Sruthi P

#RakshakaranKiReet 1/39
 June 13, 2023
SRUTHI P
112 R BLOCK,KOVAIPUDUR,COIMBAT
ORE SOUTH,COIMBATORE
COIMBATORE
COIMBATORE 641042
TAMIL NADU INDIA
M- 8870610172

,   
 ,
844938401449 COMBO

Dear Mr./Ms. SRUTHI P

Smart Solution from Tata AIA Life

We warmly welcome you to the Tata AIA Life family. At Tata AIA Life we've come together with only one purpose, to
make Good happen in the lives of people we connect with.

You have indeed made a smart choice by selecting , an excellent solution designed exclusively to meet your needs. A
combinition of two of our best products brought together to offer savings and financial protection for your family.

While we have attached a working of the solution, the kit also contains details of the individual products - Tata AIA Life
Guaranteed Return Insurance Plan and Tata AIA Life Insurance Fortune Pro.

Important things to note

l This is not a product but a combination of products which are exclusive and independent of each other. To
understand the benefits, risk factors and terms & conditions of both these products, please read the respective
Policy Document carefully.
l The combined illustration attached with this kit is to help you understand the benefits of Smart Solution
purchased by you.
l Each of the two products in the solution are exclusive and independent of each other and you may access Tata
AIA Life Insurance website www.tataaia.com to know more about the plans offered in this package. You
may also log in to the customer portal with the log in id and password shared with you in a separate mail.
l Benefits offered under this solution are subject to regular payment of premiums for each of the policies. To
ensure that you enjoy the full benefit of this Solution and fulfill your needs, please pay the premiums regularly.

We are committed to giving you best-in-class products and professional service and look forward to a
long and cherished relationship with you.

Best wishes,

Naveen Tahilyani
CEO & Managing Director
Authorised Signatory

Tata AIA Insurance Company Ltd.

Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110) CIN: U66010MH2000PLC128403. Registered & Corporate Office: 14th Floor, Tower A, Peninsula
Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life
Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor / Intermediary or visit Tata
AIA Life’s nearest branch office or call 1-860-266-9966 (local charges apply) or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com.

BEWARE OF SPURIOUS PHONE CALLS IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public receiving such
AND FICTIOUS / FRAUDULENT OFFERS phone calls are requested to lodge a police complaint

#RakshakaranKiReet Go to Table of Contents 2/39

 844938401449

XK//2/./4/2X

MU01 U225212725 COMBO 1747/1917 BROK Non Term_EIA

SRUTHI P
112 R BLOCK,KOVAIPUDUR,COIMBAT June 13, 2023
ORE SOUTH,COIMBATORE
COIMBATORE
COIMBATORE 641042
TAMIL NADU INDIA
M- 8870610172

1. Part A

Dear SRUTHI P,

Thank you for choosing us for your insurance needs. Tata AIA Life Insurance is committed to give you world-class products and
professional service.
We take great pleasure in presenting your policy document. Please check your personal details and the policy provisions carefully.
Should you have any queries, please contact your agent or contact us at the address mentioned below. You can also reach us via
email at customercare@tataaia.com or call our helpline number 1860-266-9966 (Local charges apply).

Agent Name:POLICYBAZAAR INSURANCE BROKERS PRIVATE LIMITED | Agency

Code:(004665695) | Agent Contact details: 18002585970 / care@policybazaar.com
In order to provide you better services, we request you to intimate us in the event of any change in the address of the Policyholder
or the nominee.
Free Look Provisions
You have a period of 30 days from the date of receipt of the Policy to review the terms and conditions of the Policy.
If you disagree to any of the terms or conditions, you have the option to return the original Policy document to us, by stating the
objections/reasons for such disagreement. Upon return, this Policy will terminate forthwith and all rights, benefits and interests
under the Policy will cease immediately. We will only refund an amount which will be equal to non-allocated Premium plus charges
levied by cancellation of Units plus Fund Value at the date of cancellation less Mortality Charges (including applicable taxes, duties,
cesses and levies) for the period of cover, Rider Charges (if any, including applicable taxes, cesses and levies), expenses incurred on
medical examination, if any and stamp duty. The units will be repurchased by the company at the price of the units on the date of
cancellation and any surplus or deficit shall be adjusted in the payout to the Policyholder.
At Tata AIA Life we believe that life inspires us to think ahead. Our insurance solutions are therefore designed to be a step ahead,
thus giving you an advantage to adapt to tomorrow’s changes, starting today.
We look forward to a long and cherished relationship with you.
Best wishes,
ؚ¶¶¶šØYÂÅt˞­–ÍЃį’Äɀ•Ø]`Yؚ¶¶¶šØ
For and on behalf of
Tata AIA Life Insurance Company Limited Šf•Œ]–ƒ~¯Zn¼—boÖÊ˕¬•Y¡Ódx€ºÑg|rd–g‹|

[²‘c®Ê®¿´ZÀ­oxÏm–\’šÕ–wd§©} \¨¥¿Zw±Ç–

rsŽ^“ƒ]¨²|±d€[ ƒ»·¬zú—u\^×^f¾u›sˆf
Naveen Tahilyani
CEO & Managing Director xippp©¸YÔ¡™d˜©×e țӟÃ|‰™¡Õ °Ø©©«‹
Authorised Signatory
¹yyyyy¹YyYY™Yy™YYy™™¹YyYY¹yYY™™y¹¹¹yy

Scan the QR to download e-policy document

CLICK HERE TO READ THE TERMS AND CONDITIONS

Policy Servicing Branch : 101-Boston house,Suren Road,Nr, Western Highway,Andheri E - 400093

Tata AIA Life Insurance Company Ltd (IRDA of India Regn.No.110) (CIN - U66010MH2000PLC128403)
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai 400013.

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 "Stamp duty of Rs. 138 is paid as provided under Article 47(C)/(D) of Indian Stamp Act, 1899 and included in Consolidated Stamp
duty paid to the Government of Maharashtra Treasury vide order of Addl. Controller of Stamps, Mumbai at General Stamp office,
Fort, Mumbai – 400001 vide his order No. LOA/CSD/686/2023/2076 / Date 18/04/2023 / Validity period Dt. 21/04/2023 to
Dt. 31/10/2023"

(Signature)
Proper Officer

Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04), In this policy, the
Investment risk in Investment portfolio is borne by the Policyholder

LIFE INSURED SRUTHI P

POLICY NUMBER U225212725

PREAMBLE

Tata AIA Life Insurance Company Limited (“the Company”), having received a Proposal form and other related documents with
Declaration thereto and initial premium from the Policyholder hereby issues Tata AIA Life Insurance Fortune Pro. The
Company under this Policy; does agree in consideration and subject to Policy conditions to pay the benefits under the Policy on
the happening of an insured event, while the Policy is in force. The basic insurance plan provided under this Policy, with its
amount of coverage and Premium is specified on the Policy Schedule. Entitlement to benefits, conditions for payment and other
policy details are also set out inside. This Policy is subject to terms and conditions motioned herein below and endorsements if
any.

Signature valid
Signed by: Naveen Tahilyani
Date:
Location:

This is a system generated document requiring no physical signature.

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 TABLE OF CONTENTS
Section Description Page No.

Policy schedule Detailed overview of your registered policy 6

List of the beneficial features that comprise

Key feature document 8
your plan

Range of customer-centric services offered by

Service options 12
Tata AIA Life Insurance

A pre-investment, agreed-upon form that

Proposal Form 16
proposes the details of your policy

An illustrative way of presenting year-wise

Benefit illustration premiums payable and benefits under the 25
policy

Record of all transactions that occur with the

Unit Statement 37
funds in your ULIP investment

Acknowledgement of the first premium

First premium receipt 39
payment

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 POLICY SCHEDULE
Tata AIA Life Insurance Fortune Pro (UIN: 110L112V04)
THIS SCHEDULE MUST BE READ WITH THE POLICY DOCUMENT AND IS PART OF
THE LIFE INSURANCE CONTRACT
Policy Number: U225212725
Personal Details
Name of Policyholder : SRUTHI P Name of Life Insured : SRUTHI P
Address of Policyholder : 112 R Address of Life Insured : N/A
BLOCK,KOVAIPUDUR,COIMBAT N/A
ORE SOUTH,COIMBATORE N/A
COIMBATORE N/A
COIMBATORE N/A
641042 N/A
TAMIL NADU N/A
INDIA
Client ID of Policyholder : 368786862 Client ID of Life Insured : 368786862
Date of Birth of Policyholder : 12/11/1996 Date of Birth of Life Insured : 12/11/1996
Age at entry of Policyholder : 26 years Age at entry of Life Insured : 26 years
Gender : Female Age Admitted : Yes
Gender : Female

Date of Date of
Basic Sum Date of Maturity Annualised Premium Policy Term
Base Plan/Rider Name commencement of commencement
Assured (Rs.) of Policy (Excl. taxes) (Rs.) (Years)
policy of Risk
Tata AIA Life Insurance Fortune Pro
6,90,000.00 11/06/2023 11/06/2023 11/06/2043 69,000.00 20
(UIN: 110L112V04)

Mode of Premium Due Date of Premium Applicable Modal Premium Total Modal
Premium
Base Plan/Rider Name Premium Paying Term Last Premium (Excl. taxes) taxes, cesses & (Incl. taxes) Premium(Incl.
Due Date (s)
Payment (Years) Payment (Rs.) levies (Rs.) (Rs.) taxes) (Rs.)
Tata AIA Life Insurance Fortune
Pro Monthly 10 2023/07/11 11/05/2033 5,748.00 .00 5,748 5,748.00
(UIN: 110L112V04)

Benefit Payable:
Maturity Benefit As per Clause 1 of Part C of the policy document and Benefit Illustration
Death Benefit As per Clause 2 of Part C of the policy document and Benefit Illustration

Nominee details (under section 39 of the Insurance Act 1938)

Name of the Nominee (s) Relationship with Life Assured Gender Age Nomination %
AGILA P Parents Female 51 100.00

Appointee details (Applicable in case the Nominee is a minor)

Name of the Appointee (s) Relationship with Nominee Gender Age (years)
NA NA NA NA

On examination of the Policy, if you notice any mistake, please return the Policy to the Company immediately for correction.

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 OTHER ENDORSEMENT

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 KEY FEATURE DOCUMENT
This is a Unit-Linked Individual Life Insurance Savings Plan that have potential of
market-linked returns along with life cover
Unit Linked Individual Life Insurance Savings Plan

Benefits you've opted for under the plan

Market-Linked Returns Choice of Fund Options
See your investment grow with potential Choice of 11 fund options to enhance
market linked returns and loyalty additions. investment opportunities

Life Cover
Enjoy life cover throughout the policy term

Maturity Benefit

You will receive Total fund value which is the sum of Regular/Single Premium Fund Value and Top-up Premium Fund
Value at applicable NAV on date of Maturity.

Death Benefit
In case of death of the life insured during the policy term and while the policy is in force, the Nominee/legal heir will get, Highest of
(i) Basic Sum Assured net of all “Deductible Partial Withdrawals”, if any, from the Regular/Single Premium Fund Value, or
(ii) Regular / Single Premium Fund Value of this Policy or
(iii) 105 percent of the total Regular/Single Premiums paid up to the date of death.
In addition to this: Highest of
(i) the approved Top-up Sum Assured(s) or
(ii) Top-up Premium Fund Value of this Policy or
(iii) 105 percent of the total Top-up Premiums paid up to the date of death

Grace Period Waiting Period

Monthly Mode: 15 days | Other Modes: 30 days Not Applicable

Exclusion
In case of death due to suicide within 12 months from the date of commencement of the policy or from the date of revival of the
policy, the nominee or beneficiary of the policyholder shall be entitled to fund value/policy account value, as available on the date
of intimation of death. Any charges other than Fund Management charges recovered subsequent to the date of death shall be
paid-back to the nominee or beneficiary along with death benefit

Riders The detailed provisions of the rider if availed, are available in the terms and conditions.

Stay invested in your plan and get the best growth for a secure financial future.

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Funds Available With Current Product Offerings
- A Snapshot (as on 30th September 2022)

THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER.

Equity Funds
Large Cap Equity Fund (ULIF 017 07/01/08 TLC 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV Nifty NAV INDEX
of the Fund is to generate long term capital appreciation from a
50 Change Change
portfolio that is invested predominantly in equity and equity linked
securities. Last 1 Month 30-Aug-22 46.2545 17759.30 -4.02% -3.74%
Last 3 Months 30-Jun-22 40.7928 15780.25 8.83% 8.33%
NAV as on 30 September, 22 : `44.3953 Last 6 Months 31-Mar-22 44.9060 17464.75 -1.14% -2.12% 4.26%
Last 1 Year 30-Sep-21 45.3615 17618.15 -2.13% -2.97%
Benchmark : Nifty 50 -100%
Last 2 Years 30-Sep-20 27.5988 11247.55 26.83% 23.28%
Corpus as on September, 22 : ` 1,829.71 Crs. Last 3 Years 30-Sep-19 26.5412 11474.45 18.71% 14.21% 95.74%
Last 4 Years 30-Sep-18 24.2572 10930.45 16.31% 11.83%
Last 5 Years 30-Sep-17 21.6418 9788.60 15.45% 11.80%
Since Inception 11-Jan-08 10.0000 6200.10 10.65% 7.13% Equity MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Whole Life Mid-Cap Equity Fund (ULIF 009 04/01/07 WLE 110)
Fund Details Fund Performance
Investment Objective : The primary investment objective Asset Allocation
PERIOD DATE NAV Nifty NAV INDEX
of the Fund is to generate long term capital appreciation from a
Midcap 100 Change Change
portfolio that is invested predominantly in Mid Cap Equity and
Mid Cap Equity linked securities. Investments in large cap equity Last 1 Month 30-Aug-22 86.6202 31481.70 -0.93% -2.58%
shares will be restricted to not more than 20%. Last 3 Months 30-Jun-22 75.1492 26452.75 14.19% 15.94%
Last 6 Months 31-Mar-22 83.1504 29692.30 3.20% 3.29% 4.84%
NAV as on 30 September, 22 : `85.8120 Last 1 Year 30-Sep-21 83.5801 30384.00 2.67% 0.94%
Benchmark : Nifty Midcap 100 -100% Last 2 Years 30-Sep-20 51.6024 16983.05 28.96% 34.38%
Last 3 Years 30-Sep-19 46.3089 16026.00 22.83% 24.15%
Corpus as on September, 22 : ` 8,983.47 Crs. 95.16%
Last 4 Years 30-Sep-18 43.5655 17154.35 18.47% 15.63%
Last 5 Years 30-Sep-17 44.8934 18107.95 13.83% 11.11%
Since Inception 10-Jan-07 10.0000 5066.30 14.64% 12.13% Equity MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Super Select Equity Fund (ULIF 035 16/10/09 TSS 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV Nifty500 NAV INDEX
of the fund is to provide income distribution over a period of
Shariah Change Change
medium to long term while at all times emphasizing the importance
of capital appreciation. The fund will invest significant amount Last 1 Month 30-Aug-22 53.0439 5217.64 0.45% -2.49%
in equity and equity linked instruments specifically excluding Last 3 Months 30-Jun-22 47.2496 4662.15 12.77% 9.13% 9.54%
companies predominantly dealing in Gambling, Lotteries/ Last 6 Months 31-Mar-22 52.0022 5283.83 2.47% -3.71%
Contests, Animal Produce, Liquor, Tobacco, Entertainment (Films, Last 1 Year 30-Sep-21 53.8373 5347.34 -1.03% -4.86%
TV etc) Hotels, Banks and Financial Institutions. Last 2 Years 30-Sep-20 34.4382 3358.09 24.39% 23.09%
90.46%
NAV as on 30 September, 22 : `53.2850 Last 3 Years 30-Sep-19 31.8821 2967.87 18.67% 19.68%
Benchmark : Nifty500 Shariah - 100% Last 4 Years 30-Sep-18 30.9543 2932.06 14.54% 14.77%
Last 5 Years 30-Sep-17 29.4807 2846.11 12.57% 12.32% Equity MMI & Others (Non Interest Bearing)
Since Inception 21-Oct-09 10.0000 1208.56 13.79% 11.74%
Corpus as on September, 22 : ` 1,015.72 Crs. Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

Top 200 Fund (ULIF 027 12/01/09 ITT 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The Top 200 fund will invest PERIOD DATE NAV S&P BSE 200 NAV INDEX
primarily in select stocks and equity linked instruments which are Change Change
a part of BSE 200 Index with a focus on generating long term
capital appreciation. The fund will not replicate the index but aim to Last 1 Month 30-Aug-22 99.7397 7800.62 -1.69% -3.56%
attain performance better than the performance of the Index. As a Last 3 Months 30-Jun-22 86.3529 6812.11 13.55% 10.43%
defensive strategy arising out of market conditions, the scheme may Last 6 Months 31-Mar-22 92.6421 7539.85 5.84% -0.23% 5.16%
also invest in debt and money market instruments. Last 1 Year 30-Sep-21 93.6163 7617.01 4.74% -1.24%
Last 2 Years 30-Sep-20 53.8494 4781.63 34.94% 25.43% 94.84%
NAV as on 30 September, 22 : `98.0538 Last 3 Years 30-Sep-19 47.8644 4794.25 27.00% 16.20%
Benchmark : S&P BSE 200 - 100% Last 4 Years 30-Sep-18 43.2623 4631.60 22.70% 12.89%
Last 5 Years 30-Sep-17 39.7193 4280.88 19.81% 11.94% Equity MMI & Others
Corpus as on September, 22 : ` 754.80 Crs.
Since Inception 12-Jan-09 10.0000 1091.37 18.10% 15.10%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

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Funds Available With Current Product Offerings
- A Snapshot (as on 30th September 2022)
Top 50 Fund (ULIF 026 12/01/09 ITF 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The Top 50 fund will invest primarily in PERIOD DATE NAV Nifty 50 NAV INDEX
select stocks and equity linked instruments which are a part of Nifty Change Change
50 Index with a focus on generating long term capital appreciation.
The fund will not replicate the index but aim to attain performance Last 1 Month 30-Aug-22 60.9603 17759.30 -3.63% -3.74%
better than the performance of the Index. As a defensive strategy Last 3 Months 30-Jun-22 53.5059 15780.25 9.80% 8.33%
4.56%
arising out of market conditions, the scheme may also invest in debt Last 6 Months 31-Mar-22 58.5114 17464.75 0.41% -2.12%
and money market instruments. Last 1 Year 30-Sep-21 59.0093 17618.15 -0.44% -2.97%
Last 2 Years 30-Sep-20 36.7789 11247.55 26.39% 23.28%
NAV as on 30 September, 22 : `58.7500 Last 3 Years 30-Sep-19 38.3451 11474.45 15.28% 14.21% 95.44%
Benchmark : Nifty 50 -100% Last 4 Years 30-Sep-18 36.0090 10930.45 13.02% 11.83%
Last 5 Years 30-Sep-17 32.1642 9788.60 12.80% 11.80% Equity MMI & Others
Corpus as on September, 22 : ` 148.19 Crs.
Since Inception 12-Jan-09 10.0000 2773.10 13.77% 14.17%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

Multi Cap Fund (ULIF 060 15/07/14 MCF 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
of the Fund is to generate capital appreciation in the long term PERIOD DATE NAV S&P BSE NAV INDEX
by investing in a diversified portfolio of Large Cap and Mid Cap 200 Change Change
companies. The allocation between Large Cap and Mid Cap Last 1 Month 30-Aug-22 37.4605 7800.62 -1.66% -3.56% 7.71%
companies will be largely a function of the relative valuations of Last 3 Months 30-Jun-22 32.3883 6812.11 13.75% 10.43%
Large Cap companies as against Mid Cap companies.
Last 6 Months 31-Mar-22 34.6243 7539.85 6.40% -0.23%
Last 1 Year 30-Sep-21 34.7609 7617.01 5.98% -1.24%
NAV as on 30 September, 22 : `36.8404
Last 2 Years 30-Sep-20 19.9115 4781.63 36.02% 25.43% 92.29%
Benchmark : S&P BSE 200 – 100% Last 3 Years 30-Sep-19 17.4165 4794.25 28.37% 16.20%
Corpus as on September, 22 : ` 1,706.56 Crs. Last 4 Years 30-Sep-18 15.7848 4631.60 23.60% 12.89%
Last 5 Years 30-Sep-17 13.6589 4280.88 21.95% 11.94% Equity MMI & Others
Since Inception 05-Oct-15 9.9996 3426.34 20.50% 11.91%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

India Consumption Fund (ULIF 061 15/07/14 ICF 110)

Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
of the Fund is to generate capital appreciation in the long term PERIOD DATE NAV S&P BSE NAV INDEX
by investing in a diversified portfolio of companies which would 200 Change Change
benefit from India’s Domestic Consumption growth story. The
Last 1 Month 30-Aug-22 33.9090 7800.62 -2.02% -3.56%
India Consumption Fund could provide an investment opportunity 8.28%
in the theme of rising consumption power in India for long term Last 3 Months 30-Jun-22 29.2226 6812.11 13.69% 10.43%
returns. Last 6 Months 31-Mar-22 30.8569 7539.85 7.67% -0.23%
91.72%
Last 1 Year 30-Sep-21 31.7792 7617.01 4.54% -1.24%
NAV as on 30 September, 22 : `33.2234
Last 2 Years 30-Sep-20 18.9885 4781.63 32.27% 25.43%
Benchmark : S&P BSE 200 – 100% Last 3 Years 30-Sep-19 16.9897 4794.25 25.05% 16.20%
Corpus as on September, 22 : ` 611.37 Crs Last 4 Years 30-Sep-18 15.1274 4631.60 21.74% 12.89%
Last 5 Years 30-Sep-17 14.0006 4280.88 18.87% 11.94% Equity MMI & Others
Since Inception 05-Oct-15 9.9996 3426.34 18.74% 11.91%
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

Balanced Funds
Whole Life Aggressive Growth Fund (ULIF 010 04/01/07 WLA 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV NAV INDEX
of the fund is to maximize the returns with medium to high risk. 25.50%
Change Change
Last 1 Month 30-Aug-22 58.1947 -1.84% -2.57%
Last 3 Months 30-Jun-22 53.2862 7.20% 6.11% 3.75%
NAV as on 30 September, 22 : `57.1237 Last 6 Months 31-Mar-22 57.4778 -0.62% -1.38%
2.66%
Benchmark : Nifty 50 - 65% Last 1 Year 30-Sep-21 57.6362 -0.89% -1.57%
Last 2 Years 30-Sep-20 39.6566 20.02% 16.32%
CRISIL Composite Bond
Fund Index -35% Last 3 Years 30-Sep-19 36.7470 15.84% 11.34% 68.08%
Last 4 Years 30-Sep-18 33.3510 14.40% 10.44%
Corpus as on September, 22 : ` 599.57 Crs. Equity Government Securities
Last 5 Years 30-Sep-17 31.0260 12.98% 9.89%
Since Inception 12-Jan-07 10.0000 11.72% 8.83% MMI & Others Corporate Bonds
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Whole Life Stable Growth Fund (ULIF 011 04/01/07 WLS 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
PERIOD DATE NAV NAV INDEX
of the fund is to provide reasonable returns with low to medium risk. 40.81%
Change Change
Last 1 Month 30-Aug-22 43.0661 -1.22% -1.73% 4.74%
NAV as on 30 September, 22 : `42.5426 Last 3 Months 30-Jun-22 40.5999 4.78% 4.53% 4.16%
Benchmark : Nifty 50 - 40% Last 6 Months 31-Mar-22 42.7548 -0.50% -0.86%
CRISIL Composite Bond Last 1 Year 30-Sep-21 42.5227 0.05% -0.57%
Fund Index - 60% Last 2 Years 30-Sep-20 33.0377 13.48% 11.36%
Last 3 Years 30-Sep-19 29.7729 12.63% 9.28% 50.28%
Corpus as on September, 22 : ` 173.43 Crs.
Last 4 Years 30-Sep-18 26.7897 12.26% 9.45%
Last 5 Years 30-Sep-17 25.3712 10.89% 8.54% Government Securities Equity
Since Inception 18-Jan-07 10.0000 9.65% 8.26% Corporate Bonds MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception” and
returns above “1 Year” are calculated as per CAGR.

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Funds Available With Current Product Offerings
- A Snapshot (as on 30th September 2022)
Fixed Income Funds
Whole Life Income Fund (ULIF 012 04/01/07 WLI 110)
Fund Performance Asset Allocation
Fund Details
PERIOD DATE NAV Crisil Composite NAV INDEX
Investment Objective : The primary investment objective of Bond Fund Index Change Change 29.92%
the Fund is to generate income through investing in a range of debt
and money market instruments of various maturities with a view to Last 1 Month 30-Aug-22 32.5683 4025.15 -0.21% -0.39% 20.88%
maximizing the optimal balance between yield, safety and liquidity. Last 3 Months 30-Jun-22 31.9873 3930.86 1.61% 2.00%
The Fund will have no investments in equity or equity linked Last 6 Months 31-Mar-22 32.3954 4010.08 0.33% -0.02%
instruments at any point in time. Last 1 Year 30-Sep-21 32.0454 3968.46 1.42% 1.03%
Last 2 Years 30-Sep-20 30.2287 3749.75 3.69% 3.40%
NAV as on 30 September, 22 : `32.5008 Last 3 Years 30-Sep-19 27.2003 3366.70 6.11% 6.00% 49.21%
Benchmark : CRISIL Composite Bond Last 4 Years 30-Sep-18 23.9423 2962.23 7.94% 7.86%
Fund Index -100% Last 5 Years 30-Sep-17 23.4400 2945.53 6.75% 6.36% Government Securities MMI & Others
Since Inception 06-Feb-07 10.0000 1301.73 7.82% 7.45%
Corpus as on September, 22 : ` 780.92 Crs. Corporate Bonds
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Whole Life Short Term Fixed Income Fund (ULIF 013 04/01/07 WLF 110)
Fund Details Fund Performance Asset Allocation
Investment Objective : The primary investment objective
of the Fund is to generate stable returns by investing in fixed PERIOD DATE NAV CRISIL Short- Term NAV INDEX
Bond Fund Index Change Change 31.33%
income securities having shorter maturity periods. Under normal
circumstances, the average maturity of the Fund may be in the Last 1 Month 30-Aug-22 29.0429 4127.10 -0.01% -0.08%
13.52%
range of 1-3 years. Last 3 Months 30-Jun-22 28.7754 4062.96 0.92% 1.50%
Last 6 Months 31-Mar-22 28.8745 4095.54 0.57% 0.69%
NAV as on 30 September, 22 : `29.0399 Last 1 Year 30-Sep-21 28.3958 4016.52 2.27% 2.67%
Benchmark : CRISIL Short Term Bond Fund Last 2 Years 30-Sep-20 27.1652 3788.50 3.39% 4.33%
Index -100% Last 3 Years 30-Sep-19 25.1745 3447.54 4.88% 6.15% 55.15%
Corpus as on September, 22 : ` 237.13 Crs. Last 4 Years 30-Sep-18 23.0260 3115.61 5.97% 7.26%
Last 5 Years 30-Sep-17 21.8697 2988.03 5.84% 6.66% Government Securities Corporate Bonds
Since Inception 12-Feb-07 10.0000 1286.08 7.05% 7.73% MMI & Others
Note : The investment income and prices may go down as well as up. “Since Inception”
and returns above “1 Year” are calculated as per CAGR.

Disclaimer
1. IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICY HOLDER. The Linked Insurance Product do not offer any liquidity during the first five
years of the contract. The policy holder will not be able to surrender/withdraw the monies invested in Linked Insurance Products completely or partially till the end of the fifth year.
2. The fund is managed by Tata AIA Life Insurance Company Ltd. (hereinafter the “Company”).
3. Past performance is not indicative of future performance. Returns are calculated on an absolute basis for a period of less than (or equal to) a year, with reinvestment of dividends (if any)
4. All investments made by the Company are subject to market risks. The Company does not guarantee any assured returns. The investment income and price may go down as well as up depend-
ing on several factors
5. Every effort is made to ensure that all information contained in this publication is accurate at the date of publication, however, the Company shall not have any liability for any damages of any kind
(including but not limited to errors and omissions) whatsoever relating to this material.
6. Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfillment of conditions stipulated therein. Income Tax laws are subject to change from time to time. Tata
AIA Life Insurance Company Ltd. does not assume responsibility on tax implication mentioned anywhere in this document. Please consult your own tax consultant to know the tax benefits avail-
able to you.
7. Please know the associated risks and the applicable charges, from your Insurance agent or the Intermediary or policy document issued by the insurance company.
8. Various funds offered are the names of funds and do not, in any way, indicate the quality of the funds, their future prospects & returns.
9. Premium paid in ULIPs are subject to Investment risks associated with capital markets & the NAV of the units may go up or down based on the performance of the fund and factors influencing
capital markets & the insured is responsible for his/her decision.
10. Whilst every care has been taken in the preparation of this document, it is subject to correction and markets may not perform in a similar fashion based on factors influencing the capital and debt
markets; hence this review note does not individually confer any legal rights or duties.
11. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
12. Unit Linked Life Insurance products are different from traditional insurance products and are subject to risk factors
13. Tata AIA Life Insurance Company Limited is only the name of the Insurance Company & any contract bearing the prefix ‘Tata AIA Life” is only the name of the Unit Linked Life Insurance contract
and does not in any way indicate the quality of the contract, its future prospects or returns.
14. This publication is for general circulation only. This document is for information and illustrative purposes only and does not purport to any financial or investment services and do not offer or form
part of any offer or recommendation. This document is not, and should not be regarded as investment advice or as a recommendation regarding any particular security or course of action.
15. Please make your own independent decision after consulting your financial or other professional advisor.
16. In line with IRDAI regulations, “Since inception” date will be effective from “First Unit Allocation” date instead of “First NAV declaration” date.
17. The performance of the managed portfolios and funds is not guaranteed and the value may increase or decrease in accordance with the future experience of the managed portfolios and funds.

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 SERVICE OPTIONS

Log in to one stop shop for your servicing needs

My
DigiAccount

How to login?
Visit https://myinsurance.tataaia.com

Authenticate your policy details and date of birth

Verify your registration via OTP

Your registration is now complete

Features

Simplifed OTP-based login Buy products online

single dashboard with

key policy information Easy servicing options

Pay premium, download Read interesting

receipts & statements blogs & articles

Set notification on
policy milestones

Where to pay premium

Pay on Website
Bank Website
https://apps.tataaia.com/PG/#!/policyPayment

Apps (PayZapp, Paytm, Google Pay,

My DigiAccount
Phone Pe, Jio Money, Airtel Money,
https://myinsurance.tataaia.com Itz Cash, MobiKwik, Amazon Pay)

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How to pay premium?

Credit card/debit card

Netbanking

Mobile wallets

Bharat Bill Payment System (BBPS)

UPI

Watch our video on premium payment options

https://youtu.be/Dg1CYdlBa8w

Hassle-free Standing Instructions

Ensure Non-Stop Rakshakaran by registering for Standing Instructions where premium amount
will automatically get debited on due date.

Register on https://apps.tataaia.com/PG/#!/RegAutoDebt using Credit Card or Bank Account

Ways to access digital policy document

SMS Email WhatsApp My DigiAccount DigiLocker e-Insurance

Account

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Claims Process
Claim with ease

Step 1 Register claim with necessary documentation

Step 2 Documents are verified and claim is processed

Step 3 Claim amount is disbursed

Options to inform us

claims@tataaia.com

Type CLAIM & send to +91 7045669966

Visit our website

https://www.tataaia.com/customer-service/claim-registration.html

Locate your nearest branch from

https://www.tataaia.com/contact-us.html?contactUs-2

Write to us at Tata AIA Life Insurance Company Limited, Claims department, 9th Floor,
B wing, I-Think Techno Campus (Lodha), Behind TCS, Pokhran Road No.2, Thane
(West), Mumbai – 400607

Watch our claim settlement process on https://youtu.be/BaIjmQ5X6k0

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 Connect with us for any query/request

customercare@tataaia.com www.tataaia.com

Send Hi to +91 7045669966

1-860-266-9966 (Mon - Sat | 10 am - 7 pm IST),

022-6251 9966 (Outside India)

SMS PCT <space> Policy no.<space>

Registered Email ID to 5676799

Locate your nearest branch from

https://www.tataaia.com/contact-us.html?contactUs-2

Frequently Asked Questions

• Login to My DigiAccount from

https://myinsurance.tataaia.com
How to update personal details? • You can update name, email ID, mobile number,
NEFT details, PAN, address,
Standing Instructions details here.

• Digital document is equivalent to physical document. If

I need my physical policy document.
you still need it, you can send an email to
How can I get it?
customercare@tataaia.com requesting for a copy.
customercare@tataaia.com

• Login to My DigiAccount from

Need to update nominee/beneficiary? https://myinsurance.tataaia.com
• Visit any Tata AIA Life Insurance branch

• Send a request by logging to My DigiAccount from

Need to change your
payment frequency? https://myinsurance.tataaia.com
• Visit any Tata AIA Life Insurance branch

Need to know about Freelook Charges? Refer to Freelook Cancellation Clause of the T&C, in case you
exercise freelook option to cancel the policy, you shall
receive all premiums paid without interest after the
deduction of proportionate risk premium for the period of
cover, stamp duty as mentioned on the preamble page of the
policy document, medical examination costs and taxes as
applicable. Kindly note that if you have chosen monthly mode
of premium payment, the total deductible charges may be
higher than the amount of modal premium paid by you.

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 Proposal Form

Tata AIA Life Insurance Company Limited.

PROPOSAL FORM

Kindly Fill the form in CAPITAL and only in blue or black

(For Official Use only)

Proposal Number: U225212725 Branch Code: MU01

Channel: Broking Campaign Code:
Sub Office Code: RM CAMS Code: 4967389
Agent/Broker/Specified Person/Employee: Policy Bazaar
Code: Contact Details: License No. & Validity Details:
Customer Relationship No. (For Bancassurance Channel) PAN No.
IMPORTANT GUIDELINES: 1) IN UNIT-LINKED INSURANCE POLICIES (ULIPs), THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE
POLICYHOLDER. 2) Insurance is a contract of utmost good faith between the Insurer and the Insured. The Proposer and the Life to be Assured are required to disclose
all facts in response to the questions in this application form. 3) Any cancellation/alteration is to be signed by Proposer/Life to be assured as applicable. 4) KYC
documents will be required for all the parties to the contract.
I. GENERIC DETAILS
Is this policy self-proposed? Yes . If No, please answer the following details Type of Proposer: Individual
Relation with Life Assured: Self Type of Proposal:
II. ELECTRONIC INSURANCE ACCOUNT (eIA) DETAILS OF THE PROPOSER/POLICYOWNER
If you have an e-Insurance Account (eIA) Number, please provide:
I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Tata AIA Life Insurance Company Ltd. In electronic
format(Physical copy would be sent even if proposer opts for electronic format; however, in case proposer has e-Insurance Account, only electronic copy of the Insurance
Policy will be provided)
I would like to receive my Insurance Policy and all the information related to the proposed Insurance Policy through Insurance Repository in the Electronic Format as and
when applicable. Please select the name of the Insurance Repository.
NSDL Data Management Limited
III. PRODUCT DETAILS
Premium ( )
Base Plan/ Unit Premium Return of
Sum Policy (Inclusive of Premium
Rider (Benefit Linked Life Insured Name Paying Premium
Assured ( ) Term(Years) applicable taxes, Paying Mode
Option) Name (Yes/No) Term(Years) option
cesses & levies )
Tata AIA Life
Insurance Yes Sruthi P 690000 20 10 5748 Monthly NA
Fortune Pro

Life Insured Details Benefit Payout Option Details

Rider (Benefit Benefit Payout
Option) Name Income p.a Income Income
Name DOB Gender Option Lumpsum ( )
( ) Duration(Years) Frequency

Tata AIA Vitality (Wellness Program Applicable only for specific product/riders): NA

Utilization of Rewards during the Premium Payment Term (if ‘Wellness Program’ is opted):

Kindly DATE BACK my Application to 1. Allowed only as per product specifications 2. Allowed within the same financial year 3. In case of juvenile (less than 1 year) back date is not allowed. 4. Date Back
of policy is allowed only up to the official launch date of the product.
FUND SELECTION DETAILS (To be filled for Unit Linked Products) a. Kindly mention the names of the fund chosen b. Incase you opt for a specific Portfolio Strategy (as available with individual
products), kindly mention the Fund Names or other details as applicable c. Kindly fill in whole numbers in percentage only. Decimals and Fractions not allowed.
Name of Fund % Allocation Portfolio Strategy
Whole Life Income Fund 0
Whole Life Short-Term Fixed Income Fund 0 Funds for the chosen Portfolio Strategy (If Applicable )
Whole Life Aggressive Growth Fund 0 Debt oriented fund Equity oriented fund
Whole Life Stable Growth Fund 0
Other Details(if applicable)
Whole Life Mid Cap Equity Fund 0
Large Cap Equity Fund 0
Multi Cap Fund 50 OR
India Consumption Fund 0
Top 50 fund 0
Top 200 fund 0
Super Select Equity Fund 0
Emerging Opportunities Fund 50
Sustainable Equity Fund 0
Dynamic Advantage Fund 0
IV. PROPOSER / POLICYHOLDER DETAILS (Please fill in details of Life Assured if same as Proposer)
1. Title Ms
2. Name Sruthi P

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3. Father's Name / Spouse Name PRAMOTH K
4. Mother's Name AGILA P
5. Maiden Name(For female lives only)
6. Gender/Date of Birth FEMALE/ 12-11-1996

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7. Which is your Dominant Hand? (Question to be answered only if ADDL Rider is
selected )
8. Marital Status Single
Nationality: Resident Indian
Country of Residence : India
9. Nationality (If other than resident Indian, Passport as an age proof is mandatory)
(If country of residence or nationality outside India then FATCA/ CRS-Self Certification Form
to be mandatorily completed)
Residence for Tax purposes in Jurisdiction(s) outside India No (If 'Yes' then FATCA/ CRS-Self Certification Form to be mandatorily completed)
10. Highest Educational Qualification Graduate
112 R BLOCK,KOVAIPUDUR,COIMBAT ORE SOUTH,COIMBATORE
11. Correspondence Address Landmark: Coimbatore City: COIMBATORE
State: TAMIL NADU Country: India Pin code: 641042
112 R BLOCK,KOVAIPUDUR,COIMBAT ORE SOUTH,COIMBATORE
12. Permanent/Updated Address Landmark: Coimbatore City: COIMBATORE
State: TAMIL NADU Country: India Pin code: 641042
13. Address for Communication Correspondence Address
Residence No: Mobile No: 8870610172
14. Telephone and Email Details
E-mail: sruthipramoth123@gmail.com
15. Occupation Class Salaried
a. Name of Organisation /School / College HAWORTH INDIA PVT LTD
b. Organisation Type Private Limited
c. Industry Manufacturing
d. Nature of Work Assistant - entry level
e. Annual Income ( ) 1500000
16. Income Proof Salary certificate of current financial year
17. Identity Proof (In case of Passport & Driving License please mention expiry date) Aadhar Card, Uid
18. Address Proof (Utility bills should not be older than 2 months) Aadhar Card, Uid
GBNPS1555L (kindly attach copy of Pan card)
19. Permanent Account Number ( PAN ) :
Yes I do have PAN (kindly attach copy of Form 60 duly signed)
20. CKYC No. (If available) 60056233496924
21. Source of Funds

22. Are you a Politically Exposed Person? No (Definition of PEP: "PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international
organisation /in a foreign country. This would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials,
senior executives of state owned corporations, important political party officials". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity)
or through marriage or similar (civil) forms of partnership. Close associates are individuals closely connected to a PEP, either socially or professionally")

V. LIFE ASSURED / SECONDARY ANNUITANT DETAILS (Please fill in this section only if Life Assured is different from Proposer)
1. Title
2. Name
3. Maiden Name(For female lives only)
4. Gender/Date of Birth
5. Which is your Dominant Hand?
6. Marital Status

7. Nationality (If other than resident Indian, Passport as an age proof is mandatory)
Country of Residence

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8. Highest Educational Qualification
9. Occupation Class
10. Name of Organisation/ School/College
11. Organisation Type
12. Industry
13. Nature of Work
14. Annual Income ( )
15. Income Proof
Expiry Date :
16. Identity Proof (In case of Passport & Driving License please mention expiry date)
Others :
17. Address Proof (Utility bills should not be older than 2 months) Aadhar Card, Uid
(kindly attach copy of Pan card)
18. Permanent Account Number (PAN):
I Do not have PAN (kindly attach copy of Form 60 duly signed)
19. Are you a Politically Exposed Person? No (Definition of PEP: "PEP are individuals who are or have been entrusted with prominent public functions, domestically/in an international organisation
/in a foreign country. This would include individuals who have or have had positions of Heads of State or of government, senior politicians, senior government, judicial or military officials, senior executives
of state owned corporations, important political party officials". "Close relations of PEP: Family members are individuals who are related to a PEP either directly (consanguinity) or through marriage or
similar (civil) forms of partnership. Close associates are individuals closely connected to a PEP, either socially or professionally")

VI. HEALTH & LIFESTYLE DETAILS OF THE LIFE ASSURED

1. Nature of Age proof (Non-standard age proof submission will attract extra premium)
Aadhar Id Card - Standard
2. a) Height (cms or ft) b) Weight ( kg or lbs). 165.1cms 70Kg
PART A: LIFESTYLE DETAILS
1. Are you employed in the Armed Forces, Paramilitary, Police Forces, Fire Brigade or any other similar occupation? No
2. Is your occupation/your hobbies associated with any specific accident/health hazard or are dangerous in any way (e.g. working with dangerous
or corrosive chemicals, explosives, radiation, working underwater/underground or at height, working in mines, non-commercial flying activities, No
diving, mountaineering, any form of motorbike/car racing etc.)?
3. Have you ever been charge sheeted or convicted of any criminal proceedings or have any criminal case or charge pending against you in any
No
court of law in India or abroad? If Yes, please provide complete details.
4. Do you intend to live or travel outside India for more than 30 days for reason other than family vacation in next 6 months? No
5. Do you consume or have consumed any of the following? Please tick all relevant options and provide details
Substance Quantity/ Per Day for Tobacco & Per No. of If stopped consumption, mention month and year in
Yes/ No Consumed As
Consumed week for Alcohol and Narcotics Years which last consumed
Tobacco No
Alcohol No
Any Narcotics No
PART B: HEALTH & PERSONAL DETAILS
1. Has any of your insurance application or reinstatement application on life, accident, medical or health, critical illness, or disability ever been
No
declined, postponed or accepted at extra premium or modified terms?
2. Did you have any loss or Gain of weight of 10 kgs or more in the last six months? No
3. Do you have any physical deformity / handicap or congenital defect / abnormality? No
4. Have you ever been advised to and / or have undergone any tests, investigations or surgery or had signs or symptoms of any condition, aliment
No
or injury and / or were advised treatment for or have been hospitalized for check-up or treatment other than minor flu, cold or influenza?
5. Have you ever been diagnosed with or investigated for any of the following:
a. Cardio: High or Low Blood Pressure / Raised Cholesterol / Chest Pain / Palpitation / Rheumatic Fever / Heart Murmur / Shortness of Breath /
No
Heart Attack / Stroke / Any other heart condition
b. Hormonal: High Blood Sugar/ Diabetes / Thyroid or endocrine disorder / Sugar in Urine / Any other hormonal disorder No
c. Respiratory: Asthma / Tuberculosis / chronic cough, chronic bronchitis, emphysema, pneumonia / Any other respiratory disorder No
d. Blood/Cellular: Cancer / Tumor or malignant growth / Leukemia / Anemia / Enlarged lymph nodes/ Any blood disorder No
e. Digestive/Regulatory: Recurrent indigestion / Gastritis / Stomach or Duodenal Ulcer / Hernia / Jaundice / Disorders of the liver / Cirrhosis and
No
Gastrointestinal System/ Any other disease

Go to Table of Contents 19/39

 f. Mental/Psychiatric / Neurological ailment: Symptoms or ailment relating to Brain Depression / Anxiety / Brain Disorder or disease / Mental /
Psychiatric / Transient ischemic attack /Parkinson's disease / Multiple Sclerosis / Nervous disorder / Paralysis or Paraplegia / Epilepsy / Any other No
mental or psychiatric ailment
g. Neural/Skeletal/Muscular: Musculoskeletal disorders such as Arthritis / Recurrent Back Pain / muscular dystrophies/ musculoskeletal
deformities/ Slipped disc or any other disorder of Spine, Joints, Limbs or Leprosy; / Disorders of Eye, Ear, Nose,Throat including defective sight / No
Disorder of speech or hearing and discharge from ears / Any other disorder
h. Infectious/Contagious: Were you or your spouse ever tested for Hepatitis B or C, HIV /AIDS or any other Sexually Transmitted Disease / Any
No
other disorder
i. Genitourinary: Hydrocele / fistula / piles / symptoms or ailment relating to Kidney / Kidney Stones/ Prostate, Urinary System or Reproductive
No
System / Any other disorder
6. Have you had/ are having any other illness or impairment not mentioned above? No
7. Are you presently in good health? Yes
8. Has any of your family member (Parents and Siblings) ever been diagnosed with diabetes, Hypertension, Kidney Failure, Cancer, Heart Attack
No
or any Hereditary Disorder before the age of 60?
9. Have you ever been advised to undergo any surgery or treatment or laboratory investigations (stress ECG, echocardiogram, angiography,
No
MRI/CT scan etc.) by any doctor or specialist?
10. Have you been off work due to illness for a continuous period of 7 days and above during the last 5 years? No
11. Female Life Questionnaire
a. Are you now Pregnant? If Yes, kindly state expected delivery date No
b. Have you undergone any gynecological investigations for illness, internal checkups, breast checks such as mammogram or biopsy? No
c. Have you ever consulted a doctor because of an irregularity at the breast, vagina, uterus, ovary, fallopian tubes, menstruation, complications
No
during pregnancy or child delivery or a sexually transmitted disease?
d. Have you suffered from any other disorder of the breast or reproductive organs, abnormal smear test(s) and irregular menses? No
12. If answer to any of the question above is 'yes', kindly give full details noting the question number (attach relevant copies)
Question No.: Details:
13. Family Details (Mandatory if the life to insured is Juvenile/Student/Housewife)
Date of
Family Details Name Gender (M / F) Occupation Annual Income ( ) Insurance Details (Existing /Applied for)
Birth
Father/Husband
First Child / Sibling
Second Child / Sibling
14. Family Details to be filled for Life Assured only Father Mother Brother Sister Spouse
a. If Alive, Health Status
b. If Deceased, Cause of Death
c. Age at Death/Current Age
VII. EXISTING INSURANCE DETAILS
Do you currently hold or have applied for Life Insurance/Pension/Health/Personal Accident Policies? Y / N If Yes, kindly provide details as below:
Life Assured Proposer (If Life Assured is Juvenile/Student/Housewife)
Type of Insurance (Life/ Health/ Unit Linked Company Basic Sum Type of Insurance (Life/ Health/ Unit Linked Company Basic Sum
/Pension/Personal Accident) Name Assured ( ) /Pension/Personal Accident) Name Assured ( )

VIII. NOMINEE DETAILS (Required only if Proposer & Life Assure are the same)
Base Plan/ Rider Gender Percentage ( % ) (Do not enter % in decimals & total % should be
Name Date of Birth Relationship
(Benefit Option)Name (M/F) equal to 100)
Tata AIA Life Insurance
AGILA P 27-11-1971 Female Mother 100
Fortune Pro
IX. APPOINTEE DETAILS (Required only if Nominee is less than 18 years of age)
Name Date of Birth Gender (M/F) Relationship

Go to Table of Contents 20/39

X. PAYMENT DETAILS

Premium Payment Method: Digital/Online Payment

Name of Credit Card/Debit Card Holder: Credit Card/Debit Card Number
Cheque/DD No. Issuing Bank Branch Amount Date: DD/MM/YYYY
Premium# 5748 + Taxes, cesses & levies 0 = Total Payment 5748 for months initial deposit (To be filled for monthly mode only)
On the first policy/modal anniversary I would like to change the premium payment mode to , subject to policy contract provisions. For Annual/Monthly mode issued #
policies mode change shall be accepted only on completion of first policy anniversary. #Premium is exclusive of applicable taxes, cesses & levies. All Premiums are
subject to applicable taxes, cesses & levies which will entirely be borne by the Policyholder and will always be paid by the Policyholder along with the payment of
Premium. If any imposition (tax or otherwise) is levied by any statutory or administrative body under the Policy, Tata AIA Life Insurance Company Limited reserves the
right to claim the same from the Policyholder. Alternatively, Tata AIA Life Insurance Company Limited has the right to deduct the amount from the benefits payable by Us
under the Policy. Cheque/DD should be drawn in favor of "Tata AIA Life Insurance Company Ltd. (Proposal No)". Do not issue blank cheque.
Renewal Payment Mode:

XI. Mandatory Bank Account Details:

Please provide below bank details. Bank details provided should be in the name of Proposer. All policy payouts will be made to the below mentioned bank account through
electronic transfer (NEFT). Payout would be in accordance and subject to terms and conditions of the policy.

Name of Account
Bank Account No. Bank Name and Branch Account Type IFSC Code
Holder

AXIS BANK,GROUND FLOOR F128 SITAPURA INDUSTRIAL

Sruthi P 918010061234184 Savings UTIB0002982
AREA SITAPURA JAIPUR
Note: 1. Please provide a cancelled copy of your personalized cheque. If personalized cancelled cheque is not available, attach bank statement showing account holder
name, address and account number. 2. In case of Non-Credit to the given bank account with/without assigning any reason thereof or if the transaction is delayed or not
effected at all for any reason of incomplete information, Tata AIA Life Insurance Co Ltd will not be responsible. 3. Further, the Company reserves the right to use any
alternative payout option inspite of opting for Direct Credit option. 4. If Account type is NRE/NRO then FATCA/CRS-Self Certification Form to be mandatorily completed.

XII. DECLARATION & CONSENT

• I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the
best of my knowledge and that I am authorised to propose on behalf of these other persons (applicable where the proposer and life insured are different).
• I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurer and that the policy will come into
force only after full payment of the premium chargeable.
• I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before
communication of the risk acceptance by the company.
• I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person to be insured/ proposer or from any past or
present employer concerning anything which affects the physical or mental health of the person to be insured/ proposer and seeking information from any insurer to whom an application for
insurance on the person to be insured /proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
• I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer (if any) for the sole purpose of underwriting the proposal and/or claims
settlement and with any Governmental and/or Regulatory authority.
• I confirm that I have understood the contents of this Proposal Form and I am submitting this Proposal Form with all the details which are true and correct. I have not withheld any material
information or suppressed any fact which are essential for issuance of the policy. I also hereby irrevocably authorize the Company to ascertain all the details from any third parties, as may be
required for assessing the risk.
• I agree to undergo all medical tests as determined by the Company for obtaining the policy and I further understand that the Company reserves the right to issue the policy if all the required criteria
are met and in case of any fraud or misrepresentation being established, the insurer shall take action in accordance with Section 45 of the Insurance Act, 1938 as amended time to time. I
understand that the contract will be governed by the provisions of the Insurance Act, 1938 as amended time to time, the IRDA Act, 1999 and the Regulations framed there under and that the
contract will not commence until the Company's written acceptance of this Proposal Form is received. In case of the life to be insured being a minor, I further declare and affirm that this proposal of
insurance is for the benefit of the life to be insured.
• Anti-Money Laundering Declaration: I hereby confirm that all premiums will be paid from bonafide sources and no premiums will be paid out of proceeds of crime related to any of the offence
listed in Prevention of Money Laundering Act, 2002. The Company has the right to peruse my financial profile and also agree that the Company has right to cancel the insurance contract in case I
have been found guilty of any of the provisions of any law, directly or indirectly, having relation to the laws governing prevention of money laundering in the country, by any competent court of law.
• I/We understand that in accordance with the IRDAI (Protection of Policyholders Interests) Regulations, 2017, the insurer is permitted to share policyholder information only with the statutory
authorities. I permit/authorize the Company to collect, store, communicate and process information relating to the Policy/Account and all transactions therein, by the Company and any of its
affiliates or service providers wherever situated including sharing, transfer and disclosure between them or with any entity or entities for the purpose of underwriting, policyholder servicing and
claims; and to the authorities in and/or outside India for compliance with any law or regulation whether domestic or foreign.

Date: 11-06-2023
Signature/Thumb Impression of Life Assured Signature/Thumb impression of Proposer Place: COIMBATORE
Authenticated through OTP Authenticated through OTP

I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein,
immediately in case any of the above information is found to be false or untrue or misrepresenting, before issuance of the proposal. "I, the undersigned confirm that I have
verified photocopies of the proofs submitted along with this proposal form against the originals and certify the same to be true copy".
I declare and confirm that I have carried out necessary suitability analysis while advising this product to the proposer and that the product is suitable to the proposer.
WHERE THE PROPOSAL FORM IS FILLED IN BY AGENT/INTERMEDAIRY/EMPLOYEE: I hereby declare that I have explained the contents of this proposal to the
Proposer/Annuitants in the language known to him/her and ensured that the contents have been fully understood by him/her. I have accurately recorded the Proposer/
Annuitant's responses to the information sought in the proposal form and I have read out the responses to the Proposer/Annuitants and he/she has confirmed that they
are correct

Signature of Agent/ Specified Person/ Broker/ Employee

________________________________________________________________________________________________________________________________________

ACKNOWLEDGEMENT
Tear away portion (To be handed over to the customer)
Proposal Number: ___________________

Dear Customer
We acknowledge receipt of your Cash/Cheque/DD for Rs.______________ by number ______________ dated ___ /___ /___ drawn on _______________ toward' s Initial

Go to Table of Contents 21/39

Deposit. We request you to kindly verify the details filled in the proposal form before signing the same. Please do insist on Official Receipt issued by Tata AIA Life from
your advisor within 2 working days from submission of this proposal form. In case you do not hear from us or do not receive your policy within 15 days from the date of
submission of your proposal, please visit us at www.tataaia.com or call our helpline number 1860 266 9966 (local charges apply) or email us at
customercare@tataaia.com.
This is only acknowledgement slip and not the premium receipt.

Agent code Agent name Signature of Agent Date of Acknowledgement

Go to Table of Contents 22/39

 IN CASE OF THUMB IMPRESSION OF PROPOSER/ANNUITANTS OR WHERE THE ANSWERS/SIGNATURE OF THE PROPOSER/ANNUITANTS ARE IN
VERNACULAR
Note: The below must be declared by someone other than advisor/employee of the company.
Declaration by Agent/Intermediary of Tata AIA Life Insurance Company Limited
I, _______________________________________ (name) have explained the contents of this proposal to the _________________________________________
(Proposer) in ____________________ (language) and ensured that the contents have been fully understood by him/her. I have accurately recorded the Proposer
responses to the information sought in the proposal form and I have read out the responses to the Proposer and he/she has confirmed that they are correct.

Date: 11-06-2023
Place: COIMBATORE
(Signature of the person making the declaration)
Address of the person making the declaration:

Declaration by Proposer:
I have understood the contents of this proposal explained to me in language and confirm that the responses provided by me are correct.

Date: Date: 11-06-2023

Signature/Thumb Impression of the Life Assured Place: Signature/Thumb impression of Proposer Place: COIMBATORE
Authenticated through OTP Authenticated through OTP

(Prohibition of Rebates) Section 41 - of the Insurance Act, 1938 as amended from time to time: 1. No person shall allow or offer to allow, either directly or indirectly,
as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or
part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate,
except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer.
SECTION 45 OF THE INSURANCE ACT, 1938 STATES: No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years
from the date of policy, i.e. from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the
policy, whichever is later. A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of
commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud: Provided that the insurer shall have
to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision is based.
Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question
merely because the terms of the policy adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal. For further details, please refer to
the Insurance Act, as amended from time to time.
Disclaimers: IN CASE OF A ULIP POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. Tata AIA Life Insurance
Company Limited is only the name of the Company and any contract bearing the prefix "Tata AIA Life" is only the name of the contract and does not in any way indicate the
quality of the contracts, its future prospects or returns. Premium paid in ULIP is subject to investment risks associated with capital markets & the NAV of the units may go up
or down based on the performance of the funds and factors influencing capital markets and the insured is responsible for his decision. Past performance is not indicative of
future results. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.

BEWARE OF SPURIOUS PHONE CALLS IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public
AND FICTIOUS / FRAUDULENT OFFERS receiving such phone calls are requested to lodge a police complaint

L&C/Advt/2022/Sep/2091/CAF/V1
________________________________________________________________________________________________________________________________________

1. Please carry valid Identity card to the medical examination center wherever applicable. 2. For cash payment, please visit our nearest Tata AIA Life branch. Please do
not handover cash to Agent. If handed over to the agent, the company will not be liable for any loss. 3. In case there is any change in the particulars given above including
Life Assured/Proposer's health and/or medical and/or fnancial and/or occupational status and/or being charged with and/or arrested for any criminal offence after the date
of proposal but before risk acceptance by the company; please inform the company. 4. Acceptance of premium does not constitute risk commencement. 5. Risk
commencement starts after the acceptance of risk by the company. 6. Freelook Period: If you are not satisfied with the terms & conditions/features of the policy, you have
the right to cancel the Policy by providing written notice to the Company and receive the premiums after deducting a) Proportionate risk premium for theperiod on cover &
b) Stamp duty and medical examination costs including applicable taxes, cesses & levies, which have been incurred for issuing the Policy. Such notice must be signed by
you and received directly by the Company within 15 days from the date of receipt of the policy document by you or person authorized by you. The said period of 15 days
shall stand extended to 30 days, if the policy sourced through distance marketing mode which includes solicitation through any means of communication other than in
person. For Unit Linked Life Insurance products, you would receive the non – allocated premiums plus charges levied by cancellation of units plus fund value at the date of
cancellation and after deducting the charges as mentioned in (a) & (b) above.

Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110) CIN: U66010MH2000PLC128403. Registered & Corporate Office: 14th Floor, Tower A, Peninsula
Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA
Life Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor / Intermediary or visit
Tata AIA Life’s nearest branch office or call 1-860-266-9966 (local charges apply) or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com.

Tata AIA Life Insurance Company Limited (IRDAI Regn. No.110 CIN: U66010MH2000PLC128403). Registered & Corporate Office: 14th Floor, Tower A, Peninsula
Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013. Trade logo displayed above belongs to Tata Sons Ltd and AIA Group Ltd. and is used by Tata AIA

Go to Table of Contents 23/39

Life Insurance Company Ltd under a license. For any information including cancellation, claims and complaints, please contact our Insurance Advisor/ Intermediary or visit
Tata AIA Life's nearest branch office or call 1- 860-266-9966 (local charges apply) or write to us at customercare@tataaia.com. Visit us at: www.tataaia.com.

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 Benefit Illustration
BENEFIT ILLUSTRATION

Tata AIA Life Insurance Fortune Pro

Proposal No: U225212725

Name of the Prospect / Policyholder: Sruthi P Name of the Product: Tata AIA Life Insurance Fortune Pro
Age (yrs) : 26 Tag Line : Unit Linked, Individual Life Insurance Savings Plan
Name of the Life Assured: Sruthi P Unique Identification No.: 110L112V04
Age (yrs) : 26 GST Rate: 18.0%
Sum Assured (Rs.): 6,90,000 Investment Strategy Opted for: NIL
Policy Term (yrs): 20 Funds opted for along with their risk level
Premium Payment Term (yrs): 10 Allocation Risk
Fund Name
Amount of Instalment Premium (Rs.): 5,748 Percentage Profile
Mode of Payment of Premium : Monthly Large Cap Equity Fund (ULIF 017 07/01/08 TLC 110) 0%
Whole Life Mid-cap Equity Fund (ULIF 009 04/01/07 WLE 110) 0%
Whole Life Aggressive Growth Fund (ULIF 010 04/01/07 WLA 110) 0%
Whole Life Stable Growth Fund (ULIF 011 04/01/07 WLS 110) 0%
Whole Life Income Fund (ULIF 012 04/01/07 WLI 110) 0%
Whole Life Short Term Fixed Income Fund (ULIF 013 04/01/07 WLF 110) 0%
Multi Cap Fund (ULIF 060 15/07/14 MCF 110) 50% High
India Consumption Fund (ULIF 061 15/07/14 ICF 110) 0%
Super Select Equity Fund (ULIF 035 16/10/09 TSS 110) 0%
Top 50 Fund (ULIF 026 12/01/09 ITF 110) 0%
Top 200 fund (ULIF 027 12/01/09 ITT 110) 0%
Emerging Opportunities Fund (ULIF 064 12/09/22 EOF 110) 50% High
Sustainable Equity Fund (ULIF 065 12/09/22 ESG 110) 0%
Dynamic Advantage Fund (ULIF 066 12/09/22 DAF 110) 0%

Rider Details
Rider Name (Benefit Option) UIN Sum Assured (Rs.) Coverage Term Premium Payment Term Premium without GST (Rs.)

How to read and understand this benefit illustration?

This benefit illustration is intended to show what charges are deducted from your premiums and how the unit fund, net of charges and taxes, may grow over the years of the
policy term if the fund earns a gross return of 8% p.a. or 4% p.a. These rates, i.e., 8% p.a. and 4% p.a. are assumed only for the purpose of illustrating the flow of benefits if the
returns are at this level. It should not be interpreted that the returns under the plan are going to be either 8% p.a. or 4% p.a.
Net Yield mentioned corresponds to the gross investment return of 8% p.a., net of all charges but does not consider mortality, morbidity charges, underwriting extra, if any,
guarantee charges and cost of riders, if deducted by cancellation of units. It demonstrates the impact of charges and taxes on the net yield. Please note that the mortality
charges per thousand sum assured in general, increases with age.
The actual returns can vary depending on the performance of the chosen fund, charges towards mortality, morbidity, underwriting extra, cost of riders, etc. The investment risk
in this policy is borne by the policyholder, hence, for more details on terms and conditions please read sales literature carefully.
Some 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 benefits then these will be clearly marked "guaranteed" in the illustration table on this page. If your policy offers variable benefits then the illustration on this
page will show two different rates of assumed future investment returns, of 8% p.a. and 4% p.a. 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 dependant on a number of factors including future investment performance.
Part A of this statement presents a summary view of year-by-year charges deducted under the policy, fund value, surrender value and the death benefit, at two assumed rates
of return. Part B of this statement presents a detailed break-up of the charges, and other values.

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 Tata AIA Life Insurance Fortune Pro

Part A
(Amount in Rupees)
At 4% p.a. Gross Investment Return At 8% p.a. Gross Investment Return
Policy Annualized Mortality, Commission
Fund at Mortality, Other Fund at payable to
Year Premium Morbidity Other Surrender Death Surrender Death
Charges* GST End Value Benefit Morbidity Charges* GST End Value Benefit intermediary(Rs.)
Charges of Year Charges of Year
1 69,000 786 5,068 1,053 63,411 58,921 6,90,000 785 5,074 1,054 64,730 60,147 6,90,000 0
2 69,000 717 5,840 1,180 1,28,513 1,25,256 6,90,000 713 5,879 1,187 1,33,742 1,30,485 6,90,000 0
3 69,000 646 6,292 1,249 1,95,763 1,93,320 6,90,000 636 6,395 1,266 2,07,742 2,05,299 6,90,000 0
4 69,000 573 7,111 1,383 2,64,807 2,63,179 6,90,000 553 7,316 1,416 2,86,639 2,85,011 6,90,000 0
5 69,000 497 7,953 1,521 3,35,693 3,35,693 6,90,000 462 8,297 1,577 3,70,760 3,70,760 6,90,000 0
6 69,000 295 8,133 1,517 4,09,445 4,09,445 6,90,000 255 8,661 1,605 4,61,428 4,61,428 6,90,000 0
7 69,000 233 9,032 1,668 4,85,141 4,85,141 6,90,000 174 9,788 1,793 5,58,070 5,58,070 6,90,000 0
8 69,000 165 9,270 1,698 5,63,664 5,63,664 6,90,000 80 10,306 1,869 6,61,933 6,61,933 6,90,000 0
9 69,000 89 10,227 1,857 6,44,270 6,44,270 6,90,000 4 11,598 2,088 7,72,620 7,72,620 7,72,620 0
10 69,000 14 11,209 2,020 7,27,011 7,27,011 7,27,011 0 12,974 2,335 8,90,485 8,90,485 8,90,485 0
11 0 0 9,368 1,686 7,46,325 7,46,325 7,46,325 0 11,584 2,085 9,49,457 9,49,457 9,49,457 0
12 0 0 9,603 1,728 7,66,169 7,66,169 7,66,169 0 12,317 2,217 10,12,376 10,12,376 10,12,376 0
13 0 0 9,845 1,772 7,86,557 7,86,557 7,86,557 0 13,100 2,358 10,79,507 10,79,507 10,79,507 0
14 0 0 10,093 1,817 8,07,503 8,07,503 8,07,503 0 13,934 2,508 11,51,131 11,51,131 11,51,131 0
15 0 0 10,348 1,863 8,29,024 8,29,024 8,29,024 0 14,825 2,668 12,27,550 12,27,550 12,27,550 0
16 0 0 10,610 1,910 8,51,136 8,51,136 8,51,136 0 15,775 2,839 13,09,084 13,09,084 13,09,084 0
17 0 0 10,880 1,958 8,73,853 8,73,853 8,73,853 0 16,788 3,022 13,96,075 13,96,075 13,96,075 0
18 0 0 11,156 2,008 8,97,194 8,97,194 8,97,194 0 17,870 3,216 14,88,889 14,88,889 14,88,889 0
19 0 0 11,441 2,059 9,21,174 9,21,174 9,21,174 0 19,024 3,424 15,87,916 15,87,916 15,87,916 0
20 0 0 11,733 2,112 9,45,812 9,45,812 9,45,812 0 20,255 3,646 16,93,571 16,93,571 16,93,571 0

*Other charges includes Premium Allocation Charge, Policy Admin Charge, Fund Management Charge and Rider Charges, if any. See Part B for details.

IN THIS POLICY, THE INVESTMENT RISK IS BORNE BY THE POLICYHOLDER AND THE ABOVE INTEREST RATES ARE ONLY FOR ILLUSTRATIVE PURPOSE.

I, ................ (name), have explained the premiums, charges and benefits under I,............. (name), having received the information with respect to the above, have
the policy fully to the prospect / policyholder. understood the above statement before entering into the contract.

Place :
Date : Signature of Agent/ Intermediary/ Official Date : Signature of Prospect/ Policyholder

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 Tata AIA Life Insurance Fortune Pro
Part B
Gross Yield 8% p.a Net Yield 6.42% Amount in Rupees

Premium Annualized
Annualized Allocation Premium - Mortality Policy Guarantee Rider Additions Fund Fund Surrender Death
Policy Year Premium Charge Premium charge GST Admin Charge Charges to the before FMC at End Value Benefit
(AP) (PAC) Allocation Charge Fund* FMC of Year
Charges
1 69,000 4,139 64,861 785 1,054 518 0 0 0 64,806 417 64,730 60,147 6,90,000
2 69,000 4,139 64,861 713 1,187 518 0 0 0 1,33,900 1,222 1,33,742 1,30,485 6,90,000
3 69,000 3,794 65,206 636 1,266 518 0 0 0 2,07,987 2,084 2,07,742 2,05,299 6,90,000
4 69,000 3,794 65,206 553 1,416 518 0 0 0 2,86,978 3,004 2,86,639 2,85,011 6,90,000
5 69,000 3,794 65,206 462 1,577 518 0 0 0 3,71,198 3,986 3,70,760 3,70,760 6,90,000
6 69,000 3,104 65,896 255 1,605 518 0 0 0 4,61,973 5,039 4,61,428 4,61,428 6,90,000
7 69,000 3,104 65,896 174 1,793 518 0 0 0 5,58,730 6,166 5,58,070 5,58,070 6,90,000
8 69,000 2,414 66,586 80 1,869 518 0 0 0 6,62,715 7,374 6,61,933 6,61,933 6,90,000
9 69,000 2,414 66,586 4 2,088 518 0 0 0 7,73,532 8,666 7,72,620 7,72,620 7,72,620
10 69,000 2,414 66,586 0 2,335 518 0 0 0 8,91,537 10,042 8,90,485 8,90,485 8,90,485
11 0 0 0 0 2,085 518 0 0 1,895 9,48,681 11,066 9,49,457 9,49,457 9,49,457
12 0 0 0 0 2,217 518 0 0 2,021 10,11,549 11,799 10,12,376 10,12,376 10,12,376
13 0 0 0 0 2,358 518 0 0 2,155 10,78,625 12,582 10,79,507 10,79,507 10,79,507
14 0 0 0 0 2,508 518 0 0 2,298 11,50,191 13,416 11,51,131 11,51,131 11,51,131
15 0 0 0 0 2,668 518 0 0 2,450 12,26,547 14,307 12,27,550 12,27,550 12,27,550
16 0 0 0 0 2,839 518 0 0 2,613 13,08,014 15,257 13,09,084 13,09,084 13,09,084
17 0 0 0 0 3,022 518 0 0 2,787 13,94,934 16,270 13,96,075 13,96,075 13,96,075
18 0 0 0 0 3,216 518 0 0 2,972 14,87,673 17,352 14,88,889 14,88,889 14,88,889
19 0 0 0 0 3,424 518 0 0 3,169 15,86,618 18,506 15,87,916 15,87,916 15,87,916
20 0 0 0 0 3,646 518 0 0 3,380 16,92,187 19,737 16,93,571 16,93,571 16,93,571

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 Gross Yield 4% p.a Amount in Rupees

Premium Annualized
Annualized Allocation Premium - Mortality Policy Guarantee Rider Additions Fund Fund Surrender Death
Policy Year Premium Charge Premium charge GST Admin Charge Charges to the before FMC at End Value Benefit
(AP) (PAC) Allocation Charge Fund* FMC of Year
Charges
1 69,000 4,139 64,861 786 1,053 518 0 0 0 63,486 411 63,411 58,921 6,90,000
2 69,000 4,139 64,861 717 1,180 518 0 0 0 1,28,665 1,184 1,28,513 1,25,256 6,90,000
3 69,000 3,794 65,206 646 1,249 518 0 0 0 1,95,994 1,980 1,95,763 1,93,320 6,90,000
4 69,000 3,794 65,206 573 1,383 518 0 0 0 2,65,120 2,799 2,64,807 2,63,179 6,90,000
5 69,000 3,794 65,206 497 1,521 518 0 0 0 3,36,090 3,641 3,35,693 3,35,693 6,90,000
6 69,000 3,104 65,896 295 1,517 518 0 0 0 4,09,928 4,511 4,09,445 4,09,445 6,90,000
7 69,000 3,104 65,896 233 1,668 518 0 0 0 4,85,714 5,410 4,85,141 4,85,141 6,90,000
8 69,000 2,414 66,586 165 1,698 518 0 0 0 5,64,330 6,338 5,63,664 5,63,664 6,90,000
9 69,000 2,414 66,586 89 1,857 518 0 0 0 6,45,031 7,294 6,44,270 6,44,270 6,90,000
10 69,000 2,414 66,586 14 2,020 518 0 0 0 7,27,870 8,277 7,27,011 7,27,011 7,27,011
11 0 0 0 0 1,686 518 0 0 1,490 7,45,715 8,850 7,46,325 7,46,325 7,46,325
12 0 0 0 0 1,728 518 0 0 1,529 7,65,543 9,085 7,66,169 7,66,169 7,66,169
13 0 0 0 0 1,772 518 0 0 1,570 7,85,914 9,327 7,86,557 7,86,557 7,86,557
14 0 0 0 0 1,817 518 0 0 1,612 8,06,844 9,575 8,07,503 8,07,503 8,07,503
15 0 0 0 0 1,863 518 0 0 1,655 8,28,347 9,830 8,29,024 8,29,024 8,29,024
16 0 0 0 0 1,910 518 0 0 1,699 8,50,440 10,092 8,51,136 8,51,136 8,51,136
17 0 0 0 0 1,958 518 0 0 1,744 8,73,139 10,362 8,73,853 8,73,853 8,73,853
18 0 0 0 0 2,008 518 0 0 1,791 8,96,461 10,638 8,97,194 8,97,194 8,97,194
19 0 0 0 0 2,059 518 0 0 1,839 9,20,421 10,923 9,21,174 9,21,174 9,21,174
20 0 0 0 0 2,112 518 0 0 1,888 9,45,039 11,215 9,45,812 9,45,812 9,45,812

Notes:
1. Refer the sales literature for explanation of terms used in this illustration.
2. Fund management charge is based on the specific fund option(s) chosen.
3. *Additions to the Fund refers to the Loyalty Additions under the plan.
"Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfillment of conditions stipulated therein. Tata AIA Life Insurance Company Ltd. does not
assume responsibility on tax implication mentioned anywhere in this document. Please consult your own tax consultant to know the tax benefits available to you."

I, ................ (name), have explained the premiums, charges and benefits I,............. (name), having received the information with respect to the above, have
under the policy fully to the prospect / policyholder. understood the above statement before entering into the contract.

Place :
Date : Signature of Agent/ Intermediary/ Official Date : Signature of Prospect/ Policyholder

Unique Reference Number - L&C/Advt/2022/Dec/3199

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn No. 110) (CIN: U66010MH2000PLC128403)
Registered and Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400013 Trade logo displayed above belongs to Tata
Sons Ltd and AIA Group Ltd. and is used by Tata AIA Life Insurance Company Ltd under a license. For more information, Call the Tata AIA Life Insurance Company Ltd Helpline
number1860-266-9966 (local charges apply) or Visit us at: www.tataaia.com

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Go to Table of Contents 36/39
 UNIT STATEMENT
IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT
PORTPOLIO IS BORNE BY THE POLICYHOLDER
Product Name Tata AIA Life Insurance Fortune Pro (UIN - 110L112V04)
Policy No U225212725
Policy Date 11/06/ 2023
Next Due date 11/07/ 2023
Basic Policy Premium(`) 5748.00
Rider Premium(`) .00
Service Tax on Rider Premium(`) .00
Policy Term 20
Premium Paying Term 10
Mode Monthly
Insured Name SRUTHI P
Owner Name SRUTHI P

Section 1: FUND VALUE AS AT 12 /06/2023

Regular/Single Top-Up Regular/Single Premium
Net Asset Top-Up Premium Account Surrender
Premium Premium Account
Fund Value Value(`) Units Fund Value(`) Units Fund Value(`) Value(`)
Account Account
Allocation Allocation (A) (B) C=(A*B) (D) E=(A*D) (F)
Emerging Opportunities Fund
50.00% 0.00% 10.9775 237.279891 2604.74 0.000000 0.00 2314.28
(ULIF 064 12/09/22 EOF 110)
Multi Cap Fund (ULIF 060 15/07/14
50.00% 0.00% 40.6845 64.023399 2604.76 0.000000 0.00 2526.39
MCF 110)
TOTAL 100.00% 0.00% 5209.50 0.00 4840.67

Section 2: PREMIUM INFORMATION IN THE CURRENT POLICY YEAR (2023-2023)

Regular/Single Premium Top-Up Premium
Premium Details
Current Policy Year (`) Since Inception(`) Current Policy Year(`) Since Inception(`)
Total Premium(s) Paid 5748.00 5748.00 0.00 0.00
Total Premium(s) Invested 0.00 5341.04 0.00 0.00

BREAKUP OF TOTAL CHARGES DEDUCTED IN THE CURRENT POLICY YEAR

Charge Details Regular/Single Premium (`) Top-Up Premium (`)
Total Mortality Charges on Sum Assured (68.35) 0.00
Service Tax on Mortality Charges on Sum Assured (12.30) 0.00
Total Monthly Policy Administration charges (43.13) 0.00
Service Tax on Monthly Policy Administration Charge(s) (7.76) 0.00

#RakshakaranKiReet Go to Table of Contents 37/39

 Section 3: COVERAGE INFORMATION DETAILS
Benefit Type Sum Assured (`) Effective Date Expiry Date
Basic Sum Assured 690000.00 Jun 11, 2023 Jun 11, 2043
Total Top-up Sum Assured 0.00

Current Death Benefit (Regular / Single Premium Account) as at 12 /06/2023 (`) 690000.00
Current Death Benefit (Top-up Premium Account) as at 12 /06/2023 (`) .00
Total Death Benefit as at 12 /06/2023 * (`) 690000.00

* Please refer to the Policy Contract on Death Benefit. It does not include any Supplementary Benefit with Death Coverage.

Unit Pricing methodology under Unit Linked Life insurance products has undergone changes pursuant to IRDA of India Circular ref:
IRDA/F&I/ CIR/INV/173/08/2011 dated 29th July, 2011. Policyholders are informed that effective from 16th August, 2011 we have
started calculating unit prices as per the procedure prescribed in the above Circular as amended/modified by IRDA of India from time
to time. There is no change in the number of units to the credit of any policyholder on account of this change.

**In case of Complete Withdrawal within the first five years of the policy, the proceeds of the Discontinued Policy shown in the Unit
Statement shall be paid to the policyholder post completion of the lock-in period of five years from the inception of the policy or on
death of the insured, if earlier.

“Proceeds of the Discontinued Policy” means the fund value as on the date of discontinuance plus entire income earned after
deduction of the fund management charges, subject to a minimum guarantee of interest @ 4% p.a. or as prescribed by IRDA of India
from time to time.

Contact Us:
Contact Us:
SMS 'HELP' to 5676799 for list of services offered via SMS'SERVICE' to 58888 to receive call back from our Customer Service Executives

Website www.tataaia.com Log on to the Customer Portal

Email customercare@tataaia.com

Call Center Helpline No.-1800-267-9966 (Toll Free)1860-266-9966 (Local ChargesApply) Callers Outside India 080-67603700 (Charges apply)

Write us to Tata AIA Life Insurance Company Ltd.

14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai - 400013

Kindly Note:
l Investment Risk in the investment portfolio shall be solely borne by the policyholder. The premium 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 infiuencing the capital market and the insured shall be responsible for his or her
decision.
l The underlying Fund’s Unit Price will be affected by interest rates and the performance of the underlying stocks. The Fund’s
Unit Price may goup or down refiecting the market value of the underlying assets.
l Please know the associated risks and the applicable charges, from your insurance agent or the Intermediary or policy
document issued by theinsurance company.
l Whilst every care has been taken in the preparation of this statement, it is subject to correction and this statement should be
read along with the policy document and does not individually confer any legal rights. For policy terms and conditions, please refer to
the policy document.
l This statement shall form a part of the policy document.
l As this is a computer generated statement, no signature is required.
l Service tax is applicable as per governing laws and the same shall be borne by the policyholder. Tata AIA Life Insurance
Company Limitedreserves the right to recover from the Policyholder, any levies and duties (including service tax), as imposed by the
goverment from time to time.
l Insurance cover is available under this product.
l For policy terms and conditions, please refer to the policy document. (Unique Reference No: L&C/Advt/2014/Mar/159)

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 FIRST PREMIUM RECEIPT
PERSONAL DETAILS
Tata AIA Life Insurance Fortune Pro
Policy Number: U225212725 Plan Name:
(110L112V04)
Policy Owner Name: SRUTHI P Life Assured Name: SRUTHI P
POLICYBAZAAR INSURANCE
Email ID: SRUTHIPRAMOTH123@GMAIL.COM Distributor/Agent Name:
BROKERS PRIVATE LIMITED
Contact No. : 8870610172 Distributor/Agent Contact Number: 18002585970
PAN Details GBNPS1555L

PREMIUM DETAILS
Premium Amount Due (In Rs.) 5748.00 Payment Mode Monthly
Goods & Service Tax (GST) 0.00 Next Premium Due on 11/07/2023
Total Amount (In Rs.) (a) 5748.00 Excess Amount (In Rs.) (b-a) 0.00
Amount Received (In Rs.) (b) 5,748.00

TAX BENEFIT DETAILS

Sec 80 C Sec 80 CCC Sec 80 D
5748.00 .00 .00

PAYMENT DETAILS
Receipt Number Receipt Date Amount (In Rs.) Payment Method
PP1532301 11/06/2023 5,748.00 Online Payment

Please Note:
l This document can be used as a proof for claiming deduction while filling your tax returns and tax benefits would be applicable as per
the prevailing tax laws.
l Payments made through modes other than cash are subject to clearance including through electronic mode payments.
l Any excess premium will be adjusted towards premium due in the current financial year or due in the next three months, whichever is later. Else
premium will be auto refunded post 15 days.
l Applicable govt taxes, surcharge, cess including GST would be charged in accordance with applicable Laws and Company will have the right to
recover the same from the policyholder.
l Please refer to the policy document for detailed terms and conditions and our website for FAQ on applicable tax benefits.
l In case of Unit Linked Policy (ULIP), if premium is received by us after 3:00 pm on a business day, NAV of the next business day shall apply.
GST DETAILS
Base Premium Taxable Value CGST .00% SGST/UTGST .00% IGST .00% Reverse Charge
` 5748.00 ` .00 ` .00 ` .00 ` .00
Tata AIA Life Insurance Tata AIA Life Insurance GST
HARYANA 06AABCT3784C1ZH SAC Description Life Insurance
State IN
Policy Owner's GST State TAMIL NADU Policy Owner's GSTIN NOT REGISTERED SAC Code 997132

Consolidated Revenue stamp duty paid: Notification No. Mudrank – LOA NO.CSD/612/ 2023(Validity period from dated 23-02-2023 to
31-01-2024)/665 Dated 20-02-2023 vide receipt number MH015056225202223E dated on 20-02-2023.
PAN: AABCT3784C.

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