First Name Last Name Date of Birth Mobile Email Amount of Investment (*Minimum premium is Rs. 24,000/-) Policy Term 10 15 16 17 18 19 20 21 22 23 24 25 Premium Paying Term: Single Limited Regular 5 Years 7 Years 10 Years Premium Paying Frequency: Yearly Monthly Quarterly Half Yearly Sum Assured: Plan Option Classic Benefit (Life Option) : Higher of Sum Assured or Fund Value Classic Benefit (Extra Life Option) : Higher of Sum Assured or Fund Value Plus Accidental Death Benefit Classic Plus Benefit : Sum Assured and Fund Value Classic Waiver Benefit : Sum Assured Plus on each future premium due date, an amount equal to the modal premium shall be credited to the Policy holder’s Fund Value after deduction of applicable charges. This fund value will be payable on maturity.