020911092506262383-1-BI

PREMIUM QUOTATION CUM BENEFIT ILLUSTRATION FOR NEW RISK CARE II - REGULAR _________________________________________________________________________

Name:Sandeep Mode:Yearly

Kulkarni Age:32 Premium Term:23

Gender:M

Sum Insured:2500000

Benefit Term:23

Covers

|Sum Assured |2500000 |0

| | |

Premium (Rs.) 7925 1125

| | |

|New Risk Care II - Regular |High Sum Assured Rebate

| |Premium |Ser-Tax |Edu Cess |Total

| | | | |

Yearly

| HalfYearly 6800 | 680 | 20 | 7500 |

Quarterly

Monthly

| 612 | 61 | 2 | 675 |

3468 | 347 | 10 | 3825 |

1768 | 177 | 5 | 1950 |

No Maturity Benefit for this product Death Benefit _________________________________________________________________________ Death Benefit 2500000 _________________________________________________________________________

Note: 1. Rider Benefits available under the regular premium policy are: Accidental Death Benefit, Critical Illness Benefit, Hospital Cash
#Signature of Policyholder Signature of the Sales Representative Company's Seal Date Place

020911092506262383-2-BI

Benefit and Accidental Permanent Total / Partial Disability Benefit. 2. If selected, all benefits cease at age 65. 3. Hospital Cash rates are yearly reviewable (Subject to IRDA Approval). 4. Subject to age limit restrictions, you have the flexibility to add or remove the riders at each policy anniversary. Hospital Cash Benefit and Critical Illness Benefit have to be selected at policy inception only. Hospital Cash Benefit and Critical Illness Benefit Sum Assured may be reduced or removed at each policy anniversary. Once reduced or removed, it may not be increased or included at a later date. 5. Please consult our 'Insurance Consultant' for any clarifications on this illustration. 6. Exclusions under this policy are as per the Sales Brochure. 7. Change in the nature of occupation should be immediately intimated to the company since it may affect the benefits and premium under the policies in respect of Hospital Cash, if selected. Also, please note the exclusions in this respect. 8. Surrender Value is payable after five policy years for single premium case only. 9. The Company declares that it may charge extra premium subject to underwriting of proposal before the acceptance of risk. 10. The Product does not offer any Maturity value. 11. All benefits payable under the Policy are subject to the tax laws and other financial enactments, as they exist from time to time. Please see the product brochures for details about the product. Insurance is the subject matter of the solicitation. I/We declare that I/We have read and understood the above Benefit Illustrations. Signature of Client:Date: Signature of IC:Date: Bajaj Allianz Life Insurance Company Limited, GE Plaza, Airport Road, Yerawarda, Pune - 411 006. Tel:(020) 66026777. Fax:(020) 66026789. Email: life@bajajallianz.co.in www.bajajallianzlife.co.in

#Signature of Policyholder

Signature of the Sales Representative

Company's Seal

Date

Place