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Dear Mr.

RUPESH SHAH, Date of illustration : 15/12/2017


Thank you for showing interest in Exide Life Insurance.
Based upon the inputs shared by you, we are happy to provide a detailed benefit illustration for the plan chosen by you.

Plan Summary
Personal Details
Age of Life Assured (l.b.d.) 46
Gender Male
Smoking Habit Non Smoker
Medical/Non Medical Medical
Plan Details
Product Name Exide Life Smart Term Plan
(114N083V01)
Variant Name Classic
Annual Premium (INR) 177,889 per annum
Premium Frequency Annual
Modal Premium (INR) 177,889 per annum
Total Modal Premium Inclusive 185,894
of GST(INR)
Policy Term (Years) 29
Premium Paying Term (Years) 5
Maturity Age (Years) 75
Sum Assured (INR) 10,000,000
Rider Opted No
Total Modal Premium Including Riders And GST (if any)
Modal Premium for Base plus Rider (if any) 177889 per annum
GST (if any) 8006
Total Premium To Be Paid 185895 per annum

Policyholder's Signature

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Product: Exide Life Smart Term Plan
Reference Table

Policy Age (lbd) Total Annual Premiums (Excl of Cumulative Premiums Paid (Excl Guaranteed Sum Assured Guranteed Death Guaranteed Surrender Guranteed Maturity Benefit
Year BOY GST) (Rs.) BOY of GST) (Rs.) on Death Benefit Value (Rs.) EOY (Rs.) EOY
1 46 177,889 177,889 10,000,000 10,000,000 0 0
2 47 177,889 355,778 10,000,000 10,000,000 106,733 0
3 48 177,889 533,667 10,000,000 10,000,000 160,100 0
4 49 177,889 711,556 10,000,000 10,000,000 355,778 0
5 50 177,889 889,445 10,000,000 10,000,000 444,723 0
6 51 0 889,445 10,000,000 10,000,000 444,723 0
7 52 0 889,445 10,000,000 10,000,000 444,723 0
8 53 0 889,445 10,000,000 10,000,000 453,617 0
9 54 0 889,445 10,000,000 10,000,000 471,406 0
10 55 0 889,445 10,000,000 10,000,000 480,300 0
11 56 0 889,445 10,000,000 10,000,000 498,089 0
12 57 0 889,445 10,000,000 10,000,000 506,984 0
13 58 0 889,445 10,000,000 10,000,000 524,773 0
14 59 0 889,445 10,000,000 10,000,000 542,561 0
15 60 0 889,445 10,000,000 10,000,000 551,456 0
16 61 0 889,445 10,000,000 10,000,000 569,245 0
17 62 0 889,445 10,000,000 10,000,000 578,139 0
18 63 0 889,445 10,000,000 10,000,000 595,928 0
19 64 0 889,445 10,000,000 10,000,000 613,717 0
20 65 0 889,445 10,000,000 10,000,000 622,612 0

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Product: Exide Life Smart Term Plan

Policy Age (lbd) Total Annual Premiums (Excl of Cumulative Premiums Paid (Excl Guaranteed Sum Assured Guranteed Death Guaranteed Surrender Guranteed Maturity Benefit
Year BOY GST) (Rs.) BOY of GST) (Rs.) on Death Benefit Value (Rs.) EOY (Rs.) EOY
21 66 0 889,445 10,000,000 10,000,000 640,400 0
22 67 0 889,445 10,000,000 10,000,000 649,295 0
23 68 0 889,445 10,000,000 10,000,000 667,084 0
24 69 0 889,445 10,000,000 10,000,000 684,873 0
25 70 0 889,445 10,000,000 10,000,000 693,767 0
26 71 0 889,445 10,000,000 10,000,000 711,556 0
27 72 0 889,445 10,000,000 10,000,000 720,450 0
28 73 0 889,445 10,000,000 10,000,000 738,239 0
29 74 0 889,445 10,000,000 10,000,000 889,445 889,445

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Product: Exide Life Smart Term Plan

Note:-

1. The illustration above explains the benefits and features of the proposed policy and is not a contract or representation of any guarantee or warranty.
2. Goods and Services Tax (GST) is levied on the premiums as per applicable tax laws and the same is subject to changes in the tax laws in future.
3. The Death, Surrender, Survival and Maturity benefits mentioned under the guaranteed column are guaranteed subject to the policy terms and conditions and that all
premiums being paid on time.
4. Rider Premiums are not a part of the illustration.
5. Exide Life Insurance Company Limited is only the name of the Insurance Company and Exide Life Smart Term Plan is only the name of the product and does not in any
way indicate the quality of the product, its future prospects or returns.
6. The purpose of this Benefit Illustration is only to provide a general overview about this policy. The information herein is indicative of the terms, conditions, warranties and
exceptions contained in the policy terms and conditions of Exide Life Smart Term Plan. Please read this benefit illustration in conjunction with the product brochure, policy
Terms and Conditions/Rider Terms and conditions to understand the Terms & Conditions & Exclusions carefully before concluding the sale.
7. In the event of any inconsistency/ambiguity between the terms contained herein and the policy terms and conditions, the policy terms and conditions shall prevail.

I _____________________________ (name), having received the information with respect to the above, have understood the above statement before entering into the
contract.I have also received a document containing a glossary of the various terms of the charges under the policy and I fully understand the same.
Advisor Name:
Code:
Company seal /Advisor's signature
Place
Date Policyholder's Signature
Exide Life Smart Term Plan (114N083V01) UIN . For more details on risk factors, terms and conditions, please read the sales brochure of the mentioned product carefully before concluding the sale.Tax benefits are subject to change in tax laws from time to
time.Exide Life Insurance Company Limited is a wholly owned subsidiary of Exide Industries Limited.The trademark "Exide"is owned by Exide Industries Limited and licensed to Exide Life Insurance vide Trademark license agreement dated 30th October
2014. Exide Life Insurance Company Limited . IRDAI Registration number: 114, CIN: U66010KA2000PLC028273 Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001,
India.Toll Free:1800 419 8228; Phone: 080 - 4134 5444; Visit exidelife.in.

Disclaimer: Beware of spurious phone calls and fictitious/fraudulent offers: IRDAI clarifies to public that IRDAI or its officials do not involve in activities like sale of any kind of insurance or financial products nor
invest premiums. IRDAI does not announce any bonus, public receiving such phone calls are requested to lodge a police complaint along with details of phone call, number.

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Direct Debit Mandate

All fields are mandatory and to be filled in CAPITAL LETTERS to enjoy convenient Auto Pay service. Date: 1 5 M
D D 1 M
2 1Y 7Y
I, here by unconditionally and irrevocably authorize the bank to debit my account for making premium payment to Exide Life Insurance Company Limited
through Direct Debit as per the details given below.
Policyholder's Name:*
DETAILS
POLICY

Preferred 1 5 10 15 20
Debit Date:
In case the preferred date opted is less then 14 days from the premium due date, Exide Life Insurance Company would set the debit date to be the furthest preferred debit date.
For payments made through Direct Debit Mandate the Unit Price for fund allocation will be on the due date or date when premium is applied to the policy, whichever is later.
All monthly mode proposals/policies need to be in Direct Debit mode ONLY
• I/We hereby declare that the particulars given in the direct debit mandate are correct and complete in all respects. If the transaction is delayed or not effected for incomplete or incorrect information or due
to non-availability / insufficient funds in the said bank account, I will make alternative arrangements for payments of the said premium contribution and will not hold Exide Life Insurance Company Limited or
Bank responsible for the same. • I/we authorize the representative of Exide Life Insurance Company Limited to get this mandate verified and executed. • I/We unconditionally and irrevocably authorize the
bank to debit my account for charges towards mandate verification and transactions bounced as applicable. • I agree to any increase in deductions due to change in government regulations/ service tax
rates/scheduled increase as per the product features or change in frequency of premium payment and authorize Exide Life Insurance Company Limited to effect it with the bank directly. No fresh mandate
form will be required. • I hereby authorize Exide Life Insurance Co. to enable the ECS/Direct Debit facility for my premium payments and the instance of Direct Debit/ECS debit dishonor, to re-debit my
account with the mentioned bank to recover the premium payable. • I understand that new mandate has to be submitted at the branch of Exide Life Insurance Company, 30 days prior to due date and clear
all outstanding premiums by alternate payment method. And any alteration should be submitted 15 days prior to next premium due date • In the event of any error in premium debit from my account or
procedure for above mentioned policies , my first point of contact would be Exide life Insurance Company Limited for rectification/resolution of the concern. • I understand that no premium notice / reminder
or premium receipt will be sent for premiums paid through Direct Debit mode in Physical form. • If, I/we have not specified any account to receive amount payable on above policies, Exide Life Insurance
Company Limited may credit the policy related payables to account specified in this mandate, provided policy is not assigned and owner details match bank records. • I wish to revive my policy/policies that
are not inforce stage and mentioned in this mandate form, by way of deducting all outstanding premiums along with interest (not for linked products). • I understand revival of the policy may not only
happen by paying outstanding premiums, and I shall comply with other requirements prescribed by the company for the same.
Note:
Please mention the debit amount as 10% higher than your current premium amount. This is to ensure the Direct debit request does not get dishonored if there are subsequent changes to any statutory or
service tax announced by the Government of India. For example, if the current premium payable with service tax is Rs.1000, we request you to mention the amount as Rs. 1100 in the mandate. This is to
prevent rejection/dishonor on account of any subsequent increase in service tax. The Amount debited will be the actual premium amount due.
DECLARATION

I have attached Signed, personalized, cancelled cheque


Policy Holder Signature (as per Policy)
The Direct Debit Mandate request will get rejected if:
• There is correction/ cancellation /whitener used in the mandate.
• Cancelled cheque/ photocopy not attached
• Bank account details on the form do not match bank records

IFSC Code

FOR BANK USE ONLY

We certify that the bank particulars and the signature on the below
mandate are correct as per our records and the account is active

Coll/DDM/Version 3.2
MICR Code

Account No
A/c Holder Name

Bank seal and Signature of the Bank official along with the employee code

Call : 1800 419 8228 (TOLL FREE); +91 80 4134 5444 Email : customer.service@exidelife.in Visit : exidelife.in

Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001.
(Formerly ING Vysya Life Insurance Company Limited) IRDAI Registration No. 114 CIN: U66010KA2000PLC028273

f o r o f f i c e u s e o n l y 1 5 1 2 2 0 1 7
for office use only for office use only

SB CA CC SB-NRE SB-NRO Other


CREATE
MODIFY x
CANCEL x
DIRECT DEBIT DETAILS

204485.0
x
Policy No

Proposal No
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.

1 5 1 2 2 0 1 7 Signature Primary Account holder Signature Joint Account Holder Signature Joint Account Holder
(as per bank records) (as per bank records) (as per bank records)
1 4 0 4 2 0 2 3

• This is to confirm that the declaration has been carefully read, understood & made bye me/us. • I am authorizing the User entity/Corporate to debit my account. I have
understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation /amendment request to the user entity/ corporate or the
bank where I have authorized the debit.
• UMRN is auto generated during mandate creation and is mandatory to be • Amount in figures, similar to the amount mentioned in words. (Maximum
updated durging amendment and cancellation of mandate. (Maximum length length - 13 digit Numeric, in paise)
INSTRUCTIONS TO FILL MANDATE

- 20 Alpha Numeric Characters) • Policy number.


• Date in DD/MM/YYYY format • Plan Name.
• Sponsor Bank IFSC / MICR Code, left padded with zeroes where necessary. • Frequency of Transaction.
(Maximum length - 11 Alpha Numeric Characters) • Names of Customer/s and signatures as well as seal of company (where
• Utility Code of the Service Provider. (Maximum length - 18 Alpha Numeric required). (Maximum length of Name - 40 Alpha Numeric Characters)
Characters) • Undertaking by Customer
• Name of Service Provider • Telephone Number with STD Code of Customer
• Tick on Box to select type of account to be effected • 10 digit mobile number of Customer
• Customer's legal account number, left padded with zeroes. (Maximum length - • Mail ID of Customer
35 Alpha Numeric Characters)
• I have understood that the bank,where I have authorized the debit, may
• Name of Bank and Branch levy onetime mandate processing charges as mentioned in their latest
• IFSC/MICR Code of Customer Bank. (Maximum length - 11 Alpha Numeric schedule of charges published by the bank.
Characters) • I have understood that I am authorized to cancel/amend this mandate by
• Amount payable or service or maximum amount per transaction that could be appropriately communicating the cancellation/amendment request to the
processed, in words. (Maximum length - 13 digit Numeric, in paise) user entity/corporate or the bank where I have authorized for debit

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