1911727918-BI

Bajaj Allianz
Lifelong
Assure
A Non-Linked Whole Life Plan

Key Features of the plan

Bajaj Allianz Lifelong Assure a unique plan that provides you income & protection till your 100th birthday so that
Aim of the policy
you can live worry-free for a lifetime.
Maturity - You will receive the following benefit under the policy plus any terminal bonus shall be paid.

PPT Maturity Benefit

10 years 200% of Sum Assured
15 years 250% of Sum Assured
20 years 300% of Sum Assured
Benefits under the policy Death - If all due premiums have been paid, then, in case of unfortunate death of the life assured during the
policy term, Sum Assured on Death plus vested bonus, if any plus interim bonus, if any plus terminal bonus, if
any, will be payable as death benefit to the nominee.
Bonus is payable under this policy.
1. Guaranteed Cash Back of 3% of the Sum Assured every year from the end of the PPT till the end of the year
in which the life assured is aged 99 years
2. Cash bonus, if any, paid at the end of each policy year from the end of the 6th year till the end of the year in
which the life assured is aged 99 years
Premiums at regular intervals are payable for the entire premium paying term of 10, 15 or 20 years as chosen by
Premium payment you. The premium paying term chosen by you is the basis on which Benefit Illustration has been drawn and shall
also be mentioned in the Policy Schedule.
1. Bajaj Allianz Accidental Death Benefit Rider UIN: 116B034V01
2. Bajaj Allianz Accidental Permanent Total/ Partial Disability Benefit Rider UIN: 116B036V01
3. Bajaj Allianz Critical Illness Benefit Rider UIN: 116B035V01
Riders Available
4. Bajaj Allianz Family Income Benefit Rider UIN: 116B037V01
5. Bajaj Allianz Waiver of Premium Benefit Rider UIN: 116B031V01

Bajaj Allianz Life Insurance Co. Ltd.,

G.E. Plaza, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver 2 : English
 If you have not paid 3 full years’ premium If you have paid at least 3 If you have paid at least 5 years’
in full, then, years’ premium in full and premium in full and stopped paying
1. Your policy will immediately lapse at stopped paying subsequent subsequent premiums, then,
the expiry of the grace period. premiums, then, 1. Your policy will be converted to a
2. You will have 2 years from the date of 1. 
Your policy will be paid-up policy,
Non payment of premium first unpaid premium to revive your converted to a paid-up 2. Guaranteed Cash Back & Cash
policy policy, Bonus based on the Paid-up Sum
3. You will not have any life cover during 2. 
You will not be entitled Assured will be paid till the end
the revival period of 2 years. to the full policy benefits of the policy year in which the life
4. Revival of your policy may be subject under a Paid-Up policy. assured is aged 99 years
to medicals done at your cost.
You may revive your paid-up policy during the revival period of 2 years from the due date of first unpaid premium,
Revival
subject to the revival conditions under the policy

Although it is not advisable to surrender your policy unless there is an extreme urgency, you will have the option
to surrender your policy provided
Surrender o at least 3 years’ premium have been paid,

a) On full surrender of the policy on receipt of valid documents for the same.
b) At the end of the revival period, if premiums have not been paid during the first three policy years.
c) On the date of intimation of death of the life assured.
Termination d) On date of foreclosure of the policy, if loan is taken under the policy
e) On the maturity date.
f) On payment of Early Termination Value.

You will have the option to review the terms and conditions of the policy and if you disagree to any of the terms
& conditions, you will have an option to return the policy within 15 days [thirty (30) days in case this policy is
Free Look Cancelation issued under the provisions of IRDAI Guidelines on Distance Marketing of Insurance Products] stating the reasons
for your objections.

Regd. Office Address: G.E Plaza, Airport Road, Yerawada, Pune - 411006 | Reg.No.: 116. | Visit us: www.bajajallianz.
Contact us com | BALIC CIN:U66010PN2001PLC015959 | Mail us : customercare@bajajallianz.co.in | Fax No: 02066026789
Call on : Toll free no. 1800 209 7272

Do’s and Don’ts

• Do fill the proposal form very carefully and personally in CAPITAL letters in blue ink only
• Do provide true and complete information
• Do provide correct contact number, address and email ID, and update in case of any change, so that you can
receive necessary communication
• Do sign on all the documents provided by you (Self Attestation)
• Do provide your recent passport photograph
Do’s
• Do draw cheque/ DD, in favour of “Bajaj Allianz Life Insurance Co. Ltd.”
• Do read the policy bond carefully upon receipt of the same.
• Do contact us if you do not receive the policy bond or any other communication from the Company within
30 days.
• Do read the enclosed Benefit Illustration carefully before signing
• Do register for Auto Debit Instructions/ ECS to ensure timely payments of your premium on due dates.

• Do not sign any blank proposal form

• Do not leave any column blank in the proposal form
• Do not conceal any facts as this could lead to dispute at the time of a claim
Don’ts
• Do not miss or delay your premium payment
• Do not rely on any commitments of any additional benefits made by anyone apart from what has been
highlighted herein above.

Disclaimer
This document contains the highlights of the product Bajaj Allianz Lifelong Assure UIN: 116N122V01 and is subject to the terms and conditions
as contained in the policy document. The terms and conditions as contained in the policy document shall govern the contractual relationship and
shall be binding. For details on any of the matters highlighted herein above, please refer to policy document upon receipt of the same by you. The
standard terms and conditions of the product is also available on the Company website at www.bajajallianz.com

Bajaj Allianz Life Insurance Co. Ltd.,

G.E. Plaza, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver 2 : English
 Bajaj Allianz Life Insurance Company Ltd.
BAJAJ ALLIANZ LIFELONG ASSURE
PREMIUM QUOTATION CUM BENEFIT ILLUSTRATION
(All monetary amounts are expressed in Indian Rupees & all Ages & Terms are expressed in Years)

Personal Details
Life Assured Name Xyz Xyz Xyz Life Assured Age 38
Gender Male

Policy Details
Mode Yearly Premium Paying Term 10
Pincode 400101 Branch State MAHARASHTRA
Sum Assured 100478

Premium / Benefit Details

TYPE POLICY TERM SUM ASSURED MODAL PREMIUM
LIFELONG ASSURE Main Benefit [UIN: 116N122V01] 62 100478 18500.01
High Sum Assured Rebate (HSAR) Less : 0.00
Base Policy Premium Net of HSAR 18500.01
Total Premium before Goods & Service Tax 18500.01

Premium Payable
MODE -> YEARLY HALF YEARLY QUARTERLY MONTHLY
MODAL PREMIUM PAYABLE DURING FIRST POLICY YEAR
Modal Premium before Goods & Service Tax 18500.01 NA NA NA
Goods & Service Tax @ 4.5 % 832.50 NA NA NA
Modal Premium (including GST) * 19333 NA NA NA
MODAL PREMIUM PAYABLE DURING SECOND & SUBSEQUENT YEARS
Modal Premium before Goods & Service Tax 18500.01 NA NA NA
Goods & Service Tax @ 2.25 % 416.26 NA NA NA
Modal Premium (including GST) * 18917 NA NA NA
*It includes CGST,SGST/UTGST,IGST & State Cess as applicable. Taxes and tax rates are subject to change

Case: Investment Return 8%

# ##
Polic Life Annualized Cumulative (Non- (Guarantee Death Maturity Maturity Guaranteed Special Surrender
y Assure Premium Premium (Excl Guaranteed) d) Survival Benefit ^! Benefit Benefit Surrender Surrender Value
Year d Age (Excl of GST) of GST) Survival Benefit: Under Value Value (SSV) Receivable
Benefit: Cash- Paid-Up (GSV) **
Cash Backs Policy
Bonuses
EOY EOY EOY EOY EOY EOY EOT EOY EOY EOY
1 39 18500 18500 0 0 200956 0 0 2035 0 2035
2 40 18500 37000 0 0 200956 0 0 5550 0 5550
3 41 18500 55500 0 0 200956 0 60287 16650 29246 29246
4 42 18500 74000 0 0 200956 0 80382 37000 39164 39164
5 43 18500 92500 0 0 200956 0 100478 46250 49179 49179
6 44 18500 111000 7033 0 200956 0 120574 55500 59302 59302
7 45 18500 129500 7033 0 200956 0 140669 64750 69542 69542
8 46 18500 148000 7033 0 200956 0 160765 74000 79906 79906
9 47 18500 166500 7033 0 200956 0 180860 83250 90406 90406
10 48 18500 185000 7033 3014 200956 0 89486 101052 101052
11 49 0 185000 7033 3014 200956 0 86471 101685 101685
12 50 0 185000 7033 3014 200956 0 83457 102353 102353
13 51 0 185000 7033 3014 200956 0 80443 103057 103057
14 52 0 185000 7033 3014 200956 0 77428 103801 103801
15 53 0 185000 7033 3014 200956 0 74414 104585 104585
16 54 0 185000 7033 3014 200956 0 71400 105399 105399
17 55 0 185000 7033 3014 200956 0 68385 106261 106261

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place

 18 56 0 185000 7033 3014 200956 0 65371 107175 107175
19 57 0 185000 7033 3014 200956 0 62357 108144 108144
20 58 0 185000 7033 3014 200956 0 59342 113650 113650
21 59 0 185000 7033 3014 200956 0 60028 119476 119476
22 60 0 185000 7033 3014 200956 0 57014 125651 125651
23 61 0 185000 7033 3014 200956 0 53999 131260 131260
24 62 0 185000 7033 3014 200956 0 50985 133424 133424
25 63 0 185000 7033 3014 200956 0 47971 135890 135890
26 64 0 185000 7033 3014 200956 0 46806 138666 138666
27 65 0 185000 7033 3014 200956 0 43792 141496 141496
28 66 0 185000 7033 3014 200956 0 40778 142408 142408
29 67 0 185000 7033 3014 200956 0 37763 143376 143376
30 68 0 185000 7033 3014 200956 0 34749 144664 144664
31 69 0 185000 7033 3014 200956 0 37285 146270 146270
32 70 0 185000 7033 3014 200956 0 34270 148197 148197
33 71 0 185000 7033 3014 200956 0 31256 149420 149420
34 72 0 185000 7033 3014 200956 0 28242 150846 150846
35 73 0 185000 7033 3014 200956 0 25227 152476 152476
36 74 0 185000 7033 3014 200956 0 29613 154311 154311
37 75 0 185000 7033 3014 200956 0 26599 156359 156359
38 76 0 185000 7033 3014 200956 0 23584 158629 158629
39 77 0 185000 7033 3014 200956 0 20570 161138 161138
40 78 0 185000 7033 3014 200956 0 17556 163906 163906
41 79 0 185000 7033 3014 200956 0 23791 166965 166965
42 80 0 185000 7033 3014 200956 0 20777 170217 170217
43 81 0 185000 7033 3014 200956 0 17763 171362 171362
44 82 0 185000 7033 3014 200956 0 14748 172505 172505
45 83 0 185000 7033 3014 200956 0 11734 173651 173651
46 84 0 185000 7033 3014 200956 0 8719 174818 174818
47 85 0 185000 7033 3014 200956 0 5705 176016 176016
48 86 0 185000 7033 3014 200956 0 2691 177244 177244
49 87 0 185000 7033 3014 200956 0 0 178502 178502
50 88 0 185000 7033 3014 200956 0 0 179793 179793
51 89 0 185000 7033 3014 200956 0 0 181122 181122
52 90 0 185000 7033 3014 200956 0 0 182501 182501
53 91 0 185000 7033 3014 200956 0 0 183949 183949
54 92 0 185000 7033 3014 200956 0 0 185496 185496
55 93 0 185000 7033 3014 200956 0 0 187194 187194
56 94 0 185000 7033 3014 200956 0 0 189125 189125
57 95 0 185000 7033 3014 200956 0 0 191324 191324
58 96 0 185000 7033 3014 200956 0 0 192470 192470
59 97 0 185000 7033 3014 200956 0 0 193791 193791
60 98 0 185000 7033 3014 200956 0 0 195429 195429
61 99 0 185000 7033 3014 200956 0 0 197648 197648
62 100 0 185000 0 0 200956 200956

Case: Investment Return 4%

# ##
Polic Life Annualized Cumulative (Non- (Guarantee Death Maturity Maturity Guaranteed Special Surrender
y Assure Premium Premium (Exc Guaranteed) d) Survival Benefit ^! Benefit Benefit Surrender Surrender Value
Year d Age (Excl of GST) of GST) Survival Benefit: Under Value Value (SSV) Receivable
Benefit: Cash- Paid-Up (GSV) **
Cash Backs Policy
Bonuses
EOY EOY EOY EOY EOY EOY EOT EOY EOY EOY
1 39 18500 18500 0 0 200956 0 0 2035 0 2035
2 40 18500 37000 0 0 200956 0 0 5550 0 5550
3 41 18500 55500 0 0 200956 0 60287 16650 19498 19498
4 42 18500 74000 0 0 200956 0 80382 37000 26109 37000
5 43 18500 92500 0 0 200956 0 100478 46250 32786 46250
6 44 18500 111000 1256 0 200956 0 120574 55500 39535 55500
7 45 18500 129500 1256 0 200956 0 140669 64750 46361 64750
8 46 18500 148000 1256 0 200956 0 160765 74000 53271 74000
9 47 18500 166500 1256 0 200956 0 180860 83250 60271 83250

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place

 10 48 18500 185000 1256 3014 200956 0 89486 67368 89486
11 49 0 185000 1256 3014 200956 0 86471 67790 86471
12 50 0 185000 1256 3014 200956 0 83457 68235 83457
13 51 0 185000 1256 3014 200956 0 80443 68705 80443
14 52 0 185000 1256 3014 200956 0 77428 69200 77428
15 53 0 185000 1256 3014 200956 0 74414 69723 74414
16 54 0 185000 1256 3014 200956 0 71400 70266 71400
17 55 0 185000 1256 3014 200956 0 68385 70841 70841
18 56 0 185000 1256 3014 200956 0 65371 71450 71450
19 57 0 185000 1256 3014 200956 0 62357 72096 72096
20 58 0 185000 1256 3014 200956 0 59342 75767 75767
21 59 0 185000 1256 3014 200956 0 60028 79651 79651
22 60 0 185000 1256 3014 200956 0 57014 83767 83767
23 61 0 185000 1256 3014 200956 0 53999 87507 87507
24 62 0 185000 1256 3014 200956 0 50985 88949 88949
25 63 0 185000 1256 3014 200956 0 47971 90593 90593
26 64 0 185000 1256 3014 200956 0 46806 92444 92444
27 65 0 185000 1256 3014 200956 0 43792 94331 94331
28 66 0 185000 1256 3014 200956 0 40778 94938 94938
29 67 0 185000 1256 3014 200956 0 37763 95584 95584
30 68 0 185000 1256 3014 200956 0 34749 96443 96443
31 69 0 185000 1256 3014 200956 0 37285 97513 97513
32 70 0 185000 1256 3014 200956 0 34270 98798 98798
33 71 0 185000 1256 3014 200956 0 31256 99613 99613
34 72 0 185000 1256 3014 200956 0 28242 100564 100564
35 73 0 185000 1256 3014 200956 0 25227 101650 101650
36 74 0 185000 1256 3014 200956 0 29613 102874 102874
37 75 0 185000 1256 3014 200956 0 26599 104239 104239
38 76 0 185000 1256 3014 200956 0 23584 105753 105753
39 77 0 185000 1256 3014 200956 0 20570 107425 107425
40 78 0 185000 1256 3014 200956 0 17556 109271 109271
41 79 0 185000 1256 3014 200956 0 23791 111310 111310
42 80 0 185000 1256 3014 200956 0 20777 113478 113478
43 81 0 185000 1256 3014 200956 0 17763 114241 114241
44 82 0 185000 1256 3014 200956 0 14748 115003 115003
45 83 0 185000 1256 3014 200956 0 11734 115767 115767
46 84 0 185000 1256 3014 200956 0 8719 116545 116545
47 85 0 185000 1256 3014 200956 0 5705 117344 117344
48 86 0 185000 1256 3014 200956 0 2691 118163 118163
49 87 0 185000 1256 3014 200956 0 0 119001 119001
50 88 0 185000 1256 3014 200956 0 0 119862 119862
51 89 0 185000 1256 3014 200956 0 0 120748 120748
52 90 0 185000 1256 3014 200956 0 0 121667 121667
53 91 0 185000 1256 3014 200956 0 0 122632 122632
54 92 0 185000 1256 3014 200956 0 0 123664 123664
55 93 0 185000 1256 3014 200956 0 0 124796 124796
56 94 0 185000 1256 3014 200956 0 0 126084 126084
57 95 0 185000 1256 3014 200956 0 0 127550 127550
58 96 0 185000 1256 3014 200956 0 0 128314 128314
59 97 0 185000 1256 3014 200956 0 0 129194 129194
60 98 0 185000 1256 3014 200956 0 0 130286 130286
61 99 0 185000 1256 3014 200956 0 0 131765 131765
62 100 0 185000 0 0 200956 200956
EOY: End Of Policy Year
EOT: End Of Policy Term
^! In case of Death Benefit, the corresponding number in the 'Policy Year' column should be read as the Year in which Death happens at Year-End.
# In case of Maturity Benefit under a Paid-up Policy, the corresponding number in the 'Policy Year' column should be read as the Number of Years for which
Premiums are Paid before the Policy becomes Paid-up.
## In case of Surrender Benefits, the corresponding number in the 'Policy Year' column should be read as the Year in which the Policy is Surrendered at Year-End.
** 'Surrender Value Receivable' includes Base Policy Surrender Value and Rider Surrender Value, if any.

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place

Notes & Disclaimers:
1.The above premium quotation is applicable only for a Standard Life (from medical, lifestyle and occupational point of view).
2.All of the above information must be read in conjunction with Sales Literaturein
3.For any further clarification, contact our sales representative or e-mail us on life@bajajallianz.co.in
4.Death Benefit, which is guaranteed if all the due premiums are paid in full, will be as follows :
a)For Age At Entry less than 45 years, the Death Benefit will be higher of
10 times of Annualized Premium*
105% of Total Premiums Paid*
2 times, 2.5 times or 3 times of Sum Assured for chosen PPT of 10, 15 or 20 years respectively plus Interim Cash Bonus and Terminal Bonus, if any.
b)For Age At Entry greater than or equal to 45 years, the Death Benefit will be higher of
7 times of Annualized Premium*
105% of Total Premiums Paid*
2 times, 2.5 times or 3 times of Sum Assured for chosen PPT of 10, 15 or 20 years respectively plus Interim Cash Bonus and Terminal Bonus, if any.
* Annualized Premium and Total Premiums paid in the above definition will be exclusive of Extra Premiums, Goods & Service Tax, if any.
5.Maturity Benefit, which is guaranteed if all the due Premiums are paid in full, will be as follows:

Premium Paying Term Sum Assured Payable on Death

10 years 200% of Base Sum Assured
15 years 250% of Base Sum Assured
20 years 300% of Base Sum Assured
6.Guaranteed Cash Back equal to 3% of Sum Assured will be receivable every year starting from the end of Premium Paying Term.
7.Cash Bonus, if any, (which is non-guaranteed and which would be based on actual experience) will be receivable every year starting from the end of 6th Policy
Year.
8.If at least one full years Premium has been paid but three full years Premiums have not been paid and twelve months have been completed under the Policy, Early
Termination Value will be available. In case of early termination by the Policyholder or non-payment of due Premiums during this period, the following Early
Termination Value will be receivable:
No. of Full Year Premiums Paid Percentage of total premiums paid
1 11 %
2 15 %
9.The Base Policy shall acquire Surrender Benefit equal to the higher of Guaranteed Surrender Value (GSV) and Special Surrender Value (SSV) after at least 3 full
years' Premiums have been paid.
10.The Guaranteed Surrender Value (GSV) (as per the following table) will be a percentage of Premiums paid (where Premiums considered would exclude Premiums
paid for any Additional Rider Benefits or other extra Premiums) less the total of all the Guaranteed Cash Backs received.

Policy Surrender Year Percentage of the premiums paid till

date
3 30 %
4 to 20 50 %
21 to 25 52 %
26 to 30 53 %
31 to 35 56 %
36 to 40 60 %
41 onwards 65 %
11.The displayed Special Surrender Values (SSVs) are not guaranteed but only indicative. These may change from time to time subject to approval from IRDA.
12.Any rider can be excluded at anytime before the Maturity Date. The Rider Life Assured is eligible for Surrender Value on exclusion of the rider.
a)if the Rider Premium Paying Term is less than Rider Policy Term AND .
b)after two full years Rider Premiums have been paid when Policy Term is less than 10 years .
OR
after three full years Rider Premiums have been paid when Policy Term is 10 years or more
Surrender Value of the chosen rider =70%*{(n-t)/n}^2*Total Premiums paid for that particular rider cover where: n is rider policy term and t is elapsed
duration in years and fraction thereof from the date of commencement of rider cover Base policy will continue as per its own provisions even after
cancellation of one or more rider(s).
13.The Surrender Value Receivable includes Base Policy Surrender Value and Rider Surrender Value, if any.
14.The investment returns shown above are only for illustrative purposes as mandated by the IRDA and do not in any way indicate the upper and lower limits of
possible investment returns.
15.Goods & Service Tax would be levied as per applicable tax laws. These taxes and tax rates are subject to change from time to time.
16.Premiums payable and benefits receivable would be eligible for tax benefits, as per the then existing tax laws.

Insurance is a subject matter of solicitation.

Read this illustration along with the product brochure for detailed terms and conditions.

I declare that I have read the terms and conditions and understood the above benefit illustration.

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place

Signature of Proposer
Date:

I have explained the benefit illustration to the proposer.

Signature of Sales Representative

Date:

Bajaj Allianz Life Insurance Company Limited

GE Plaza, Airport Road, Yerawada, Pune - 411 006
Tel:(020) 66026777; Fax:(020) 66026789
Email: life@bajajallianz.co.in
www.bajajallianz.com

Signature of Policyholder Signature of Sales Representative Company's Seal Date Place