Aviva Life Insurance Company India Limited

Premium Quotation
Version Number: 65
Prepared On : 27/4/2019
Date of Commencement :27/4/2019
Age of the Life Insured (On DOC):34
Proposal Number: Years
Gender : Male
Product Features

1. Name of the Product : Aviva Dhan Samruddhi

2. Unique Identification No. : 122N097V03
3. Premium Paying Frequency : Annual
4. Cover Description and Premium:

Total Modal
Modal
Premium *Goods & Services Tax Premium Amount
Sum Assured Coverage Term Premium
Payment Term (Yearly)
(Yearly)
Year 1 Year 2 onwards Year 1 Year 2 onwards
600000 20 10 37,014 1666 833 38,680 37,847
Total Amount : 38,680 37,847

Illustration-Benefits

Policy Annualised Accrued Guaranteed Guaranteed Guaranteed **Guaranteed Non

Duration Premium Guaranteed Survival Death Maturity Surrender Guaranteed
+ Goods & Services Addition Benefit(At Benefit(At Benefit (At Value Special
Tax (At year year end) year end) year end) (GSV)(At the Surrender
end) end of year Value (SSV) (At
after payment the end of year
of Survival after payment of
Benefit) Survival
Benefit)
1 38,680 3,331 603,331
2 37,847 6,663 606,663 22,208 34,832
3 37,847 9,994 609,994 33,313 56,998
4 37,847 13,325 613,325 74,028 82,331
5 37,847 16,656 46,268 616,656 46,268 64,562
6 37,847 19,988 619,988 64,775 96,228
7 37,847 23,319 623,319 83,282 142,143
8 37,847 26,650 626,650 161,011 194,391
9 37,847 29,981 629,981 186,921 252,973
10 37,847 33,313 46,268 633,313 185,070 271,620
11 36,644 636,644 185,070 289,451
12 39,975 639,975 185,070 307,449
13 43,306 643,306 185,070 341,697
14 46,638 646,638 185,070 376,277
15 49,969 46,268 649,969 138,803 348,674
16 53,300 653,300 157,310 383,838
17 56,631 656,631 157,310 419,334
18 59,963 659,963 157,310 455,164
19 63,294 663,294 157,310 491,327
20 66,625 666,625 527,823 175,817 527,823

Note

All the benefits shown in the above table are guaranteed provided all the due premiums are paid except the special surrender values.
Special Surrender Values may change as decided by the company from time to time, subject to prior approval from IRDA.
* Taxes including but not limited to Goods & Services Tax, Cesses as applicable shall also be levied as notified by the Government from
time to time. Tax laws are subject to change.
This quotation does not include any additional premium payable due to underwriting or effect of any applicable taxes on such additional
premium.
** A policy can be surrendered provided all due premiums of at least first two policy years have been paid. A minimum guaranteed
surrender value will be payable, which will be equal to Premiums paid (excluding any extra premium and/or taxes) X GSV factor less the
survival benefits already paid. Surrender Value payable is greater of the Guaranteed Surrender Value (GSV) and Special Surrender Value
(SSV). For further details please refer product key feature.
If at least first years’ premiums have been paid and the next due premium is not paid before the expiry of the grace period, then the policy
 will lapse. If such a lapsed policy is not reinstated within the Reinstatement Period (i.e. within 2 years from the due date of first unpaid
premium), 30% of all premiums paid (excluding taxes and any other extra premium) will be payable at the end of the reinstatement period
and the policy shall terminate. If death occurs during the Reinstatement period, 30% of all premiums paid (excluding taxes and any other
extra premium) shall be payable at the time of death and the policy shall terminate thereafter.
For more details on terms and conditions please read sales brochure of this plan carefully before concluding a sale.

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

Signature of Intermediary
Place: Policyholders’ Signature:
Date: Place:
Date:

Aviva Dhan Samruddhi

Important points you must know about this policy
What is Aviva Dhan Aviva Dhan Samruddhi is a money back plan that pays guaranteed cash back every 5
Samruddhi? years and a guaranteed lump sum at maturity.
The plan offers guaranteed additions every year on your Annual Premium depending upon the
Policy Term as defined below.The Guaranteed Additions will only accrue if all due premiums have
been paid.
What is the guarantee under Policy Term in years 10 15 20
this plan? Guaranteed Additions as a percentage of
7%8%9%
Annualized Premium
The Guaranteed Additions applicable for your proposal will be 9 %
of Annualized Premium per year. Please refer to the Key Feature brochure for details.
What is the Term of this You can select a term of 10, 15 or 20 years subject to maximum maturity age of
policy? 70 years. You have selected the policy term of 20 years.
This plan offers fixed policy terms of 10, 15, 20 years and premium payment term as 10 years for
What are the Premium all options.
Payment Term options under The premium payment frequency allowed is Yearly, Half-yearly, Quarterly & Monthly. (For monthly
this plan? mode, ECS or Direct Debit is mandatory) You have selected the policy term of 20 years and
opted to pay premium at Annual frequency.
   •Death Benefit: The amount payable on death shall be highest of the following amounts:

1. 10 times of annualized premium (excluding taxes and extra premiums, if any), or

2. 105% of all the premiums paid (excluding taxes and extra premiums, if any) as on date of
death or
3. sum assured of the policy plus the Guaranteed Additions accrued till the date of death
What are the benefits under without deduction of any survival benefits already paid
this plan?
   •Survival Benefit: Guaranteed survival benefit is 125% of the Annualized Premium (excluding
taxes and extra premium, if any)
at the end of every 5 policy years except at maturity, if all due premiums have been paid up to
such date.
   •Maturity Benefit: Sum Assured plus guaranteed additions accrued under the policy less all
Survival Benefits paid.
  • If you stop paying premium within the first year of the policy; the policy will be terminated after
the end of reinstatement period without any benefit or value.
  • If you stop paying premium during the second year of the policy; the policy will be terminated by
paying 30% of Premiums paid at the end of reinstatement period or death whichever is earlier
(excluding taxes & extra premium, if any)
What happens if I stop   • If premiums have not been paid after second year of the policy(at least 2 years premiums are
paying my premiums? paid), the policy becomes
a paid-up policy and:
  • Maturity and Death benefits will be reduced depending on the ratio of premiums paid to
premiums payable towards the policy.
  • No future Guaranteed Additions are paid. Please refer to the Key Feature brochure for
details.
You do have an option to cash-in (surrender) this policy if premiums were paid for at least 2
Can I cash in (surrender) the
years, after deduction of applicable surrender penalty. The surrender amount will be less than the
policy during the term of the
amount of premiums paid in most cases. Please refer to the Key Feature brochure and
policy?
Illustration for details.
In case of death of life insured due to suicide within 12 months:

1. From the date of inception of the policy, Your nominee or beneficiary shall be entitled to
80% of the premiums paid excluding any payment for taxes and extra premiums, provided
What is not covered under
the policy is in force or
this policy (Exclusions)?
2. from the date of revival of the policy, Your nominee or beneficiary shall be entitled to an
amount which is higher of 80% of the premiums paid excluding any payment for taxes and
extra premiums or the Surrender Value as available on the date of death
 You have Freelook Period of 15 days from the date you receive your policy document. In case
Do I have a right to review
you do not agree with terms and conditions, you may cancel the policy where the premium you
my purchase?
have paid will be refunded after deducting expenses incurred on medicals and stamp duty.
We request you to personally fill the proposal form and provide accurate information to ensure that your claim is not
reduced or declined because of non-disclosure or misrepresentation of information.
Please note:
   •Aviva is not liable for any claim until receipt of premium in full, completion of underwriting and acceptance of risk.
  • This document does not contain the full terms and conditions of the Policy. Details of the terms and conditions, and exclusions
of the insurance contract are contained in the Key Feature brochure. It is important that you read the entire Key Feature brochure.
I confirm that I have read the Key Feature brochure and the Official Illustration of the insurance product along with this document
and understand the features such as policy benefits, premium payable including the number of years for which premium is required
to be paid, lock-in period, whether any guarantee is available and if yes then subject to what conditions.

I agree and confirm to the use of electronic medium, including email, as a mode of communication from and to the Company.

Signature of Life Assured

Signature of the Proposer
(In case different from Proposer)
Proposer name Name of Life Assured
Proposal number Proposal Date