Bajaj Allianz Life

Smart Wealth
Goal V
A Unit-linked Non-Participating Individual Life
Savings Insurance Plan

Key Features of the plan

Type of Bajaj Allianz Life Smart Wealth Goal V - Wealth Variant is a unit-linked non-participating
Plan individual life savings insurance plan

Aim of the Bajaj Allianz Life Smart Wealth Goal V - Wealth Variant - a plan loaded with smart features like
Return of Life Cover charge, Return of Allocation charge and multiple investment strategies
policy
to make the most of your investment.
Maturity Benefit -
You will receive the regular premium Fund Value/ Single Premium Fund Value plus top up
premium Fund Value as on the maturity date, provided all due premiums have been paid.
Death Benefit -
Provided the policy is in-force, the death benefit payable to the Nominee as lump-sum is:
• The higher of the prevailing sum assured or regular premium Fund Value/ Single premium
fund value plus
• The higher of top-up premium sum assured or top-up premium Fund Value, if any; All the
above as on date of receipt of intimation of Death
The Death Benefit is subject to the Guaranteed Death Benefit, which is at least 105% of the
Total Premiums paid
Benefits Note- Please refer Sales Literature for more details
under the
Loyalty Benefits -
policy Return of Premium Allocation Charge (ROAC) - At the end of the 15th Policy year, the total of all the
Premium Allocation charges deducted under the Policy will be added into the Fund as Loyalty Benefit.
Fund Boosters - At the end of 10th/15th policy year and every 5th policy year thereafter till 60th
policy year (as applicable in the policy), FB as a %-age of the average of the daily Regular
Premium Fund Values(1) or the average of the daily Single Premium Fund Values(2) during the
previous 3 years (including the current year). The applicable percentages are as given in the
table below.
End of Variant 10th 15th 20th 25th 30th 35th 40th 45th 50th 55th 60th
Policy Year year year year year year Year year year year year year
Fund LP/RP 1.5% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2%
Booster Single N/A 2.00% 3.00% N/A N/A
(%) Premium N/A

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
 Return of Mortality Charge (ROMC) -
At the end of the policy term, on the maturity date, the total amount of mortality charges
deducted in respect of life cover provided throughout the policy term, will be added back as
Non- ROMC, to the Regular Premium Fund Value/Single premium fund value and Top-up Premium
payment Fund Value, as applicable. ROMC is not applicable in case of a Surrendered, Discontinued or
Paid-up policy and will be payable provided all due Regular Premiums under the policy have
of premium
been paid up to date.

Bonus -
No bonus is payable in this policy.

Premium
Premiums at regular intervals are payable for the policy term.
payment
If you do not pay regular premiums during If you do not pay regular premium after the
the first five policy Year, then at the end of first five policy years, then, your policy will
grace period the policy will be converted to be converted to a paid-up policy immediately
discontinued policy. with reduced paid-up benefits. You will have
• You can revive your policy by paying all to choose any of the following two options on
due regular premiums within a period of receiving the notice from us to intimate you
three (3) years about your policy status -
• If we do not receive any intimation
from you about the policy revival, or we Option A - Pay all due regular premiums or
receive an intimation, but the policy is not communicate agreeing to pay all due regular
revived, then, we will be constrained to premiums, within a period of three (3) years or
take discontinuance action
• At any time, you have the option to Option B - Surrender the Policy
Non- pay-
completely withdraw from the Policy
ment of
without any risk cover, Guaranteed Benefit, If you do not pay all due regular premiums or
premium Periodical Money Backs/Loyalty Benefits, we do not receive any intimation from you,
ROMC and receive the Discontinued value then, policy will continue as paid-up till the ex-
(as Surrender Value) at the end of the piry of the revival period, at the end of which,
lock-in period of five Policy years or the the Surrender Value will be paidthe Surrender
date of surrender, whichever is later Value will be paid
Alternatively, you can choose to surrender the
Policy without any risk cover and in that case
your life cover shall cease immediately.
The Surrender Value will be available after the
end of lock in period of 5 years or date of sur-
render, whichever is later
You will not be able to revive your policy once
surrendered.
You may revive your discontinued policy during the revival period of three (3) years from the
Revival
date of discontinuance of the policy provided the policy is not terminated already
Although it is not advisable to surrender your policy unless there is an extreme urgency, you
will have the option to surrender your policy anytime
i. On surrender during the lock-in period of first five years, the regular premium Fund Value/
Single premium fund value, less the discontinuance/ surrender charge plus the top
up premium Fund Value, if any, as on the date of surrender, will be transferred to the
Surren- discontinued life policy Fund (maintained by the company), and life cover shall cease
der of the immediately. The Discontinuance Value as at the end of the lock-in period will be available
Policy to you as Surrender Value.
ii. On surrender after the lock-in period of first five years, the Surrender Value available will
be regular premium Fund Value/Single premium fund value plus top up premium Fund
Value, if any, as on the date of surrender.
The policy shall thereafter terminate upon payment of the full Surrender/ Discontinuance
Value by the company

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
 Charges Details
Policy Year (years) 1 2 3 4 5 6 to PPT
Premium Allo- Yearly Mode 6% 6% 6% 3% 3% Nil
cation Charge Other Modes 5% 5% 5% 3% 3% Nil
Single Premium 3% --------
Top-up Premium: 2%

Charges Type Year 1-5 Year 6-10 Year 11 onwards

Policy LP/RP 1.08% per annum 3% per annum Nil
under the
Administration Single Premium Nil 0.5% p.a of SP
Plan
Charge (PAC) The policy administration charge will be subject to maximum of Rs. 500 in any
month
Fund Fund Management
Charge per annum
Equity Growth Fund II 1.35%
Accelerator Mid Cap Fund II 1.35%
Pure Stock Fund 1.35%
Pure Stock Fund II 1.30%
Asset Allocation Fund II 1.25%
Bluechip Equity Fund 1.25%
Flexi Cap Fund 1.35%
Sustainable Equity Fund 1.35%
Liquid Fund 0.95%
Fund Bond Fund 0.95%
Management Midcap Index Fund 1.35%
Charge (FMC) Dynamic Asset Allocation Fund 1.35%
Smallcap Fund 1.35%
Individual Short Term Debt Fund 1.35%
Smallcap Quality Index Fund 1.35%
Nifty Alpha 50 Index Fund 1.35%
Nifty 200 Alpha 30 Index Fund 1.35%
Nifty 500 Multicap Momentum Quality 50 Index Fund 1.35%
Nifty 200 Momentum 30 Index Fund 1.35%
Focused 25 Fund 1.35%
Nifty 500 Multifactor 50 Index Fund 1.35%
BSE 500 Enhanced Value 50 Index Fund 1.35%
Discontinued Life Policy Fund 0.50%
This charge would be adjusted in the Unit Price
Miscellaneous A miscellaneous charge of `100/- per transaction shall be charged.
Charge Note- Please refer Sales Literature for more details

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
 Where the pol- Discontinuance charge Discontinuance charge for
icy is discon- for the policies having the policies having An-
tinued during annualized Premium up to nualized Premium above
the policy year `50000/- `50000/-
Lower of 20% * (AP or FV) sub- Lower of 6% * (AP or FV) sub-
1
ject to maximum of `3,000 ject to maximum of `6,000
Lower of 15% * (AP or FV) sub- Lower of 4% * (AP or FV) sub-
2
ject to maximum of `2,000 ject to maximum of `5,000
Lower of 10% * (AP or FV) sub- Lower of 3% * (AP or FV) sub-
3
ject to maximum of `1,500 ject to maximum of `4,000
Lower of 5% * (AP or FV) sub- Lower of 2% * (AP or FV) sub-
4
ject to maximum of `1,000 ject to maximum of `2,000
5 & above Nil Nil
Discontinu-
Under Single Premium
ance/ Surren-
der Charge Where the pol- Discontinuance charge Discontinuance charge for
icy is discon- for the policies having the policies having An-
tinued during annualized Premium up to nualized Premium above
the policy year `50000/- `50000/-
Charge
Lower of 20% * (AP or FV) sub- Lower of 6% * (AP or FV) sub-
1
ject to maximum of `3,000 ject to maximum of `6,000
Lower of 15% * (AP or FV) sub- Lower of 4% * (AP or FV) sub-
2
ject to maximum of `2,000 ject to maximum of `5,000
Lower of 10% * (AP or FV) sub- Lower of 3% * (AP or FV) sub-
3
ject to maximum of `1,500 ject to maximum of `4,000
Lower of 5% * (AP or FV) sub- Lower of 2% * (AP or FV) sub-
4
ject to maximum of `1,000 ject to maximum of `2,000
5 & above Nil Nil
Discontinuance Charge for top ups is Nil.
AP – Annualized Premium & FV – Regular Premium Fund Value
Mortality Charge will be deducted at each monthly anniversary by
Mortality cancellation of units. | Female Life Assured will be eligible for an age-set-
Charge back of 3 years. | For sub-standard lives, extra Mortality charge will be
applicable which will be deducted as charges by cancellation of units.
Goods and Service Tax/any other applicable tax levied, subject to changes
Goods and
in tax laws are charged based on type of policy, communication address of
Service Tax
Policy Holder. This may change subject to change in rate/state in address
(GST)
of the Policy Holder as on date of adjustment

• The Policy will terminate on payment of the last instalment.

 If you have opted for the Settlement Option
• This Policy shall automatically and immediately terminate on the earlier occurrence of
any of the following events:
 On foreclosure of the Policy
 On the date of receipt of intimation of death of the Life Assured (unless the Settlement
Termina-
option has been opted for)
tion  On payment of Discontinued value or Surrender Value
 The Maturity Date, unless Settlement Option has been opted
 The expiry of the Settlement period, if opted
 On cancellation of Policy during Free look period
 On refund of eligible Premiums/Surrender value under Suicide clause on suicide of
Life Assured

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
 You have a free look period of thirty (30) days from the date of receipt of the policy document ,
to review the terms and conditions of the policy and where you disagree to any of those terms
or conditions, or otherwise and have not made any claim, you have the option to return the
policy to the Company for cancellation, stating the reasons for his objection, then, you shall be
Free Look entitled to a refund of the Regular premiums and any Top-Up Premium paid, subject only to a
Cancella- deduction of a proportionate risk premium for the period of cover and the expenses incurred
tion on medical examination and stamp duty charges.
In addition to deductions above, the Company shall also be entitled to repurchase the Units at
the Unit Price as on the date of cancellation.
The request for cancellation of the policy during free look period shall be processed and
premium shall be refunded within 7 days of receipt of such request.

Regd. Office Address: Bajaj Allianz Life insurance Company Ltd, Bajaj Allianz House,
Contact Airport Road, Pune - 411006 | Reg.No.: 116. | Visit us: www.bajajallianzlife.com | BALIC
us CIN:U66010PN2001PLC015959 | Mail us : customercare@bajajallianz.co.in | Call on : Toll free
no. 1800 209 7272

Do’s
• 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 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
Do’s & Company within 30 days.
Don’ts • 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.

Don’ts
• 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
• 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 Life Smart Wealth Goal V
(UIN:116L201V04) 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 | BALIC CIN : U66010PN2001PLC015959 | Mail us : customercare@bajajallianz.co.in | Call
on : Toll free no. 1800 209 7272.

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116. Ver. 1: English
Quotation No : 60081478984

Bajaj Allianz Life Smart Wealth Goal V

A Unit-linked Non-Participating Individual Life Savings Insurance Plan

Name of the Prospect/ Policyholder: Valued Customer Name of the Product: Bajaj Allianz Life Smart Wealth Goal V
Age (in years): 40 Variant: Wealth
Gender: Female Tag Line: A Unit-linked Non-Participating Individual Life Savings
Name of the Life Assured: Valued Customer Insurance Plan
Age (in years): 40 Unique Identification Number: 116L201V04
Gender Female GST Rate: 18.00%
Name of Joint Life: NA Investment Strategy Opted for: Investor Selectable Portfolio Strategy
Age of Joint Life: NA Fund opted for along with risk levels
Gender of Joint Life: NA Fund Name SFIN Fund Fund Management Risk Level
Apportionment% Charge
Sum Assured (in Rs.): 20,00,000
Equity Growth Fund II - 0% 1.35% Very High
Policy Term (in years): 10 ULIF05106/01/10EQTYGROW02116
Premium Payment Term (in Years): 5 Accelerator Mid-Cap Fund II - 0% 1.35% Very High
Amount of Instalment Premium (in Rs.): 2,00,000 ULIF05206/01/10ACCMIDCA02116
Mode of Payment of Premium: Annual Pure Stock Fund II - 0% 1.30% Very High
ULIF07709/01/17PURSTKFUN2116
Pure Stock Fund - 0% 1.35% Very High
ULIF02721/07/06PURESTKFUN116
Asset Allocation Fund II - 0% 1.25% High
ULIF07205/12/13ASSETALL02116
Bluechip Equity Fund - 0% 1.25% High
ULIF06026/10/10BLUECHIPEQ116
Bond Fund - ULIF02610/07/06BONDFUNDLI116 100% 0.95% Moderate
Liquid Fund - ULIF02510/07/06LIQUIDFUND116 0% 0.95% Low
Flexi Cap Fund - ULIF07917/11/21FLXCAPFUND116 0% 1.35% Very High
Sustainable Equity Fund - 0% 1.35% Very High
ULIF08017/11/21SUSEQUFUND116
Small Cap Fund - 0% 1.35% Very High
ULIF08717/01/23SMALLCAPFU116
Dynamic Asset Allocation Fund - 0% 1.35% High
ULIF08617/01/23DYNASALLOC116
Individual Short Term Debt Fund - 0% 0.95% Moderate
ULIF08817/01/23INDSTRMDBT116
Midcap Index Fund - 0% 1.35% Very High
ULIF08919/10/23MIDCPINDFD116
Smallcap Quality Index Fund - 0% 1.35% Very High
ULIF09103/01/24SMCPQYINDF116
Nifty Alpha 50 Index Fund - 0% 1.35% Very High
ULIF09221/05/24NYAPA50IND116
Nifty 200 Alpha 30 Index Fund - 0% 1.35% Very High
ULIF09321/05/24N200AP30IN116
Nifty 200 Momentum 30 Index Fund - 0% 1.35% Very High
ULIF09429/10/24N200MO30IN116
Nifty 500 Multicap Momentum Quality 50 Index 0% 1.35% Very High
Fund - ULIF09527/12/24N500MM50IN116
Focused 25 Fund - 0% 1.35% Very High
ULIF09606/02/25FOCUSED25F116
Nifty 500 Multifactor 50 Index Fund - 0% 1.35% Very High
ULIF010302/06/25N500MF50IN116
BSE 500 Enhanced Value 50 Index Fund - 0% 1.35% Very High
ULIF010406/08/25B500EV50IN116

Product / Riders Details

Base Plan / Sum Policy Premium Premium Instalment Premium Instalment Premium
Rider Name of Product / Rider Option Chosen UIN Assured Term Payment Term Payment Mode Without GST GST Rate with GST
(Years) (Years)
Base Plan Bajaj Allianz Life Smart Wealth Not Applicable 116L201V04 20,00,000 10 5 Annual 2,00,000 18% on 2,00,000
Goal V Charges
Rider Bajaj Allianz Life Linked Accidental Death Benefit 116A057V01 60,00,000 10 5 Annual 7,124 18% on 8,406
Accident Protection Rider II Premium
Rider Bajaj Allianz Life Linked Accidental Total Permanent 116A057V01 20,00,000 10 5 Annual 1,444 18% on 1,704
Accident Protection Rider II Disability Benefit Premium
Rider Bajaj Allianz Life Linked New Critical 116A060V01 20,00,000 10 5 Annual 9,060 18% on 10,691
Critical Illness Benefit Rider Premium
Total 2,17,628 2,20,801

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 illustrations 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 dependent on a number of factors including future investment performance.
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 returns of 8% p.a. and 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 exclusive of taxes on the net yield. Please note that the mortality charges per

O.X
Quotation No : 60081478984

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.
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 breakup of the charges, and other values.

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Quotation No : 60081478984

Part A (Amount in Rupees)

At 4% p.a. Gross Investment Return At 8% p.a. Gross Investment Return

Policy Year Annualised Premium Mortality Charges Other Charges# GST Fund at End of Year Surrender Value Death Benefit Mortality Charges Other Charges# GST Fund at End of Year Surrender Value Death Benefit
1 2,00,000 2,464 15,925 3,310 1,85,579 1,79,579 20,00,000 2,459 15,962 3,316 1,92,820 1,86,820 20,00,000
2 2,00,000 2,363 17,717 3,614 3,76,551 3,71,551 20,00,000 2,343 17,862 3,637 3,98,887 3,93,887 20,00,000
3 2,00,000 2,235 19,561 3,923 5,73,100 5,69,100 20,00,000 2,184 19,893 3,974 6,19,152 6,15,152 20,00,000
4 2,00,000 2,060 15,527 3,166 7,82,723 7,80,723 20,00,000 1,958 16,134 3,257 8,62,224 8,60,224 20,00,000
5 2,00,000 1,840 17,551 3,490 9,98,564 9,98,564 20,00,000 1,660 18,531 3,634 11,22,179 11,22,179 20,00,000
6 0 1,955 15,588 3,158 10,17,399 10,17,399 20,00,000 1,669 17,007 3,362 11,89,063 11,89,063 20,00,000
7 0 2,088 15,769 3,214 10,36,609 10,36,609 20,00,000 1,669 17,666 3,480 12,60,490 12,60,490 20,00,000
8 0 2,238 15,954 3,275 10,56,184 10,56,184 20,00,000 1,653 18,370 3,604 13,36,792 13,36,792 20,00,000
9 0 2,411 16,141 3,339 10,76,109 10,76,109 20,00,000 1,615 19,122 3,733 14,18,325 14,18,325 20,00,000
10 0 2,608 16,332 3,409 11,34,631 11,34,631 20,00,000 1,546 19,926 3,865 15,44,974 15,44,974 20,00,000

# includes all charges other than mortality charge, See Part B for details
In the above illustration, it is assumed that the Premiums are paid at the beginning of the year and benefits are payable at the end of the year.

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

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

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

Part B

(Amount in Rupees)

Gross 8% Net 6.21 % Death Benefit

Yield Yield

Premium Annualised GST Policy Return of Mortality Charge Additions to the Fund Systematic Fund FMC Fund at Surrender Waiver Income
Policy Annualised Allocation Premium - Mortality (Excl Admin. Guarantee Other (Including (Loyalty Addition + Partial before Incl End of Lump of
Year Premium Premium
Charge Allocation Charge Charge on Charge Charge Charges* ROIBC,ROMBC,ROWC, if any) Fund Booster*) Withdrawal FMC GST Year Value Sum Premium Benefit
FMC) + Family Benefit including ROAC
1 2,00,000 12,000 1,88,000 2,459 2,991 2,160 0 0 0 0 0 1,94,947 2,126 1,92,820 1,86,820 20,00,000 0 0
2 2,00,000 12,000 1,88,000 2,343 2,970 2,160 0 0 0 0 0 4,03,256 4,369 3,98,887 3,93,887 20,00,000 0 0
3 2,00,000 12,000 1,88,000 2,184 2,942 2,160 0 0 0 0 0 6,25,918 6,765 6,19,152 6,15,152 20,00,000 0 0
4 2,00,000 6,000 1,94,000 1,958 1,821 2,160 0 0 0 0 0 8,71,634 9,410 8,62,224 8,60,224 20,00,000 0 0
5 2,00,000 6,000 1,94,000 1,660 1,768 2,160 0 0 0 0 0 11,34,417 12,238 11,22,179 11,22,179 20,00,000 0 0
6 0 0 0 1,669 1,380 6,000 0 0 0 0 0 12,02,051 12,989 11,89,063 11,89,063 20,00,000 0 0
7 0 0 0 1,669 1,380 6,000 0 0 0 0 0 12,74,257 13,766 12,60,490 12,60,490 20,00,000 0 0
8 0 0 0 1,653 1,378 6,000 0 0 0 0 0 13,51,389 14,597 13,36,792 13,36,792 20,00,000 0 0
9 0 0 0 1,615 1,371 6,000 0 0 0 0 0 14,33,809 15,484 14,18,325 14,18,325 20,00,000 0 0
10 0 0 0 1,546 1,358 6,000 0 0 18,755 20,735 0 15,21,916 16,432 15,44,974 15,44,974 20,00,000 0 0

(Amount in Rupees)

Gross 4% Death Benefit

Yield

Premium Annualised GST Policy Return of Mortality Charge Additions to the Fund Systematic Fund FMC Fund at Surrender Waiver Income
Policy Annualised Allocation Premium - Mortality (Excl Admin. Guarantee Other (Including (Loyalty Addition + Partial before Incl End of Lump of
Year Premium Premium
Charge Allocation Charge Charge on Charge Charge Charges* ROIBC,ROMBC,ROWC, if any) Fund Booster*) Withdrawal FMC GST Year Value Sum Premium Benefit
FMC) + Family Benefit including ROAC
1 2,00,000 12,000 1,88,000 2,464 2,992 2,160 0 0 0 0 0 1,87,662 2,083 1,85,579 1,79,579 20,00,000 0 0
2 2,00,000 12,000 1,88,000 2,363 2,974 2,160 0 0 0 0 0 3,80,748 4,197 3,76,551 3,71,551 20,00,000 0 0
3 2,00,000 12,000 1,88,000 2,235 2,951 2,160 0 0 0 0 0 5,79,473 6,373 5,73,100 5,69,100 20,00,000 0 0
4 2,00,000 6,000 1,94,000 2,060 1,840 2,160 0 0 0 0 0 7,91,416 8,693 7,82,723 7,80,723 20,00,000 0 0
5 2,00,000 6,000 1,94,000 1,840 1,800 2,160 0 0 0 0 0 10,09,646 11,082 9,98,564 9,98,564 20,00,000 0 0
6 0 0 0 1,955 1,432 6,000 0 0 0 0 0 10,28,713 11,314 10,17,399 10,17,399 20,00,000 0 0
7 0 0 0 2,088 1,456 6,000 0 0 0 0 0 10,48,136 11,527 10,36,609 10,36,609 20,00,000 0 0
8 0 0 0 2,238 1,483 6,000 0 0 0 0 0 10,67,929 11,745 10,56,184 10,56,184 20,00,000 0 0
9 0 0 0 2,411 1,514 6,000 0 0 0 0 0 10,88,076 11,967 10,76,109 10,76,109 20,00,000 0 0
10 0 0 0 2,608 1,549 6,000 0 0 22,262 16,006 0 11,08,556 12,192 11,34,631 11,34,631 20,00,000 0 0

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Quotation No : 60081478984

Family Benefit
Benefit @8% Benefit @4%
Fund value at the end of year-with family benefit 15,51,885 11,39,966
Fund value at the end of year-without family benefit 15,44,974 11,34,631

In the above illustration, it is assumed that the Premiums are paid at the beginning of the year and benefits are payable at the end of the year.
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. In case rider charges are collected explicitly through collec on of rider premium, and not by way of cancella on of units, then such charges are not considered in this illustra on. In other cases, rider charges are
included in other charges.
4. Other charges include morbidity (applicable to Child Wealth Variant) & rider charges, if any.

I, ______ _____, have explained the premiums, charges and benefits under the policy fully to I, Valued Customer,
the prospect / policyholder.
have understood the above statements before entering into the contract.

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

Notes: Bajaj Allianz Life Smart Wealth Goal V Variant-(Wealth):

1. Please consult our 'Insurance Consultant' for any clarifications on this illustration.
2. Unit Linked Life Insurance Products are different from the traditional insurance products and are subject to the risk factors.
3. All benefits payable under the Policy are subject to the tax laws and other financial enactments, as they exist from time to time.
4. The Regular Premium and Top Up Premium, if any, paid is subject to investment risks associated with capital markets and Unit Prices may go up and down based on the performance of the underlying assets in
the Funds and the factors influencing the Capital market and the Life Assured/ Policyholder is responsible for his/ her decisions.
5. Bajaj Allianz Life Insurance is the name of the company & Bajaj Allianz Life Smart Wealth Goal V is only the name of the Insurance Plan (Variant-Wealth) and does in no way indicate the quality of the policy, its
future prospects or returns.
6. On death of the life assured, Higher of (Prevailing Sum Assured or Regular Premium Fund Value) plus Higher of (Top up Sum Assured or Top up Premium Fund Value) is payable, provided all due premiums are
paid up to date
The total death benefit shall be at least the Guaranteed Benefit of 105% of Total premiums paid
7. Loyality Additions (LAs) : will be added into the fund, provided all due premiums under the policy are paid up to the date of each LA. The LAs available in the product are:
Return of Premium Alloca on Charge (ROAC): At the end of the 15th policy year or on the maturity date of the policy, whichever is earlier, the total of all the premium alloca on charges w.r.t.
regular/limited/single premium/s deducted under the policy will be added into the fund.
Fund Boosters (FBs) : At the end of 10 policy year and every 5 policy year therea er ll 60 policy year (as applicable in the policy), FB as a %- age of the average of the daily Regular Premium Fund Values
or the average of the daily Single Premium Fund Values during the previous 3 years (including the current year). The applicable %-ages are given in the table below.
End of Policy 10th year th
Year 15 year 20th year 25th year 30th year 35th year 40th year 45th year 50th year 55th year 60th year
FB %-ages 1.5% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00%
There will not be any Loyalty Benefits w.r.t. any Top-Up premiums paid or any Top-up Premium Fund Value.
8. Return Of Mortality Charge (ROMC): Provided all premiums due under the policy are paid up to date, the total amount of all mortality charges deducted will be added to the Fund value on the date of
maturity.
9. The mortality charges & policy administration charges, if any, are deducted through cancellation of units.
The policy administration charge will be subject to maximum of Rs.500 in any month.
10. Fund Management Charge will be adjusted in the unit price. Fund Management charge would be 1.35% for Equity Growth Fund II, Accelerator Mid Cap Fund II, Pure Stock Fund, Flexi Cap Fund, Sustainable
Equity Fund, Small Cap Fund, Dynamic Asset Allocation Fund, Midcap Index Fund, SmallCap Quality Index Fund,Nifty Alpha 50 Index Fund,Nifty 200 Alpha 30 Index Fund,Nifty 200 Momentum 30 Index Fund,Nifty
500 Multicap Momentum Quality 50 Index Fund, Focused 25 Fund, Nifty 500 Multifactor 50 Index Fund and BSE 500 Enhanced Value 50 Index Fund. 1.30% for Pure Stock Fund II. 1.25% for Asset Allocation Fund
II and Bluechip Equity Fund .0.95% for Liquid Fund and Bond Fund. 0.50% for Discontinuance Life Policy Fund.
11. Equity Growth Fund II,Accelerator Mid Cap Fund II , Pure Stock Fund , Asset Allocation Fund II,Bluechip Equity Fund , Liquid Fund , Bond Fund , Flexi CapFund , Sustainable Equity Fund , Pure Stock Fund II, Small
Cap Fund, Dynamic Asset Allocation Fund, Individual Short Term Debt Fund, Midcap Index Fund, SmallCap Quality Index Fund, Nifty Alpha 50 Index Fund,Nifty 200 Alpha 30 Index Fund,Nifty 200 Momentum 30
Index Fund,Nifty 500 Multicap Momentum Quality 50 Index Fund, Focused 25 Fund, Nifty 500 Multifactor 50 Index Fund and BSE 500 Enhanced Value 50 Index Fund are the name of the Funds being offered
currently with Bajaj Allianz Life Smart Wealth Goal V and in any manner does not indicate the quality of the Fund, their future prospects or returns.
12. Segregated Fund Identification Number (SFIN) of the funds offered with this product are given below:

Fund SFIN No.

Accelerator Mid Cap Fund II ULIF05206/01/10ACCMIDCA02116
Equity Growth Fund II ULIF05106/01/10EQTYGROW02116
Pure Stock Fund ULIF02721/07/06PURESTKFUN116
Pure Stock Fund II ULIF07709/01/17PURSTKFUN2116
Asset Allocation Fund II ULIF07205/12/13ASSETALL02116
Bluechip Equity Fund ULIF06026/10/10BLUECHIPEQ116
Liquid Fund ULIF02510/07/06LIQUIDFUND116
Bond Fund ULIF02610/07/06BONDFUNDLI116
Flexi Cap Fund ULIF07917/11/21FLXCAPFUND116
Sustainable Equity Fund ULIF08017/11/21SUSEQUFUND116
Small Cap Fund ULIF08717/01/23SMALLCAPFU116
Dynamic Asset Allocation Fund ULIF08617/01/23DYNASALLOC116
Individual Short Term Debt Fund ULIF08817/01/23INDSTRMDBT116
Midcap Index fund ULIF08919/10/23MIDCPINDFD116
SmallCap Quality Index fund ULIF09103/01/24SMCPQYINDF116
Discontinuance Life Policy Fund ULIF07026/03/13DISCONLIFE116
Nifty Alpha 50 Index Fund ULIF09221/05/24NYAPA50IND116
Nifty 200 Alpha 30 Index Fund ULIF09321/05/24N200AP30IN116
Nifty 200 Momentum 30 Index Fund ULIF09429/10/24N200MO30IN116
Nifty 500 Multicap Momentum Quality 50 Index Fund ULIF09527/12/24N500MM50IN116
Focused 25 Fund ULIF09606/02/25FOCUSED25F116
Nifty 500 Multifactor 50 Index Fund ULIF010302/06/25N500MF50IN116
BSE 500 Enhanced Value 50 Index Fund ULIF010406/08/25B500EV50IN116
13. The past performance of any of the funds of the company is not indicative of the future performance of the fund.
14. Discontinuance/ Surrender Charge as applicable under Regular/ Limited Premium Units in this policy is given below

O.X
Quotation No : 60081478984

Where the policy is discontinued Discontinuance charge for the policies having annualized Discontinuance charge for the policies having annualized
during the policy year premium up to Rs. 50000/- premium above Rs. 50000/-
1 Lower of 20% * (AP or FV) subject to maximum of Rs. 3,000 Lower of 6% * (AP or FV) subject to maximum of Rs. 6,000
2 Lower of 15% * (AP or FV) subject to maximum of Rs. 2,000 Lower of 4% * (AP or FV) subject to maximum of Rs. 5,000
3 Lower of 10% * (AP or FV) subject to maximum of Rs. 1,500 Lower of 3% * (AP or FV) subject to maximum of Rs. 4,000
4 Lower of 5% * (AP or FV) subject to maximum of Rs. 1,000 Lower of 2% * (AP or FV) subject to maximum of Rs. 2,000
5 & above Nil Nil
AP – Annualized Premium & FV – Regular Premium Fund Value
Discontinuance/ Surrender Charge as applicable under Single Premium Units in this policy is given below:

Where the policy is discontinued Maximum Discontinuance Charges for the policies having Maximum Discontinuance Charges for the policies having
during the policy year Single Premium up to Rs. 3,00,000/- Single Premium above Rs. 3,00,000/-
1 Lower of 2% * (SP or FV) subject to maximum of Rs. 3,000 Lower of 1% * (SP or FV) subject to maximum of Rs. 6,000
2 Lower of 1.5% * (SP or FV) subject to maximum of Rs. 2,000 Lower of 0.7% * (SP or FV) subject to maximum of Rs. 5,000
3 Lower of 1% * (SP or FV) subject to maximum of Rs. 1,500 Lower of 0.5% * (SP or FV) subject to maximum of Rs. 4,000
4 Lower of 0.5% * (SP or FV) subject to maximum of Rs. 1,000 Lower of 0.35% * (SP or FV) subject to maximum of Rs. 2,000
5 & above Nil Nil
SP – Single Premium & FV – Single Premium Fund Value
15. The policyholder may, at any time, surrender the policy. On surrender during the lock-in period, fund value, less the applicable discontinuance/surrender charge as on the date of surrender, will be transferred to
the Discon nued Life Policy Fund, and all risk cover will be terminated immediately. The op on to revive the policy will not be available to such a surrendered policy. The discon nuance charge will be applicable
only to the Regular Premium Fund Value.
16. There is no surrender charge on surrender of Top Up Premium Units.
17. Indicated Surrender value is not guaranteed.
18. Charges under the policy are subject to applicable Goods & Service Tax, and will be deducted by cancellation of units.
19. Addition to the Fund implies Loyalty Benefits as mentioned in 7 above.
20. The rate of return illustrated for various funds are shown at 4% and 8% in confirmation with the guidelines on illustrations set by the IRDA, and should not be construed as forecast.
21. Returns demonstrated are net of all charges.
22. Please refer to the product sales literature for details about the product including the exclusions under the plan.
23. Insurance is a subject matter of solicitation.
24. Option of Systematic Partial Withdrawal, shall be triggered based on the start year, withdrawal amount / percentage and the frequency specified by you.
The value of the payments will depend on the number of units and respec ve fund NAVs on the date of payment. You may change or terminate systema c par al withdrawals at any point of
time in future. Withdrawals shall be as per the terms and conditions of the policy.

Bajaj Allianz Life Insurance Co. Ltd.,

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg No.: 116.
Tel: (020) 66026777.
Email: customercare@bajajallianz.co.in
www.bajajallianzlife.com

O.X
 CUSTOMER INFORMATION SHEET / KNOW Y OUR POLICY.

This document provides key information about your policy. You are also advised to go through your policy
document.
We request you to kindly review the CIS and acknowledge the same through a link shared to you on your
registered mobile number/Email ID/WhatsApp.

Policy
Sr. Description in Simple Words
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
Name of the
Insurance Bajaj Allianz Life Smart Wealth Goal V
Product and Policy
1 UIN - 116L201V04
Unique Schedule
Identification Variant: Wealth
Number (UIN)
Quotation
2 60081478984
number
Type of
3 Insurance Linked
Policy
Installment Premium (Rs)*: 2,17,628
Mode of Premium Payment: Annual
Sum Assured on Death (Rs): 20,00,000
Basic Policy Sum Assured on Maturity (Rs): Not Applicable Policy
4 Premium Payment Term (Years): 5
Details Schedule
Policy Term (Years): 10

*Instalment Premium includes Rider Premium, if opted but excludes

applicable GST & cess and Extra Premium (if any)
Benefits payable on maturity: Part C

Fund Value Section 5

Benefits payable on death:

Higher of Prevailing Sum Assured or Regular Premium Fund Value/ Single

Premium Fund Value
Part C
Plus
Section 5
Higher of Top-up Sum Assured or Top-up Premium Fund Value

The Death Benefit is subject to the Guaranteed Death Benefit of 105% of

the Total Premiums paid, till the date of death.
Part D
Survival Benefits excluding that payable on maturity: Not Applicable Section
Policy 11
5 Coverage/ben
efits payable
 Surrender benefits:
Part D
During the first 5 policy year: Discontinuance value at the end of the
lock-in period will be payable as surrender value. Section 9
After first 5 policy year: Fund value as on the date of surrender.
Options to policyholders for availing benefits, if any, covered under
Part D
the policy:
Section
Policy holder / Claimant can opt to take maturity benefit and death benefit in
11
form of installments spread over a period of 5 years under Settlement option
Other benefits/options payable, specific to the policy, if any: Not
-
Applicable
Part B
Lock-in period for Linked Insurance products: Five (5) Years
Section 1
Partial Withdrawal (Non- Systematic)- Available
Top-up premium- Available
Switch Funds - Available
Settlement Option - Available
Change Premium Paying Term (Applicable only for Regular
Options premium version)– Available
available (in Systematic partial withdrawal- Available Part D
6 case of Linked Decrease sum assured (Applicable only for a Top up Sum
Assured) - Available Section
Insurance 11
Products) Reduce Regular premium - Available
Premium Apportionment (Only if investor selectable strategy is
selected)- Available
Change Premium Payment Frequency: Available
Switch Portfolio strategies: Available

Option
available(in
7 case of NA
Annuity
product)
 Sum Assured
Rider Name Rider Benefit UIN
(Rs.)
Bajaj Allianz Life
Linked Accidental
Linked Accident 116A057V01 ₹60,00,000
Death Benefit
Protection Rider II
Bajaj Allianz Life Linked Accidental
Riders Opted if Linked Accident Total Permanent 116A057V01 ₹20,00,000 Policy
8
Any Protection Rider II Disability Benefit Schedule

Bajaj Allianz Life

Linked New Critical - 116A060V01 ₹20,00,000
Illness Benefit Rider

For details on the rider, please refer the customer information sheet of the
respective rider.
Suicide claim provision: In case of death due to suicide within 12 months
Exclusions from the Date of Commencement of Risk or from the date of latest revival of
(events where the Policy, whichever is later, the Claimant shall be entitled to the Fund Part F
insurance Value, as available on the date of intimation of death.
9 Section
coverage is
not payable), if There is no other exclusion applicable w.r.t death other than suicide clause. 21
any
No other exclusions in the product
Waiting
10 Period/ /lien Not Applicable
Period, if any

Thirty (30) days for premium payment frequencies other than monthly and Part B
11 Grace Period
fifteen (15) days for monthly frequency. Section 1

Free Look Part D

12 Thirty (30) Days
Period Section 6
Lapse

If premiums have not been paid

Part D
During the first five (5) policy years: Policy will be converted to a
discontinued life policy at the end of the grace period Section 7

After first five (5) policy years: Policy will be, immediately & automatically,
converted to a paid-up policy at the end of the grace period.
Lapse, paid-up
13 and Revival of Paid-up
the Policy Part D
If premiums have not been paid

After the lock-in period, Policy will be, immediately & automatically, Section 7
converted to a paid-up policy at the end of the grace period
Revival (Only Applicable for policies with Regular Premium payment) Part D

Three (3) years from the date of first unpaid premium Section 8
 Policy Loan If
14 Not Applicable
Applicable
1. Turn Around Time (TAT) for claims settlement and brief
procedure:
Link for Brief Procedure :

https://www.bajajallianzlife.com/life-insurance-claim-
assistance.html

Link for Turn Around Time (TAT) for claims settlement:

https://www.bajajallianzlife.com/content/dam/balic-
web/pdf/customer-services/services-

2. Helpline/Call Centre Numbers:

Claims / Part F
1800-209-7272 (Toll Free)
15 Claims Mail Us : customercare@bajajallianz.co.in Section
Procedure 33
3. Contact details of the insurer:

Bajaj Allianz Life Insurance Company Limited

House, Ground Floor, Bajaj Allianz, Airport Rd, Yerawada, Pune,

Maharashtra 411006

4. Link for downloading claim form and list of documents required

including bank account details:

https://www.bajajallianzlife.com/life-insurance-claim-assistance.html

WhatsApp- 8806727272

Turn Around Time (TAT):

https://www.bajajallianzlife.com/content/dam/balic-web/pdf/customer-
services/services-tat.pdf

Helpline/Call Centre number: 1800 209 7272

Contact details of the insurer: In case you have any query, you may
communicate with the Company:
Part G
Policy 1. By post at: Customer Care Desk, Bajaj Allianz Life Insurance Company
16 Ltd., Bajaj Allianz House, 5th floor, Airport Road, Yerawada, Pune – Section
Servicing
411006 36
2. By Email: customercare@bajajallianz.co.in

Link for downloading applicable form and list of documents required

including bank account details:

https://bajajallianzlifeonline.co.in/online/portal/logon/serviceRequest.do?
user_name=WEBSITE&p_flag=0
 Contact details of Grievance Redressal Officer of the insurer:
Grievance Redressal Officer of the insurer - In case you do not receive a
response within 14 days or if you are not satisfied with the resolution, you
may approach Grievance Redressal Officer at gro@bajajallianz.co.in

Link for registering the grievance with the insurer’s portal:Insurance

company grievance portal - Part G

Grievances https://webpartner.bajajallianz.com/GrvOnlineApi/indexOnlineGrv.jsp#_ga=2 Section

17 36 and
/Complaints .7272630.541013491.1717475077-
1601763320.1694668355&_gac=1.52751388.1715749803.EAIaIQobChMIy Section
_eqivKOhgMVdWsPAh0NFQrEEAAYASAAEgJObPD_BwE 37

Contact details of Ombudsman: Find your nearest Ombudsman office at

http://www.cioins.co.in/ombudsman
 Declaration by the policyholder

I have read the above and confirm having noted the details
Place:
Date: (Signature of the Policy Holder)

Web-link for the product where sample policy document can be downloaded:
https://www.bajajallianzlife.com/ulip-plans/smart-wealth-goal.html
Disclaimer:
In case of conflict in the content mentioned hereinabove, the terms and conditions mentioned in the policy
document shall prevail.
 CUSTOMER INFORMATION SHEET / KNOW Y OUR POLICY.

This document provides key information about your policy. You are also advised to go through your policy
document.
We request you to kindly review the CIS and acknowledge the same through a link shared to you on your
registered mobile number/Email ID/WhatsApp.

Policy
Sr. Description in Simple Words
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
Name of Bajaj Allianz Life Linked Accident Protection Rider II Policy
1 Insurance
Schedule
Product/ Policy (UIN - 116A057V01)
Quotation Policy
2 60081478984
number Schedule
Type of As per
Benefit (Where an Insurance Policy pays a fixed amount under the policy on
3 Insurance base
the occurrence of a covered event)
Product/ Policy policy
Benefit Option Sum Assured (Rs.)
Accidental Death benefit (ADB) / Accidental Death benefit ₹ 60,00,000
Sum Insured (ADB) with ROP
Accidental Total Permanent Disability (ATPD) / Accidental Policy
4 (Basis) (Along Total Permanent Disability (ATPD) with ROP
₹ 20,00,000
Schedule
with amount) Maturity Benefit (In case Accidental Death benefit with ROP
and / or Accidental Total Permanent Disability with ROP Not Applicable
variant is opted)
The rider has the following options to choose from:

1. Accidental Death benefit (ADB) / Accidental Death benefit (ADB)

Part C –
with ROP: In the event of death due to an accident, higher of
Section
Guaranteed Benefit (i.e. 105% of Total Premiums Paid) or ADB Sum
3
Assured will be paid as a lumpsum and the ADB benefit will terminate.

2. Accidental Total Permanent Disability (ATPD) / Accidental Total

Policy Permanent Disability (ATPD) with ROP: In the event of Total Permanent Part C –
Coverage Disability of the Life Assured due to an accident, higher of Guaranteed Section
(What the Benefit (i.e. 105% of Total Premiums Paid) or ATPD Sum Assured will be 3
5 paid as a lumpsum and the ATPD benefit will terminate.
policy covers)
(Policy Clause In case Accidental Death benefit (ADB) with ROP and / or Accidental
Number/s) Total Permanent Disability (ATPD) with ROP variant is opted) – Total Part C –
Premiums paid under the Rider will be paid out on the Rider Maturity Date, Section
provided the Rider is in-force. The Rider will terminate immediately & 3
automatically on payment of the Maturity Benefit.
 Accidental Death Benefit & Accidental Death Benefit with ROP

i)Death occurs as a result of the Rider Life Assured committing any breach
of law with criminal intent.

ii) Death as a consequence of the Rider Life Assured being under the
influence of alcohol or drugs other than in accordance with the directions of
a registered medical practitioner.

iii) Death as a result of self-inflicted injuries.

iv) Death occurs as a result of the Rider Life Assured taking part in any
naval, military or air force operation during peace time.

v) Death occurs as a result of the Rider Life Assured participating in or

training for any dangerous or hazardous sport or competition or riding or
driving in any form of race or competition.

vi) Death occurs as a result of suicide.

Part D –
vii) Death occurs as a result of aviation, gliding or any form of aerial flight Section 5
other than as a fare paying passenger of a recognised airline on regular
routes and on a scheduled timetable.

viii) Death occurs as a result of war, invasion, civil war, rebellion, riots.

ix) Poison, gas or fumes (voluntary or involuntarily, accidentally or otherwise

taken, administered, absorbed or inhaled).

x) Service in the armed forces, or any police organization, of any country at

war or service in any force of an international body.

xi) Nuclear Contamination: the radioactive, explosive or hazardous nature of

nuclear fuel materials or property contaminated by nuclear fuel materials or
accident arising from such nature.

xii) Death as a result of any disease or infection.

Exclusions
(what the
6 policy does not Accidental Total Permanent Disability Benefit & Accidental Total
cover) Permanent Disability Benefit with ROP

i) Disability as a result of the Rider Life Assured committing any breach of

law with criminal intent.

ii) Disability of Rider Life Assured as a result of war, invasion, civil war,
rebellion or riot.

iii) Disability as a consequence of the Rider Life Assured being under the
influence of alcohol or drugs other than drugs prescribed by and taken in
accordance with the directions of a registered medical practitioner.

iv) Disability as a result of the Rider Life Assured taking part in any naval,
military or air force operation.

v) Disability as a result of the Rider Life Assured participating in or training

for any dangerous or hazardous sport or competition or riding or driving in
any form of race or competition.

vi) Disability of Rider Life Assured as a result of aviation, gliding or any form
of aerial flight other than as a fare paying passenger on a civilian airline
plying on regular routes and according to a scheduled timetable.

vii) Disability of Rider Life Assured as a result of attempted self-injury.

Part D –
viii) Any condition that is pre-existing at the time of inception of the policy. Section 5
Pre-existing condition means any condition, ailment, injury or disease: -

a. That is/are diagnosed by a physician within 48 months prior to the Date

of Commencement of Rider Cover or latest revival, whichever is later, or

b. For which medical advice or treatment was recommended by, or received

from, a physician within 48 months prior to the Date of Commencement of
Rider Cover or latest revival, whichever is later.

This exclusion will not be applicable to conditions, ailments or injuries or

related condition(s) which are underwritten and

accepted by the insurer at inception or at reinstatement.

ix) Poison, gas or fumes (voluntary or involuntarily, accidentally or otherwise

taken, administered, absorbed or inhaled).

x) Service in the armed forces, or any police organization, of any country at

war or service in any force of an international body.

xi) Nuclear Contamination: the radioactive, explosive or hazardous nature of

nuclear fuel materials or property contaminated by nuclear fuel materials or
accident arising from such nature.

xii) Disability as a result of any disease or infection.

 Waiting Period
Time
period
during
which
specified
diseases /
treatment Not
7 s are not Not Applicable Applicabl
covered e
It is
counted
from the
beginning
of the
policy
coverage
 Financial limits
of coverage

i. Sub-limit (It is
a pre-defined
limit and the
insurance
company will
not pay any
amount in
excess of this
limit)

ii. Co-payment
(It is a
specified
amount/percen
tage of the
admissible
claim amount i) Sub limit – Not Applicable
to be paid by
policyholder/in ii) Co-payment – Not Applicable Not
8 sured) Applicabl
iii) Deductible – Not Applicable e
iii. Deductible
(It is a iv) Any other limit (as applicable) – Not Applicable
specified
amount: - up to
which an
insurance
company will
not pay any
claim, and -
which will be
deducted from
total claim
amount (if
claim amount
is more than
the specified
amount)
iv. Any other
limit (as
applicable)
 Turn Around Time (TAT) for claims settlement and brief procedure:

· Link for Brief Procedure: https://www.bajajallianzlife.com/life-

insurance-claim-assistance.html

· Link for Turn Around Time (TAT) for claims settlement:

https://www.bajajallianzlife.com/content/dam/balic/pdf/customer-
services/services-tat.pdf

Helpline/Call Centre Numbers:

Claims/ Claims Part F –
9 1800-209-7272 (Toll Free) Section
Procedure
Mail Us : customercare@bajajallianz.co.in 13

Contact details of the insurer: Bajaj Allianz Life Insurance Company

Limited House, Ground Floor, Bajaj Allianz, Airport Rd, Yerawada, Pune,
Maharashtra 411006

Link for downloading claim form and list of documents required

including bank account details: https://www.bajajallianzlife.com/life-
insurance-claim-assistance.html

Turn Around Time (TAT):

https://www.bajajallianzlife.com/content/dam/balic/pdf/customer-
services/services-tat.pdf

Helpline/Call Centre number: 1800 209 7272

Part G –
Contact details of the insurer: In case you have any query, you may
Policy As per
10 communicate with the Company:
Servicing Base
1. By post at: Customer Care Desk, Bajaj Allianz Life Insurance Company Policy
Ltd., Bajaj Allianz House, 5th floor, Airport Road, Yerawada, Pune – 411006

2. By Email: customercare@bajajallianz.co.in

Link for downloading applicable forms and list of documents required

including bank account details:
https://bajajallianzlifeonline.co.in/online/portal/logon/serviceRequest.do?
user_name=WEBSITE&p_flag=0
 Contact details of Grievance Redressal Officer of the insurer:
Grievance Redressal Officer of the insurer - In case you do not receive a
response within 14 days or if you are not satisfied with the resolution, you
may approach Grievance Redressal Officer at gro@bajajallianz.co.in

Link for registering the grievance with the insurer’s portal: Insurance Part G –
Grievances/Co company grievance portal As per
11 -https://webpartner.bajajallianz.com/GrvOnlineApi/indexOnlineGrv.jsp#_ga= Base
mplaints
2.7272630.541013491.1717475077- Policy
1601763320.1694668355&_gac=1.52751388.1715749803.EAIaIQobChMIy
_eqivKOhgMVdWsPAh0NFQrEEAAYASAAEgJObPD_BwE

Contact details of Ombudsman:

Find your nearest Ombudsman office at: http://www.cioins.co.in/ombudsman

Free look cancellation – 30 days
Policy Renewal – Not applicable Part D
Things to
12 Migration and Portability – Not applicable –Secti
remember
Change in sum insured – Not applicable on 7
Moratorium Period – Not applicable
Please disclose all pre-existing disease/s or condition/s before buying a
rider. Non-disclosure may affect the claim settlement. Disclosure of material
Your Proposal
13 information while applying for the rider and changes during the rider period
obligations form
should be communicated to Bajaj Allianz Life Insurance customer care ID via
registered email id of the customer.
 Declaration by the policyholder

I have read the above and confirm having noted the details
Place:
Date: (Signature of the Policy Holder)

Web-link for the product where sample policy document can be downloaded:
https://www.bajajallianzlife.com/content/balic/en/riders-insurance-plans.html/
Disclaimer:
In case of conflict in the content mentioned hereinabove, the terms and conditions mentioned in the policy
document shall prevail.
 CUSTOMER INFORMATION SHEET / KNOW Y OUR POLICY.

This document provides key information about your policy. You are also advised to go through your policy
document.
We request you to kindly review the CIS and acknowledge the same through a link shared to you on your
registered mobile number/Email ID/WhatsApp.

Policy
Sr. Description in Simple Words
Title Clause
No. (Please refer to applicable Policy Clause Number in next column)
Number
Name of Bajaj Allianz Life Linked New Critical Illness Benefit Rider Policy
1 Insurance
Schedule
Product/Policy (UIN - 116A060V01)
Quotation Policy
2 60081478984
number Schedule
Type of As per
Benefit (Where an Insurance Policy pays a fixed amount under the policy on
3 Insurance Base
the occurrence of a covered event)
Product/ Policy Policy
Sum Insured Option Sum Assured (Rs.) Policy
4 (Basis)(Along
with amount) Critical ₹ 20,00,000 Schedule

Policy
Coverage Critical Illness Benefit:
(What the Part C -
5
policy covers?) On first diagnosis of any one of the critical illness as mentioned in Policy Section 4
(Policy Clause document, the rider sum assured will be paid in lumpsum.
Number/s)
Suicide Clause

In case of death of base policy Life Assured due to suicide within 12 months
from the date of commencement of risk under the rider or from the date of Part D -
revival of the rider, as applicable, the nominee of the Policyholder shall be Section 5
entitled to 80% of the total Rider Premiums paid till the date of death or the
termination value available as on the date of death whichever is higher,
provided the rider is in force.
 Other Exclusions

i. There are no other exclusions if the Contingent Event is death.

ii. The critical illness benefit shall not be paid on any of the lives covered
in case of the following conditions:

If the diagnosis of such Critical Illness was made within 90 days of the
start of coverage (i.e. during the waiting period).
If the insured dies within the survival period as per definition from date
of the diagnosis of the covered CI.
Intentional self-inflicted injury, suicide or attempted suicide.
For any medical conditions suffered by the life assured or any medical
procedure undergone by the life assured, if that medical condition or
that medical procedure was caused directly or indirectly by influence of
Exclusions(wh
drugs, alcohol, narcotics or psychotropic substances unless taken in
at the policy
6 accordance with the lawful directions and prescriptions of a registered
does not
medical practitioner.
cover)
Engaging in or taking part in hazardous activities*, including but not
limited to, diving or riding or any kind of race; martial arts; hunting;
mountaineering; parachuting, bungee-jumping; under water activities
involving the use of breathing apparatus or not. Annexure
*Hazardous Activities mean any sport or pursuit or hobby, which is - K of
potentially dangerous to the Insured Member whether he is trained or Policy
not. Documen
Participation by the insured person in a criminal or unlawful act with t
criminal intent.
For any medical condition or any medical procedure arising from
nuclear contamination; the radioactive, explosive or hazardous nature
of nuclear fuel materials or property contaminated by nuclear fuel
materials or accident arising from such nature.
For any medical condition or any medical procedure arising either as a
result of war, invasion, act of foreign enemy, hostilities (whether war be
declared or not), armed or unarmed truce, civil war, mutiny, rebellion,
revolution, insurrection, terrorism, military or usurped power, riot or civil
commotion, strikes or participation in any naval, military or air force
operation during peace time.
For any medical condition or any medical procedure arising from
participation by the insured person in any flying activity, except as a
bona fide, fare paying passenger and aviation industry employee like
pilot or cabin crew of a recognized airline on regular routes and on a
scheduled timetable.
Any External Congenital Anomaly which is not as a consequence of
Genetic disorder.
Failure to follow medical advice.
 Waiting Period
Time
period
during
which
specified
diseases/t
reatments Part C –
90 days from date of commencement of risk of rider or from the latest date
7 are not
of revival. Section 4
covered
It is
counted
from the
beginning
of the
policy
coverage
 Financial limits
of coverage

i)Sub-limit (It is
a pre-defined
limit and the
insurance
company will
not pay any
amount in
excess of this
limit)

ii)Co-payment
(It is a
specified
amount/percen
tage of the
admissible
claim amount
to be paid by
policyholder/in i. Sub limit – Not Applicable
sured) ii. Co-payment – Not Applicable Not
8 iii. Deductible – Not Applicable Applicabl
iii)Deductible iv. Any other limit (as applicable) – Not Applicable e
(It is a
specified
amount:

- Up to which
an insurance
company will
not pay any
claim, and

- Which will be
deducted from
total claim
amount (if
claim amount
is more than
the specified
amount)

iv) Any other

limit (as
applicable)
 1. Turn Around Time (TAT) for claims settlement and brief
procedure:
Link for Brief Procedure : https://www.bajajallianzlife.com/life-
insurance-claim-assistance.html
Link for Turn Around Time (TAT) for claims settlement:
https://www.bajajallianzlife.com/content/dam/balic/pdf/customer-
services/services-tat.pdf
2. Helpline/Call Centre Numbers:

1800-209-7272 (Toll Free)

Part F -
Claims/Claims Mail Us : customercare@bajajallianz.co.in
9 Section
Procedure
3. Contact details of the insurer:
15
Bajaj Allianz Life Insurance Company Limited

House, Ground Floor, Bajaj Allianz, Airport Rd, Yerawada, Pune,

Maharashtra 411006

4. Link for downloading claim form and list of documents required

including bank account details:

https://www.bajajallianzlife.com/life-insurance-claim-assistance.html

WhatsApp- 8806727272

Turn Around Time (TAT):

https://www.bajajallianzlife.com/content/dam/balic/pdf/customer-
services/services-tat.pdf

Helpline/Call Centre number: 1800 209 7272

Contact details of the insurer: In case you have any query, you may Part G –
Policy communicate with the Company: As per
10
Servicing base
1. By post at: Customer Care Desk, Bajaj Allianz Life Insurance
policy
Company Ltd., Bajaj Allianz House, 5th floor, Airport Road, Yerawada,
Pune – 411006

2. By Email: customercare@bajajallianz.co.in

Link for downloading applicable forms and list of documents required

including bank account details
: https://bajajallianzlifeonline.co.in/online/portal/logon/serviceRequest.do?
user_name=WEBSITE&p_flag=0
 Contact details of Grievance Redressal Officer of the
insurer: Grievance Redressal Officer of the insurer - In case you do not
receive a response within 14 days or if you are not satisfied with the
resolution, you may approach Grievance Redressal Officer
at gro@bajajallianz.co.in
Part G-
Link for registering the grievance with the insurer’s
Grievances/Co As per
11 portal: Insurance company grievance portal
mplaints Base
- https://webpartner.bajajallianz.com/GrvOnlineApi/indexOnlineGrv.jsp#_g
Policy
a=2.7272630.541013491.1717475077-
1601763320.1694668355&_gac=1.52751388.1715749803.EAIaIQobChM
Iy_eqivKOhgMVdWsPAh0NFQrEEAAYASAAEgJObPD_BwE

Contact details of Ombudsman: Find your nearest Ombudsman office

at http://www.cioins.co.in/ombudsman
Free look cancellation - 30 days
Policy Renewal - Not applicable Part D –
Things to
12 Migration and Portability - Not applicable Section
remember
Change in sum insured - Not applicable 7
Moratorium Period - Not applicable
Please disclose all pre-existing disease/s or condition/s before buying a
rider. Non-disclosure may affect the claim settlement.
Your Proposal
13 Disclosure of material information while applying for the rider and changes
obligations form
during the rider period should be communicated to Bajaj Allianz Life
Insurance customer care ID via registered email id of the customer.
 Declaration by the policyholder

I have read the above and confirm having noted the details
Place:
Date: (Signature of the Policy Holder)

Web-link for the product where sample policy document can be downloaded:
https://www.bajajallianzlife.com/riders-insurance-plans.html
Disclaimer:
In case of conflict in the content mentioned hereinabove, the terms and conditions mentioned in the policy
document shall prevail.