Max New York Life Fast Track PlanTM

Unit Linked Insurance Plan

UIN No:104L067V01
Policy/Proposal No:[_________________]
Date of Illustration : Jun 27, 2012 1:41:33 AM

IN THIS POLICY, THE INVESTMENT RISK IN THE INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER
Personal Details

Product Features

Proposer
Age of Proposer

30 Years

Life Insured

Investment Options

Policy Term (Years)

20 Years

Growth Fund

0%

Premium Paying Term

10 Years

Growth Super Fund

0%

Premium Paying Mode

Annual

Balanced Fund

100%

Age of Life Insured at inception of

Policy

30 Years

Modal Premium

Rs 2,00,000.00

Conservative Fund

0%

Gender of Life Insured

Male

Annualised Target Premium

Rs 2,00,000.00

Money Market Fund

0%

State

Other

Sum Assured of Base Policy

Rs 20,00,000.00

Secure Fund

0%

Systematic Transfer Plan

No

DD Rider Sum Assured, if Opted

PAB Rider Sum Assured, if Opted
Gross Yield

10 %

Net Yield (This includes service tax & all charges) *

7.92 %

Net Yield (This excludes service tax, mortality, morbidity, rider and guaranteed benefit charges) *

8.42 %

Net Reduction in Yield (This excludes service tax & mortality, morbidity, rider and guaranteed benefit charges)

1.58 %

Service Tax including Cess

12.36 %

* The yields shown above do not take partial withdrawals into consideration.

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 6% and 10% are used as an illustration.
MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 1 of 4

YEARLY ILLUSTRATIVE DETAILS

(This shall form a part of the policy document)
The following provides year-by-year statements of various charges along with performance of the fund expected over the duration of the policy with assumed rate of return as mentioned:
All cash flows are in Rs
General Details
Policy
Year

Premium Details

Age of life
Assured Annualize
d Target
premium

Top-up
Premium

Charges & Service Tax Details

Premium
Allocation
charge

Amount
Policy
Available Administr Guarantee
for
ation
Charge
Investmen Charge
t (out of
premium)

Risk
Charges

Fund
Managem
ent
Charge

Scenario 1 (Gross Yield :- 10% pa)

Other
Charges

Total
Charges

Service
Tax

Fund
Value
before
FMC

Fund
Value
(EOY)

Partial
Death
Withdraw Guarantee Surrender Benefit(E
al (EOY) d Loyalty
Value
OY)
Additions (EOY) ***
to fund (if
any)

Maturity
Benefit

Commissi
ons
/Brokerag
e if
payable **

30

2,00,000

8,000

1,92,000

1,500

3,215

2,168

14,882

1,900

2,04,421

2,01,925

1,95,925

22,01,925

11,900

31

2,00,000

8,000

1,92,000

1,575

3,217

4,493

17,285

2,263

4,26,328

4,21,153

4,16,153

24,21,153

2,000

32

2,00,000

8,000

1,92,000

1,654

3,277

7,017

19,948

2,663

6,67,186

6,59,104

6,55,104

26,59,104

2,000

33

2,00,000

8,000

1,92,000

1,736

3,367

9,757

22,860

3,100

9,28,588

9,17,351

9,15,351

29,17,351

2,000

34

2,00,000

8,000

1,92,000

1,823

3,491

12,730

26,044

3,577

12,12,258

11,97,596

11,97,596

31,97,596

2,000

35

2,00,000

8,000

1,92,000

1,914

3,649

15,957

29,520

4,097

15,20,068

15,01,691

15,01,691

35,01,691

2,000

36

2,00,000

8,000

1,92,000

2,010

3,839

19,458

33,306

4,663

18,54,055

18,31,646

18,31,646

38,31,646

2,000

37

2,00,000

8,000

1,92,000

2,111

4,061

23,256

37,427

5,279

22,16,429

21,89,645

21,89,645

41,89,645

2,000

38

2,00,000

8,000

1,92,000

2,216

4,317

27,377

41,910

5,949

26,09,591

25,78,060

25,78,060

45,78,060

2,000

10

39

2,00,000

8,000

1,92,000

2,327

4,835

31,847

47,009

6,705

30,35,874

29,99,196

29,99,196

50,99,196

2,000

11

40

2,443

5,230

34,495

42,168

6,181

32,88,270

32,48,543

32,48,543

53,48,543

12

41

2,566

5,637

37,363

45,566

6,681

35,61,779

35,18,748

35,18,748

56,18,748

13

42

2,694

5,996

40,472

49,162

7,213

38,58,269

38,11,658

38,11,658

59,11,658

14

43

2,828

6,383

43,843

53,054

7,789

41,79,680

41,29,187

41,29,187

62,29,187

15

44

2,970

6,865

47,496

57,331

8,420

45,28,037

44,73,337

44,73,337

65,73,337

16

45

3,118

7,449

51,455

62,023

9,111

49,05,532

48,46,272

48,46,272

69,46,272

17

46

3,274

8,138

55,745

67,157

9,867

53,14,542

52,50,341

52,50,341

73,50,341

18

47

3,438

8,932

60,393

72,763

10,690

57,57,647

56,88,093

56,88,093

77,88,093

19

48

3,610

9,829

65,428

78,867

11,586

62,37,652

61,62,300

61,62,300

82,62,300

20

49

3,790

10,828

70,882

85,501

12,559

67,57,604

66,75,970

66,75,970

87,75,970

66,75,970

** Please refer to the following notes:

--The actual amount of commission paid to the agent may be lower or higher than the depicted value as the actual payout is dependent on factors such as total business procured and policy renewability.
--TDS is deducted from Commission/ brokerage payable to the agent / broker on this policy.
--Offering or accepting a rebate is prohibited under Section 41 of the Insurance Act, 1938 and is a punishable offense.

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 6% and 10% are used as an illustration.
MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 2 of 4

All cash flows are in Rs

General Details
Policy
Year

Premium Details

Age of life
Assured Annualize
d Target
premium

Top-up
Premium

Charges & Service Tax Details

Premium
Allocation
charge

Amount
Policy
Available Administr Guarantee
for
ation
Charge
Investmen Charge
t (out of
premium)

Risk
Charges

Fund
Managem
ent
Charge

Scenario 2 (Gross Yield :- 6% pa)

Other
Charges

Total
Charges

Service
Tax

Fund
Value
before
FMC

Fund
Value
(EOY)

Partial
Death
Withdraw Guarantee Surrender Benefit(E
al (EOY) d Loyalty
Value
OY)
Additions (EOY) ***
to fund (if
any)

Maturity
Benefit

Commissi
ons
/Brokerag
e if
payable **

30

2,00,000

8,000

1,92,000

1,500

3,215

2,124

14,839

1,894

1,96,938

1,94,491

1,88,491

21,94,491

11,900

31

2,00,000

8,000

1,92,000

1,575

3,217

4,319

17,111

2,236

4,02,941

3,97,967

3,92,967

23,97,967

2,000

32

2,00,000

8,000

1,92,000

1,654

3,277

6,615

19,545

2,602

6,18,393

6,10,774

6,06,774

26,10,774

2,000

33

2,00,000

8,000

1,92,000

1,736

3,367

9,016

22,119

2,987

8,43,694

8,33,310

8,31,310

28,33,310

2,000

34

2,00,000

8,000

1,92,000

1,823

3,491

11,526

24,840

3,394

10,79,259

10,65,985

10,65,985

30,65,985

2,000

35

2,00,000

8,000

1,92,000

1,914

3,649

14,151

27,714

3,823

13,25,523

13,09,226

13,09,226

33,09,226

2,000

36

2,00,000

8,000

1,92,000

2,010

3,839

16,895

30,743

4,274

15,82,943

15,63,485

15,63,485

35,63,485

2,000

37

2,00,000

8,000

1,92,000

2,111

4,061

19,763

33,934

4,749

18,51,994

18,29,234

18,29,234

38,29,234

2,000

38

2,00,000

8,000

1,92,000

2,216

4,317

22,760

37,293

5,249

21,33,175

21,06,963

21,06,963

41,06,963

2,000

10

39

2,00,000

8,000

1,92,000

2,327

4,835

25,891

41,052

5,801

24,26,741

23,96,923

23,96,923

44,96,923

2,000

11

40

2,443

5,230

27,004

34,677

5,045

25,31,000

24,99,899

24,99,899

45,99,899

12

41

2,566

5,637

28,163

36,365

5,286

26,39,504

26,07,070

26,07,070

47,07,070

13

42

2,694

5,996

29,369

38,059

5,529

27,52,502

27,18,678

27,18,678

48,18,678

14

43

2,828

6,383

30,625

39,837

5,784

28,70,163

28,34,892

28,34,892

49,34,892

15

44

2,970

6,865

31,933

41,768

6,060

29,92,585

29,55,808

29,55,808

50,55,808

16

45

3,118

7,449

33,293

43,861

6,356

31,19,865

30,81,522

30,81,522

51,81,522

17

46

3,274

8,138

34,706

46,119

6,675

32,52,098

32,12,127

32,12,127

53,12,127

18

47

3,438

8,932

36,174

48,544

7,016

33,89,383

33,47,722

33,47,722

54,47,722

19

48

3,610

9,829

37,697

51,136

7,379

35,31,827

34,88,411

34,88,411

55,88,411

20

49

3,790

10,828

39,277

53,896

7,765

36,79,540

36,34,304

36,34,304

57,34,304

36,34,304

EOY - End of Year

***The Policyholder may surrender/discontinuance the policy at any time after inception of the policy. However, surrender value would only be payable on completion of five years from the inception.

Signature of Agent/Specified Person/Principal officer:___________________________________________

Policy Holders Signature:___________________________________________

This is only an Illustrative document. The Benefits if guaranteed, are clearly marked so. For variable benefits, investment growth rates of 6% and 10% are used as an illustration.
MAX NEW YORK LIFE INSURANCE CO. LTD, 11th Floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon 122 002

Page 3 of 4

Important Notes:

Section A
-- Max New York Life Insurance Company is the name of the Company and Max New York Life Fast Track PlanTM is the name of the Unit Linked Life Insurance Policy and does not in any way indicate the future prospects or returns of the said Plan.
-- 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. 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 two 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.
-- Unit Linked Life Insurance products are different from traditional insurance products and are subject to risk factors mentioned in the policy document.
-- The Premiums paid in unit-linked life insurance policies are subject to investment risks associated with capital markets and the NAVs of the units may go up or down based on the performance of the fund and factors influencing the capital market. The
insured is responsible for his or her decisions.
-- Past performance of the investment funds do not indicate the future performance of the same. There are no guaranteed or assured returns.
-- 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.
-- Service Tax and Education Cess would be levied as per applicable laws and would be to the account of the policyholder.
-- You may be entitled to certain tax benefits on your premiums and benefits. Please note all the tax benefits are subject to tax laws prevailing at the time of payment of premium or receipt of benefits by you.

Section B
-- Risk charges include sum at risk charges, where sum at risk is equal to total of Base Sum Assured.
-- Rider Charges, if any, will be included in Risk Charges.
-- There are no other charges in this product.
-- Surrender and Maturity Benefits are inclusive of Partial Withdrawals, if any.
I _____________________________________________________________________________________ (Name), having received the information with respect to the above, have understood the above statement before entering into the contract.

Signature of Agent/Corporate Agent/Specified Person/Broker:

Policy Holders Signature:

Name and ID:

Policy Holders Name:

Place:

Date:

Date:
Company Seal:

2010.1.2.8.6.57.05agency13012000000112932 1000000001000000 10000018001000000 0

Page 4 of 4