Bajaj Allianz Life Goal Assure

A Unit-link ed Insurance Plan

Name of the Prospect/ Policyholder: maya bhatia Name of the Product: Bajaj A llianz Life Goal A ssure
Age (Years): 54 Tag Line: A Unit-link ed Non Participating Life Insurance Plan
Nam e of the Life Assured: m aya bhatia Unique Identification Num ber: 116L153V02
Age (Years): 54 GST Rate: 18.00%
Sum Assured (Rs.): 1,080,000 Investm ent Strategy O pted for: Investor selectable Portfolio Strategy
PolicyTerm (Years): 5 Fund opted foralong with risk levels
Prem ium Paym ent Term (Years): 5 Fund
Fund
Fund Nam e SFIN Apportionm ent% Managem ent Risk Level
Am ount of Instalm ent Prem ium (Rs.) 9,000 Charge
Mode of paym ent of Prem ium : Monthly Equity Growth Fund II -
ULIF05106/01/10EQ TYGRO W 02116 100 1.35% Very High

Accelerator Mid-Cap Fund II -

1.35% Very High
ULIF05206/01/10ACCMIDCA02116
Pure Stock Fund II -
ULIF07709/01/17PURSTKFUN2116 1.30% Very High

Pure Stock Fund -

1.35% Very High
ULIF02721/07/06PURESTKFUN116
Asset Allocation Fund II - 1.25% High
ULIF07205/12/13ASSETALL02116
Bluechip EquityFund -
ULIF06026/10/10BLUECHIPEQ 116 1.25% High

Bond Fund -
0.95% Moderate
ULIF02610/07/06BO NDFUNDLI116
Liquid Fund - 0.95% Low
ULIF02510/07/06LIQ UIDFUND116
Som e benefits are guaranteed and som e benefits are variable with returns based on the future perform ance of your insurer carrying on life insurance business. If your policy offers
guaranteed benefits then these will be clearly m ark ed 'guaranteed' in the illustration table on this page.If your policy offers variable benefits then the illustrations on this page will
show two different rates of assum ed future investm ent returns, of 8% p.a. and 4% p.a. These assum ed rates of return are not guaranteed and they are not the upper or lower
lim its of what you m ight get back , as the value of your policy is dependent on a num ber of factors including future investm ent perform ance.

How to read and understand this benefit illustration?

This benefit illustration is intended to show what charges are deducted from your prem ium s and how the unit fund, net of charges and tax es, m ay grow over the years of the policy
term if the fund earns a gross returns of 8% p.a. and 4% p.a. These rates, i.e. 8% p.a. and 4% p.a. are assum ed 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 m entioned corresponds to the gross investm ent return of 8% p.a., net of all charges but does not consider m ortality, m orbidity charges, underwriting ex tra, if any,
guarantee charges and cost of riders, if deducted by cancellation of units. It dem onstrates the im pact of charges ex clusive of tax es on the net yield. Please note that the m ortality
charges per thousand sum assured in general, increases with age.

The actual returns can vary depending on the perform ance of the chosen fund, charges towards m ortality, m orbidity, underwriting ex tra, cost of riders, etc. The investm ent risk in
this policy is borne by the policyholder, hence, for m ore details on term s and conditions please read sales literature carefully.
Part A of this statem ent presents a sum m ary view of year-by-year charges deduct under the policy, fund value, surrender value and the death benefit, at two assum ed rates of
return. Part B of this statem ent presents a detailed break up of the charges, and other values.

Part A
(Am ount in Rupees)
A t 4% p.a. Gross Investment Return A t 8% p.a. Gross Investment Return
Policy A nnualised Mortality Other GST Fund Value (at Surrender Value Death Mortality Other GST Fund Value (at Surrender Value Death Commission
Year Premium Charge Charges# Year End) (at year end) Benefit Charge Charges# Year End) (at year end) Benefit
1 1,08,000 4,433 1,155 1,006 1,03,597 97,597 10,80,000 4,430 1,166 1,007 1,05,752 99,752 10,80,000 -
2 1,08,000 4,375 2,593 1,254 2,09,681 2,05,361 10,80,000 4,352 2,664 1,263 2,18,230 2,13,910 10,80,000 -
3 1,08,000 4,229 4,066 1,493 3,18,413 3,15,173 10,80,000 4,160 4,257 1,515 3,37,993 3,34,753 10,80,000 -
4 1,08,000 3,986 5,578 1,721 4,29,971 4,27,971 10,80,000 3,835 5,954 1,762 4,65,663 4,63,663 10,80,000 -
5 1,08,000 3,627 7,130 1,936 5,65,208 5,65,208 10,80,000 3,349 7,764 2,000 6,22,057 6,22,057 10,80,000 -

# includesallcharges other than m ortality charge, See Part B for details

IN THIS POLICY, THE INVESTMENT RISK IS BORNE BY THE POLICYHOLDER A ND THE A BOVEINTEREST RA TES A RE ONLY FOR ILLUSTRA TIVE PURPOSE.

I, ................... (nam e), have ex plained the prem ium s, charges and benefits I, ................ (nam e), having received the inform ation with respect to the
under the policy fully to the prospect / policyholder. above, have understood the above statem ent before entering into the contract

Place : Signature of Agent/ Interm ediary / O fficial Date : Signature of Prospect/ Policyholder
Date :
Part B

Gross 8% Net 6.39 % (A mount in Rupees)

Yeild Yield
A nnualised
Premium Premium - GST Policy Return Fund Fund Fund Surrender
Policy A nnualised Mortality (Excl Guarantee Other Loyalty Fund of Management Death
Year Premium A llocation Premium Charge on A dministration Charge Charges* A ddition Booster Mortality before Charge Inc Value Value Benefit
Charge A llocation Charge FMC (EOY) (EOY)
Charge FMC) Charge GST

1 1,08,000 - 1,08,000 4,430 869 400 - - - - - 1,06,656 904 1,05,752 99,752 10,80,000
2 1,08,000 - 1,08,000 4,352 859 420 - - - - - 2,20,877 2,647 2,18,230 2,13,910 10,80,000
3 1,08,000 - 1,08,000 4,160 828 441 - - - - - 3,42,496 4,503 3,37,993 3,34,753 10,80,000
4 1,08,000 - 1,08,000 3,835 774 463 - - - - - 4,72,142 6,480 4,65,663 4,63,663 10,80,000
5 1,08,000 - 1,08,000 3,349 690 486 - - - - 20,127 6,10,519 8,588 6,22,057 6,22,057 10,80,000
Gross (A mount in Rupees)
4% 2.44 %
Yeild
A nnualised GST Return Fund
Premium Premium - Policy Fund Fund Surrender
Policy A nnualised A llocation Premium Mortality (Excl A dministration Guarantee Other Loyalty Fund of before Management Value Value Death
Year Premium Charge on Charge Charges* A ddition Booster Mortality Charge Inc Benefit
Charge A llocation FMC) Charge Charge FMC GST (EOY) (EOY)
Charge
1 1,08,000 - 1,08,000 4,433 870 400 - - - - - 1,04,488 891 1,03,597 97,597 10,80,000
2 1,08,000 - 1,08,000 4,375 863 420 - - - - - 2,12,244 2,564 2,09,681 2,05,361 10,80,000
3 1,08,000 - 1,08,000 4,229 841 441 - - - - - 3,22,690 4,278 3,18,413 3,15,173 10,80,000
4 1,08,000 - 1,08,000 3,986 801 463 - - - - - 4,36,006 6,035 4,29,971 4,27,971 10,80,000
5 1,08,000 - 1,08,000 3,627 740 486 - - - - 20,650 5,52,398 7,840 5,65,208 5,65,208 10,80,000
Notes:

1. Refer the sale literature for ex planation of term s used in this illustration.
2. Fund m anagem ent charge is based on the specific fund option(s) chosen.
3. In case rider charges are collected ex plicitly through collecIon of rider prem ium , and not by way of cancellaIon of units, then, such charges are not considered in this illustration.
In other cases, rider charges are included in other charges.

I, ................... (nam e), have ex plained the prem ium s, charges and benefits I, ................ (nam e), having received the inform ation with respect to the
under the policy fully to the prospect / policyholder. above, have understood the above statem ent before entering into the contract

Place : Signature of Agent/ Interm ediary / O fficial Date : Signature of Prospect/ Policyholder
Date :
Disclaimers

1. Please consult our 'Insurance Consultant' forany clarifications on this illustration.

2. Unit Link ed Life insurance Products are different from the traditional insurance products and are subject to the risk factors.

3. All benefits payable under the Policy are subject to the tax laws and other financial enactm ents, as they ex ist from tim e to tim e.

4. The Regular Prem ium and Top Up Prem ium , if any, paid is subject to investm ent risk s associated with capital m ark ets and Unit Prices m ay go up and down based on the
perform ance of the underlying assets in the Funds and the factors influencing the Capital m ark et and the Life Assured/ Policyholder is responsible for his/ her decisions.

5. Bajaj Allianz Life Insurance is the nam e of the com pany & Bajaj Allianz Future Gain is only the nam e of the Plan and does in no way indicate the quality of the policy, its future
prospects or returns.

6. DeathBenefit :
i) O n death of the life assured during the policy term while the policy is not term inated, ifall the prem ium s are paid up to date: Higher of (Sum assured or Regular Prem ium Fund
Value) Plus Higher of (Top up Sum Assured or Top up Prem ium Fund Value) as on date of intim ation of death. This benefit is subject to a m inim um guaranteed benefit of
105%oftotal prem ium s paid
ii) The policywillterm inate on the date ofintim ation of death ofthelifeassured.

7. LoyaltyAddition: For a policy with annualized prem ium Rs. 5 lacs & above and with policy term 10 years or above, at the end ofeach policy year, starting from the 6th policy year,
ifall prem ium s under the policy are paid up to date, LoyaltyAddition will be added into the Regular Prem ium Fund Value. The am ount of LoyaltyAddition that will beadded in to the
Regular Prem ium Fund Value will bea percentage of oneAnnualized Prem ium , as per thetable given below. No Loyalty Addition will be available on the surrendered policy,
Regular Prem ium Fund Value will bea percentage of oneAnnualized Prem ium , as per thetable given below. No Loyalty Addition will be available on the surrendered policy,
discontinued policy or a policy converted to paid-up. LoyaltyAddition is not available for a policy with PT 5 years.
PT 10 Years 15 Years 20 Years
Loyalty Addition 0.50% 1.00% 1.50%

8. Fund Booster: Fora policywith policy term 10 years orabove, at theend ofthe policy term , on the date ofm aturity, ifall prem ium s under the policy are paid up to date, Fund Booster
(FB) will be added into the Regular Prem ium Fund Value. No Fund Booster will be available on the surrendered policy, discontinued policy ora policy converted to paid-up.
Theam ount of FB that will beadded in to the Regular Prem ium Fund Value will bea percentage of oneAnnualised Prem ium (AP),as per thetable given below. Fund Booster is
PT 10 Years 15 Years 20 Years notavailablefora policywith PT 5 years.
Fund Booster % 20% 40% 60%

9. Return O f Mortality Charge (RO MC):At the end of the policy term , on the date ofm aturity, ifall prem ium s under the policy are paid up to date, the total am ount of m ortality
charge deducted throughout the policy term w.r.t regular prem ium and top-up prem ium will be added, respectively, into the Regular Prem ium Fund Valueand into the Top up Fund
Value, asapplicable. Theabove willex cludeany ex tra m ortality chargeand/oranyGSTw.r.t. m ortality charge deducted. The am ount of RO MC w.r.t. regular prem ium and top up
prem ium (ifany) will beadded into each fund will bein thesam e proportion ofthefund valuesasat the date of addition. Unit Price as on the date of RO MC addition will be used for the
unitisation .No RO MC will be available in a surrendered policy, discontinued policy or a policy converted to paid-up.

10. The Com pany declares that the m ortality charges is subject to underwriting of proposal, and m ay change before the acceptance of risk . The com pany further declares that the
proposal deposit receipt given herein does not bind thecom pany to accept therisk .

11. The m ortality charges &policy adm inistration charges, ifany,are deducted through cancellation of units.
- Policy Adm inistration Charge Rs. 400 p.a. inflating at 5% p.a., subject to m ax im um of Rs. 6,000 in any year. The charge is applicable during and after the prem ium paym ent
term and will be deducted ateachm onthly anniversary by cancellation of unitsat prevailing unit price.

12. Fund Managem ent Charge will be adjusted in the unit price. Fund Managem ent charge would be 1.35% for Equity Growth Fund II , Accelerator Mid Cap Fund II and Pure Stock
Fund, 1.30% for Pure Stock Fund II, 1.25% for Asset Allocation Fund II and Bluechip Equity Fund .0.95% for Liquid Fund and Bond Fund, 0.50%for Discontinuance Life Policy Fund

13. Equity Growth Fund II,Accelerator Mid Cap Fund II , Pure Stock Fund,Pure Stock Fund II, Asset Allocation Fund II,Bluechip Equity Fund , Liquid Fund , Bond Fund are the nam e of
the Funds being offered currently with Bajaj Allianz Life GoalAssure and in anym anner does not indicate the quality of the Fund, their future prospects or returns.

14. Segregated Fund Identification Num ber (SFIN) of the funds offered with this product are given below:

Fund SFIN No
Equity Growth Fund II ULIF05106/01/10EQ TYGRO W 02116
Accelerator Mid Cap Fund II ULIF05206/01/10ACCMIDCA02116
Pure Stock Fund ULIF02721/07/06PURESTKFUN116
Pure Stock Fund II ULIF07709/01/17PURSTKFUN2116
Asset Allocation Fund II ULIF07205/12/13ASSETALL02116
Bluechip Equity Fund ULIF06026/10/10BLUECHIPEQ 116
Liquid Fund ULIF02510/07/06LIQ UIDFUND116
Bond Fund ULIF02610/07/06BO NDFUNDLI116
Discontinuance Life Policy Fund ULIF07026/03/13DISCO NLIFE116
15. The past perform ance ofany ofthefunds ofthecom pany is not indicative ofthefuture perform ance ofthefund.

16. DisconInuance/ Surrender Charge as applicable in Regular Prem ium Units in this policy is given below. It is applicable when regular prem ium under the policy is discontinued or
the policy is surrendered.

Where the policy is discontinued Discontinuance charge for the policies having Discontinuance charge for the policies having
during the policy year annualized premium up to Rs. 50000/- annualized premium above Rs. 50000/-

1 Lower of 20% * (AP or FV) subject to m ax im um of Rs. Lower of 6% * (AP or FV) subject to m ax im um of Rs.
3,000 6,000
Lower of 15% * (AP or FV) subject to m ax im um of Rs. Lower of 4% * (AP or FV) subject to m ax im um of Rs.
2 2,000 5,000
Lower of 10% * (AP or FV) subject to m ax im um of Rs. Lower of 3% * (AP or FV) subject to m ax im um of Rs.
3
1,500 4,000

4 Lower of 5% * (AP or FV) subject to m ax im um of Rs. Lower of 2% * (AP or FV) subject to m ax im um of Rs.
1,000 2,000
5 & above Nil Nil
17. The policyholder m ay, at any tim e, surrender the policy. O n surrender during the lock -in period, fund value, less the applicable discontinuance/surrender chargeas on the date
ofsurrender, will betransferred to the Discontinued Life Policy Fund,and allrisk cover will beterm inated im m ediately. The option to revivethe policy will not be available to such a
surrendered policy. The discontinuance value as at the end of the lock -in period will be available as surrender value. O n surrenderafter thelock -in period, thesurrender
valueavailable will befund valueas on the date ofsurrender.

18. Indicated Surrender valueis not Guaranteed.

19. Charges under the policy are subject to applicable Goods & Service Tax , and will be deducted by cancellation of units.

20. The rate of return illustrated for various funds are shown at 4% and 8% in conform aIon with the guidelines on illustraIons set by the IRDA, and should not be construed as
forecast.

Returns dem onstrated are net of all charges.

Please refer to the product sales literature for details about the product including the ex clusions under the plan.
Please see the product brochure for details about the product.
Insurance is the subject m atter of the solicitation.

Bajaj A llianz Life Insurance Co. Ltd.,

Bajaj A llianz House, A irport Road, Yerawada, Pune - 411006. Reg No.: 116.

Tel:(020) 66026777. Fax:(020) 66026789.

Email: [email protected]

www.bajajallianzlife.com