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For Office Use Only (w.e.f. Nov 15 / V1.4)

Illustration No: KAIP-3030M-6901-Y95
Quotation Number:BB23112015A000903
Proposal No:
Policy No:

Kotak Assured Income Plan - Benefit Illustration

A Life Insurance Plan
UIN:107N069V03
This shall form a part of the policy document
Dear Mr. sandipbhai makvana,
The illustration is approved by the Board of Directors of the Company and takes into account the guidelines for illustrations set by the Life Insurance
Council and the IRDAI. Some benefits are guaranteed and some benefits are variable with returns based on the future performance of your life insurance
company. If your policy offers guaranteed returns then these will be clearly marked guaranteed in the illustration table on this page. If your policy offers
variable returns then the illustrations on this page will show two different rates of assumed investment returns. These assumed rates return are not
guaranteed and they are not upper or lower limits of what you might get back as the value of your policy is dependent on a number of factors including
future investment performance.
Plan Details
Name of Life Insured

Mr. sandipbhai makvana

Date of Birth of Life Insured

Age of the Life Insured (in yrs)
Gender of Life Insured

24 August 1985

Name of the Product

Kotak Assured Income Plan

Unique Identification Number

30

Basic Sum Assured (in Rs.)

Male

107N069V03
9,50,000

Amount of Installment Premium (in

Rs.)

95,000

Policy Term (in yrs)

30

Maturity Benefit (%)

107%

Premium Payment Term (in yrs)

10

Assured Annual Income (%)

10.1%

Name of the Proposer

Mr. sandipbhai makvana

Age of the Proposer (in yrs)

Mode

30

Sum Assured on death (in Rs.)

Region

10,16,500
Rest of India

Yearly

Rider Details
Rider Name

Rider Sum Assured

Life Guardian Rider (UIN 107B012V02)

Not Selected

Accidental Disability Guardian Benefit (UIN 107B011V02)

Not Selected

Age of the Proposer, if Life Guardian or Accidental Disability

Guardian Benefit is opted for (yrs)

Rider Term

Rider Premiums

Not Applicable

Please Note: Rider Premiums will have to be paid additionally

Total Yearly Premium

95,000

Add:Service Tax and Cess applicable during first policy year

3,444

Total Yearly Premium (Including of Service Tax and Cess) payable in the First Policy Year

98,444

Add:Service Tax and Cess applicable from second year and onwards

1,722

Total Yearly Premium (Including of Service Tax and Cess) payable from second year and onwards

96,722

Page 1 of 5

Quotation Number:BB23112015A000903
Guaranteed Plan Benefits

End of Year

Annual Premium (Exclusive of

ST & C)

Sum Assured on death

Assured Annual Income

Guaranteed Maturity Benefit

Surrender Value3

Guaranteed Surrender Value

95,000

10,16,500

95,000

10,16,500

95,000

10,16,500

85,500

85,500

95,000

10,16,500

1,90,000

1,90,000

95,000

10,16,500

2,37,500

2,37,500

95,000

10,16,500

2,85,000

2,85,000

95,000

10,16,500

3,32,500

3,32,500

95,000

10,16,500

3,80,000

3,80,000

95,000

10,16,500

4,27,500

5,13,000

10

95,000

10,16,500

4,75,000

6,17,500

11

10,16,500

5,41,500

6,65,000

12

10,16,500

6,08,000

7,60,000

13

10,16,500

6,74,500

8,07,500

14

10,16,500

7,41,000

8,55,000

15

10,16,500

95,950

8,07,500

9,50,000

16

10,16,500

95,950

7,87,550

9,49,050

17

10,16,500

95,950

7,67,600

9,48,100

18

10,16,500

95,950

7,47,650

8,99,650

19

10,16,500

95,950

7,27,700

8,98,700

20

10,16,500

95,950

7,07,750

8,97,750

21

10,16,500

95,950

6,97,300

8,96,800

22

10,16,500

95,950

6,86,850

8,48,350

23

10,16,500

95,950

6,76,400

8,47,400

24

10,16,500

95,950

6,65,950

8,46,450

25

10,16,500

95,950

6,55,500

8,45,500

26

10,16,500

95,950

6,54,550

8,44,550

27

10,16,500

95,950

6,53,600

7,96,100

28

10,16,500

95,950

6,52,650

7,95,150

29

10,16,500

95,950

6,51,700

7,94,200

30

10,16,500

10,16,500

Page 2 of 5

Quotation Number:BB23112015A000903
Terms & Conditions:
1.

The Illustration is for a healthy individual and would be subject to underwriting.

2.

On death of the Life Insured Sum Assured on death (as mentioned below) will be payable.
Sum Assured on death is Higher of:
(i) 106% of Basic Sum Assured
(ii) Guaranteed Maturity Benefit
Due Premiums and Outstanding premiums for the year in which death occurs (applicable for non-annual premium paying policies) will be adjusted
from the Death Benefit.

3.

The policy acquires surrender value after three years premiums are paid in full. The Surrender Value shown above is higher of Guaranteed
Surrender Value or Special Surrender Value.

4.

The Guaranteed Surrender Value will be 'X' percent of total Premiums paid (excluding Service Tax, Rider premium and Extra Premium, if any)
less Assured Annual Income already paid, where 'X' percent varies by year of surrender and is mentioned in the table below:
Policy Year:

Policy Year:

Policy Year:

Policy Year:

N.A

N.A

30%

50%

50%

50%

50%

50%

50%

10

11

12

13

14

15

16

17

18

50%

57%

64%

71%

78%

85%

93%

101%

109%

19

20

21

22

23

24

25

26

27

117%

125%

134%

143%

152%

161%

170%

180%

190%

28

29

30

200%

210%

220%

5.

If the Policyholder requests to surrender the Policy, the Company shall pay a Surrender Value and the same will be quoted in writing by the
Company, on receipt of a written request from the policyholder. In any case, higher of the Guaranteed Surrender Value or Special Surrender
Value will be payable. For more details, please refer the sales brochure.

6.

The policy is automatically made Reduced Paid-Up where policy has acquired Surrender Value and due premiums are not received within the
grace period.
The Maturity Benefit and Assured Annual Income will be based on Reduced Paid-Up Basic Sum Assured where
Reduced Paid-Up Sum Assured = Basic Sum Assured (Total Premiums paid / Total premiums payable over the term)
The Sum Assured on death mentioned above is reduced to Reduced Paid-Up Sum Assured on death as follows:
Reduced Paid-Up Sum Assured on death = Sum Assured on death as at the date of paid-up [(Total Premiums paid / Total premiums payable
over the term)]
For more details, please refer to Sales Brochure.
Rider benefit will be available as per Reduced Paid-Up Sum Assured of Rider (if applicable).

7.

A lapsed or Paid-Up policy can be revived with or without riders within 2 years from the date of the first unpaid premium. Revival can be done
without evidence of good health on payment of the outstanding premiums and handling charges, if the payment is made within six months from
the date of the first unpaid premium. Thereafter to revive the policy, evidence of good health would be required along with payment of the
outstanding premiums and handling charges. On revival, only future benefits shall be reinstated to their original level.

8.

The above illustrated benefits are derived on the basis of details of life insured provided at the time of filling the proposal form. If the details are
found inaccurate or there are any changes before or at the time of the policy issuance for eg: change in age, the illustrated benefits will be subject
to revision.

9.

Service Tax & Cess, as applicable are levied at the applicable Tax rates in accordance with the prevailing Tax Laws. Prevailing tax laws are
applicable on this policy which may vary from time to time.

10.

The values shown are for illustrative purposes only. For more details on risk factors, terms and conditions please read sales brochure carefully
before concluding a sale.

11.

TDS at prevailing rate will be deducted from any amount paid under a life insurance policy subject to the provisions of prevailing tax laws. In case
of non-availability of valid PAN, TDS will be deducted at higher rate. Tax laws are subject to changes from time to time. Kindly consult your tax
advisor for tax implication of your policy.

Page 3 of 5

Quotation Number:BB23112015A000903
Declaration by the Life Advisor/Specified person of Corporate Agent/Authorised Employee of Broker /Relationship Officer
I......................................................................(Full Name), declare that I have explained all the contents of this benefit illustration including the
features, terms & conditions and risk factors of the proposed plan to the Proposer.
____________________

________________________________

Date

Signature

Signature of the Life Advisor/Specified person of Corporate Agent/Authorised Employee of Broker /Relationship Officer

Declaration by the Proposer

I......................................................................(Full Name),having received this benefit illustration and all other information with respect to the
above, have read and understood the structure of benefits, terms and conditions and risk factors of the proposed plan and duly acknowledge the
benefit illustration before entering into the contract.
Place _______________________
NA

__________________

_________________________________________

Date

Signature/Right thumb impression of the Proposer

[CompanySealImage]

________________________________________________________________________________________________________________________
Kotak Mahindra Old Mutual Life Insurance Limited.
CIN: U66030MH2000PLC128503
Regd. Off: 4th Floor, Vinay Bhavya Complex, 159 A ,CST Road, Kalina, Santacruz (East), Mumbai - 400 098,India.
Regn. No: 107. Toll Free No.: 1800 209 8800. Website: http://insurance.kotak.com
Insurance is the subject matter of solicitation.

Page 4 of 5

Quotation Number:BB23112015A000903
Category

Occupation of Proposer

Income Of Proposer

LIST OF DOCUMENTS TO BE ATTACHED

1. Proposal Form
2. Photo ID Proof
3. Address Proof of Proposer
4. Age Proof of Insured
5. Photocopy of Cancel Cheque
6. DNC Format
7. Latest Benefit Illustration
8. Pan Card of Proposer OR Payor
9. Age Proof of Proposer
10. Agent Confidentiality Report
11. Income Proof of the Secondary Life to be Insured

Page 5 of 5