3/25/15 RELIANCE'S GUARANTEED MONEY BACK PLAN

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This shall form a part of the policy document

Benefit Illustration of RELIANCE'S GUARANTEED MONEY BACK PLAN

Name of the life insured : prashant shinde Proposal No :

Age of the Policyholder: : 30 Policy No :

Prepared on : 25/03/2015

Name of the Insurance

Advisor: pratap

Sex : Male

Unique Identification No. : 121N084V02

Basic CoverPolicy Term 15 Mode of Premium Payment Yearly Annualised Premium 18390

Total Installment premium (excluding service tax) 18390 Total Installment premium payable^ Year

1:

18958 Total Installment premium payable^

Year 2 onwards :

18674

Sum Assured 165000 Frequency 1 Premium Payment Term 10

Age Proof Standard

Note :Some benefits are guaranteed and some benefits are variable with returns based on the future performance of Reliance Life Insurance. 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 illustration on this page will show two different rates of assumed investment returns.These assumed rates of return are not

guaranteed and they are not the 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. Statement of various charges

alongwith growth of the fund expected over the duration of the policy with assured rate of interest as mentioned.

Benefit illustration table (all figures are in rupees)

YearsAge of

Policyholder

Annualised

premium

excluding servicetax

Service

Tax onPremium

Premium

(inclusive ofService tax)

Basic

SumAssured

Guaranteed Loyalty

Addition accrued at theend of the year

Guaranteed

MaturityAddition

Death

Benefit

Benefit Paid on

Death due toaccident

Money back

benefit at theend of year

Maturity

Benefit

Guaranteed

SurrenderValue (GSV)*

Special

Surrender

Value(SSV)*

Surrender

value(SV)**

1 30 18390 568 18958 165000 3300 0 183900 348900 0 0 3678 0 3678

2 31 18390 284 18674 165000 6600 0 183900 348900 0 0 11034 0 11034

3 32 18390 284 18674 165000 9900 0 183900 348900 0 0 27585 10028 27585

4 33 18390 284 18674 165000 13200 0 183900 348900 0 0 36780 15867 36780

5 34 18390 284 18674 165000 16500 0 183900 348900 0 0 45975 23534 45975

6 35 18390 284 18674 165000 19800 0 183900 348900 0 0 55170 33505 55170

7 36 18390 284 18674 165000 23100 0 183900 348900 0 0 68227 46370 68227

8 37 18390 284 18674 165000 26400 0 183900 348900 0 0 82387 62856 82387

9 38 18390 284 18674 165000 29700 0 183900 348900 0 0 99306 83861 99306

10 39 18390 284 18674 165000 33000 0 193095 358095 0 0 115857 110488 115857

11 40 0 0 0 165000 36300 0 193095 358095 24750 0 98463 107836 107836

12 41 0 0 0 165000 39600 0 193095 358095 24750 0 81069 104653 104653

13 42 0 0 0 165000 42900 0 193095 358095 24750 0 63675 100833 100833

14 43 0 0 0 165000 46200 0 193095 358095 24750 0 48120 96250 96250

15 44 0 0 0 165000 49500 24750 193095 358095 66000 74250 0 0 0

Total installment premium payable is inclusive of services tax & cess and extra premium for non standard age proof (NSAP), if any.

*Guaranteed Surrender Value & Special Surrender value is calculated at year end after paying survival benefits

** Acquired surrender value is payable only after completion of first three policy years.

Insurance is the subject matter of solicitation. Reliance Life Insurance Company Limited is a fully licensed life insurance company registered with the Insurance Regulatory and Development Authority (Registration No:

121) in accordance with the provisions of the Insurance Act 1938.

The premium amount shown above is calculated assuming that the life Proposed/Assured is a normal healthy person.

In the event the Life Proposed/Assured is suffering from any sickness/ medical problems or in the event of any past medical history, the premium will be adjusted accordingly, as per the underwriting guidelines of RelianceLife Insurance Company Limited.

The main objective of the illustration is that the client is able to appreciate the features of the product and the flow of benefits in different circumstances with some level of quantification.

The above amounts assume that all premiums are paid when due. Further, the above death and surrender values are illustrated assuming that all the modal/installment premium payable in a policy year are paid (i.e. the

event occurs at the end of the policy year). If death or surrender occur and only some of the modal/ installment premium are paid, then the death or surrender values will only consist of that premium that has been paid.

Accordingly, the death or surrender values at a time other than at the end of the policy year will be lower than those illustrated above.

Disclaimers:-

1. This premium quotation is indicative. The premium rate charged to the customers may be different depending upon the factors such as health, occupation of the customer and other intrinsic factors such as non submission

of documentary evidences like age proof.

2. The current rate of service tax along with education cess is 3.09% and 1.545% on first year premiums and renewal premiums respectively on base policy premium and a service tax along with education cess of 12.36% islevied on rider premiums. The service tax rate will be revised as and when notified by the Government.

3. Rider premium rates, (if applicable) have not been taken into account in calculating the base premium.

4. For authoritative details of the rates and the terms and conditions applicable to the particular person/policy, kindly refer to the specifications in the policy document after issuance.

5. For more details on risk factor, terms and conditions, please read Sales brochure of the particular plan carefully before concluding a sale.

6. Subject to the guaranteed minimum surrender value, the company may however pay a special surrender value calculated according to the basis and method in use from time to time.

7. The policy acquires Guaranteed surrender value after one year full premiums are paid.

8. If Premium paying term is less than 10 years, the policy acquires Special Surrender Value after two years full premiums are paid and If Premium paying term is greater than or equal to 10 years, the policy acquires Special

Surrender Value after three years full premiums are paid.

9. Special Surrender Value (SSV) is a non guaranteed benefit. It is calculated as SSV Factor multiplied by the Paid Up Sum Assured. The SSV Factor is dependent on the benefits payable for the paid up policy and is

expressed as a percentage of Paid Up Sum Assured. The company reserves the rights to change the SSV Factor from time to time depending on the economic environment, experience and other factors, subject to IRDAapproval.

10. Guaranteed Surrender Value is GSV factor multiplied by the total premiums paid , excluding rider premiums and extra premium paid, if any, less any survival benefits already paid. Policy will acquire GSV only if first

3/25/15 RELIANCE'S GUARANTEED MONEY BACK PLAN

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annualized premium have been paid. For GSV factors, kindly refer to the Policy document.11. For policies with premium paying term less than 10, the policy acquires a paid up value after two years full premiums are paid. Please refer to sales brochure for more details.

12. For policies with premium paying term greater than or equal to 10, the policy acquires a paid up value after three years full premiums are paid. Please refer to sales brochure for more details.

13. Taxes, duties or surcharges of whatever description levied by any statutory authority will be applicable.

I pratap have explained the information with respect to the above, to the prospect before entering entering into the contract.

Intermediary's Signature:

Place:

Date:

I prashant shinde having received the information with respect to the above, have understood the above statement before entering into the contract.

Policyholders' Signature:

Place:

Date:

Marketing officials' Signature: Policyholder's Signature:

Company Seal:

Place:

Date:

“For more details on risk factors , terms and conditions please read sales brochure carefully before concluding a sale”.