HNB ASSURANCE PLC

Iceland Business Centre, Level-03

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

HNB Assurance PrivilegedLife Product Quotation No: 202001GLE0000263 - 2

Details of The Main life Assured Details of Spouse and Children

Name Mr. HELAPURA ANANDA Age - Spouse (Years) Not Selected
Date of Birth 1995-02-08 Age - Child 01 (Years) Not Selected
Age - Life Assured (Years) 25 Age - Child 02 (Years) Not Selected
Age at Maturity (Years) 50 Age - Child 03 (Years) Not Selected
Occupation Businessman Age - Child 04 (Years) Not Selected

Details of the Main Cover Details of the Main Cover

Basic Annual Premium
Sum Assured Multiplier
Basic Sum Assured
Life Insurance Need
BA 60,000
10
600,000
Health
Term of the policy
Basic Premium paying Term
Mode
25
25
Monthly

Additional Rider Benefits

Life Assured Spouse
Additional Rider Benefits Annual Premium Annual
Sum Assured (Rs.) Sum Assured (Rs.)
N
(Rs.) Premium (Rs.)
Additional life Benefit N/A N/A N/A N/A
Accidental Death Benefit N/A N/A N/A N/A
Total Permanent Disability Benefit (Accident & Sickness) 1,000,000 3,250 N/A N/A
Permanent Partial Disability Benefit 1,000,000 1,000 N/A N/A
H

Hospitalisation Benefit Private Hospital 9,000 N/A

Covering 180 days (Amount 6,239 N/A
per day) Government Hospital 6,000 N/A
Critical Illness Benefit 1,000,000 5,310 N/A N/A
Surgery Benefit N/A N/A N/A N/A
Supreme Health Benefit (Medical Reimbursement)
N/A N/A N/A N/A
Covered countries :N/A
Monthly Income Benefit N/A N/A N/A N/A
Cancer Rider Benefit 500,000 891 N/A N/A
Sum Assured (Rs.)
Annual
Additional Rider Benefits - Children Government
Private Hospital Premium (Rs.)
Hospital
Child 1 N/A N/A N/A
Child 2 N/A N/A N/A
Hospitalisation Benefit Covering 180 days (Amount per day)
Child 3 N/A N/A N/A
Child 4 N/A N/A N/A
Child 1 N/A N/A
Child 2 N/A N/A
Critical Illness Benefit (Covering 15 Critical Illnesses)
Child 3 N/A N/A
Child 4 N/A N/A

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 Child 1 N/A N/A
Child 2 N/A N/A
Surgery Benefit
Child 3 N/A N/A
Child 4 N/A N/A
Child 1 N/A N/A

Supreme Health Benefit (Medical Reimbursement) Child 2 N/A N/A

Covered Countries : N/A Child 3 N/A N/A
Child 4 N/A N/A

Waiver of
Waiver of Premium Benefit Monthly Annual Premium
Premium
Waiver of Basic Premium due to death of Life Assured N/A N/A
Waiver of Spouse & Childrens Rider Premium due to death of Life Assured N/A N/A
Waiver of Basic Premium due to total permanent disability of Life Assured 5,000 629
Waiver of Insured's additional life,Critical Illness Rider, Spouse and Childrens Rider
443 56
Premium due to total permanent disability of Life Assured

Death Benefits - Payable during Basic premium paying term of the policy
Loss of Life due to Natural Causes
Loss of Life due to an accident
BA 600,000 or fund value at the date of death whichever is higher
600,000 or fund value at the date of death whichever is higher
* With Waiver of Premium on death
[Link] Basic sum assured is higher than the investment account balance at the time of death, difference between Basic sum assured and investment
account balance shall be paid. Investment account continues to build up and maturity benefit shall be paid at the maturity date to the beneficiary.
[Link] Basic sum assured is less than the investment account balance at the time of death, Investment account continue to be built up and maturity
benefit shall be paid at the maturity date to the beneficiary.

Premium
Basic Premium 5,000
N
Extra Premium due to Occupation loading for Basic Benefit 0
Additional Rider Premium 1,448
Renewal Policy Fee 10
Total Monthly Premium during first 25 years of the policy (Rs.) 6,458
H

Rs. 400.00 is charged as Policy fee with 1 st premium in addition to above mentioned installment premium

Fund Values as at Expiry based on premium paying frequency

Premium Paying Frequency Assumed Rate of Dividend - 7% Assumed Rate of Dividend - 9% Assumed Rate of Dividend - 11%
Yearly 3,057,186 4,069,381 5,458,749
Half Yearly 3,011,022 3,989,046 5,326,154
Quarterly 2,988,112 3,949,267 5,260,651
Monthly 2,972,900 3,922,890 5,217,270

Maturity Benefit Options - Based on Monthly Premium payment Mode

Option Assumed Rate of Dividend - 7% Assumed Rate of Dividend - 9% Assumed Rate of Dividend - 11%
Lump Sum 2,972,900 3,922,890 5,217,270
Withdraw upto 50% of the fund at the maturity and balance is kept as a health fund for health claims until death of life assured or fund
Health Fund
is exhausted whichever occurs earlier

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

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 Illustration of Fund buildup - Based on Monthly Premium payment mode
Assumed Rate of Dividend - 7% Assumed Rate of Dividend - 9% Assumed Rate of Dividend - 11%
Age Nearest Basic Annual Rider Annual
Policy Year Illustrative fund value Illustrative Surrender Illustrative fund value Illustrative Surrender Illustrative fund value at Illustrative Surrender
B'day Premium Premium
at the year end value at the year end at the year end value at the year end the year end value at the year end

1 26 60,000 17,375 14,520 0 14,670 0 14,818 0

2 27 60,000 17,375 48,458 0 49,249 0 50,043 0

3 28 60,000 17,375 96,826 0 99,116 0 101,435 0

4 29 60,000 17,375 157,411 86,576 162,383 89,311 167,472 92,109

5 30 60,000 17,375 221,679 133,007 230,773 138,464 240,186 144,112

6 31 60,000 17,375 289,775 188,354 304,600 197,990 320,131 208,085

7 32 60,000 17,375 361,942 253,359 384,329 269,030 408,072 285,651

8 33 60,000 17,375 438,414 328,811 470,425 352,819 504,808 378,606

9 34 60,000 17,375 519,524 415,619 563,509 450,807 611,373 489,099

10 35 60,000 17,375 605,395 514,586 663,903 564,317 728,387 619,129

11 36 60,000 17,375 761,862 685,675 838,956 755,061 924,939 832,445

12 37 60,000 17,375 863,999 777,599 963,115 866,803 1,075,061 967,555

13 38 60,000 17,375 972,282 875,054 1,097,315 987,583 1,240,410 1,116,369

14 39 60,000 17,375 1,086,774 978,097 1,241,911 1,117,720 1,421,885 1,279,696

15 40 60,000 17,375 1,207,992 1,087,193 1,397,958 1,258,163 1,621,415 1,459,274

16 41 60,000 17,375 1,336,333 1,202,699 1,566,371 1,409,734 1,840,814 1,656,732

17

18

19

20

21

22
42

43

44

45

46

47
60,000

60,000

60,000

60,000

60,000

60,000
17,375

17,375

17,375

17,375

17,375

17,375
BA
1,472,450

1,616,340

1,768,695

1,930,015

2,164,845

2,349,644
1,325,205

1,454,706

1,591,825

1,737,014

1,948,360

2,114,680
1,748,503

1,944,724

2,156,526

2,385,156

2,697,389

2,969,144
1,573,653

1,750,252

1,940,874

2,146,641

2,427,651

2,672,229
2,082,610

2,347,979

2,639,826

2,960,809

3,380,788

3,775,893
1,874,349

2,113,181

2,375,843

2,664,728

3,042,709

3,398,303

23 48 60,000 17,375 2,545,339 2,290,805 3,262,537 2,936,283 4,210,518 3,789,466

24 49 60,000 17,375 2,752,576 2,477,319 3,579,304 3,221,374 4,688,638 4,219,774

N
25 50 60,000 17,375 2,972,900 2,675,265 3,922,890 3,529,937 5,217,270 4,694,395

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

* Guaranteed minimum interim dividend rate for 2020 - 7%

H

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

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Notes on above Illustration & Quotation

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

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

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

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

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

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

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

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

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

Assuring you of our very best services at all times.

HNB ASSURANCE PLC,

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

Authorised Signatory Date : 28/02/2020

Confirmation from Life to be Assured

N
This is to confirm that Mr/ Mrs ..................................…................. Sales Advisor have come to meet me and clearly explained the terms and conditions
enumerated in the insurance policy along with the benefits as per details mentioned in the above quotation. I further hereby declare and confirm that
Sales Advisor provided me the advice in a manner that enable me to make an informed decision and I fully understood the benefits mentioned in this
quotation and decided to purchase this product since it meets my life insurance needs.

Mr. HELAPURA ANANDA ...................................................................................

H

Customer Name Customer Signature

NIC No : 950392533V Date : 28/02/2020

Confirmation from the Sales Advisor

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

...................................................... ....................................... J5358 28/02/2020

Sales Advisor's Name Signature Code Date

Main life sum at risk 1,600,000 , Spouse : 0

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