Proposal No

Policy No

ILLUSTRATION OF BENEFITS FOR BHARTI AXA LIFE ACCIDENTAL DEATH BENEFIT RIDER

UIN No 130B008V01 llustration generated by Online

Product Code eADB Illustration Date 07/04/2020

PERSONAL DETAILS BENEFITS AND PREMIUM DETAILS

Accidental Death Benefit Rider
Life To Be Insured Plan Name
SEIKH SHAHAJADA

Age as on last birthday ( in Years) 22 53

Gender Male Premium Payment Term (In Years) 53

Occupation Premium Mode Monthly

75

PROPOSER DETAILS Sum Assured (Rs.) 2000000

Proposer Name SEIKH SHAHAJADA Annualized Premium (Rs.) 1000

Age as on last birthday ( in Years) 22 Modal Premium Payable(Rs.) 87

GST in the 1st year 16

Total Amount Payable By You (Rs.) in the 1st year 103

Explanation
1.
2. The illustration is based on the standard risk class,without taking in to consideration your own circumstances. They will be determined according to our
underwriting decision.
3.
4. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
5.
advice.
6.
any way indicate the quality of the contract, its future prospects or returns.

Declaration by Proposer
-

issue a revised illustration with the Policy Bond.

I hereby give consent to all the declarations mentioned above. ■ Yes  No



Name of the Proposer ________________________________________________________________________________________________________________

SEIKH SHAHAJADA

Date __________________________________________________________Place________________________________________________________________

Insurance is the subject matter of the solicitation.

Bharti AXA Life Insurance Company Limited

Registered address- Unit No. 1904, 19th Floor, Parinee Crescenzo, 'G' Block, Bandra Kurla Complex, BKC Road, Behind MCA Ground, Bandra East, Mumbai -400051, Maharashtra
Service Unit address- Bharti AXA Life Insurance Company Limited, Spectrum tower, 3rd Floor, Malad link road, Malad (west), Mumbai 400064. Maharashtra
Email: service@bharti-axalife.com, visit us at: www.bharti-axalife.com, Regn. No: 130.