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Name of the Prospect / Abc Proposal No: 12980154

Policyholder:
Name of the Product: Tata AIA Life Guaranteed
Age (years) : 58 Gender:Male Return Insurance Plan

Tag Line : Individual, Non-Linked Non-Participating

Name of the Life Assured 1 : Abc Life Insurance Savings Plan
Age (years) : 58 Gender:Male Unique Identification No.: 110N152V13

Name of the Life Assured 2 : NA I GST Rate: 4.5% for first year
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Age (years) : red I am red 2.25% second year onwards
NA Gender:NA
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Policy Term (years) : 27
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Premium Payment Term (years) : 12
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Amount of Instalment Premium 141253
(Rs.): I am red I am red

Mode of Payment of Premium : Annual I am red I am red

This benefit illustration is intended to show year-wise premiums payable and

benefits under the policy.

Policy Details
Basic Sum Assured (First Death) Rs. 1034000
Policy Option Endowment
Basic Sum Assured (Second Death, if any) Rs. NA

Sum Assured on First Death (at inception of the policy) Rs. 1825296
Guaranteed Annual Income (GAI)* NA
Sum Assured on Second Death, if any (at inception of the policy) Rs. NA

Rider Details

Tata AIA Vitality (Wellness

No
Program)

Details of Life
Insured/Partner under Benefit Payout
Rider Name/UIN^ the Benefit Option Return of Benefit Premium Sum Premium Year 1
(Benefit Option/Benefit premium Option Payment Assured p.a. without Discount
Payout Option) Income option Term Term (Rs.) GST (Rs.) (Rs.)
Lumpsum Income
Name Age(yrs) Gender Duration
(Rs.) p.a.(Rs.)
(yrs)
CPR - Term and Terminal
Illness (Lumpsum and Fixed Abc 58 M 1000000 NA NA No 27 12 1000000 25170 NA
Income)#

^CfPR: Tata AIA Life Insurance Non-Linked Comprehensive Protection Rider, UIN:110B033V03
#Premium calculated for Term Booster on Abc is considering underwriting class as preferred.

Premium Summary
I am red Base Plan Riders Total Instalment Premium

Instalment Premium without GST (Rs.) 110000 25170 135170

Instalment Premium with First year GST (Rs.) 114950 26303 141253

Instalment Premium post applicable discount with First year GST (Rs.) 114950 26303 141253

Instalment Premium with GST 2nd year onwards (Rs.) 112475 25736 138211
 (Amount in Rupees)
Guaranteed Non - Guaranteed
Other Benefits,
Survival if any Death
Policy Single/ Annualized Death
Benefit / (Guaranteed Benefit
Year Premium Maturity Benefit Min Guaranteed Special Surrender
Accrued Maturity (Second
Benefit (First Surrender Value Value
Guaranteed Benefit/ Death, if
Death)
Additions Guaranteed any)
Annual Income)
1 110000 91265 0 0 1825296 NA 0 0

2 110000 182530 0 0 1916561 NA 68829 59322

3 110000 273794 0 0 2007826 NA 121706 102217

4 110000 365059 0 0 2099090 NA 230130 158801

5 110000 456324 0 0 2190355 NA 289602 213864

6 110000 547589 0 0 2281620 NA 350078 273794

7 110000 638854 0 0 2372885 NA 411284 354716

8 110000 730118 0 0 2464150 NA 491459 445372

9 110000 821383 0 0 2555414 NA 576947 524773

10 110000 912648 0 0 2646679 NA 668569 632465

11 110000 1003913 0 0 2737944 NA 765685 749892

12 110000 1095178 0 0 2829209 NA 882501 905347

13 0 1186442 0 0 2920474 NA 923595 992961

14 0 1277707 0 0 3011738 NA 967153 1114343

15 0 1368972 0 0 3103003 NA 1013448 1210171

16 0 1460237 0 0 3194268 NA 1062756 1373535

17 0 1551502 0 0 3285533 NA 1113889 1511345

18 0 1642766 0 0 3376798 NA 1168398 1688399

19 0 1734031 0 0 3468062 NA 1228201 1838073

20 0 1825296 0 0 3559327 NA 1292111 2064410

21 0 1916561 0 0 3650592 NA 1360402 2263367

22 0 2007826 0 0 3741857 NA 1446547 2507044

23 0 2099090 0 0 3833122 NA 1526428 2798179

24 0 2190355 0 0 3924386 NA 1613793 3100265

25 0 2281620 0 0 4015651 NA 1709189 3413304

26 0 2372885 0 0 4106916 NA 1813164 3778363

27 0 2464150 1825296 4289446 4198181 NA 0 0

Note: Annualized premium excludes underwriting extra premium, frequency loadings on premiums, the premium paid towards the riders, if any, and Goods
and Services Tax.

*Under Option III: The policyholder shall also be given the option to receive the Guaranteed Annual Income (GAI) on a monthly basis. This option has to be
chosen at inception and cannot be altered once chosen. The GAI illustrated above is the total amount payable in a year on selection of monthly mode and
1/12th of this amount will be payable monthly.
Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfillment of conditions stipulated therein. Tata AIA Life Insurance
Company Ltd. does not assume responsibility on tax implication mentioned anywhere in this document. Please consult your own tax consultant to know the
tax benefits available to you.

I, ______________________________ (name), have explained I,______________________________ (name), having received the information
the premiums and benefits under the product fully to the prospect/ with respect to the above, have understood the above statement before entering
policyholder. into the contract.

Place: I am red
Date: Signature of Agent/ Intermediary/ Official Date: Signature of Prospect/ Policyholder

Unique Reference Number - L&C/Advt/2024/Apr/1153 (Rider- L&C/Advt/2022/Sep/2271)

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013
Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license.
For more information, Call the Tata AIA Life Insurance Company Ltd Helpline number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com

(I)V.99.00/FY2024-2025_Q1/RELEASE 01-04-24/EXPIRY 30-06-2024 004731278SBGRIPSLVBN1 26-06-2024,10:52 AM

 Tata AIA Life Insurance - IRDA of India Regn no. 110

Customer Information Sheet/Know Your Policy

This document provides key information about your policy. You are also advised to go through your policy document.

Policy
SR. Description
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
1 Name of Insurance Tata AIA Life Insurance Non-Linked Comprehensive Protection Rider (UIN Policy
Product/ Rider 110B033V03) (A Non-Linked, Non-Participating Individual Health Rider) Schedule

2 Policy Number 12980154 Policy

Schedule

3 Type of Insurance Benefit (Where your insurance policy pays fixed amount on the occurrence of a Clause of
Product/Policy covered event) Part C

4 Sum Insured Sum Lumpsum Income Income Policy

(Basis)(Along with Benefit Option Schedule
Assured (Rs.) p.a.(Rs.) Duration (Yrs)
Amount)
Term Benefit with Accelerated
1000000 1000000 NA NA
Terminal Illness

In case of any change in Sum Assured after submission of proposal, please refer to
your latest Benefit Illustration Document.

5 Policy Coverage (What Benefit Option: Clause of

the policy covers) Term Benefit with Accelerated Terminal Illness:: Part C
and Part F

The Insured Amount under this option is payable on earlier of death or diagnosis
of Terminal illness of the Life Insured.

Maturity Benefit:
If you have chosen Return of Premium option at inception of the rider, on survival
till end of the Coverage Term provided the rider/benefit option is notterminated,
the Total Premiums Paid (Excluding loading for Modal Rider Premiums) towards
the respective benefit option shall be returned, after deduction of any claim payout
made under the respective benefit option and
In case the payout under Return of Premium option is triggered, the premiums
waived (if any) shall be added to the Total Premiums Paid by the Policyholder for
the calculation of the Return of Balance Premium for the respective Benefit
Option.

6 Exclusions (What the Term Benefit with Accelerated Terminal Illness: Clause of
policy does not cover) Part C
and Part
Suicide Exclusion:In case of death due to suicide within 12 months from the date F.
of commencement of risk under the policy or from the date of revival of the policy,
as applicable, the nominee or beneficiary of the policyholder shall be entitled to at Refer
least 80% of the totalpremiums paid till the date of death or the surrender value Definition
available as on the date of death whichever is higher, provided the policy is in and
force. Exclusions
No other claim would be entertained by the Company except the refund of 80% Annexure
Total Premiums Paid or the acquired surrender value, as applicable.
Apart from Suicide exclusion detailed above, no other exclusion is applicable in
the event of death.
Terminal Illness Exclusion: The Life Insured will not be entitled to any Terminal
Illness benefit if it is causeddirectly or indirectly due to or occasioned, accelerated
or aggravated by intentional self-inflicted injury or attempted suicide, whether
medically sane or insane.

7 Waiting Period Benefit Option Waiting Period Applicable Clause of

Part C
Term Benefit with Accelerated Terminal Illness Not Applicanble and Part F

8 Financial Limits of Not Applicable. Clause of

coverage Part C
 Tata AIA Life Insurance - IRDA of India Regn no. 110

coverage Part C

9 Claims/Claims To register claim, please visit the Company through any service touch points Clause of
Procedure mentioned in Policy servicing section. Part C
Reimbursement Claim Process: and Part F

1. Get treatment in hospital/nursing home as per the norm.

2. After paying the bills Intimate the claim to Company for reimbursement of the
amount
3. Register and submit all relevant and mandatory claim documents.
4. Company verifies/scrutinizes the documents and claim submitted basis your
policy coverage and details.
5. If claim is approved, Payment is settled into customer's account.

Please note that,

1. If any queries, a query letter will be sent to you.

2. If claim is rejected/denied, a rejection letter mentioning the reason for rejection
will be sent to you.

10 Policy Servicing Clause of

i. E-mail us at [email protected] Part D
ii. Contact your Tata AIA Life Agent / Distributor and Part
iii. Call our helpline number 1-860-266-9966 (Call charges apply) G
iv. Visit the nearest the Tata AIA Life branch or CAMS Service Center
v. Log on to Online Customer Portal by visiting www.tataaia.com
vi. Write to us on the following address:
Tata AIA Life Insurance Company Limited 9th Floor, B - Wing, I-Think Techno
Campus, Behind TCS (Lodha), Pokhran Road No.2, Thane (West), Mumbai - 400
607

11 Grievances/Complaints You can register grievances through below modes: Clause of

Part G
i. Email us at [email protected]
ii. Service avenues as mentioned above for Policyholder Servicing [other than email
].

Kindly address your complaints to "Grievance Redressal Department"

For escalations, (In case not satisfied with the decision or not receipt of any
response), customers can email to [email protected] or write to - Grievance
Redressal Officer (GRO) Tata AIA Life Insurance Company Limited, 9th Floor, B -
Wing, I-Think Techno Campus, Behind TCS (Lodha), Thane (West), Mumbai - 400
607.
Insurance Ombudsman:
Where the redressal is not satisfactory despite the escalations, you may represent to
the Ombudsman. For contact details, contact number and email of the relevant
Ombudsman office, kindly refer the policy document or visit the IRDA of India
website http://www.policyholder.gov.in - Ombudsman / List of Insurance
Ombudsmen or our website www.tataaia.com.

12 Things to remember Freelook Period Clause of

Within a free look period of 30 days from the date of receipt of the Policy whether the Part C
policy is sourced electronically or otherwise You can return the policy for and Part
cancellation stating the reasons for the same, if You disagree to any of the terms or D
conditions of the Policy. Within Freelook You are entitled to a refund of the premium
paid without interest after deduction of proportionate risk premium stamp duty and
medical examination cost along with applicable taxes and cesses or levies, if any.
In respect of a linked insurance product, You shall receive the non-allocated
Premium plus charges levied by cancellation of Units plus Fund Value at the date of
cancellation less the deductions mentioned above.

Fraud, Mis-statement or Suppression: Clause of

Any fraud, mis-statement or suppression of a material fact under the Policy shall be Part C
dealt in accordance with Section 45 of the Insurance Act, 1938 as amended from and Part F
time to time.

13 Your Obligations Clause of

Please disclose all pre-existing disease/s or condition/s before buying a Policy. Part C
Non-disclosure may result in claim not being paid. and Part F
All information sought in the Proposal form is Material for issuance of the policy and
and settlement of claim. Annexure
Disclosure of Material Information and any changes therein during the Policy 1/
period should be communicated to us by Annexure
Sending an email to [email protected] from your email id registered A
with us
Submission of the Request for Change form* (filled and signed) at any Tata
AIA Life Insurance Branch or Service Centre
 Tata AIA Life Insurance - IRDA of India Regn no. 110

AIA Life Insurance Branch or Service Centre

*Request for Change form is available on our website - www.tataaia.com

"We", "Us", "Our", "Insurer" or "Company" refers to Tata AIA Life Insurance Company Limited.

Declaration by the Policy Holder:

I have read the above and confirm having noted the details. I further confirm the below that:

a. In case of any change to the Sum Insured/ Rider after submission of the proposal, the details in the revised Benefit
Illustration and Customer Information Sheet would be applicable.
b. I have received a copy of the CIS through the download utility/ through my Salesperson.
c. I am aware that on request I can avail of the CIS in local language.

Place:
Date:
(Signature of Policy)