For Office Use Only (w.e.f. Nov 17 / Ver 1.

0)

Illustration No: KETP-4728M-1366-S548

Quotation Number: 01030519172049557

Proposal No:

Policy No:

Kotak e-Term Plan - Benefit Illustration

A Pure Protection Life Insurance Plan

UIN: 107N104V01

This shall form a part of the policy document

Dear Mr. Ravi Patel,

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 of 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. Ravi Patel Name of the Product Kotak e-Term Plan

Date of Birth of Life Insured 07 December 1971 Unique Identification Number 107N104V01

Age of the Life Insured (in yrs) 47 Basic Sum Assured (in Rs.) 1,00,00,000

Tobacco user No Policy Term (in yrs) 28

Gender of Life Insured Male Premium Payment Term (in yrs) Single Premium

Name of Proposer Mr. Ravi Patel Mode of premium payment Single

Age of the Proposer (in yrs) 47 Premium Payment Option Single Premium

Gender of Proposer Male Plan Option Life Plus

Amount of Installment Premium

5,47,700 Payout Option Immediate Payout
(in Rs.)

Amount of Step-Up option fee (in

Not Applicable Agent’s Branch Location Gujarat
Rs.)

Proposer’s Current Location Gujarat Step-Up Option Not Applicable

Existing Customer No Existing Policy number Not Applicable

Rider Details

Rider Premium
Rider Name Rider Sum Assured Rider Term Rider Premium
Payment Term

Kotak Permanent Disability Benefit Rider (UIN:

Not Selected
107B002V03)

Kotak Critical Illness Plus Benefit Rider (UIN:

Not Selected
107B020V01)

Note: Rider Premiums will have to be paid additionally

Total Single Premium (excluding Goods and Services Tax and Cess as applicable) (Rs.) 5,47,700

Add: Goods and Services Tax and Cess as applicable 98,586

Total Single Premium (including Goods and Services Tax and Cess as applicable) (Rs.) payable throughout the
6,46,286
premium payment term

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 Quotation Number:01030519172049557
Guaranteed Benefits

End of Policy Year Age Premium 2 Death Benefit3 Surrender Value5

1 48 5,47,700 1,00,00,000 3,83,390

2 49 0 1,00,00,000 3,66,959

3 50 0 1,00,00,000 3,56,005

4 51 0 1,00,00,000 3,39,574

5 52 0 1,00,00,000 3,23,143

6 53 0 1,00,00,000 3,12,189

7 54 0 1,00,00,000 2,95,758

8 55 0 1,00,00,000 2,84,804

9 56 0 1,00,00,000 2,68,373

10 57 0 1,00,00,000 2,51,942

11 58 0 1,00,00,000 2,40,988

12 59 0 1,00,00,000 2,24,557

13 60 0 1,00,00,000 2,13,603

14 61 0 1,00,00,000 1,97,172

15 62 0 1,00,00,000 1,86,218

16 63 0 1,00,00,000 1,69,787

17 64 0 1,00,00,000 1,53,356

18 65 0 1,00,00,000 1,42,402

19 66 0 1,00,00,000 1,25,971

20 67 0 1,00,00,000 1,15,017

21 68 0 1,00,00,000 98,586

22 69 0 1,00,00,000 82,155

23 70 0 1,00,00,000 71,201

24 71 0 1,00,00,000 54,770

25 72 0 1,00,00,000 43,816

26 73 0 1,00,00,000 27,385

27 74 0 1,00,00,000 16,431

28 75 0 1,00,00,000

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 Quotation Number:01030519172049557

Terms & Conditions:

1. This is non-participating term insurance plan. The illustration stated is for a healthy individual and under the assumption that this is the only policy
the client has with Kotak Life Insurance and would be subject to underwriting.

2. Premium payable in a policy year including Step-Up option fee (if any) and Extra Premium (if any), but excluding Goods and Services Tax and
Cess and Rider Premium, if any.

3. In case of an unfortunate event of death of the Life Insured during the term of the plan, the nominee / beneficiary shall receive the Sum Assured
on Death (on acceptance of the death claim).
Where Sum Assured on Death is as follows:

For Regular & Limited Premium,

Highest of the following:
a) Sum Assured# OR
b) 11 times Annualized Premium* OR
c) 105% of all premiums paid till the date of death

For Single Premium,

Higher of the following:
a) Basic Sum Assured, OR
b) 1.25 times the Single Premium

* Annualised Premium is the premium payable in a policy year, excluding the underwriting extra premiums, loadings for modal premium, Goods
and Services Tax, Cess and Rider Premium if any.
# Sum Assured shall be Basic Sum Assured adjusted for increase /decrease in Basic Sum Assured, due to exercising of Step-up /Step-down
option by the policyholder.

Additionally, since the policyholder has opted for Life Plus Option, an Accidental Death Benefit (equal to the Basic Sum Assured) shall be payable
as lump sum in the event of the Life Insured’s death due to any accident, to the Nominee / Beneficiary subject to a maximum of Rs 1 Cr.

Since the Payout Option mentioned above is 'Immediate Payout',the Sum Assured on Death shall be paid immediately on acceptance of death
claim.

4. There is no maturity benefit payable under this plan.

5. For Limited pay policies with Premium Payment Term of less than 10 years, the policy will acquire Surrender Value provided premiums due for at
least 2 consecutive policy years have been paid in full. For Limited pay policies with Premium Payment Term of 10 years and above, the policy will
acquire Surrender Value provided premiums due for at least 3 consecutive policy years have been paid in full.
Single pay policies will acquire Surrender Value immediately after the payment of Single Premium.

The Surrender Value for Limited pay policies shall be calculated as 75% x (sum of premiums paid) x ((Policy Term -Premium Payment
Term)/Policy Term) x (Balance Policy Term to run / Policy Term).
The Surrender Value for Single pay policies shall be calculated as 75% x (single premium paid) x ((Policy Term - 1)/Policy Term) x (Balance
Policy Term to run / Policy Term).

For Regular pay policy, Surrender value is not available.

For more details, please refer the sales brochure.

6. For the Limited pay policies, after the policy acquires Surrender Value, if the subsequent premiums are not paid within the Grace Period, the Base
Policy will be converted into a Reduced Paid-Up policy by default. Death benefit will be Reduced Paid-Up Sum Assured on death,
where Reduced Paid-Up Sum Assured on death is: (Total Premium paid / Total Premium payable) X Sum Assured on death

Since the Policyholder has opted for ‘Life Plus’ Option, upon conversion to Reduced Paid-Up, the policy will continue with Reduced Paid-Up Sum
Assured on death and Reduced Paid-Up Accidental Death Benefit covering accidental death where,
Reduced Paid-Up Accidental Death Benefit = (Total Premiums Paid / Total Premiums Payable) X Accidental Death Benefit

Single Pay Policy will become fully Paid-Up after payment of Single Premium.

Reduced Paid-Up option will not be available for Regular Premium paying Policies.

Rider benefit (if opted) will be available as per Reduced Paid-Up Sum Assured.

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7. A lapsed or Reduced Paid-Up policy can be revived with or without riders within 2 years from the date of the first unpaid premium. The
Policyholder can revive the Policy without evidence of good health on payment of the outstanding premiums and interest charge, 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 interest charge. On revival, all benefits under the policy will be reinstated.

8. Step-Up option is an option whereby you can increase your basic Sum Assured in future without medical examination. This Option is available
only for Regular premium Pay polices. For more details, please refer Sales Brochure.

9. 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

10. Goods and Services Tax and Cess as applicable shall be levied at the applicable Tax rates in accordance with the prevailing Tax Laws. Prevailing
Tax Laws will be applicable on this policy which may vary from time to time.

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.

12. 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.

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 Quotation Number:01030519172049557

Statement of Consent 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,
charges (if any), terms & conditions and risk factors of the proposed plan to the Proposer.

__________________ _____________________________________

Date Signature of the Life Advisor/Specified person of

Corporate Agent/Authorised Employee of
Broker /Relationship Officer

Statement of Consent 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/features of benefits, charges (if any), terms and conditions and risk factors under the proposed plan and duly
acknowledge the benefit illustration before entering into the contract.

Place ____________________________________ Date ____________________________________

______________________________________________________

Signature/Right thumb impression of the Proposer

________________________________________________________________________________________________________________________
Kotak Mahindra Life Insurance Company Ltd. (Formerly known as Kotak Mahindra Old Mutual Life Insurance Ltd.)
CIN: U66030MH2000PLC128503
Regd. Off: 2nd Floor, Plot # C- 12, G- Block, BKC, Bandra (E), Mumbai - 400051
Regn. No: 107. Toll Free No.: 1800 209 8800. Website: http://insurance.kotak.com

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 Quotation Number:01030519172049557

Category Occupation of Proposer Income Of Proposer

Non Rural Self Employed 8,00,000

LIST OF DOCUMENTS TO BE ATTACHED

1. Proposal Form
2. Address Proof Of Proposer
3. Age Proof Of Insured
4. PhotoCopy Of Cancel Cheque
5. DNC Format
6. Latest Benefit Illustration
7. PAN Card Of Proposer
8. PAN Card of Company
9. Current Address Proof Of theTrust
10. PAN Card Of TheTrust
11. Trust Deed
12. Income Proof Of The Life To Be Insured
13. Photo ID Proof
14. Standard Age Proof Life Insured
15. Agent Confidentiality Report
16. Identity Proof Address Proof and Photo of Individual signing the Proposal Form

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