECTIVE DATE/ DATE OF COMMENCEMENT OF RISK (Applicable if

Systematic Transfer Plan option or Dynamic Fund Allocation option is not chosen)
ALLOCATION PROPORTION
FUND NAME
(as a % of the Single/Regular Premium)
Secure Fund
Conservative Fund
Balanced Fund
Growth Fund 100
Growth Super Fund
High Growth Fund

VI. INVESTMENT OPTIONS

The Funds currently available for investment under the Policy and the investment objectives of each Fund are as below:
NAME OF Risk
INVESTMENT OBJECTIVES INVESTMENT MIX
FUND Rating
Secure Fund (SFIN: Fund invests in debt instruments such as Government securities, corporate bonds, Government securities: 50-100% Low
ULIF00425/06/04LIFES money market instruments etc. issued primarily by Government of India/State Corporate bonds: 0-50% Money
ECURE104) Governments, corporates and banks. The Fund also invests in money market market & Cash instruments: 0-40
instruments as prescribed by the Authority. No investment is made in equities. Equities: Nil
Conservative Fund (SFIN: Fund invests primarily in debt instruments such as Government securities, corporate Government securities: 50-80% Low
ULIF00325/06/04LIFEC bonds, money market instruments etc, issued primarily by Government of India/State Corporate bonds: 0-50% Money
ONSER104) Governments and to some extent in corporate bonds and money market instruments. market & Cash instruments:
The Fund invests up to 15% of Fund corpus in equities. 0-40% Equities: 0-15%
Balanced Fund (SFIN: Fund invests primarily in debt instruments such as Government securities, corporate bonds, Government Securities: 20-50% Medium
ULIF00225/06/04LIFE money market instruments etc. issued primarily by Government of India/State Governments Corporate bonds: 20-40% Money
BALANC104) and to some extent in corporate bonds and money market instruments. The Fund invests market & Cash instruments:
minimum of 10% and up to maximum of 40% of Fund corpus in equities. 0-40%
Equities: 10-40%
Growth Fund (SFIN: Fund invests in various asset classes such as equities, Government securities, corporate Government securities: 0-30% High
ULIF00125/06/04LIFE bonds and money market instruments. The equities exposure in the Fund will at all times Corporate bonds: 0-30% Money
GROWTH104) be at a minimum of 20% but not more than 70%. The Fund invests the remaining Fund market & Cash instruments:
corpus in debt instruments across Government, corporate and money market papers. 0-40%
Equities: 20-70%
Growth Super Fund (SFIN: Fund is primarily equity oriented by ensuring at least 70% of the Fund corpus is Government securities: 0-20% High
ULIF01108/02/07LIF invested in equities at all times. The remaining is invested in debt instruments across Corporate bonds: 0-20% Money
EGRWSUP104) Government, corporate and money market papers market & Cash instruments:
0-30%
Equities: 70-100%
High Growth Fund (SFIN: The fund is a multi-cap fund with a focus on mid cap equities, where predominant Government securities: 0-30% Very High
ULIF01311/02/08LIFE investments are equities of companies with high growth potential in the long term (to Corporate bonds: 0-30%
HIGHGR104) target high growth in capital value assets). At least 70% of the Fund corpus is invested Money market & Cash
in equities at all times. However, the remaining is invested in government securities, instruments:0-30% Equities:
corporate bonds and money market instruments; hence the risk involved is relatively 70-100%
higher

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 Secure Plus Fund (SFIN: The Fund invests in debt instruments such as Government securities, corporate Government securities: 60-100% Low
ULIF01628/04/ bonds, money market instruments, etc. issued primarily by the Government of Corporate bonds: 0-40% Money
09LIFESECPL India/State Governments, corporates and banks. The Fund also invests in money market market & Cash instruments:
S104) available only under instruments as prescribed by IRDA. No investment is made in equities. 0-40%
Systematic Transfer Plan Equities: Nil

Discontinuance Policy Fund (SFIN: ULIF02021/06/13LIFEDISCON104)

The investment mix for the Discontinuance Policy Fund is as follows:
Money market instruments: 0% - 40%
Government securities: 60% - 100%
The minimum guaranteed interest rate on this Fund is 4.0% (Four percent) per annum (or as mandated by the Authority from time to time). The Fund Management Charge
for the Discontinuance Policy Fund is 0.5% per annum. The excess income earned in the Discontinuance Policy Fund over and above the minimum guaranteed interest
rate shall also be apportioned to the Discontinuance Policy Fund.
VII. CHARGES
The following charges shall be levied under this Policy during the Policy Term:
1. Premium Allocation Charge: This charge is calculated as a percentage of the Single Premium/Regular Premiums payable and shall be deducted from the Single
Premium/Regular Premium received before the same are allocated to the Unit Account. The Premium Allocation Charge is as follows:

For Policies where the premium payment mode is Regular Premium:

PREMIUM ALLOCATION
POLICY YEAR CHARGE
(as a % of the Regular Premium)
1 4%
2-5 3%
6-10 (if applicable) 3%
11 onwards (if applicable) 0%

For Policies where the premium payment mode is Single Premium:

PREMIUM ALLOCATION
POLICY YEAR CHARGE
(as a % of the Single Premium)
1 4%
2-10 N/A
2. Fund Management Charge: This charge is levied for management of the Funds and is calculated as a percentage of the Fund Value and shall be appropriated by adjusting
the NAV. The Fund Management Charge shall be levied on each Valuation Date throughout the Policy Term at rates specified below. The rate to be levied will be equal
to the annual rate, as given below, divided by 365 and multiplied by the number of days that have elapsed since previous Valuation Date:
FUND MANAGEMENT
CHARGE
FUND NAME
(levied as a % per annum of the
Fund Value)
Secure Fund 0.90%
Conservative Fund 0.90%
Balanced Fund 1.10%
Growth Fund 1.25%
Growth Super Fund 1.25%
Secure Plus Fund (available under
0.90%
Systematic Transfer Plan)
High Growth Fund 1.25%
3. Policy Administration Charge: This charge is levied for administration of this Policy throughout the Policy Term and levied starting from the Effective Date/ Date
of Commencement of Risk and on each Monthly Anniversary by cancelling an appropriate number of Units in the Unit Account at the prevailing NAV. The Policy
Administration Charge is as follows:
Premium Payment POLICY ADMINISTRATION CHARGE
Mode/Premium (as a % of the Single Premium/Annualised
Frequency Premium)
Single Premium 0.05% per month compounding @ 3% perannum from the 2nd Policy Year with a
cap of ` 200 (Rupees Two Hundred) per month.
Regular Premium with 0.33% per month compounding @ 4% per annum from the 2nd Policy Year with a
annual Premium Frequency cap of ` 500 (Rupees Five Hundred) per month.
Regular Premium with 0.24% per month compounding @ 4% per annum from the 2nd Policy Year with a
Premium Frequency other than annual cap of ` 500 (Rupees Five Hundred) per month.
4. Switch Charge: Nil
5. Partial Withdrawal Charge: Nil
6. Premium Redirection Charge: Nil
7. Miscellaneous Charge: Nil
8. Mortality Charge: This charge is levied on the Sum at Risk for providing life insurance cover to the Life Insured during the Policy Term/ settlement period. The
mortality rates(s) as specified in table below is guaranteed for the entire Policy Term. The mortality charge shall be levied on the Life Insured's attained Age, over the
duration of this Policy and in accordance with the table specified below:

Mortality Charge per Rs.1,000/- Sum at Risk

Attained Age Mortality Rate Attained Age Mortality Rate
0 4.45 38 1.55
1 3.90 39 1.67
2 2.94 40 1.80
3 2.21 41 1.96
4 1.67 42 2.14
5 1.27 43 2.35
6 0.96 44 2.59
7 0.74 45 2.87
8 0.59 46 3.20
9 0.49 47 3.57

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 10 0.44 48 3.98
11 0.43 49 4.44
12 0.45 50 4.95
13 0.49 51 5.48
14 0.55 52 6.05
15 0.61 53 6.64
16 0.68 54 7.26
17 0.74 55 7.89
18 0.80 56 8.54
19 0.85 57 9.23
20 0.89 58 9.94
21 0.92 59 10.71
22 0.94 60 11.53
23 0.96 61 12.43
24 0.97 62 13.41
25 0.98 63 14.50
26 0.99 64 15.69
27 1.00 65 17.01
28 1.02 66 18.46
29 1.03 67 20.06
30 1.06 68 21.82
31 1.08 69 23.75
32 1.12 70 25.86
33 1.16 71 28.16
34 1.22 72 30.67
35 1.28 73 33.41
36 1.36 74 36.39
37 1.45 75 39.64
During the Policy Term, a proportionate mortality charge shall be levied by Us on every Monthly Anniversary by cancelling an appropriate number of Units from the
Unit Account at the prevailing NAV.
9. Discontinuance/Surrender Charge: This charge shall be levied on the Discontinuance of the Policy in accordance with the following table:

For Policies where the premium payment mode is Regular Premium:

Policy Year in Maximum discontinuance charges for the policies having Annualized Premium:
which surrender/
Discontinuance
Up to Rs.50,000/-, are lower of Above Rs.50,000/-, are lower of
occurs
As a percentage of As a percentage As a percentage of As a percentage
Fixed amount (in Rs.) Fixed amount (in Rs.)
Annualized Premium of Fund Value Annualized Premium of Fund Value
1st Policy Year 20% 20% 3,000 6% 6% 6,000
2nd Policy Year 15% 15% 2,000 4% 4% 5,000
3rd Policy Year 10% 10% 1,500 3% 3% 4,000
4th Policy Year 5% 5% 1,000 2% 2% 2,000
5th and onwards Nil Nil Nil Nil Nil Nil

For Policies where the premium payment mode is Single Premium:

Policy Year in Maximum discontinuance charges for the policies having Single Premium:
which surrender/
Discontinuance
Up to Rs.3,00,000/-, are lower of: Above Rs.3,00,000/-, are lower of:
occurs
As a percentage of As a percentage As a percentage of As a percentage
Fixed amount (in Rs.) Fixed amount (in Rs.)
Annualized Premium of Fund Value Annualized Premium of Fund Value
1st Policy Year 2.00% 2.00% 3,000 1.00% 1.00% 6,000
2nd Policy Year 1.50% 1.50% 2,000 0.70% 0.70% 5,000
3rd Policy Year 1.00% 1.00% 1,500 0.50% 0.50% 4,000
4th Policy Year 0.50% 0.50% 1,000 0.35% 0.35% 2,000
5th and onwards Nil Nil Nil Nil Nil Nil

10. Taxes: All Charges are subject to applicable taxes, cess and levies, as may be applicable from time to time.
NOTE: On examination of this Policy, if You notice any mistake or error, this Policy should be returned to Us for rectifying the same.
This Schedule forms an integral part of the Policy document and should be read in conjunction.

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1. DEFINITIONS & INTERPRETATION cc. "Proposal Form" means the form filled in and completed by
1.1 Definitions You, giving full particulars, for the purpose of obtaining insurance
a. "Age" means the Life Insured's age on last birthday as on the Effective coverage under this Policy;
Date/ Date of Commencement of Risk or on the previous Policy dd. "Regular Premium" means the premium payable to Us in regular
Anniversary, as the case may be; instalments in the manner and at the intervals ("Premium Frequency")
b. "Annualised Premium" is the amount specified in the Schedule, and specified in the Schedule;
means the Premium amount payable in a Policy Year, excluding rider ee. "Revival Period" means a period of 3 (Three) years from the date of
premiums, underwriting extra premium on riders and the taxes, cesses first unpaid Regular Premium during which You are entitled to revive
and levies, if any; the Policy which was discontinued due to non-payment of Regular
c. "Authority" means the Insurance Regulatory and Development Premium;
Authority of India established under the Insurance Regulatory and ff. "Schedule" means the policy schedule and any endorsements attached
Development Authority Act, 1999; to and forming part of the Policy and if an updated Schedule is issued,
d. "Business Day" means a day on which Our head office is open for then, the Schedule which is latest in time;
conducting business and does not include public holidays and all other gg. "Single Premium" means the premium paid to Us in a single instalment
days when the stock exchange is closed; as specified in the Schedule;
e. "Charges" means the policy charges applicable under this Policy which hh. "Surrender Value" means the value payable on the surrender of the
are listed and described in the Schedule; Policy which is calculated by Us in accordance with the terms of the
f. "Date of Discontinuance" means the date on which We receive a written Policy;
intimation from You about the surrender of the Policy or on the expiry ii. "Sum Assured" means the amount specified in the Schedule that is
of Grace Period whichever is earlier; payable on the Life Insured's death in accordance with the terms of the
g. "Discontinuance" means the state of the Policy arising out of the Policy;
surrender of the Policy or on non-payment of the Regular Premium due jj. "Sum at Risk" means an amount which is positive and is highest of the
before the expiry of Grace Period; following:
h. "Discontinuance Policy Fund" means Our segregated fund that is set i. Sum Assured less (partial withdrawals made during the two
aside and is constituted by the fund value of all policies discontinued years immediately preceding the date of calculation of sum at
during the Lock in Period on which a minimum guaranteed interest rate risk and Fund Value); or
of 4% (Four percent) per annum (or as mandated by the Authority from ii. Minimum Death Benefit less Fund Value as on the date of
time to time) is guaranteed to be paid; calculation of sum at risk
i. "Date of Commencement of Risk / Effective Date" means the date as iii. Zero.
specified in the Schedule, on which the insurance cover/risk under this NOTE:During the settlement period 'Sum at Risk' shall be higher of
Policy commences; Minimum Death Benefit less Fund Value as on the date of death of the
j. "Funds" means the segregated investment funds established and Life Insured or zero.
managed by Us as listed and described in the Schedule; kk. "Unit" means a specific portion of the underlying Fund, which is
k. "Fund Value" means the total number of Units in Fund(s) multiplied by representative of Your entitlement in such Funds;
the respective NAV of the Fund(s); ll. "Unit Account" means a notional account opened and managed by Us
l. "Grace Period" means a period of 15 (Fifteen) days from the Regular for You, in which the Units are allocated following the receipt of the
Premium due date if the Premium Frequency is monthly and 30 Single Premium/Regular Premium and in which the Units are cancelled
(Thirty) days from the Regular Premium due date for all other Premium by Us for the purpose of paying the benefits and for recovering the
Frequencies; applicable Charges;
m. "Guaranteed Loyalty Additions" means the additional Units created in mm. "Valuation Date" means the date on which We value the assets to which
accordance with Clause 3.5 of this Policy; each of the Funds is referenced for the purpose of declaring the NAV.
n. "Insurance Act" means the Insurance Act, 1938; We will determine the valuation, the frequency of which shall be every
o. "Life Insured" means the person named in the Schedule, whose life is Business Day;
insured under this Policy; nn. "You" or "Your" or "Policyholder" means the person named in the
p. "Lock in Period" means a period of 5 (Five) consecutive years from the Schedule as the policyholder; and
Effective Date/ Date of Commencement of Risk; oo. "We", "Us" or "Our" or "Company" means Max Life Insurance
q. "Maturity Date" means the date specified in the Schedule on which the Company Limited.
Policy Term expires, the Policy terminates and the maturity benefits as 1.2. Interpretation
specified in Clause 3.2 become payable unless the settlement option has a. The words and phrases listed above shall be deemed to have the meanings
been chosen by You; attributed to them wherever they appear in this Policy, unless the context
r. "Minimum Death Benefit" means 105% (Hundred and Five percent) otherwise requires.
of the total Single Premium/Regular Premium received until the date of b. References to the masculine or the singular will include references to the
the Life Insured's death; feminine and the plural, and vice versa.
s. "Monthly Anniversary" means the date in every month corresponding c. References to any statute or statutory enactment shall include
with the Effective Date/ Date of Commencement of Risk and if such re-enactment or amendment to the same.
corresponding date does not exist in a particular month, then the last day d. Clause headings are for sake of reference only and have no interpretive
of that month; value.
t. "NAV" or "Net Asset Value" or "Unit Price" means the price per Unit; e. Reference to days, unless the context otherwise requires, means calendar
u. "Nominee" means the person named by You and registered by Us in days only.
accordance with Clause 11.3 of this Policy who is authorized to receive 2. ELIGIBILITY CONDITIONS
the Death Benefit under the Policy in accordance with the terms of the 2.1. You agree that:
Policy; a. the Policy has been written on a single life basis only;
v. "Paid-Up Policy" means a Policy under which the due Premiums have b. You have represented to Us that the Life Insured is not less than Age
been discontinued after the completion of the Lock-in Period; 91 days on the Effective Date/ Date of Commencement of Risk and not
w. "Paid-up Sum Assured" means the amount payable under a Paid-up more than:
Policy which is equal to the Sum Assured multiplied by the resultant of i. Age 60 (Sixty) on the Effective Date/ Date of Commencement of
the total number of Regular Premiums received by Us divided by the Risk, if the premium payment mode is Single Premium or Regular
total number of Regular Premiums payable by You during the Premium Premium with a Premium Payment Term of 5 (Five) years;
Payment Term; ii. Age 50 (Fifty) on the Effective Date/ Date of Commencement of
x. "Policy" means this "Max Life Fast Track Super" plan which is Risk, if the premium payment mode is Regular Premium with a
governed by the documents comprising these terms and conditions, the Premium Payment Term of 20 (Twenty) years.
Proposal Form, the Schedule and any additional information/documents c. The maximum Age of the Life Insured on the Maturity Date shall not
provided to Us in respect of the Proposal Form, any endorsements issued exceed Age 70 (Seventy). The minimum Age of the Life Insured on the
by Us from time to time along with any written information/instructions Maturity Date shall not be below Age 18 (Eighteen) Years.
from You subject to Our acceptance of the same; 3. BENEFITS
y. "Policy Anniversary" means the annual anniversary of the Effective 3.1. Death Benefit
Date/ Date of Commencement of Risk; a. Subject to Clause 4, 5, 10.6, 11.11 and 11.12 in the event of the Life
z. "Policy Term" means the term of the Policy as specified in the Schedule Insured's death when the insurance coverage under the Policy is in
which is 10 (Ten) years if the premium payment mode is Single force, We shall pay the higher of the Sum Assured reduced by partial
Premium or Regular Premium with a Premium Payment Term of 5 (Five) withdrawals made during the two years immediately preceding the date
years; and 20 (Twenty) years if the premium payment mode is Regular of death of the Life Insured; or the Fund Value (on the date of the Life
Premium with Premium Payment Term of 20 years; Insured's death), provided that the amount payable shall in no event be
aa. "Policy Year" means a period of 12 (Twelve) months commencing from less than the Minimum Death Benefit.
the Effective Date/ Date of Commencement of Risk and every Policy b. The death benefit amount shall be payable to You (if You are not the
Anniversary thereafter; Life Insured) or to the Nominee (if You are the Life Insured) or to Your
bb. "Premium Payment Term" means the term during which the Regular legal heirs or legal representatives (if You are not alive and there are no
Premiums are payable under the Policy, as specified in the Schedule; Nominees or all Nominees have pre-deceased the Life Insured).
10 of 33
 c. Settlement option will not be provided. 3.6. Survival Benefit
3.2. Maturity Benefit No survival benefits are payable under this Policy.
Subject to Clause 4, 10.6, 11.11 and 11.12, on the Maturity Date, if the Life 4. PAYMENT OF BENEFITS
Insured is alive and the insurance cover under this Policy is in force or if this 4.1. Subject to Clause 11.11 below, the benefits under this Policy are payable only
Policy is a Paid-Up Policy in accordance with Clause 5, We will pay the Fund on submission of satisfactory proof to Us. For processing a claim under this
Value applicable on the Maturity Date to You unless You have opted for the Policy, We require:
settlement option in accordance with Clause 3.3 below and We have accepted (a) written notice of the claim at the earliest;
the same. (b) all the following documents to be submitted to Us:
3.3. Settlement Option (i) claimant's statement in the prescribed form;
You may opt to exercise the settlement option at least 15 (Fifteen) days before (ii) original Policy document;
the Maturity Date by giving Us a written request. Under the settlement option (iii) death certificate issued by the local/municipal authority (for
accepted by Us: payment of the death benefit only);
(a) You will receive the value of Units, as per the prevailing NAV, in (iv) valid identity and address proof of the claimant/ Nominee(s)
periodic instalments (i.e. annually, semi-annually, quarterly or monthly) (for payment of the death benefit) which must be self attested;
for a maximum period of 5 (Five) years from the Maturity Date. We (v) valid succession certificate/order from a competent court
will pay the first instalment under the settlement option on the Maturity specifying that the claimant is entitled to collect the amounts
Date. Under the settlement option, the Units payable towards each due under the Policy (for all claims where You are not alive and
installment will be equal to the number of Units available before payment there are no Nominee(s) or all Nominee(s) have pre-deceased
of the installment divided by the number of remaining installments. the Life Insured).
Your written request to apply for the settlement option shall specify the (c) other information, details or documentation specified by Us for
proposed duration for payment and the frequency of payment of each assessing the claim.
instalment. 4.2. Any person claiming the benefits under this Policy can download the claim
(b) For the duration that the settlement option is in force: request documents from Our website www.maxlifeinsurance.com or can
(1) the Policy will continue after the Maturity date for a period not obtain the same from any of Our branch offices.
exceeding 5 years from the Maturity Date with risk cover equal 4.3. We reserve the right to scrutinise the information and documents submitted
to 105% of the total Premiums received on the Life Insured's life by the claimant and/or investigate the claim and deny the claim partially
under the Policy after the Maturity Date. Mortality Charge will be or completely on the basis of Our scrutiny of the documents or investigation,
deducted; as the case may be. We will pay the benefits under the Policy only subject to
(2) We will deduct the applicable Fund Management Charge; Our satisfaction:
(3) You shall not be permitted to make any partial withdrawals. (a) that the benefits have become payable as per. the terms and conditions
(4) You may switch Units between the Funds upon which applicable of this Policy; and
switching charges will be deducted; and (b) of the bonafides and credentials of the said person or persons claiming
(5) You shall continue to bear all inherent risks in the investment the benefits under this Policy.
portfolio. 4.4. Any benefit/claim payment under this Policy shall be made by Us in Indian
(c) You may opt to terminate the settlement option at any time when the Rupees or in any other currency in accordance with the applicable Indian Law.
settlement option is in force by giving Us a written notice. We shall 4.5. Once the benefits under this Policy are paid to person(s) specified in the Policy,
pay the Fund Value prevailing on the date of receipt of such notice and the same shall constitute a valid discharge of Our liability under the Policy.
terminate the Policy. 5. PREMIUM PAYMENTS & DISCONTINUANCE PROVISIONS
(d) If Life Insured dies when the settlement option is in force, We will pay [Note: The provisions of Clause 5 below are not applicable if the premium
the Fund Value prevailing as on the date of the death of the Life Insured payment mode is Single Premium]
to You provided that the amount payable shall in no event be less than 5.1. The Regular Premium is due and payable to Us by the due date specified in
the Minimum Death Benefit and terminate the Policy. the Schedule. If the Regular Premium is not paid by the due date, You may
3.4. Surrender pay the same during the Grace Period. During the Grace Period the insurance
At any time during the Policy Term, You have the right to surrender the Policy cover will continue and all Charges under the Policy will continue to apply.
by giving Us a written notice: You are not permitted to change the Regular Premium amount or the Premium
(a) Surrender within the Lock in Period Payment Term during the Policy Term.
(i) If You surrender the Policy within the Lock in Period, we will 5.2. The Regular Premium can be paid by You annually, semi-annually, quarterly
credit the Fund Value by creation of Units into the Discontinuance or monthly as per the Premium Frequency chosen by You. You may change the
Policy Fund after deducting applicable Discontinuance/Surrender Premium Frequency by submitting a written request to Us, provided that such
Charges. change in Premium Frequency will be effective only on the Policy Anniversary
(ii) On the expiry of the Lock in Period, We will close the Unit Account following the receipt of such request.
and the value of Units in the Discontinuance Policy Fund as at that 5.3. You may pay the Regular Premiums at any of Our offices or through Our
date shall be paid to You. website www.maxlifeinsurance.com or by any other means, as informed by
(iii) Until the expiry of the Lock in Period, only the Fund Management Us from time to time. Any Regular Premium paid by You through a cheque
Charge applicable on the Discontinuance Policy Fund shall be or any other instrument/medium will be deemed to have been received only
levied and no other Charges will be levied by Us. after the same has been fully realised and credited to Our bank account.
(iv) If the Life Insured dies after the Fund Value has been transferred 5.4. The premium payment receipt shall be issued in Your name and shall be
to the Discontinuance Policy Fund, We will close the Unit Account subject to realisation of the cheque or any other instrument/medium.
and the value of Units in the Discontinuance Policy Fund on the 5.5. We will not accept any additional premium or top-up premium under this
date of death of Life Insured shall be paid to You or the Nominee. Policy.
(b) Surrender after the completion of the Lock in Period 5.6. If the Regular Premium is not received in full by the expiry of the Grace Period
(i) If You surrender the Policy after the completion of the Lock in the provisions of Clause 5.7 or 5.8 will apply, as the case may be.
Period, We shall close the Unit Account and pay the Surrender 5.7. Discontinuance of Payment of Regular Premium during the Lock in
Value which is equal to the Fund Value prevailing on the date of Period
receipt of a valid request for surrender. (a) If the Regular Premium is not received before the expiry of the Grace
3.5. Guaranteed Loyalty Additions Period, We will, within 3 (Three) months of the first unpaid Regular
(a) Guaranteed Loyalty Additions shall be made available as specified in Premium, give a written notice to You informing You the status of the
Clause 3.5 (b), only if the premium payment mode is Regular Premium Policy and provide You the option to revive the Policy within the Revival
with a Premium Payment Term of 20 (Twenty) years provided the Life Period;
Insured is alive and all due Regular Premiums have been received by Us. (b) In the event that You opt to revive the Policy but do not revive the Policy
(b) We will add 0.30% of the Fund Value to the Fund(s) by creation during the Revival Period, We will close the Unit Account and pay the
of additional Units at the end of every Policy Year starting from the proceeds of the Discontinuance Policy Fund to You at the end of the
11th (Eleventh) Policy Year. For each subsequent year, the Guaranteed Revival Period or Lock in Period whichever is later.
Loyalty Additions shall increase by 0.02% of the Fund Value prevailing (c) If You do not exercise the above option to revive the Policy during
at the end of that policy year. For instance, at the end of 12th (Twelfth) the Revival Period, the Policy shall continue without any risk cover
Policy Year, the Guaranteed Loyalty Additions will be 0.32% (i.e. 0.30% (and rider cover, if any) and the Funds shall remain invested in the
Discontinuance Policy Fund, and at the end of the Lock in Period, We
+ 0.02%) of the Fund Value at the end of 12th (Twelfth) Policy Year, will close the Unit Account and pay the proceeds of the Discontinuance
for 13th (Thirteenth) Policy Year the Guaranteed Loyalty Additions will Policy Fund to You, and terminate the Policy.
be 0.34% (i.e. 0.30% + 0.02% + 0.02%) of the Fund Value at the end of (d) Upon expiry of the Grace Period, in case of Discontinuance of
the Policy due to non-payment of Regular Premium, on the Date
13th (Thirteenth) Policy Year, and so forth.
of Discontinuance, We will credit the Fund Value, by creation of
(c) The additional Units shall be credited in different Funds in proportion of
Units, into the Discontinuance Policy Fund after deducting applicable
the Fund Value at the time of such additions.
Discontinuance/Surrender Charges. The risk cover under the Policy
(d) Guaranteed Loyalty Additions shall be made available, as applicable,
and any applicable riders will cease and no further Charges will be
where the Premium reduction option has been opted by You, if any.
levied by Us other than the Fund Management Charge applicable on the
Discontinuance Policy Fund.
11 of 33
 (e) If the Policy is surrendered by You, any time before the proceeds under 2. Complete Withdrawal from the Policy without any risk cover:
the Policy is paid out, the provisions as mentioned in Clause 3.4(a) If You exercise the option of complete withdrawal, then, on such date,
relating to surrender of the Policy within the Lock in Period will be the provisions relating to surrender of the Policy after the Lock in Period
applicable. as per Clause 3.4(b) shall be applicable.
(f) If You have chosen in writing the option to revive the Policy within the 6. AUTOMATIC TERMINATION/FORECLOSURE OF THE POLICY
Revival Period, You may exercise the option to revive the Policy during If at any time during the Policy Term or settlement period, the Fund Value becomes
the Revival Period, subject to the following conditions: equal to or less than zero, the Policy will terminate.
1. You give Us a written request to revive the Policy or the Policy 7. ALLOCATION OF PREMIUM
along with rider cover; and We will allocate the Single Premium/Regular Premiums on the later of the date of
2. Life Insured produces an evidence of insurability (in form of receipt of the premium or the premium due date, as the case may be to the Funds
declaration of health condition and/or relevant medical reports) chosen by You and in the allocation proportion specified in the Schedule (or as
at Your own cost, acceptable to Us as per Our board approved modified from time to time) after deduction of the Premium Allocation Charge.
underwriting policy; and 8. FUNDS
3. You pay Us all overdue Regular Premiums in full. 8.1. The Funds currently available for investment under the Policy and the
(g) On revival, the insurance cover under the Policy and any applicable investment objectives of each Fund are specified in the Schedule.
riders as at the Date of Discontinuance will be restored and the Fund 8.2. We may add, close, combine or modify any Fund with the prior approval of
Value of the Units in the Discontinuance Policy Fund as on the date of Authority. We will send You prior written notice of at least 60 (Sixty) days of
the revival shall be credited back to the Fund(s) chosen by You. The our intention to add, close, combine or modify any Fund.
Discontinuance/Surrender Charges deducted will also be added back to 8.3. The underlying assets in all Funds belong to Us. Your investment in any
the Unit Account. Fund shall not and shall not be deemed to give rise to any legal or beneficial
(h) The amount of Regular Premium paid on revival, less any Premium ownership or right to You, the Life Insured or Nominee in either the assets to
Allocation Charges attributable to the Regular Premium paid on revival which the Funds are referenced or the income from those assets or any surpluses
in accordance with the ratio in which the Regular Premium should be in any Funds or in Our profits or assets.
allocated in the Funds specified by You will be used to purchase Units 9. UNITS & UNIT PRICE
at the Unit Price as on the date of revival. 9.1. We will initially open a Unit Account as on the Effective Date/ Date of
(i) An amount equal to the Policy Administration Charge falling due Commencement of Risk.
between the Date of Discontinuance and the date of revival will be levied 9.2. Units will be purchased and cancelled at the Unit Price/NAV. The number of
on revival by cancelling Units in the Unit Account at their Unit Price. Units shall be expressed up to 3 (Three) decimal places.
(j) In case the Life Insured dies during the period of Discontinuance, We 9.3. Units will be cancelled from the Unit Account for recovering applicable
shall pay the Fund Value as on the date of death and any Discontinuance Charges and for payment of benefit amounts and other amounts which are
Charges deducted by Us shall be added back to the Fund Value, in case payable from the Fund Value.
the Policyholder has exercised the option to revive the Policy. 9.4. Units are purely notional and are only for the purpose of determining the
(k) During the period of Discontinuance, You shall not be allowed to Charges recoverable and amounts payable under the Policy. Neither the Units
exercise switches or partial withdrawals. nor the Unit Account give rise or shall be deemed to give rise to any legal or
5.8. Discontinuance of Payment of Regular Premium after the Lock in Period beneficial ownership or right to You, the Life Insured or Nominee in either the
a) If the Regular Premium is not received in full by the expiry of the Grace assets to which the Funds are referenced or the income from those assets or any
Period, the Policy shall be immediately and automatically converted into surpluses in any Funds or in Our profits or assets.
a Paid-up Policy. On such Discontinuance, We will, within 3 (Three) 9.5. The price of a Unit shall be calculated as per the following formula:
months of the first unpaid Regular Premium, give a written notice to You Market value of investments held by the segregated fund plus value of current
informing You of the status of the Policy and provide You the option to assets minus (value of current liabilities and provisions, if any) divided by
exercise one of the following options in writing ): number of Units on Valuation Date (before creation/redemption of Units).
1. revive the Policy within the Revival Period; 9.6. The NAV shall be determined on each Valuation Date. The NAV in respect of
2. complete withdrawal (surrender) of the Policy without any risk each Fund will be determined by dividing the value of the Fund with the number
cover; of Units on the Valuation Date subject to rounding up or down by not more than
b) If the complete withdrawal option is exercised by You, the provisions 1% (One per cent) of a Rupee.
relating to surrender of the Policy after the Lock in Period as per Clause 9.7. Unit Encashment
3.4 (b) will be applicable. (a) For Single Premium/Regular Premium received by a local cheque or a
c) In the event that You opt to revive the Policy but do not revive the Policy demand draft payable at par at the place where the Single Premium/Regular
during the Revival Period, We will pay the Fund Value to You at the end Premium is received or by cash before 3:00 p.m. on a Business Day, the
of the Revival Period. closing NAV of the day on which the Single Premium/Regular Premium is
d) If You do not exercise any of the above options, the Policy will continue received by Us shall be applicable.
to be a Paid-up Policy and at the end of the Revival Period, We will pay (b) For Single Premium/Regular Premium received by a local cheque or a
the Fund Value to You, and terminate the Policy. demand draft payable at par at the place where the Single Premium/Regular
e) During the period up to the Date of Discontinuance, the risk cover will Premium is received or by cash after 3:00 p.m. on a Business Day, the
continue and all Charges under the Policy will continue to apply. closing NAV of the next Business Day shall be applicable.
f) During the Revival Period, the risk cover under a Paid-up Policy shall (c) For Single Premium/Regular Premium received through an outstation
be restricted to the Paid-up Sum Assured and all applicable Charges i.e. cheque/demand draft, the closing NAV of the Business Day on which
Policy Administration Charge, Mortality Charge and Fund Management such cheque/demand draft is realized shall be applicable.
Charge will continue to be levied. During this period, the Rider cover, (d) For valid requests for switching, partial withdrawal, redirection or surrender
if any, will cease. received up to 3.00 p.m. on a Business Day, the closing NAV of the same
g) If You have chosen in writing the option to revive the Policy within the day shall be applicable.
Revival Period, You may exercise any of the following options in writing (e) For valid requests for switching, partial withdrawal, redirection or surrender
during the Revival Period: received after 3.00 p.m. on a Business Day or in case of any request received
1. Revive the Policy: on a day which is not a Business Day, the closing NAV of the next Business
Revive the Policy, subject to the following conditions: Day shall be applicable.
a. You give Us a written request to revive the Policy or the Policy (f) For all transactions including death benefit or maturity benefit payments
along with rider cover; and that arise on a day which is not a Business Day, the closing NAV of the
b. Life Insured produces an evidence of insurability(in form of next Business Day shall be applicable.
declaration of health condition and/or relevant medical reports) 10. OPTIONS AVAILABLE UNDER THE POLICY
at Your own cost, acceptable to Us as per Our board approved 10.1. Premium Redirection
underwriting policy; and (a) You may redirect the Regular Premium between the Funds by giving
c. You pay Us all overdue Regular Premiums in full. Us written notice of the proposed amended allocation proportion before
The amount of Regular Premium paid on revival, less any Premium the Regular Premium due date. We will change the allocation proportion
Allocation Charges attributable to the Regular Premium paid on revival provided that:
in accordance with the ratio in which the Regular Premium should be (i) the amount/proportion of Regular Premium to be paid into each
allocated in the Funds specified by You will be used to purchase Units Fund at the time of re-direction is specified by You in Your request
at the Unit Price as on the date of revival. for re-direction;
We shall credit all the Guaranteed Loyalty Additions that would (ii) We will not permit more than 6 (Six) premium redirections in any
otherwise have been payable for the Revival Period in accordance with Policy Year.
Clause 3.6 at the Fund Value prevailing on the date of revival. 10.2. Switch
During the period up to the expiry of the Revival Period or the earlier (a) You may switch Units from one Fund to any other Fund by giving Us
exercise of any of the above options, the Policy will continue with a written request. We will cancel Units from the Fund from which You
reduced risk cover and all applicable Charges i.e. Policy Administration wish to switch out and purchase Units in the Fund in which You have
Charge, Mortality Charge and Fund Management Charge will be levied chosen to re-invest, provided that:
during the Revival Period. (i) the amount to be switched is at least Rs.5,000 (Rupees Five
Thousand);

12 of 33
 (ii) We will not permit more than 12 (Twelve) switches in any Policy 10.5. Systematic Transfer Plan
Year. (a) You may opt to exercise the Systematic Transfer Plan at any time during
(iii) switching will not be allowed during the period of Discontinuance. the Policy Term by giving Us a prior written notice but only if the
(b) We may, in Our discretion and with the prior approval of the premium payment mode is Single Premium or Regular Premium with
Authority, impose a partial or complete ban on switches for a period annual Premium Frequency and the Dynamic Fund Allocation option was
not exceeding 30 (Thirty) days, if in Our view it is appropriate not in force or was not opted for at any time during the Policy Term. Once
in order to maintain the stability of a Fund or if it is necessary accepted, the Systematic Transfer Plan shall be effective from the Policy
to protect the interests of the policyholders. This ban may be Anniversary immediately following the receipt of the written notice.
imposed under extraordinary circumstances such as non-availability (b) If the Systematic Transfer Plan is in force, then We will automatically
of market prices or the occurrence of any catastrophe where the allocate the Single Premium/Regular Premium received (after deducting
declaration of the Unit Price is not possible. Premium Allocation Charges) to purchase Units in the Secure Plus Fund.
(c) Switching shall be allowed during the settlement period. On each subsequent monthly anniversary, the Fund Value of [1/(13 less
10.3. Partial Withdrawals month number in the Policy Year)] of the Units available at the beginning
(a) You may make a partial withdrawal by giving Us a written request. We of the month] shall be switched to the Growth Super Fund by cancelling
will affect the partial withdrawal provided that: Units in the Secure Plus Fund, and purchasing Units in the Growth Super
(i) the amount to be withdrawn is at least Rs.5,000 (Rupees Five Fund till the availability of Units in Secure Plus Fund.
Thousand); For instance:
(ii) the maximum amount of partial withdrawal in any Policy Year does Policy month 1: 1/(13-1)= 1/12th of the Units to be switched
not exceed 50% (Fifty percent) of the Fund Value as on the date Policy month 2: 1/(13-2)= 1/11th of the Units to be switched
of the partial withdrawal subject to the Fund Value immediately Policy month 11: 1/(13-11)= 1/2 of the Units to be switched
after the partial withdrawal being at least equal to one Annualised Policy month 12: 1/(13-12)= balance Units to be switched
Premium or 25% of Single Premium (as applicable). For the sake of (c) We will not levy any switching charges for the operation of the Systematic
clarity, You may make a maximum of 2 (Two) partial withdrawals Transfer Plan.
in a Policy Year such that the summation of percentages of Fund (d) You shall not be permitted to make partial withdrawals from the Secure
Value withdrawn is not more than 50% (Fifty percent); Plus Fund during the period when this option is in force.
(iii) We will not permit any partial withdrawal before the (e) If You do not pay the Regular Premium due within the Grace Period,
commencement of the 6th (Sixth) Policy Year; then the Systematic Transfer Plan shall not be applicable for that year's
(iv) We will not permit any partial withdrawal before the minor Life premium and Regular Premium received after the Grace Period shall be
Insured attains the majority i.e. no partial withdrawal will be allocated to the Growth Super Fund or any other Funds specified by
allowed till the Life Insured attains Age of 18 years; You. Unless You notify Us otherwise in writing, the Systematic Transfer
(v) We will not permit more than 2 (Two) partial withdrawals in any Plan shall apply to future Regular Premium received within the Grace
Policy Year; Period.
(vi) The Sum Assured shall be reduced by all partial withdrawals made (f) You may opt out of the Systematic Transfer Plan during the Policy Term
during the 2 (Two) Policy Years immediately preceding the Life by giving Us prior written notice, in which case this option will cease to be
Insured's death We may, in Our discretion and with the prior effective from the Policy Anniversary following the receipt of the request.
approval of the Authority, impose a partial or complete ban on (g) You may opt for either the Systematic Fund Transfer Option or Dynamic
partial withdrawals for a period not exceeding 30 (Thirty) days, if Fund Allocation option at the inception or during the Policy Term but not
in Our view it is appropriate in order to maintain the stability of a both. If You have opted for any one of the options, You cannot opt for
Fund or if it is necessary to protect the interests of the policyholders. the other.
This ban may be imposed under extraordinary circumstances such 10.6 Premium Reduction
as non-availability of market prices or the occurrence of any (a) Upon payment of full Premiums for the first Five Policy Years, You have
catastrophe where the declaration of the Unit Price is not possible. an option to decrease the Premium upto 50% of the original Annualized
10.4. Dynamic Fund Allocation Premium subject to the minimum Premium limit as approved by the
(a) You may opt to exercise the Dynamic Fund Allocation option only prior Authority under the product. To opt, an intimation should be given to Us
to the Effective Date/ Date of Commencement of Risk. If this option is 15 days prior to the Premium due date.
in force, then We will automatically allocate the Single Premium/Regular (b) The Sum Assured under the Policy will be also be reduced proportionately
Premium received on the later of the date of receipt of the Single and all the applicable charges will be deducted accordingly.
Premium/Regular Premium or the due date of Regular Premium and (c) This option may be exercised only once during the Policy Term and once
switch Units in the Funds on each Policy Anniversary, in a pre-determined reduced, the Premium cannot be subsequently increased.
proportion specified in the applicable table below: (d) The Sum Assured of attached rider (if any) and the rider premium will also
be reduced proportionately, subject to the regulatory boundary conditions
For Policies where the premium payment mode is Single Premium or for riders. If the revised rider benefit is not within the prescribed limits,
Regular Premium with a Premium Payment Term of 5 years: the rider benefit will be terminated and termination conditions of the rider
shall apply.
11. GENERAL CONDITIONS
Assets under Assets under
11.1. Free Look Period
Policy Years to management to be management to
(a) You have a period of 15 (Fifteen) days or 30 (Thirty) days, if the Policy
the Maturity maintained under be maintained
has been acquired through distance marketing (i.e. by any means of
Date the Growth under the
communication other than in person) from the date of receipt of the
Super Fund Secure Fund
Policy to review the terms and conditions of the Policy and where You
8-10 70% 30% disagree to any of those terms or conditions, You have the option to
4-7 50% 50% return the Policy stating the reasons for Your objections, upon which You
0-3 30% 70% shall be entitled to an amount which will be equal to non-allocated Single
Premium/Regular Premium plus Charges levied by cancellation of Units
For Policies where the premium payment mode is Regular Premium plus Fund Value at the date of cancellation less Charges deducted
with a Premium Payment Term of 20 years: towards mortality and rider benefits (including applicable taxes, cesses
and levies on these Charges) for the period of cover, expenses incurred
Assets under Assets under on medical examination, if any, and on account of stamp duty.
Policy Years to management to be management to 11.2 Risk Factors
the Maturity maintained under be maintained You understand and agree that:
Date the Growth under the (i) Max Life Fast Track Super is a unit-linked non-participating
Super Fund Secure Fund individual life insurance plan. Unit linked life insurance products are
16-20 80% 20% different from the traditional life insurance products and are subject to
investment risks.
11-15 60% 40%
(ii) Max Life Fast Track Super is only the name of the Policy and does
6-10 40% 60% not in any way indicate the quality of the Policy, its future prospects
0-5 20% 80% or returns.
(iii) the names of the Funds do not in any manner indicate the quality of the
(b) You shall not be permitted to make premium redirections or switch Units Funds, their future prospects or returns.
between the Funds during the period when this option is in force. (iv) We do not guarantee the Fund Value or Unit Price. Depending on
(c) You may opt out of the Dynamic Fund Allocation option during the Policy market risk and the performance of the Funds to which the Units are
Term by giving Us a prior written request, in which case this option will referenced, the Fund Value may fall, rise or remain unchanged and You
cease to be effective from the Policy Anniversary following the receipt are responsible for Your decisions. There can be no assurance that the
of Your request. Once You have opted out, You shall not be permitted to objectives of any Fund will be achieved and none is given by Us.
recommence the Dynamic Fund Allocation option during the Policy Term. (v) the past performance of any Fund is not necessarily indicative of the
future performance of any Funds.

13 of 33
 (vi) the Funds do not offer a guaranteed or assured return except in case of 11.14. Administrative & Judicial Intervention
Discontinuance Policy Fund which offers minimum guarantee of 4% If the Authority or any administrative or judicial body imposes any condition
(Four percent) currently or as prescribed by the Authority from time on or in relation to this Policy for any reason, We will be bound to follow the
to time. same which may include suspension of some or all benefits and obligations
(vii) this is a non-participating policy. under this Policy.
11.3. Nomination 11.15. Force Majeure
Nomination is allowed as per Section 39 of the Insurance Act, 1938 as If Our performance or any of Our obligations are in any way prevented
amended from time to time. [A leaflet containing the simplified version of the or hindered as a consequence of any act of God or state, strike, lock out,
provisions of the above section is enclosed in Annexure - (2) for reference]. legislation or restriction by any Government or any other authority or any
11.4. Assignment other circumstances beyond Our anticipation or control, the performance of
Assignment is allowed as per Section 38 of the Insurance Act, 1938 as this Policy shall be wholly or partially suspended during the continuance
amended from time to time. [A leaflet containing the simplified version of the of such force majeure conditions. Under an intimation/approval of the
provisions of the above section is enclosed in Annexure - (3) for reference]. Authority, We will resume Our obligations under the Policy, to the extent
11.5. Suicide Exclusion possible, after the force majeure conditions cease to exist even for the period
(i) If the Life Insured commits suicide, whether sane or insane, within 12 during which the force majeure conditions existed.
(Twelve) months from the Effective Date/ Date of Commencement of 11.16. Amendments
Risk or from the date of the latest revival of the Policy, the benefits No amendment to this Policy shall be effective, unless such amendment is
under the Policy shall immediately and automatically cease. We will expressly approved by Us in writing.
terminate the Policy by paying only the Fund Value prevailing on the 11.17. Termination of Policy
date of intimation of death of the Life Insured. This Policy shall terminate upon happening of the earliest of the following
(ii) Any charges other than Fund Management Charges recovered events:
subsequent to the date of death shall be added back to the Fund Value as i) on the date on which We receive a valid free look cancellation request
available on the date of intimation of death. as per Clause 11.1 from You; or
11.6. Upon Death of Policyholder and Change in Policyholder ii) on payment of death benefit as per Clause 3.1 of this Policy or the date of
(a) If You and the Life Insured are different then, upon Your death, no intimation of repudiation of the claim in accordance with the provisions
benefits shall become payable under this Policy. Your legal heirs may of this Policy; or
continue to avail the benefits under this Policy, by paying the due iii) payment of proceeds of the Discontinuance Policy Fund or Surrender
premiums to Us and by submitting the requisite documents as specified Value, as applicable; or
by Us and subject to other conditions prescribed by Us from time to time. iv) upon the Fund Value becoming equal to or less than zero in accordance
(b) You may request Us to make the Life Insured the policyholder under the with Clause 6 of this Policy; or
Policy by giving Us prior written notice provided that the Life Insured v) on the Maturity Date; or
shall not become the policyholder unless the Life Insured meets all our vi) in case You have chosen the settlement option, on receipt of Your request
eligibility criteria in accordance with Our internal policies and guidelines for termination of the settlement option or the expiry of the settlement
and We have issued a written endorsement under the Policy confirming period chosen by You.
the change in policyholder. 11.18. Grievance Redressal Procedure
(c) From the date of Our written endorsement confirming the Life Insured (a) All consumer grievances and/or queries may be first addressed to
as the policyholder, You shall automatically cease to have any rights, Our customer helpdesk mentioned below or to the office address as
benefits or obligations under the Policy and all rights, benefits and mentioned in the Schedule:
obligations shall vest entirely with the Life Insured. i. Max Life Insurance Company Limited, Plot No. 90A,
11.7. Other Restrictions Sector 18, Gurugram, 122015, Haryana, India, Helpline
This Policy contains no restrictions as to travel or occupation. No.- 1860 120 5577 or (0124) 4219090, Email:
11.8. Policy Loan [email protected], Or
You are not entitled to loans under this Policy. ii. To any office of Max Life Insurance Company Limited.
11.9. Policy Currency (b) If Our response is not satisfactory or there is no response within 15
This Policy is denominated in Indian Rupees. All payments to Us under the (Fifteen) days:
Policy shall be in Indian Rupees. i. the complainant file a written complaint full details of the
11.10. Taxation complaint and the complainant's contact information, to the
(a) All Premiums are subject to applicable taxes, cesses and levies which following official for resolution:
shall be entirely borne by You and will be paid by You along with the Grievance Redressal Officer,
Premium. If any imposition (tax or otherwise) is levied on Us by any Max Life Insurance Company Limited
statutory or administrative body under this Policy, We reserve the right Plot No. 90A, Sector 18
to claim the same from You. Alternatively, We have the right to deduct Gurugram, 122015, Haryana, India
the amount from the benefits payable by Us under this Policy. Helpline No - 1860 120 5577 or (0124) 4219090
(b) Tax benefits and liabilities under this Policy are subject to prevailing Email - [email protected]
tax laws. Tax laws and the benefits arising from the same are subject ii. the complainant or his legal heirs may approach the Grievance
to change. You are advised to seek the opinion of Your tax advisor in Cell of the IRDAI on the following contact details:
relation to applicable tax benefits and liabilities. IRDAI Grievance Call Centre (IGCC)
11.11. Fraud, Misrepresentation and Forfeiture Toll Free No:155255 or 1800 4254 732
Fraud, misrepresentation and forfeiture would be dealt with in Email ID: [email protected]
accordance with provisions of Section 45 of the Insurance Act, 1938 as iii. You can also register Your complaint online at
amended from time to time. [A leaflet containing the simplified version http://www.igms.irdai.gov.in/
of the provisions of the above section is enclosed in Annexure - (1) for iv. You can also register Your complaint through by submitting
reference] Your complaint to:
11.12. Declaration of the Correct Age Consumer Affairs Department
Declaration of the correct Age and/ or gender of the Life Insured is important Insurance Regulatory and Development Authority of India
for Our underwriting process and calculation of Premiums payable under the Sy No. 115/1, Financial District,
Policy. If the Age and/or gender declared in the Proposal Form is found to be Nanakramguda,Gachibowli, Hyderabad - 500032
incorrect at any time during the Policy Term or at the time of claim, We may Ph: (040) 20204000
revise the Premium with interest and/or applicable benefits payable under the (c) If You are not satisfied with Our decision, or have not received
Policy in accordance with the Premium and benefits that would have been any response from Us within a period of 1 (One) month or
payable, if the correct Age and/ or gender would have made the Life Insured rejection of complaint by Us, the complainant or his legal heirs or
eligible to be covered under the Policy on the Date of Commencement of nominee, or assignee may approach the Insurance Ombudsman at
Risk subject to Section 45 of the Insurance Act, 1938 as amended from time the address mentioned in Annexure A or at the Authority's website
to time www.irdai.gov.in, or on Council of Insurance Ombudsmen website at
11.13. Electronic Transactions www.cioins.co.in, if Your grievance pertains to:
You will adhere to and comply with all such terms and conditions as i. delay in settlement of a claim beyond the time specified in
prescribed by Us from time to time, and all transactions effected by or the regulations, framed under the Insurance Regulatory and
through facilities for conducting remote transactions including the Internet, Development Authority of India Act, 1999;
world wide web, electronic data interchange, call centres, tele-service ii. any partial or total repudiation of a claim by Us;
operations (whether voice, video, data or any combination thereof) or by iii. dispute with regard to Premium paid or payable in terms of the
means of electronic, computer, automated machines network or through Policy; or
other means of telecommunication, established by Us or on Our behalf, iv. misrepresentation of Policy terms and conditions at any time in
for and in respect of this Policy, or for any payment or receipt of Single the Policy document or Policy contract;
Premium/Regular Premium or in relation to any of Our products and services, v. dispute on the legal construction of the Policy in so far as the
shall constitute legally binding and valid transactions when executed in dispute relates to claim;
adherence to and in compliance with the terms and conditions for such vi. Policy servicing by Us, our agents or intermediaries;
facilities, as may be prescribed by Us from time to time.
14 of 33
 vii. issuance of insurance policy, which is not in conformity with
the proposal form submitted by You;
viii. non issuance of any insurance document after receipt of the
Premium.
ix. any other matter resulting from non-observance of or
non-adherence to the provisions of any regulations made by
the IRDAI with regard to protection of policyholders' interests
or otherwise, or of any circulars, Guidelines or instructions
issued by the IRDAI or of the terms and conditions of the policy
contract, in so far as they relate to issues mentioned in this para
11.3 above.
(d) As per Rule 14 of the Insurance Ombudsman Rules, 2017, a complaint
to the Insurance Ombudsman can be made only within a period of 1
(One) year after receipt of the insurer rejecting the representation or
after receipt of Our decision which is not to your satisfaction or if We
fail to furnish reply after expiry of a period of one month from the date
of receipt of the written representation of the Complainant, provided
the complaint is not on the same matter, for which any proceedings
before any court, or consumer forum or arbitrator is pending.
11.19. Communications and Notices
(a) Our contact details are mentioned in Clause 11.18 (a) of this Policy. For
any updates, please visit Our website www.maxlifeinsurance.com. You
should mention the correct Policy number for all communications made
by You to Us and for all Single Premium/Regular Premium remittances
made by You.
(b) All notices meant for Us must be in writing and delivered to Our address
as mentioned in Clause 11.18 (a) above, or such other address as We may
notify from time to time.
(c) All notices meant for You will be in writing and will be sent by Us to
Your address as shown in the Schedule or as communicated by You and
registered by Us. We will send You the notice through post, courier,
hand delivery, fax or email/electronic mode or by any other means as
determined by Us. If You change Your address, or if the address of the
Nominee changes, You must notify Us immediately in writing. Failure
in timely notification of change of address could result in a delay in
processing of benefits payable under the Policy.
11.20. Governing Law and Jurisdiction:
(a) Indian law shall govern this Policy and the relationship between You and
Us.
(b) This Policy and all rights, obligations and liabilities arising hereunder,
shall be enforced in accordance with the Indian law.
(c) The competent courts in India shall have exclusive jurisdiction over all
matters and causes arising out of this Policy.

ENDORSEMENT

STAMP DUTY AMOUNT : `120

Paid by e-Stamps Certificate no. 31/Issue Date: 19-04-2022/Vide Treasury

(E-CHALLAN) GRN NO.89387553 for Rs. 50000000

R Krishnakumar
Authorized Signatory

15 of 33
 9. A transfer or assignment made in accordance with Section 38 shall automatically
Annexure 1 cancel the nomination except in case of assignment to the insurer or other transferee
Section 45 - Policy shall not be called in question on the ground of mis-statement or assignee for purpose of loan or against security or its reassignment after repayment.
after three years In such case, the nomination will get affected to the extent of insurer's or transferee's
Provisions regarding policy not being called into question in terms of Section 45 of or assignee's interest in the policy. The nomination will get revived on repayment of
the Insurance Act, 1938, as amended from time to time are as follows: the loan.
1. No Policy of Life Insurance shall be called in question on any ground whatsoever 10. The right of any creditor to be paid out of the proceeds of any policy of life insurance
after expiry of 3 yrs from shall not be affected by the nomination.
a. the date of issuance of policy or 11. In case of nomination by policyholder whose life is insured, if the nominees die
b. the date of commencement of risk or before the policyholder, the proceeds are payable to policyholder or his heirs or legal
c. the date of revival of policy or representatives or holder of succession certificate.
d. the date of rider to the policy 12. In case nominee(s) survive the person whose life is insured, the amount secured by
whichever is later. the policy shall be paid to such survivor(s).
2. On the ground of fraud, a policy of Life Insurance may be called in question within 13. Where the policyholder whose life is insured nominates his
3 years from a. parents or
a. the date of issuance of policy or b. spouse or
b. the date of commencement of risk or c. children or
c. the date of revival of policy or d. spouse and children
d. the date of rider to the policy e. or any of them
whichever is later. the nominees are beneficially entitled to the amount payable by the insurer to the
For this, the insurer should communicate in writing to the insured or legal policyholder unless it is proved that policyholder could not have conferred such
representative or nominee or assignees of insured, as applicable, mentioning the beneficial title on the nominee having regard to the nature of his title.
ground and materials on which such decision is based. 14. If nominee(s) die after the policyholder but before his share of the amount secured
3. Fraud means any of the following acts committed by insured or by his agent, with the under the policy is paid, the share of the expired nominee(s) shall be payable to the
intent to deceive the insurer or to induce the insurer to issue a life insurance policy: heirs or legal representative of the nominee or holder of succession certificate of such
a. The suggestion, as a fact of that which is not true and which the insured does not nominee(s).
believe to be true; 15. The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life
The active concealment of a fact by the insured having knowledge or belief of insurance policies maturing for payment after the commencement of Insurance Laws
b.
the fact; (Amendment) Act 2015.
c. Any other act fitted to deceive; and 16. If policyholder dies after maturity but the proceeds and benefit of the policy has not
d. Any such act or omission as the law specifically declares to be fraudulent. been paid to him because of his death, his nominee(s) shall be entitled to the proceeds
4. Mere silence is not fraud unless, depending on circumstances of the case, it is the duty and benefit of the policy.
of the insured or his agent keeping silence to speak or silence is in itself equivalent 17. The provisions of Section 39 are not applicable to any life insurance policy to which
to speak. Section 6 of Married Women's Property Act, 1874 applies or has at any time applied
5. No Insurer shall repudiate a life insurance policy on the ground of fraud, if the insured except where before or after Insurance Act, 1938 as amended from time to time, a
/ beneficiary can prove that the misstatement was true to the best of his knowledge nomination is made in favour of spouse or children or spouse and children whether or
and there was no deliberate intention to suppress the fact or that such mis-statement not on the face of the policy it is mentioned that it is made under Section 39. Where
of or suppression of material fact are within the knowledge of the insurer. Onus of nomination is intended to be made to spouse or children or spouse and children under
disproving is upon the policyholder, if alive, or beneficiaries. Section 6 of MWP Act, it should be specifically mentioned on the policy. In such a
6. Life insurance Policy can be called in question within 3 years on the ground that any case only, the provisions of Section 39 will not apply.
statement of or suppression of a fact material to expectancy of life of the insured was
incorrectly made in the proposal or other document basis which policy was issued [Disclaimer: This is only a simplified version prepared for general information.
or revived or rider issued. For this, the insurer should communicate in writing to You are advised to refer to the Insurance Act 1938 as amended from time to time
the insured or legal representative or nominee or assignees of insured, as applicable, for complete and accurate details.]
mentioning the ground and materials on which decision to repudiate the policy of life
insurance is based. Annexure 3
7. In case repudiation is on ground of mis-statement and not on fraud, the premium Section 38 - Assignment and Transfer of Insurance Policies
collected on policy till the date of repudiation shall be paid to the insured or legal Assignment or transfer of a policy should be in accordance with Section 38 of the
representative or nominee or assignees of insured, within a period of 90 days from Insurance Act, 1938 as amended from time to time. The extant provisions in this
the date of repudiation. regard are as follows:
8. Fact shall not be considered material unless it has a direct bearing on the risk 1. The policy may be transferred/assigned, wholly or in part, with or without
undertaken by the insurer. The onus is on insurer to show that if the insurer had been consideration.
aware of the said fact, no life insurance policy would have been issued to the insured. 2. An Assignment may be effected in a policy by an endorsement upon the policy itself
9. The insurer can call for proof of age at any time if he is entitled to do so and no or by a separate instrument under notice to the Insurer.
policy shall be deemed to be called in question merely because the terms of the 3. The instrument of assignment should indicate the fact of transfer or assignment and
policy are adjusted on subsequent proof of age of life insured. So, this Section will the reasons for the assignment or transfer, antecedents of the assignee and terms on
not be applicable for questioning age or adjustment based on proof of age submitted which assignment is made.
subsequently. 4. The assignment must be signed by the transferor or assignor or duly authorized agent
and attested by at least one witness.
[Disclaimer: This is only a simplified version prepared for general information. 5. The transfer or assignment shall not be operative as against an insurer until a notice
You are advised to refer to the Insurance Act 1938 as amended from time to time in writing of the transfer or assignment and either the said endorsement or instrument
for complete and accurate details.] itself or copy there of certified to be correct by both transferor and transferee or their
duly authorised agents have been delivered to the insurer.
Annexure 2 6. Fee to be paid for assignment or transfer can be specified by the Authority through
Section 39 - Nomination by Policyholder Regulations.
Nomination of a life insurance policy is as below in accordance with Section 39 of 7. On receipt of notice with fee, the insurer should Grant a written acknowledgement
the Insurance Act, 1938 as amended from time to time. The extant provisions in this of receipt of notice. Such notice shall be conclusive evidence against the insurer of
regard are as follows: duly receiving the notice.
1. The policyholder of a life insurance policy on his own life may nominate a person or 8. If the insurer maintains one or more places of business, such notices shall be delivered
persons to whom money secured by the policy shall be paid in the event of his death. only at the place where the policy is being serviced.
2. Where the nominee is a minor, the policyholder may appoint any person to receive the 9. The insurer may accept or decline to act upon any transfer or assignment or
money secured by the policy in the event of policyholder's death during the minority endorsement, if it has sufficient reasons to believe that it is
of the nominee. The manner of appointment is to be laid down by the insurer. a. not bonafide;
3. Nomination can be made at any time before the maturity of the policy. b. not in the interest of the policyholder;
4. Nomination may be incorporated in the text of the policy itself or may be endorsed c. not in public interest; or
on the policy communicated to the insurer and can be registered by the insurer in the d. is for the purpose of trading of the insurance policy.
records relating to the policy. 10. Before refusing to act upon endorsement, the insurer should record the reasons in
5. Nomination can be cancelled or changed at any time before policy matures, by an writing and communicate the same in writing to policyholder within 30 days from
endorsement or a further endorsement or a will as the case may be. the date of policyholder giving a notice of transfer or assignment.
6. A notice in writing of change or cancellation of nomination must be delivered to the 11. In case of refusal to act upon the endorsement by the insurer, any person aggrieved
insurer for the insurer to be liable to such nominee. Otherwise, insurer will not be by the refusal may prefer a claim to IRDAI within 30 days of receipt of the refusal
liable if a bonafide payment is made to the person named in the text of the policy or letter from the insurer.
in the registered records of the insurer. 12. The priority of claims of persons interested in an insurance policy would depend on
7. Fee to be paid to the insurer for registering change or cancellation of a nomination the date on which the notices of assignment or transfer is delivered to the insurer;
can be specified by the Authority through Regulations. where there are more than one instruments of transfer or assignment, the priority will
8. On receipt of notice with fee, the insurer should grant a written acknowledgement to depend on dates of delivery of such notices. Any dispute in this regard as to priority
the policyholder of having registered a nomination or cancellation or change thereof. should be referred to the Authority.
16 of 33
13. Every assignment or transfer shall be deemed to be absolute assignment or transfer
and the assignee or transferee shall be deemed to be absolute assignee or transferee,
except
a. where assignment or transfer is subject to terms and conditions of transfer or
assignment
OR
b. where the transfer or assignment is made upon condition that
i. the proceeds under the policy shall become payable to policyholder or
nominee(s) in the event of assignee or transferee dying before the insured; or
ii. the insured surviving the term of the policy.
Such conditional assignee will not be entitled to obtain a loan on policy or
surrender the policy. This provision will prevail notwithstanding any law or
custom having force of law which is contrary to the above position.
14. In other cases, the insurer shall, subject to terms and conditions of assignment,
recognize the transferee or assignee named in the notice as the absolute transferee or
assignee and such person
a. shall be subject to all liabilities and equities to which the transferor or assignor
was subject to at the date of transfer or assignment;
b. may institute any proceedings in relation to the policy; and
c. obtain loan under the policy or surrender the policy without obtaining the consent
of the transferor or assignor or making him a party to the proceedings
15. Any rights and remedies of an assignee or transferee of a life insurance policy under
an assignment or transfer effected before commencement of the Insurance Laws
(Amendment) Act, 2015 shall not be affected by this section.

[Disclaimer: This is only a simplified version prepared for general information.

You are advised to refer to the Insurance Act, 1938 as amended from time to time
for complete and accurate details.]

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Annexure A: List of Insurance Ombudsman

AHMEDABAD - Office of the Insurance Ombudsman, 6th Floor, Jeevan Prakash Bldg, Tilak Marg, Relief Road,Ahmedabad-380
001. Tel.:- 079-25501201/02/05/06 Email: [email protected] (State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman
and Diu.)
BENGALURU - Office of the Insurance Ombudsman, Jeevan Soudha Bldg. ,PID No. 57-27-N-19, Ground Floor 19/19, 24th Main Road, JP Nagar, Ist Phase,
Bengaluru - 560 078. Tel.:- 080-26652049/26652048 Email: [email protected] (State of Karnataka)
BHOPAL - Office of the Insurance Ombudsman, 2nd Floor, Janak Vihar Complex, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal(M.P.)-462
003. Tel.: 0755 - 2769201 / 2769202 Email: [email protected] (States of Madhya Pradesh and Chhattisgarh)
BHUBANESHWAR - Office of the Insurance Ombudsman, 62, Forest park, Bhubneshwar - 751 009. Tel.: 0674 - 2596461 /2596455 Email:
[email protected] (State of Orissa).
CHANDIGARH - Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 - D, Chandigarh- 160 017. Tel.:
0172 - 2706468 / 2706196 Email: [email protected] [States of Punjab, Haryana (excluding 4 districts viz, Gurugram, Faridabad, Sonepat
and Bahadurgarh) Himachal Pradesh, Union Territories of Jammu & Kashmir, Ladakh and Chandigarh]
CHENNAI - Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai - 600 018. Tel.: 044
- 24333668/ 24335284 Email: [email protected] (State of Tamil Nadu, and Union Territories - Puducherry Town and Karaikal (which are part
of Union Territory of Pondicherry)).
DELHI - Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building., Asaf Ali Road, New Delhi-110 002. Tel.:- 011-23232481/23213504 Email:
[email protected] (State of Delhi, 4 districts of Haryana viz, Gurugram, Faridabad, Sonepat and Bahadurgarh)
ERNAKULAM - Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, M. G. Road, Ernakulam - 682015. Tel.: 0484 - 2358759
/ 2359338 Email: [email protected] (States of Kerala and Union Territory of (a) Lakshadweep (b) Mahe - a part of Union Territory of
Puducherry)
GUWAHATI - Office of the Insurance Ombudsman, "Jeevan Nivesh", 5th Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati-781
001(ASSAM) Tel.:- 0361-2632204/2602205 Email: [email protected] (States of Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh,
Nagaland and Tripura.)
HYDERABAD - Office of the Insurance Ombudsman, 6-2-46, 1st Floor, Moin Court, Lane Opp. Saleem Function Palace, A.C. Guards, Lakdi-Ka-Pool,
Hyderabad-500 004. Tel.: 040 - 23312122 Email: [email protected] (State of Andhra Pradesh, Telangana and Yanam and part of the Union
Territory of Pondicherry.)
JAIPUR - Office of the Insurance Ombudsman, Ground Floor, Jeevan Nidhi II Bldg, Bhawani Singh Marg, Jaipur - 302005 Tel.: 0141 - 2740363 Email:
[email protected] (State of Rajasthan)
KOLKATA - Office of the Insurance Ombudsman, Hindustan Building. Annexe, 7th Floor, 4, C.R. Avenue, Kolkata-700 072. Tel :
033-22124339/22124340 Email: [email protected] (States of West Bengal, Sikkim, and Union Territories of Andaman & Nicobar Islands)
LUCKNOW - Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-2, Nawal Kishore Road, Hazaratganj, Lucknow-226 001. Tel : 0522
-2231331/2231330 Email: [email protected] (Following Districts of Uttar Pradesh: Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
Allahabad, Mirzapur, Sonbhadra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki,
Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.)
MUMBAI - Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz(W), Mumbai - 400054. Tel :
022- 69038821/23/24/25/26/27/28/29/30/31 Email: [email protected] (State of Goa and Mumbai Metropolitan Region excluding areas of Navi
Mumbai and Thane)
NOIDA - Office of the Insurance Ombudsman, 4th Floor, Bhagwan Sahai Palace,Main Road, Naya Bans, Sector-15, Distt: Gautam Buddh Nagar, U.P.
- 201301. Tel : 0120-2514252/2514253 Email: [email protected] (State of Uttaranchal and the following Districts of Uttar Pradesh:Agra, Aligarh,
Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad,
Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.)
PATNA - Office of the Insurance Ombudsman, 2nd floor, North Wing, Lalit bhawan, Bailey Road, Patna - 800001 Tel : 0612-2547068 Email:
[email protected] (State of Bihar, Jharkhand.)
PUNE - Office of the Insurance Ombudsman,3rd Floor, Jeevan Darshan Bldg, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan peth, Pune - 411030 Tel :
020-41312555 Email: [email protected] (State of Maharashtra including Navi Mumbai and Thane and excluding Mumbai Metropolitan Region.)

18 of 33
 MAX LIFE INSURANCE COMPANY LIMITED
Regd. Office : 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur,
District Nawanshahr, Punjab- 144533
Head Office: 11th & 12th Floor, DLF Square, Jacaranda Marg, DLF City
Phase-II, Gurugram Haryana, 122 002.

For Unit linked Plans, THE INVESTMENT RISK IN

Unit Linked Proposal
INVESTMENT PORTFOLIO IS BORNE BY THE
Form POLICYHOLDER
PROPOSAL NUMBER: 609819495
GO/CA/Broker Code: ADEL1

Do you have a Max Life Insurance Policy or have currently applied simultaneous policies? If yes give Policy/Proposal number? -(863957247)

Purpose of Insurance: WEALTH ACCUMULATION/INVESTMENT

Objective of Insurance: INDIVIDUAL POLICY
Product Solution: NA Existing Customer: YES

A. Personal Details

Proposer Life to be Insured(if other than proposer)

1. Title MS

First PARVEEN

2. Name Middle

Last SAINI

First K
3. Father's / Husband's
Name
Last L TULI

4. Date of Birth 04-02-1972

5. Gender FEMALE

6. Nationality INDIAN

6a. Residential country

Residence for Tax purposes in Jurisdiction(s) outside India : NO

(If Yes then FATCA & CRS-Self Certification Form to be mandatorily completed)

7. Marital Status WIDOW

8. Education Qualification GRADUATE

9. Relationship with Proposer SELF

10. Industry Type OTHERS

11. Organisation Type PARTNER/PROP

12. Occupation/Job Title SELF EMPLOYED

13. Name of Entity / Employer NA

14. Annual Income(Rs.) 500000

15. Is the Life Insured / Proposer / Nominee / Payor a Politically Exposed Person ? : NO

16. Nominee Details

Title MS

First SAGARIKA

Name Middle

Last SAINI

Date of Birth 01-12-1996

Gender FEMALE

Page 1 of 5 19 of 33
Percentage 100

Relationship with Proposer DAUGHTER

17. Current Residential Address

House No./Apt. Name: FLAT NO 21 PLOT NO 102

Society Road/Area/Sector: SITA RAM APARTMENT I P EXT
Village/Town: PATPARGANJ EAST DELHI
Landmark:
City: NEW DELHI
Pin Code: 110092 State/UT: DELHI Country: INDIA
Mobile No. 1: 9999669623 Mobile No. 2: 9599911156 STD Code: Landline:
Email: [email protected]

18. Permanent Residential Address (Optional)

House No./Apt. Name: FLAT NO 21 PLOT NO 102

Society Road/Area/Sector: SITA RAM APARTMENT I P EXT
Village/Town: PATPARGANJ EAST DELHI
Landmark:
City: NEW DELHI
Pin Code: 110092 State/UT: DELHI Country: INDIA

19. Preferred Mailing Address. Current Residential

20. Do you wish to hold this Policy electronically under e-lnsurance ? NO

B. Coverage Information-Type of Coverage

Coverage Coverage Premium Annual Target Modal GST

a. Base Plan
Term Multiple Payment Term Premium (Rs.) Premium (Rs.) (Rs.)

MAX LIFE FAST TRACK SUPER PLAN 10 10 5 60000 5000 0

Modal Premium without GST* and Cess: 5000 GST* and Applicable Cess: 0 Total Premium Paid: 5000

(*GST shall comprise of CGST, SGST/UTGST or IGST (whichever is applicable) including cesses and levies, if any. All applicable taxes, cesses and levies, as per
prevailing laws, shall be borne by you)
You can either opt for one of the below mentioned automated strategies or choose
c. INVESTMENT OPTIONS: to manage your funds on your own through self-managed Portfolio Strategy. Please
tick if any of the below Strategy is applicable.

i. Systematic Transfer Plan: NO iii. Dynamic Fund Allocation Strategy: NO v. Self-Managed Portfolio Strategy : YES

ii. Lifecycle Based Portfolio Strategy: NO iv. Trigger Based Portfolio Strategy: NO

Growth Diversified High Sustainable Growth Secure Money Dynamic bond

Balanced Secure Conservative
Super equity Growth Equity Fund Fund Plus* Market II fund
0% 0% 0% 0% 100 % 0% 0% 0% 0% 0% 0%

*Secure Plus fund is not applicable with Self-Managed Portfolio Strategy

d. Would you like to opt for Smart Withdrawal Option? No
e. When would you like your Smart Withdrawal Payouts to begin from? Please specify the policy year here. NA

f. Please state your required frequency of Smart Withdrawal Payouts.

g. Please state the % of Fund Value that you would require in an year NA %

2. NEFT Bank A/C Details of Proposer:

All Payouts will be credited to this account through Electronic mode of payment. (This will be applicable at select cities as per facilities/
arrangements of Max Life Insurance).
MICR Code: 110002610 Bank Account Number: 51017237625

IFSC Code: SBIN0031502 Account Holder's Name: PARVEEN SAINI

Type of Bank A/C: Savings Account Bank Name & Branch: STATE BANK OF INDIA DELHI

Banking Since: NA

3. Permanent Account Number (PAN): AYNPS0404M

TDS may be applicable, in accordance with Income Tax Act Form 60 required: NO
1961, as amended from time to time.

Page 2 of 5 20 of 33
4. Mode of Payment: MONTHLY 5. Renewal premium by: ECS 6. Source of Funds: BUSINESS

7. Is payor different from proposer/insured ? NO

8. Are you a Max Life Agent or an employee of a Max group company/ Corporate Agents? NO

9. Premium Payment Details

Amount in Words: TEN THOUSAND

Paid Rs: 10000 Payment by CHEQUE

Cheque / Draft No. / Online Transaction 898815 Date: 27-06-2022

Bank Name & Branch: SBI

C. Information of Life Insured

1. Do you have any life or Critical Illness insurance policy issued, pending approval from any other insurance companies or
has your application for Life/Health/Critical illness insurance or its reinstatement ever been offered at modified NO
terms,rejected or postponed ?

Life to be
Proposer
Insured

2. In the next 12 months do you intend to travel or reside abroad other than on holiday of less than 4 weeks? NO NA

3. Do you participate or do you intend to participate in any hazardous activities as part of your Occupation/ Sports/
NO NA
Hobby?

4. Have you ever been convicted or are you under investigation for any criminal charges ? NO NA

5. For Female Life Insured YES

Life to be
Proposer
Insured

a. Spouse Occupation NA NA

b. Spouse Annual Income NA NA

c. Spouse Insurance Amount NA NA

e. Full Name Prior to Marriage (If there is a name change post marriage): NA NA

f. Are you pregnant? NO NA

6. For Minor Life To Be Insured (Age < 18 yrs.) NO

D. Medical Information

1. Family Details Proposer Life Insured

Has any two (2) or more of your family members (parents & Siblings) ever been diagnosed with diabetes or
NA NA
hypertension or kidney failure or cancer or heart Attack or any Hereditory Disorder before the age of 60 ?

2.

Proposer Life To Be Insured

Height 160 cm NA
Weight 75 kg NA

Life to be
3. Have you ever been investigated, treated or diagnosed with any of the following conditions. Proposer
Insured

i) Diabetes /High blood sugar levels NO NA

ii) Hypertension/ High Blood Pressure, High Cholesterol or Thyroid disorder NO NA

iii) Heart or vascular disorder including chest pain, stroke, heart attack or Angioplasty, CABG or any other heart surgery. NO NA

iv) Breathing or lung disorders including asthma, emphysema, tuberculosis. NO NA

v) Liver or digestive system related disorder including jaundice ,gall bladder, pancreas or Hepatitis B/C. NO NA

vi) Any abnormal growth like tumour,lump,cancer or blood disorder, including anemia or thalassaemia or Sexually transmitted
NO NA
disease ( STD ) including HIV or AIDS.

vii) Any kind of Kidney or bladder disorder, including kidney failure, renal stone, nephritis or prostrate disorder. NO NA

viii) Any neurological or mental health problem like paralysis, multiple sclerosis, Parkinson's, epilepsy, depression or anxiety. NO NA

ix) Muscular-skeletal or joint disorders, including any kind of arthritis, gout, osteoporosis. NO NA

Page 3 of 5 21 of 33
 x) Are you having history of any hospitalization, treatment or investigation? NO NA

xi) Have you advised now or in last 5 yrs tests like X-Ray/CT scan/MRI/ Ultrasonography/ ECG/Blood test or any other investigatory
NO NA
or diagnostic tests, or any type of surgery.

Xii) Have you ever been diagnosed with any form of internal or external congenital anomaly or defect i.e. any condition(s) which is
NO NA
present since birth, and which is abnormal with reference to form, structure or position?

Xiii) Have you had any genetic testing before? NO NA

4.Tobacco/Alcohol/Drugs
Do you consume any of the following ?
Consumption:

Proposer Life Insured

i) Tobacco ( Smoking /Chewing) currently or even occasionally in last 1 year ? NO NA

ii) Alcohol (ML) - Beer/Wine/Hard Liquor. NO NA

iii) Are you taking drugs like Cannabis/Marijuana,Ecstacy,Heroin,LSD,Amphetamines or any other illegal drugs? NO NA

E. Declaration And Authorisation

1. DECLARATION BY PROPOSER
I/We hereby declare that I/We fully understand the meaning and scope of the Proposal form and the questions contained above and I am submitting the completed
proposal form of my/our own volition, and confirm that I/We have not been induced by anyone to make the Proposal. I/We have been explained the nature of
questions and the importance of disclosing all material information.

I/We further declare that all the statements and declarations herein shall be the basis of a contract between me/us and the Company and that I/We have made
complete, true and accurate disclosure of all the facts and circumstances and have not withheld any information that may be relevant to enable the Company to
make an informed decision about the acceptability of the Proposal. I agree that in case of any fraud or misstatement, action will be initiated as per Section 45 of
Insurance Act, 1938, as amended from time to time. I/We undertake to notify the Company, forthwith in writing, of any change in any of the statements made in the
Proposal subsequent to the signing of this proposal and before acceptance of risk and issuance of the Policy by the Company. The first and subsequent year
premium will be paid out of legally acquired source of income. I will provide information as and when required by the Company, acting on its own or under any order
or instruction received from Statutory Authorities, as regards to the sources of funds or utilizations or withdrawals. I agree that the Company may provide any
information related to me as available to the Company at any time, to any Statutory Authority in relation to the any laws including the laws governing prevention of
money laundering, applicable in the country. To enable the Company to assess the risk under my/our proposal or for any other purpose in relation to the policy, l/we,
my/our heirs, administrators or executors or assignees hereby authorize my past or present employer(s)/business association/medical practitioners /other agencies
or governmental and/or any regulatory bodies, insurance repositories, CERSAI/ UIDAI, reinsurers / hospitals or diagnostic centres/ other insurance companies/
service providers to disclose and make available to the Company such details/records, as may be requested by the Company. I understand that I have disclosed my
personal information with Max life and I hereby provide consent to Max Life to share, store my information with its authorized service providers for servicing this
policy/proposal such as issuance, underwriting renewal and claims process with respect to this policy as per the regulation applicable from time to time. I/We submit
the mandate to credit My / Our account towards all payments against the above policy and agree and understand that payouts would be processed through
electronic mode of payment and will be affected at select cities as per facilities/ arrangements of Max Life Insurance. I/We authorize Max Life to send all
communications by letter, E-mail, SMS. I/We agree to receive regular reminders, updates / alerts from Max life from time to time.

I/ We authorize Max Life to send all communication by electronic means.

OTP Confirmation Date: 27-06-2022 13:59:22 Place: NEW DELHI

2. DECLARATION BY PRINCIPAL OFFICER/AGENT ADVISOR/SPECIFIED PERSON

I do declare and confirm that I have met and explained the Product features, benefits, premium paying term, nature of the questions contained in this Proposal form
and other relevant terms and conditions to the Proposer and the Life Insured. I have also explained that the answers to the questions forms the basis of the contract
of the Insurance between the Company and the Proposer / Life Insured, and if any untrue statement is contained therein and / or any information that may be
relevant to enable the Company make an informed decision, the Company shall have the right to vary the benefits which may be payable and / or treat the policy
voidable at the option of the Company subject to section 45 of the Insurance Act, 1938 as amended from time to time. I confirm that to the best of my knowledge the
Life Insured does not suffer from any physical or mental abnormality or handicap or has / had been hospitalised, undergone any surgery or treatment, or he /she is
involved in activities including any hazardous avocation or occupation or any other information material for underwriting this proposal form, unless expressly stated
in this Proposal. I also declare and represent to the Company that I am in full compliance with the regulatory requirements applicable to agent / corporate agent /
specified person / broker prescribed by the Insurance Act 1938, as amended from time to time and any other regulation, circular, instruction issued by IRDAI from
time to time. I confirm that I have verified the identity, current / permanent residential address of the Proposer/ Life Insured, the nature of his/her business and his /
her financial status basis the Max Life AML moral hazard checklist.

Is this a Replacement Sale? If yes, I have adequately explained

NO
the consequences of replacement sale to the customer.
Relationship of Principal Officer/Agent Advisor/Specified Person with the
Name of Principal Officer/Agent Advisor/Specified Person
Proposer/Life Insured

Customer MRS. PARVEEN SAINI TULI

Signature / OTP Confirmation Date / Thumb Impression / Electronic

Signature of Proposer:- 27-06-2022 14:11:51
Signature / OTP Confirmation Date / Thumb Impression / Electronic
Signature of Sales Manager : 438732
This system generated benefit Proposal form shall be treated as signed by
me.

Phone No. with STD Code:- 9999669623

Page 4 of 5 22 of 33
We confirm that we have made joint efforts in soliciting the prospect and will be jointly responsible for performing the service related to the policy. We further confirm
that the objective of sharing the commission is not for qualifying for any contest and/or reward & recognition programs of the company.

(Applicable only if more than one Agent Advisors share the commission)

Name(s) of Principal Officer/AA/Spec Person Principal Officer/AA/Spec Person Code % Share

Mrs. Parveen Saini Tuli 438732 100

Important Notes: (1) Any payment/s including initial payment accompanying this proposal, cash or by bearer instrument must be made at any of the Company's
General Office only. (2) Crossed cheque or bank drafts must be made in favour of MAX LIFE INSURANCE COMPANY LIMITED ACCOUNT (Proposal No. as
above) maybe handed over to the Agent Advisor. (3} Receipt of the Completed Proposal and initial payment does not create any obligations upon the Company to
underwrite the risk. The Company shall not be liable until it has underwritten the risk and issued the Policy. If the Policy is sent by post it shall be deemed to have
been delivered to and received by you in the ordinary course within 3 (three) days of posting. We draw your attention to Section - 39, Section - 45 and Section - 41
of the Insurance Act 1938 which reads as follows-

Section 39: In case nomination facility is availed, section 39 of the Insurance Act, 1938 as amended from time to time shall apply.

Section 45: No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of issuance of policy, from
the date of the Commencement of Risk or Revival of the policy or the date of the rider to the policy, whichever is later. However, Insurer may question the Policy at
any time within three years from the date of issuance of policy, from the date of Commencement of Risk or Revival of the policy or the date of the rider to the policy,
whichever is later, on the ground of fraud, in which case insurer shall inform Proposer/Life Insured/legal representatives in writing specifying the grounds and
materials on which such decision is based. For other details please referto Section 45 of the Insurance Act, 1938 as amended from time to time.

Section 41: (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance in
respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the
policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published
prospectuses or tables of the insurer.

ULIP_STD_1221_5.5

Additional Declaration:

I am submitting my Electronic Application of my own volition and have understood the contents of the Electronic Application, and the relevant sales literature
including product features, benefits, applicable charges and am aware of the investment risk under the Policy.

I / We are aware that suitability information has been collected from me/us and recommendation on purchase of life insurance product has been made only basis
such information and any product selected by me/us that differs from such recommendation is on the basis of my/our personal choice. I / we have seen and
understood the benefit illustration shown to me / us on the screen electronically or provided to me / us in physical form, as the case may be. I / we have disclosed
all material information and not withheld any information that may be relevant to enable Max Life to take an informed decision about the acceptability of the
Electronic Application. I also confirm that the information in the Electronic Application, including the state of health and lifestyle habits of the life to be insured is
true and complete. I / we have submitted the confirmation number sent on my mobile number/ email id as a confirmation of the contents of the Electronic
Application and the benefit illustration and agreement to the terms therein.

I/We understand and agree that by submitting the Electronic Application, I / we will be bound by the statements / disclosures of material facts made therein in the
same manner, as if I / we have signed and submitted a written proposal for insurance to the Company and these shall be the basis of a contract between me/us
and the Company. I / we undertake to notify the Company of any change in statements made in the Electronic Application subsequent to its submission and
before acceptance of risk and issuance of the policy by the Company. I / we understand that in case the Company detects any fraud or mis-statement or
suppression of fact material to my/our life expectancy, the Company reserves the right to take appropriate action in accordance with Section 45 of the Insurance
Act.

I / we hereby declare and confirm that details provided in Form 60 attached to this Electronic Application (wherever applicable) are true and correct to the best of
my knowledge and belief. I declare that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse, minor child
etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in which the above
transaction is held will be less than maximum amount not chargeable to tax.

I / we understand that the Company will not be liable unless the premium is received and realized by it within the time period stipulated for the same subject to
underwriting by it. I / we hereby authorize the Company to conduct screening / confirmation of my / our health status through medical examinations on the basis
of which, the Company may accept, decline or offer alternate terms on my proposal. I/we hereby authorize my past and present employer(s) / associate(s) /
medical practitioner(s) / any insurer or any other organization to disclose and make available to the Company my/our information.

I / We have filled the proposal electronically and have received the benefit illustration and filled up proposal form on email and registered mobile OR reviewed it
on tablet / desktop and after observing the said copy, I /we confirm that all the content / information therein is correct to the best of my / our knowledge.

I have opted for the Combination Solution voluntarily (wherever applicable) as it would assist me in planning my finances. I also understand that these are
different products and can also be purchased separately.

I do hereby certify that above stated information regarding the nationality and tax residential status is correct in all respects and may be used for all purposes,
including reporting to statutory authorities & compliances, and understand that it is my responsibility to report the changes, if any, to Max Life within 2 weeks of
occurrence of such change.

Signature / OTP Confirmation Date / Thumb Impression / Signature / OTP Confirmation Date / Thumb Impression / Electronic Signature of Sales
Electronic Signature of Proposer: 27-06-2022 14:11:51 Manager :438732

Phone No. with STD Code :9999669623

Page 5 of 5 23 of 33
 Pre Issuance Verification Confirmation

Date : 27-Jun-2022

Reference Number: 4002875252

Dear parveen

Subject: Confirmation of successful completion of Pre Issuance Verification Process

Greetings from Max Life Insurance Company!

Thank you for completing Pre Issuance verification of your application. We

would like to assure you that your decision to take the Life Insurance Policy
with us is a prudent one.

This is with regards to the Policy Number: 609819495 where in you have completed
pre issuance verification process for further processing of your application. Details
are as follows:

Pre Issuance Verification Questions Your Responses

Are you aware that you have to pay the premiums for 5 years against your
1 Yes
policy?

2 Are you aware that your policy will get matured after 10 years? Yes

Are you aware that your Life insurance cover is of Rs. 600000.00 (Sum
3 Yes
Assured)?

Are you aware that in this plan there is a lock in period of 5 years & returns
4 are not guaranteed. An illustration showing returns on 4% and 8% has been Yes
reviewed by you .

5 Diabetes /High blood sugar levels No

6 Hypertension/ High Blood Pressure, High Cholesterol or Thyroid disorder No

Heart or vascular disorder including chest pain, stroke, heart attack or

7 No
Angioplasty, CABG or any other heart surgery.

8 Breathing or lung disorders including asthma, emphysema, tuberculosis. No

Liver or digestive system related disorder including jaundice ,gall bladder,

9 No
pancreas or Hepatitis B/C

24 of 33
 Any abnormal growth like tumour,lump,cancer or blood disorder, including
10 anemia or thalassaemia or Sexually transmitted disease ( STD ) including HIV No
or AIDS

Any kind of Kidney or bladder disorder, including kidney failure, renal stone,
11 No
nephritis or prostrate disorder.

Any neurological or mental health problem like paralysis, multiple sclerosis,

12 No
Parkinson, epilepsy, depression or anxiety.

Muscular-skeletal or joint disorders, including any kind of arthritis, gout,

13 No
osteoporosis.

14 Are you having history of any hospitalization, treatment or investigation? No

Have you advised now or in last 5 yrs tests like X-Ray/CT scan/MRI/
15 Ultrasonography/ ECG/Blood test or any other investigatory or diagnostic No
tests, or any type of surgery?

Have you ever been diagnosed with any form of internal or external congenital
16 anomaly or defect i.e. any condition(s) which is present since birth, and which No
is abnormal with reference to form, structure or position?

17 Have you had any genetic testing before? No

Have you or any of your Family member(s) been tested for Covid-19 or
suffered from fever, cough, sore throat or Flu like symptoms in last 2 months
18 No
or have you or your family members traveled overseas post 1st Jan'20 or
have any plans to travel Overseas in next 6 Months?

Are you working as a COVID warrior/ Health Care Worker (directly involved in
19 service COVID diagnosed people/ Doctors/ Nurses/ Allied health care No
professional

Do you consume any of the following? Tobacco ( Smoking /Chewing)

20 No
currently or even occasionally in last 1 year?

21 Alcohol ? No

Are you taking drugs like cannabis/Marijuana, Ecstacy, Heroin, LSD,

22 No
Amphetamines or any other illegal drugs?

I’m aware that suitability information has been collected from me and in person recommendation on purchase of life
insurance product has been made only basis such information and if product selected by me that differs from such
recommendation is on the basis of my personal choice. (If ULIP product) I have gone through the risk profiler and
understood the risks associated with investments in the above funds. Basis my financial goals and needs, I have made a
conscious decision to allocate premium as given information. I hereby agree, declare and confirm that I have read and
understood the benefit illustration, key feature document (if applicable as per regulation) and the proposal form sent on my

25 of 33
registered mobile number and email. I have filled up the verification, health & habit questions and agree for it to be part of
the proposal form. I hereby confirm that all the content / information therein are true and correct to the best of my
knowledge and belief.
We look forward to being your partner for life and are committed to provide you with the best of our services.

Regards,
Max Life Insurance Co. Ltd.

Please note:
- This letter does not confirm issuance of the insurance policy. Issuance of Policy is subject to realization of premium
and completion of underwriting requirements.
- Please ensure that all the information provided by you including the medical facts are accurate as per Pre Issuance
Verification Process completed by you. If incase of non-disclosure or misrepresentation, company has the right to
reject the policy.
- Once the Policy is issued, you have a freelook period of 15 days from receipt of the insurance policy to review its
terms and conditions.

This email is electronically generated

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 Proposal No: 609819495

Name of the Prospect/Policyholder: Ms. PARVEEN SAINI Name of the Product: Max Life Fast Track Super Plan
Tag Line: A Unit Linked Non Participating Individual Life Insurance Plan
Age & Gender: 50 Years, Female
Policy Option: NA
Name of the Life Assured: Ms. PARVEEN SAINI Unique Identification No: 104L082V04
GST Rate: 18.00%
Age & Gender: 50 Years, Female Max Life State: Delhi
Policyholder Residential State: Delhi
Sum Assured: `6,00,000 Investment Strategy Opted for: NA
Policy Term & Premium Payment Term: 10 Years & 5 Years
Funds opted for along with their risk level
Amount of Installment Premium: `5,000 [Please specify the customer specific fund
Mode of payment of premium: Monthly option): Growth Fund (Risk Rating-High) : 100%

How to read and understand this benefit illustration?

This benefit illustration is intended to show what charges are deducted from your premiums and how the unit fund, net of charges and taxes, may grow over the years of the policy term if the fund earns a gross
return of 8% p.a. or 4% p.a. These rates, i.e., 8% p.a. and 4% p.a. are assumed only for the purpose of illustrating the flow of benefits if the returns are at this level. It should not be interpreted that the returns
under the plan are going to be either 8% p.a. or 4% p.a.
Net Yield mentioned corresponds to the gross investment return of 8% p.a., net of all charges but does not consider mortality, morbidity charges, underwriting extra, if any, guarantee charges and cost of riders, if
deducted by cancellation of units. It demonstrates the impact of charges exclusive of taxes on the net yield. Please note that the mortality charges per thousand sum assured in general, increases with age.
The actual returns can vary depending on the performance of the chosen fund, charges towards mortality, morbidity, underwriting extra, cost of riders, etc. The investment risk in this policy is borne by the
policyholder, hence, for more details on terms and conditions please read sales literature carefully.
Part A of this statement presents a summary view of year-by-year charges deducted under the policy, fund value, surrender value and the death benefit, at two assumed rates of return. Part B of this statement
presents a detailed break-up of the charges, and other values.
Note: Some 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 benefits then
these will be clearly marked “guaranteed” in the illustration table on this page. If your policy offers variable benefits then the illustration on this page will show two 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 actual
future investment performance.
Rider Details

Critical Illness and Disability-Secure Rider - Coverage Variant NA

Critical Illness and Disability-Secure Rider - Rider Premium
NA
Payment Term and Rider Term
Critical Illness and Disability-Secure Rider - Rider Sum Assured NA

Premium Summary
Base Plan Max Life Critical Illness and Disability-Secure Rider Total Installment Premium
Installment Premium without GST (in Rs.) 5,000 0 5,000
Installment Premium with first year GST (in Rs.) 5,000 0 5,000

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Installment Premium with GST 2nd year onwards (in Rs.) 5,000 0 5,000
UIN: 104L082V04 Page 1 of 4
 Part A
(Amount in Rupees.)
At 4% p.a. Gross Investment Return At 8% p.a. Gross Investment Return
Commission
Policy Annualized
payable to
Year Premium Mortality, Morbidity Fund at End Surrender Mortality, Fund at End Surrender
Other Charges* GST Death Benefit Other Charges* GST Death Benefit intermediary
Charges of Year Value Morbidity Charges of Year Value

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1 60,000 2,829 4,484 1,316 52,480 48,764 6,00,000 2,827 4,489 1,317 53,572 49,779 6,00,000 3,000

2 60,000 2,839 4,627 1,344 1,06,877 1,04,045 6,00,000 2,826 4,660 1,348 1,11,227 1,08,395 6,00,000 600

3 60,000 2,802 5,392 1,475 1,62,576 1,60,452 6,00,000 2,761 5,483 1,484 1,72,567 1,70,443 6,00,000 600

4 60,000 2,701 6,178 1,598 2,19,679 2,18,263 6,00,000 2,611 6,357 1,614 2,37,930 2,36,514 6,00,000 600

5 60,000 2,534 6,984 1,713 2,78,299 2,78,299 6,00,000 2,366 7,287 1,738 3,07,686 3,07,686 6,00,000 600

6 - 2,535 5,615 1,467 2,79,621 2,79,621 6,00,000 2,257 6,073 1,499 3,22,083 3,22,083 6,00,000 -

7 - 2,734 5,713 1,520 2,80,638 2,80,638 6,00,000 2,317 6,343 1,559 3,37,227 3,37,227 6,00,000 -

8 - 2,947 5,811 1,576 2,81,320 2,81,320 6,00,000 2,361 6,626 1,618 3,53,181 3,53,181 6,00,000 -

9 - 3,169 5,908 1,634 2,81,646 2,81,646 6,00,000 2,380 6,924 1,675 3,70,022 3,70,022 6,00,000 -

10 - 3,413 6,004 1,695 2,81,574 2,81,574 6,00,000 2,379 7,237 1,731 3,87,828 3,87,828 6,00,000 -
*See Part B for details

IN THIS POLICY, THE INVESTMENT RISK IS BORNE BY THE POLICYHOLDER AND THE ABOVE INTEREST RATES ARE ONLY FOR ILLUSTRATIVE PURPOSE.

I, Mrs. Parveen Saini Tuli (name), have explained the premiums, charges and benefits under I, PARVEEN SAINI (name), having received the information with respect to the above, have
the policy fully to the prospect / policyholder. understood the above statement before entering into the contract.

Place:
Date: 6/27/22 Signature / OTP Confirmation Date / Thumb Impression / Date:6/27/22 Signature / OTP Confirmation Date / Thumb Impression /
Electronic Signature of Agent/ Intermediary / Official Electronic Signature of Prospect/ Policyholder

This system generated benefit illustration shall be treated as signed by me.

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UIN: 104L082V04 Page 2 of 4
 Part B
Gross Yield 8% p.a. Net Yield 5.34% Amount in Rupees
Premium Annualized Premium - Policy
Policy Annualized Mortality Guarantee Other Additions to the Fund before Fund at End of Surrender Death
Allocation Premium Allocation GST Admin. FMC
Year Premium (AP) Charge Charge Charges* fund* FMC the Year Value Benefit
Charge (PAC) Charges Charge

1 60,000 2,400 57,168 2,827 1,317 1,728 - - - 53,999 361 53,572 49,779 6,00,000

2 60,000 1,800 57,876 2,826 1,348 1,797 - - - 1,12,481 1,063 1,11,227 1,08,395 6,00,000

3 60,000 1,800 57,876 2,761 1,484 1,869 - - - 1,74,707 1,814 1,72,567 1,70,443 6,00,000

4 60,000 1,800 57,876 2,611 1,614 1,944 - - - 2,41,014 2,613 2,37,930 2,36,514 6,00,000

5 60,000 1,800 57,876 2,366 1,738 2,022 - - - 3,11,775 3,465 3,07,686 3,07,686 6,00,000

6 - - - 2,257 1,499 2,102 - - - 3,26,768 3,970 3,22,083 3,22,083 6,00,000

7 - - - 2,317 1,559 2,186 - - - 3,42,132 4,156 3,37,227 3,37,227 6,00,000

8 - - - 2,361 1,618 2,274 - - - 3,58,317 4,352 3,53,181 3,53,181 6,00,000

9 - - - 2,380 1,675 2,365 - - - 3,75,402 4,559 3,70,022 3,70,022 6,00,000

10 - - - 2,379 1,731 2,459 - - - 3,93,466 4,778 3,87,828 3,87,828 6,00,000

Gross Yield 4% p.a. Amount in Rupees

Premium Annualized Premium - Policy
Policy Annualized Mortality Guarantee Other Additions to the Fund before Fund at End of Surrender Death
Allocation Premium Allocation GST Admin. FMC
Year Premium (AP) Charge Charge Charges* fund* FMC the Year Value Benefit
Charge (PAC) Charges Charge

1 60,000 2,400 57,168 2,829 1,316 1,728 - - - 52,900 356 52,480 48,764 6,00,000

2 60,000 1,800 57,876 2,839 1,344 1,797 - - - 1,08,092 1,030 1,06,877 1,04,045 6,00,000

3 60,000 1,800 57,876 2,802 1,475 1,869 - - - 1,64,609 1,723 1,62,576 1,60,452 6,00,000

4 60,000 1,800 57,876 2,701 1,598 1,944 - - - 2,22,551 2,434 2,19,679 2,18,263 6,00,000

5 60,000 1,800 57,876 2,534 1,713 2,022 - - - 2,82,031 3,163 2,78,299 2,78,299 6,00,000

6 - - - 2,535 1,467 2,102 - - - 2,83,766 3,512 2,79,621 2,79,621 6,00,000

7 - - - 2,734 1,520 2,186 - - - 2,84,799 3,527 2,80,638 2,80,638 6,00,000

8 - - - 2,947 1,576 2,274 - - - 2,85,494 3,537 2,81,320 2,81,320 6,00,000

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UIN: 104L082V04 Page 3 of 4
 Premium Annualized Premium - Policy
Policy Annualized Mortality Guarantee Other Additions to the Fund before Fund at End of Surrender Death
Allocation Premium Allocation GST Admin. FMC
Year Premium (AP) Charge Charge Charges* fund* FMC the Year Value Benefit
Charge (PAC) Charges Charge

9 - - - 3,169 1,634 2,365 - - - 2,85,827 3,543 2,81,646 2,81,646 6,00,000

10 - - - 3,413 1,695 2,459 - - - 2,85,757 3,545 2,81,574 2,81,574 6,00,000

*There are no charges included in other charges. Guaranteed Loyalty Additions declared as per the product terms and conditions are included on Additions to the fund.
Notes: 1. Refer the sales literature for explanation of terms used in this illustration.
2. Fund management charge is based on the specific fund option(s) chosen.
3. In case rider charges are collected explicitly through collection of rider premium, and not by way of cancellation of units, then, such charges are not considered in this illustration. In other cases, rider charges are included in
other charges.

I, Mrs. Parveen Saini Tuli (name), have explained the premiums, charges and benefits under I, PARVEEN SAINI (name), having received the information with respect to the above, have
the policy fully to the prospect / policyholder. understood the above statement before entering into the contract.

Place:
Date: 6/27/22 Signature / OTP Confirmation Date / Thumb Impression / Date:6/27/22 Signature / OTP Confirmation Date / Thumb Impression /
Electronic Signature of Agent/ Intermediary / Official Electronic Signature of Prospect/ Policyholder

This system generated benefit illustration shall be treated as signed by me.

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UIN: 104L082V04 Page 4 of 4
19,50,600000,5000.00,N,N,F,h,100
 Premium Receipt
Receipt No.: 609819495 /2022-23/01 | Receipt Date: 27-JUN-2022
Personal Details
Policy Number: 609819495 Email ID: [email protected]
Policyholder Name: Ms. Parveen Saini PAN Number: AYNPS0404M
Address: FLAT NO 21 PLOT NO 102
SITA RAM APARTMENT I P EXTN
KARKARDOOMA, PATPARGANJ EAST DELHI
NEW DELHI-110092 Delhi
Mobile Number: 9999669623
Policy Details Connect for more details
Plan Name: Max Life Fast Track Super Premium (5 Pay) Name
Life Insured: Ms. Parveen Saini Policy Commencement Date: 27-JUN-2022 Mrs. Parveen Saini Tuli
Premium Payment Term: 5 Years Policy Term: 10 Years Date of Maturity: 27-JUN-2032
(period of which premium to be paid) Contact Number
Modal Premium: ` 5,000.00 Rider Sum Assured: ` 0.00 Base Sum Assured: ` 6,00,000.00 9999669623
Mudrank : NA
Fund Statement as on 27-JUN-2022
Closing Summary
Closing NAV/Market Market Value
Particulars
Units (A) (Nos) Price (B) (`) of fund (A x B) (`)
Growth Fund-Pr Driven - ULIF00125/06/04LIFEGROWTH104 57.53305 74.81421 4,304.29
Total 4,304.29

27-JUN-2022 to
Monthly `5,000.00 26-JUL-2022 27-JUL-2022
*Important Note:
1. If the payment has been made other than in cash, this receipt is conditional upon realization of the amount in Max Life's account.
2. Amount received would be adjusted against the due premium as per the policy contract. In case policy contract is lapsed, the risk coverage is subject to the reinstatement as per terms
and conditions of policy.
3. Premiums may be eligible for tax benefits under section 80C/80CCC/80D/37(1) of the Income Tax Act 1961. You are advised to seek an opinion of a Tax advisor in relation to the applicable
tax benefits and liabilities. The above mentioned amount includes GST which is applicable as and when the charges are levied and shall comprise CGST, SGST / UTGST or IGST (whichever
is applicable) including cesses and levies, if any as per prevailing laws and shall be borne by you. Currently base GST rate is 18% apart from cess in some states.
4. You may request a detailed policy account statement by writing to us at the below mentioned details.
5. Applicable charges as per Part E of the Policy terms and conditions, would be charged from the Fund Value and Goods and Service Tax would be levied thereon @18%
This is an electronically generated receipt and does not require signature.
URM20 PRODUCT UIN:104L082V04
E.&O.E

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 609819495
---------------------------------------------------------------------------------------

** ACKNOWLEDGEMENT OF RECEIPT OF POLICY **

I hereby acknowledge the receipt of the Policy Document along with a copy of Proposal Form, Benefit Illustration
& Key Feature Document.
I am aware that the policy purchased by me is Max Life Fast Track Super a Unit Liked plan with below mentioned
plan details :-

(Relationship with the Policy Holder)

Self

Spouse

Parents

Children (Only if above 18 years)

Others ___________________________ (please specify relationship)

___________ ___________________________
___________________________
Date Recipient's Signature Recipient's Full Name

c.c. : 438732 MRS. PARVEEN SAINI TULI

Work Ph 1 : Home Ph 1 : 9999669623
Work Ph 2 : Home Ph 2 :
Office : Delhi 1

"Note - Please submit this form within 10 days of receiving the Policy Pack to your nearby Max Life office/
Agent / Max Employee". Kindly submit self attested id proof of the receiver if signed by Spouse /Parents/ Major
Child/ Others."

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