HDFC

1. Personal Details
Name of Prospect / Policyholder Mr Abdul matheen
Age 41
Name of Life Assured Mr Abdul matheen
Age 41
Policy Term 37
Premium Payment Term 12
Amount of Installment Premium 200000
Mode of Premium of Payment Annual
Proposal No.
Name of the Product: HDFC Life Smart Income Plan
Tag Line: A non-linked, participating individual life
insurance Savings Plan
Unique Identification Number: 101N166V01
GST Rate 1st year: 4.5%, 2nd year onwards: 2.25%
80002685854
HDFC Life Smart Income Plan - Benefit Illustration
A non-linked, participating individual life insurance Savings Plan
Dear Abdul matheen
Thank you for showing interest in HDFC Life Insurance. Based upon the inputs shared by you, we are happy to provide a detailed benefit illustration for the plan chosen by you.
How to read and understand this benefit illustration?
This benefit illustration is intented to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a.
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.
Policy Details
Survival Benefit Option Enhanced Income Basic Sum Assured 15,99,699
Guaranteed Income Payout Mode Annual Sum Assured on Death (at inception of the policy)
Rs.
20,00,000
Bonus Type Simple Reversionary Income Bonus
Premium Summary
Base Plan Riders Total Installment Premium
Instalment Premium without GST 2,00,000 0 2,00,000
Date of Illustration : 02 / 01 / 2023
Quotation No

2. Instalment Premium with First Year GST 2,09,000 0 2,09,000
Instalment Premium with GST 2nd Year onwards 2,04,500 0 2,04,500
Premium Summary
(Amounts in Rupees)
(Amount in Rs.)
Policy
Year
Annualized
Premium
Guaranteed Benefits Non-Guaranteed Benefits @ 4% p.a. Non-Guaranteed Benefits @ 8% p.a.
Total Benefits Including Guaranteed and Non-Guaranteed Benefit
Survival / Maturity Benefit Death Benefit
Survival
Benefit
Surrender
Benefit
Death
Benefit
Maturity
Benefit
Simple
Reversionary
Income Bonus
Cash
Bonus
Surrender
Benefit
Simple
Reversionary
Income Bonus
Cash
Bonus
Surrender
Benefit
Total Survival / Maturity
Benefit incl Terminal
Bonus, if any @ 4%
Total Survival / Maturity
Benefit incl Terminal
Bonus, if any @ 8%
Total Death Benefit
incl of Terminal Bonus,
if any @ 4%
Total Death Benefit incl
of Terminal Bonus, if
any @ 8%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 2,00,000 0 0 20,00,000 0 0 NA 0 87,983 NA 0 0 0 20,00,000 20,87,983
2 2,00,000 0 1,20,000 20,00,000 0 0 NA 1,52,131 1,75,967 NA 1,68,866 0 0 20,00,000 21,75,967
3 2,00,000 0 2,10,000 20,00,000 0 0 NA 2,82,667 2,63,950 NA 3,29,307 0 0 20,00,000 22,63,950
4 2,00,000 0 4,00,000 20,00,000 0 0 NA 4,21,041 3,51,934 NA 5,13,670 0 0 20,00,000 23,51,934
5 2,00,000 0 5,00,000 20,00,000 0 0 NA 5,64,534 4,39,917 NA 7,19,781 0 0 20,00,000 24,39,917
6 2,00,000 0 6,00,000 20,00,000 0 0 NA 7,14,266 5,27,901 NA 9,49,973 0 0 20,00,000 25,27,901
7 2,00,000 0 7,00,000 20,00,000 0 0 NA 8,70,876 6,15,884 NA 12,06,163 0 0 20,00,000 26,15,884
8 2,00,000 0 8,00,000 20,00,000 0 0 NA 10,35,325 7,03,868 NA 14,90,868 0 0 20,00,000 27,03,868
9 2,00,000 0 9,90,000 20,00,000 0 0 NA 12,08,573 7,91,851 NA 18,06,816 0 0 20,00,000 27,91,851
10 2,00,000 0 11,00,000 21,00,000 0 0 NA 13,91,418 8,79,834 NA 21,56,698 0 0 21,00,000 29,79,834
11 2,00,000 0 12,10,000 23,10,000 0 0 NA 15,84,502 9,67,818 NA 25,43,125 0 0 23,10,000 32,77,818
12 2,00,000 0 13,20,000 25,20,000 0 0 NA 17,88,943 10,55,801 NA 29,69,646 0 0 25,20,000 38,63,747
13 0 0 14,40,000 25,20,000 0 0 NA 18,50,052 11,43,785 NA 31,72,839 0 0 25,20,000 39,75,726
14 0 1,59,970 12,80,030 25,20,000 0 0 NA 18,47,332 12,31,768 NA 31,68,175 1,59,970 2,47,953 25,20,000 40,87,705
15 0 1,59,970 11,20,060 25,20,000 0 0 NA 18,43,973 12,31,768 NA 31,62,414 1,59,970 2,47,953 25,20,000 41,11,701
16 0 1,59,970 9,60,090 25,20,000 0 0 NA 18,40,134 12,31,768 NA 31,55,829 1,59,970 2,47,953 25,20,000 41,35,696
17 0 1,59,970 9,20,120 25,20,000 0 0 NA 18,35,495 12,31,768 NA 31,47,873 1,59,970 2,47,953 25,20,000 41,59,691
18 0 1,59,970 7,60,151 25,20,000 0 0 NA 18,30,056 12,31,768 NA 31,38,545 1,59,970 2,47,953 25,20,000 41,83,687
19 0 1,59,970 6,00,181 25,20,000 0 0 NA 18,23,657 12,31,768 NA 31,27,572 1,59,970 2,47,953 25,20,000 42,07,682
20 0 1,59,970 5,60,211 25,20,000 0 0 NA 18,16,138 12,31,768 NA 31,14,677 1,59,970 2,47,953 25,20,000 42,31,678
21 0 1,59,970 4,00,241 25,20,000 0 0 NA 18,07,500 12,31,768 NA 30,99,862 1,59,970 2,47,953 25,20,000 42,55,673
22 0 1,59,970 2,40,271 25,20,000 0 0 NA 17,97,582 12,31,768 NA 30,82,853 1,59,970 2,47,953 25,20,000 42,79,669
23 0 1,59,970 80,301 25,20,000 0 0 NA 17,86,064 12,31,768 NA 30,63,100 1,59,970 2,47,953 25,20,000 43,03,664
24 0 1,59,970 40,331 25,20,000 0 0 NA 17,72,946 12,31,768 NA 30,40,603 1,59,970 2,47,953 25,20,000 43,27,660
Quotation No

3. 25 0 1,59,970 0 25,20,000 0 0 NA 17,57,589 12,31,768 NA 30,14,266 1,59,970 2,47,953 25,20,000 43,51,655
26 0 1,59,970 0 25,20,000 0 0 NA 17,39,833 12,31,768 NA 29,83,813 1,59,970 2,47,953 25,20,000 43,75,651
27 0 1,59,970 0 25,20,000 0 0 NA 17,19,037 12,31,768 NA 29,48,148 1,59,970 2,47,953 25,20,000 43,99,646
28 0 1,59,970 0 25,20,000 0 0 NA 16,95,041 12,31,768 NA 29,06,995 1,59,970 2,47,953 25,20,000 44,23,642
29 0 1,59,970 0 25,20,000 0 0 NA 16,67,206 12,31,768 NA 28,59,259 1,59,970 2,47,953 25,20,000 44,47,637
30 0 1,59,970 0 25,20,000 0 0 NA 16,35,052 12,31,768 NA 28,04,115 1,59,970 2,47,953 25,20,000 44,71,633
31 0 1,59,970 0 25,20,000 0 0 NA 15,81,462 12,31,768 NA 27,12,208 1,59,970 2,47,953 25,20,000 44,95,628
32 0 1,59,970 0 25,20,000 0 0 NA 15,20,834 12,31,768 NA 26,08,230 1,59,970 2,47,953 25,20,000 45,19,624
33 0 1,59,970 0 25,20,000 0 0 NA 14,52,367 12,31,768 NA 24,90,809 1,59,970 2,47,953 25,20,000 45,43,619
34 0 1,59,970 0 25,20,000 0 0 NA 13,74,461 12,31,768 NA 23,57,201 1,59,970 2,47,953 25,20,000 45,67,615
35 0 1,59,970 0 25,20,000 0 0 NA 12,85,678 12,31,768 NA 22,04,938 1,59,970 2,47,953 25,20,000 45,91,610
36 0 1,59,970 0 25,20,000 0 0 NA 11,84,097 12,31,768 NA 20,30,727 1,59,970 2,47,953 25,20,000 46,15,606
37 0 0 0 25,20,000 1,59,970 0 NA 0 12,31,768 NA 0 1,59,970 22,79,571 25,20,000 46,39,601
(Amounts in Rupees)
(Amount in Rs.)
Policy
Year
Annualized
Premium
Guaranteed Benefits Non-Guaranteed Benefits @ 4% p.a. Non-Guaranteed Benefits @ 8% p.a.
Total Benefits Including Guaranteed and Non-Guaranteed Benefit
Survival / Maturity Benefit Death Benefit
Survival
Benefit
Surrender
Benefit
Death
Benefit
Maturity
Benefit
Simple
Reversionary
Income Bonus
Cash
Bonus
Surrender
Benefit
Simple
Reversionary
Income Bonus
Cash
Bonus
Surrender
Benefit
Total Survival / Maturity
Benefit incl Terminal
Bonus, if any @ 4%
Total Survival / Maturity
Benefit incl Terminal
Bonus, if any @ 8%
Total Death Benefit
incl of Terminal Bonus,
if any @ 4%
Total Death Benefit incl
of Terminal Bonus, if
any @ 8%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Notes:
1. Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any and Goods and Service Tax.
2. Refer Sales Literature for explanation of terms used in this Illustration.
3. NA refers to Not Applicable
I, ___________________________ (name), have explained the premiums and benefits under the
policy fully to the prospect / policyholder.
Date:
Place:
Signature of Agent/ Intermediary/ Official
I, ___________________________ (name), having received the informa on with respect to the
above, have understood the above statement before entering into the contract.
Date: Signature of Prospect / Policyholder
Quotation No

4. Customer Acknowledgement Copy (Assignment/Reassignment form)
Branch Stamp
For queries or more information, call us on 1860-267-9999 (Local charges apply) | 022-68446530 (STD charges apply). Available Mon-Sat from 10 am to 7 pm. DO NOT prefix any country code e.g. +91 or 00.
Email – service@hdfclife.com | nriservice@hdfclife.com (For NRI customers only) Visit – www.hdfclife.com
Customer Acknowledgement Copy (NACH MANDATE INSTRUCTION)
Application Number or Policy Number ________________________________________
Policyholder Name: __________________________________________ Customer Relations Officer: ______________________
Date D D M M Y Y Y Y
Note: 1. Request for activation of Auto Debit facility has to be submitted atleast 30 days prior to the next premium due date at the nearest HDFC Life branch.
2. Request for de-activation of Auto Debit facility has to be submitted atleast 15 days prior to the next premium due date at the nearest HDFC Life branch.

PSRF022312052111 | CANA
DECLARATION:
1. I/We hereby declare that the particulars given above are correct and complete. 2. I/We hereby declare that in case of a third party account holder, a KYC form of the account holder shall be
submitted. 3. I/We undertake to keep sufficient funds in the account mentioned in the mandate as on the date of execution of debit. 4. I/We hereby authorise the Bank/Tech Process Solutions Ltd/Bill
desk/any other intermediaries to communicate my/our funding account details (as may be necessary) to HDFC Life Insurance Company Limited for the specific purpose of recovering my/our HDFC
Life premium/EMI payments through a debit instruction to my/our account. 5. I/We hereby authorise HDFC Life, in the instance of the ECS/SI/DD/NACH failing for any reason, to authorise the
Bank/Tech Process Solutions Ltd/Bill desk to recover the premium/EMI payable through a direct debit to my/our account with the mentioned bank. 6. If the transaction is delayed or not effected at
all for reasons of incomplete or incorrect information, I will not hold HDFC Life, the Bank or the other Intermediaries responsible. 7. I/We agree that for changing the premium/EMI amount as per
my/our requirement, I/We will furnish a fresh mandate for such change in the premium/EMI amount, which will supersede all other mandates previously given. 8. I/We agree that in the event of
violation by me/us of any undertaking confirmed in the agreement herein, shall amount to an event of the terms of the Insurance Policy and HDFC Life shall be entitled to invoke the remedies available
to it in terms of the policy agreement. 9. I/We agree that in the event of the Bank being unable to debit my/our account for want of sufficient funds or for any other reason, HDFC Life shall be entitled
to deal with my policy in manner as described in the policy provisions, unless the payment is received by any alternative mode on or before the specified date. 10. I/We hereby authorise my/our Bank
to debit my/our account with the amount of service tax and other levies as may be stipulated by the Government, from time to time, on the premium/EMI stated above and for this purpose, no further
or revised authority is required by my/our Bank. 11. I/We hereby authorise that in the instance of a transaction failure towards an ECS request, HDFC Life can represent twice the transaction to
my/our account for realising this premium/EMI 12. I/We wish to avail the ECS/SI/DD/NACH facility and hereby express my unconditional consent to debit premium/EMI of my policy to above through
participation in Electronic Clearing System (ECS)/Direct Debit. I/We understand and agree that premium/EMI amount to be debited from my/our account may vary due to taxes and other statutory
levies as may be applicable from time to time. 13. I/We understand and accept that the transaction will be effected on the policy on the due date (provided the day is a working day). I/We agree to
discharge the responsibility expected of me/us as participant(s) under the scheme. I/We take full responsibility of the correctness of the details filled herein. 14. I/We authorise the above mentioned
bank to debit my bank account if my/our ECS mandate is active and until I/We give a written request for cancellation of ECS/SI/DD/NACH. 15. In the future, if I/We opted out of ECS/Direct Debit
mode, there may be an increase in premium/EMI amount. 16. I/We understand and agree that the submission of this form does not mean that the request will be processed. I/ We understand that
any payout under the policy shall be strictly in accordance with the policy terms and conditions. Also, any payment shall be subject to realisation of the last renewal premium/EMI payment. 17. I/We
also understand and agree that the Company reserves the right to use any payout option. 18. For SI with HDFC Bank/Ratnakar Bank, premium will be debited from your account on the debit date.
However, in case of failure, we will debit your account anytime again upto 180 days from the date of debit.19. I/We authorise the above mentioned bank to debit the amount from my bank account
if my/our ECS/SI/DD/NACH is active, until I/We give a written request for cancellation of the Mandate. 20. I authorise the Company to deduct all the outstanding premium along with interest (in case
of non Unit Linked Products) for the purpose of revival. I am aware that in case of Conventional products, company may deduct the Mortality and the other charges for the period while the policy was
in lapsed stage. I understand that the Company reserves the right to refuse revival of the policy 21. In case a preferred day of debit is selected, the debit attempt will done on the
Preferred Billing Date instead of the premium due date. 22. In case of EMI collection for Loan-Against-Policy, the Company may process debit attempts post the EMI due date to recover pending
payments.
Important Note:
1. Any cancellation, correction, alteration, etc. should be countersigned by the Account Holder. 2. For SI cases (HDFC Bank/Ratnakar Bank), the NAV allotted will be the date on which the bank
gives a confirmation of the debit. 3. For ECS, NAV would be allocated on the basis of the debit date. 4. Direct debit facility (non ECS location) is offered by ICICI Bank, Citibank, Union Bank of India,
Bank of Baroda, State Bank of India, Axis Bank and Punjab National Bank only. 5. For Direct Debit, NAV will be provided for the day when the payment is received in the HDFC Life account. 6.
Request for de-activation of Auto debit facility has to be submitted at least 12 days prior to the next premium/EMI due date. 7. The premium/EMI will be debited starting from the premium/EMI due
date which occurs after the date of this mandate till the last premium/EMI due date unless the mandate is revoked. 8. In case of any increase or decrease in premium/EMI amount due to changes in
payment frequency or any policy related changes including reduction in premium/EMI*, the existing debit instruction will be de-activated. Hence, a fresh Auto Debit Mandate is required to be
submitted at any HDFC Life branch at least 30 days prior to the next premium/EMI due date. 9. In case of PBD option, the NAV will be allocated as per preferred billing date and not premium/EMI
due date. 10. Grace period in case of PBD will start from premium/EMI due date only and not from Preferred billing date. 11. Maximum amount not to exceed 150% of model premium/EMI amount.
12. Higher amount is to be written to accommodate any increase in premium/EMI due to changes in service tax, scheduled increase as per product specification and changes in frequency payment.
13. As per regulatory changes, it is mandatory to submit PAN/Form 60 (if PAN is not available). Please update via My Account/service@hdfclife.com/18602679999/HDFC Life branch. Ignore if
submitted.
*Reduction in premium/EMI is a product-specific alteration.
**Preferred Billing Date: _________day of the month (*Turn over leaf for your preferred dates according to PTD) Preferred Billing Date option available for ECS/DD/SI.
EMI facility is applicable for Loan Against Policy.
HDFC Life Insurance Company Limited (HDFC Life). CIN: L65110MH2000PLC128245. IRDAI Registration No. 101.
Regd. Off:13th Floor, Lodha Excelus, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai - 400 011.
NACH MANDATE INSTRUCTION
UMRN F O R O F F I C E U S E O N L Y Date D D M M Y Y Y Y
Sponsor Bank Code Utility Code
I/We hereby authorise HDFC LIFE to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/OTHER
Bank a/c number
with bank Name of customers bank IFSC or MICR
an amount of Rupees `
Reference No. 1 Application / Policy No. 1 Do not fill
Do not fill
Do not fill
Mobile No.
Reference No. 2 Application / Policy No. 2 Email ID
I/We agree for the debit of mandate processing charges by the bank whom I am/we are authorising to debit my/our account as per latest schedule of charges of the bank.
PERIOD
From D D M M Y Y Y Y Signature Primary Account holder Signature Primary Account holder Signature Primary Account holder
To D D M M Y Y Y Y
Or  Until Cancelled 1. Name as in bank records 2. Name as in bank records 3. Name as in bank records
Tick ()
CREATE 
MODIFY
CANCEL
FREQUENCY MONTHLY Qtly H. Yrly Yrly  As & when presented DEBIT TYPE Fixed Amount  Maximum Amount
This is to confirm that the declaration has been carefully read, understood & made by me/us. I am/We are authorising the User entity/corporate to debit my/our account.
I/We have understood that I am/we are authorised to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the User entity/corporate or the
bank where I/we have authorised the debit.
0 2 0 1 2 0 2 3
1.98022E9
0 2 0 1 2 0 2 3
0 2 0 1 2 0 2 3

5. PTD **Preferred Billing Dates for the Policy- (PBD within 10 days from PTD)
1 4 8 12 16 20 24 28
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30   
31   
** Preferred Billing Date option available for ECS/DD/SI.
Customer Acknowledgement Copy (Assignment/Reassignment form)
Branch Stamp
For queries or more information, call us on 1860-267-9999 (Local charges apply) | 022-68446530 (STD charges apply). Available Mon-Sat from 10 am to 7 pm. DO NOT prefix any country code e.g. +91 or 00.
Email – service@hdfclife.com | nriservice@hdfclife.com (For NRI customers only) Visit – www.hdfclife.com
Customer Acknowledgement Copy (NACH MANDATE INSTRUCTION)
Application Number or Policy Number ________________________________________
Policyholder Name: __________________________________________ Customer Relations Officer: ______________________
Date D D M M Y Y Y Y
Note: 1. Request for activation of Auto Debit facility has to be submitted atleast 30 days prior to the next premium due date at the nearest HDFC Life branch.
2. Request for de-activation of Auto Debit facility has to be submitted atleast 15 days prior to the next premium due date at the nearest HDFC Life branch.

Branch STAMP
Relationship with Policyholder (Please tick): Spouse Parent Sibling Child
Grandparents Employer for Employee Company for a Director Individual
HUF Partnership Trust
Director's / Partner / Trustee / Karta / Father's / Spouse's Name
___________________________________________________
PAN
Declaration to be made by a third person where:
The life assured has signed in vernacular / has not filled the application. I hereby declare
that I have explained the contents of this application form to the life to be assured in
___________________language and have truthfully recorded the answers provided to
me. I further declare that the life to be assured has signed in my presence.
Declarant Name: _____________________________________________________
Signature__________________ Date: ___________ Place: __________________
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