Illustration Format

Life Partner Plus
UIN- 104N029V01
Participating
Policy/Proposal No:[ _________________ ]
Date of Illustration - Oct 13, 2011 7:26:15 PM
Insured
RUDRA
Age at inception of Policy
Sex
Male
Class
Standard
Face Amount
Rs 2,13,604
Bonus Option
Paid Up Additions
Payment Mode
Annual Billed
Payor Name
Payor Age
Payor Sex
Male
Premium Payment Term
10 Pay
PREMIUM SUMMARY
Basic Premium
Rs
25,000.21
Annual - Billed
TOTAL
Rs
25,000.21
Annual - Billed
Signature of Agent/Specified Person/Principal officer:___________________________________________
Policy Holders Signature:___________________________________________
MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002
Page 1 of 5
YEARLY DETAIL
The following ledger provides year by year illustrative figures for premiums required, for the policy that you have chosen.
General Details
Year
Guaranteed
Age
Non Guaranteed Lower Rate 6%:
Annual
Premium
Death
Benefit
Surrender
Value
Money
Back
Payments
Net
Outlay
( Rs )
( Rs )
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
25,000
25,000
25,000
25,000
Non Guaranteed Higher Rate 10%:
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
Net
Outlay
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(BOY)
25,000
25,000
50,750
25,000
77,273
22,954
25,000
50,750
77,273
3,749
25,000
1,04,592
30,759
25,000
1,32,730
38,641
25,000
1,55,518
25,000
2,17,356
25,000
1,61,712
46,604
25,000
25,000
1,91,563
10
25,000
2,13,604
54,644
62,768
11
25,000
2,13,604
70,970
10
12
11
13
25,000
2,13,604
2,13,604
12
13
14
15
14
16
15
16
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
25,000
25,000
25,000
22,954
25,000
2,580
3,899
34,658
3,277
6,741
45,381
2,87,484
3,995
10,421
25,000
3,65,547
4,738
25,000
4,42,533
5,502
25,000
5,03,827
71,679
25,000
72,397
2,13,604
73,121
2,13,604
73,851
2,13,604
74,591
17
2,13,604
18
2,13,604
17
19
18
20
19
21
20
21
50,750
77,273
7,055
22,954
25,000
2,00,439
5,065
7,339
38,098
25,000
2,94,730
6,534
12,903
51,544
57,026
25,000
4,05,744
8,094
20,220
66,825
15,003
69,647
25,000
5,33,283
9,753
29,466
84,111
20,549
83,316
25,000
6,68,433
11,523
40,825
1,03,593
6,291
27,104
98,074
25,000
7,96,813
13,406
54,466
1,25,436
5,71,188
7,106
34,729
1,06,408
25,000
9,40,357
15,408
70,582
1,42,261
6,44,355
7,330
43,463
1,15,860
10,99,009
16,376
89,337
1,61,734
7,17,003
7,562
52,761
1,25,882
12,61,304
17,427
1,09,809
1,82,930
7,89,153
7,803
62,643
1,36,494
14,27,576
18,539
1,32,129
2,05,980
8,60,847
8,056
73,138
1,47,729
15,97,912
19,739
1,56,427
2,31,017
75,336
9,32,140
8,313
84,299
1,59,635
17,72,597
21,033
1,82,901
2,58,237
76,090
10,02,996
8,587
96,140
1,72,230
19,51,879
22,413
2,11,705
2,87,795
2,13,604
76,850
10,73,501
8,867
1,08,717
1,85,567
21,35,907
23,902
2,43,037
3,19,887
2,13,604
77,619
11,43,638
9,159
1,22,067
1,99,686
23,24,957
25,489
2,77,115
3,54,735
2,13,604
78,395
12,13,420
9,461
1,36,245
2,14,640
25,19,156
27,221
3,14,178
3,92,572
22
2,13,604
79,179
12,82,849
9,783
1,51,287
2,30,466
27,18,913
29,070
3,54,476
4,33,655
23
2,13,604
79,971
13,51,989
10,103
1,67,251
2,47,223
29,24,367
31,062
3,98,265
4,78,237
22
24
2,13,604
80,770
14,20,752
10,446
1,84,199
2,64,969
31,35,789
33,182
4,45,896
5,26,666
23
25
2,13,604
81,578
14,89,207
10,800
2,02,196
2,83,773
33,53,248
35,497
4,97,665
5,79,242
24
26
2,13,604
82,393
15,57,344
11,178
2,21,287
3,03,681
35,77,188
37,993
5,53,915
6,36,309
25
27
2,13,604
83,218
16,25,223
11,570
2,41,570
3,24,788
38,07,894
40,683
6,15,091
6,98,309
26
28
2,13,604
84,049
16,92,831
11,974
2,63,110
3,47,159
40,45,625
43,583
6,81,601
7,65,650
Page 2 of 5
General Details
Year
Guaranteed
Age
Annual
Premium
Death
Benefit
Surrender
Value
Money
Back
Payments
Net
Outlay
( Rs )
( Rs )
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
Net
Outlay
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(BOY)
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
27
29
2,13,604
84,891
17,60,153
12,392
2,85,988
3,70,878
42,90,653
46,706
7,53,928
28
30
2,13,604
85,739
18,27,167
12,837
3,10,288
3,96,027
45,43,230
50,067
8,32,587
9,18,326
29
31
2,13,604
86,597
18,93,923
13,297
3,36,097
4,22,695
48,03,591
53,730
9,18,089
10,04,686
30
32
2,13,604
87,462
19,60,400
13,770
3,63,456
4,50,918
50,72,214
57,670
10,10,931
10,98,393
31
33
2,13,604
88,336
20,26,581
14,276
3,92,419
4,80,755
53,49,379
61,907
11,11,638
11,99,974
32
34
2,13,604
89,220
20,92,538
14,798
4,23,098
5,12,319
56,35,390
66,515
12,20,878
13,10,098
33
35
2,13,604
90,113
21,58,255
15,355
4,55,534
5,45,648
59,30,778
71,466
13,39,248
14,29,361
34
36
2,13,604
91,015
22,23,804
15,927
4,89,825
5,80,840
62,35,862
76,783
14,67,444
15,58,458
35
37
2,13,604
91,924
22,89,165
16,517
5,26,051
6,17,975
65,50,974
82,553
16,06,206
16,98,131
36
38
2,13,604
92,843
23,54,334
17,148
5,64,275
6,57,118
68,76,692
88,745
17,56,323
18,49,166
37
39
2,13,604
93,772
24,19,390
17,795
6,04,584
6,98,356
72,13,370
95,387
19,18,566
20,12,338
38
40
2,13,604
94,710
24,84,315
18,463
6,47,062
7,41,772
75,61,385
1,02,579
20,93,824
21,88,534
39
41
2,13,604
95,656
25,49,105
19,172
6,91,775
7,87,432
79,21,360
1,10,284
22,83,037
23,78,694
40
42
2,13,604
96,613
26,13,830
19,902
7,38,934
8,35,547
82,93,690
1,18,620
24,87,535
25,84,148
41
43
2,13,604
97,579
26,78,478
20,677
7,88,612
8,86,190
86,78,994
1,27,628
27,08,417
28,05,995
42
44
2,13,604
98,555
27,43,106
21,475
8,40,933
9,39,488
90,77,905
1,37,271
29,46,937
30,45,492
43
45
2,13,604
99,539
28,07,703
22,324
8,95,924
9,95,463
94,90,813
1,47,682
32,04,070
33,03,609
44
46
2,13,604
1,00,535
28,72,342
23,196
9,53,716
10,54,251
99,18,419
1,58,819
34,81,214
35,81,749
45
47
2,13,604
1,01,541
29,37,007
24,092
10,14,359
11,15,900
1,03,61,168
1,70,824
37,79,562
38,81,103
46
48
2,13,604
1,02,556
30,01,692
25,043
10,77,931
11,80,486
1,08,19,805
1,83,654
41,00,570
42,03,125
47
49
2,13,604
1,03,583
30,66,468
26,023
11,44,540
12,48,123
1,12,94,829
1,97,581
44,45,677
45,49,260
48
50
2,13,604
1,04,617
31,31,331
27,057
12,14,300
13,18,917
1,17,87,315
2,12,344
48,16,747
49,21,364
49
51
2,13,604
1,11,954
31,96,345
28,124
12,87,351
13,99,305
1,22,97,537
2,28,343
52,15,426
53,27,380
50
52
2,13,604
1,20,368
32,61,508
29,254
13,63,815
14,84,183
1,28,26,599
2,45,424
56,43,811
57,64,179
51
53
2,13,604
1,29,459
33,26,885
30,417
14,43,877
15,73,336
1,33,75,081
2,63,781
61,04,030
62,33,489
52
54
2,13,604
1,39,291
33,92,470
31,646
15,27,699
16,66,990
1,39,43,843
2,83,363
65,98,478
67,37,770
53
55
2,13,604
1,49,941
34,58,320
32,915
16,15,479
17,65,420
1,45,33,470
3,04,525
71,29,575
72,79,517
54
56
2,13,604
1,61,495
35,24,430
34,253
17,07,459
18,68,955
1,51,45,114
3,27,241
77,00,479
78,61,974
55
57
2,13,604
1,74,049
35,90,848
35,635
18,03,887
19,77,936
1,57,79,647
3,51,453
83,14,291
84,88,339
8,38,818
Page 3 of 5
General Details
Year
Guaranteed
Age
Annual
Premium
Death
Benefit
Surrender
Value
Money
Back
Payments
Net
Outlay
( Rs )
( Rs )
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
56
58
2,13,604
1,87,715
57
59
2,13,604
58
60
2,13,604
59
61
60
62
61
63
62
63
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
Net
Outlay
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(BOY)
Death
Benefit
Annual
Bonus
Surrender
value of PUA
Total
Surrender
Value
(BOY)
( Rs )
(EOY)
( Rs )
(EOY)
( Rs )
(EOY)
36,57,564
37,093
19,05,336
20,93,051
1,64,37,638
3,77,732
2,02,614
37,24,611
38,632
20,11,947
22,14,561
1,71,20,401
4,05,900
96,88,271
98,90,885
2,02,864
16,020
37,92,027
40,223
21,23,830
23,26,694
1,78,28,728
4,36,255
1,04,54,752
1,06,57,616
2,13,604
2,03,146
16,020
-16,020
38,59,799
41,059
22,41,207
24,44,353
-16,020
1,85,63,770
4,67,182
1,12,79,297
1,14,82,443
2,13,604
2,03,462
16,020
-16,020
39,26,597
41,948
23,63,506
25,66,968
-16,020
1,93,23,823
5,00,667
1,21,64,610
1,23,68,072
2,13,604
2,03,817
16,020
-16,020
39,92,497
42,898
24,91,008
26,94,825
-16,020
2,01,10,355
5,36,505
1,31,15,740
1,33,19,556
64
2,13,604
2,04,218
16,020
-16,020
40,57,574
43,906
26,24,125
28,28,343
-16,020
2,09,24,241
5,75,041
1,41,38,324
1,43,42,542
65
2,13,604
2,04,673
16,020
-16,020
41,21,890
44,934
27,63,354
29,68,027
-16,020
2,17,66,594
6,16,667
1,52,39,042
1,54,43,715
64
66
2,13,604
2,05,182
16,020
-16,020
41,85,441
46,057
29,10,562
31,15,744
-16,020
2,26,38,763
6,61,816
1,64,33,156
1,66,38,338
65
67
2,13,604
2,05,765
16,020
-16,020
42,48,292
47,283
30,64,790
32,70,554
-16,020
2,35,41,895
7,10,516
1,77,20,403
1,79,26,168
66
68
2,13,604
2,06,435
16,020
-16,020
43,10,539
48,532
32,27,074
34,33,509
-16,020
2,44,77,265
7,63,495
1,91,12,000
1,93,18,436
67
69
2,13,604
2,07,211
16,020
-16,020
43,72,154
49,887
33,98,408
36,05,619
-16,020
2,54,46,561
8,20,570
2,06,20,625
2,08,27,835
68
70
2,13,604
2,08,112
16,020
-16,020
44,33,199
51,346
35,80,242
37,88,354
-16,020
2,64,50,672
8,83,045
2,22,61,628
2,24,69,740
69
71
2,13,604
2,09,163
16,020
-16,020
44,93,714
52,911
37,74,458
39,83,621
-16,020
2,74,91,410
9,51,073
2,40,55,206
2,42,64,369
70
72
2,13,604
2,10,400
16,020
-16,020
45,53,714
54,623
39,83,440
41,93,840
-16,020
2,85,69,896
10,26,176
2,60,25,972
2,62,36,371
71
73
2,13,604
2,11,863
16,020
-16,020
46,13,227
56,485
42,10,176
44,22,039
-16,020
2,96,87,954
11,08,930
2,82,05,184
2,84,17,047
72
74
2,13,604
2,29,624
16,020
-16,020
46,72,254
58,536
44,58,650
46,88,275
-16,020
3,08,46,783
12,01,441
3,06,33,179
3,08,62,803
Rs 2,29,624
Maturity Value:
Rs 47,46,811
89,75,784
91,63,500
Rs 3,20,64,243
NOTES:
(BOY)
Beginning of Year Value
(EOY)
End of Year Value
Page 4 of 5
Important Notes:
-- This illustration is applicable for sale in Jammu & Kashmir only (exclusive of service tax).
-- This is only an illustrative document. It does not purport to be a contract of insurance and does not in any way create any rights and/or obligations. Bonuses (if applicable and shown in the illustration) are not guaranteed, and bonus rates will be based on
the actual company experience from time to time. Some of the benefits are guaranteed and some benefits are variable with returns based on the future performance of your insurer carrying on life insurance business. 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 the different rates of assumed future 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.
-- Policy benefits are payable provided all premiums are paid, when they are due. The illustrative benefits above assume that all premiums that are due will be paid on the due dates.
-- Please refer to the product brochures, for understanding the product features and explanation of the terms used in this illustration.
-- Service Tax and Education Cess would be levied as per applicable laws and would be to the account of the policyholder.
-- This plan may entitle you to certain tax benefits on your premiums as well as on your maturity value:
-- U/s 80C of the Income Tax Act 1961 on your premiums.
-- U/s 10(10D) of the Income Tax Act 1961 on your maturity proceeds of the policy.
-- U/s 80D of the Income Tax Act 1961, on your premiums towards Health insurance.
(Please note that if the premium paid in a financial year exceeds 20% of the Sum Assured, under section 10 (10D) benefit will not be available and 80C benefit will not be available for the premium exceeding 20% of the Sum Assured under the current tax
laws.)
-- The company reserves the right to revise the premium rates at portfolio level in plans for health insurance based upon the actuarial review of the claims experience subject to prior approval of IRDA and shall be communicated to you at least 30 days
prior to such change.
I ________________________________________________________ (Name), having received the information with respect to the above, have understood the above statement before entering into the contract.
Signature of Agent/Specified Person/Principal Officer:
Policy Holders Signature:
Name and ID:
Policy Holders Name:
Place:
Date:
Date:
Company Seal:
2010.1.2.8.6.56.40APS41880931213604110000 100000001000000 10000018001000000 0 1
Page 5 of 5

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Life Partner Plus

Age at inception of Policy

Premium Payment Term

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

Non Guaranteed Lower Rate 6%:

Non Guaranteed Higher Rate 10%:

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

Non Guaranteed Lower Rate 6%:

Non Guaranteed Higher Rate 10%:

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

Non Guaranteed Lower Rate 6%:

Non Guaranteed Higher Rate 10%:

Beginning of Year Value

End of Year Value

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

Signature of Agent/Specified Person/Principal Officer:

Policy Holders Signature:

Name and ID:

Policy Holders Name:

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