Union Assurance PLC (PQ12), No. 20, St. Michael's Road, Colombo 03, Sri Lanka Telephone: Hotline (+94) 112 990 990 | Shortcode: 1330 | General (+94) 112 990 000 | Fax: Life Insurance: (+94) 112 438 165 Human Resources (+94) 112 320 595 | Email: info@unionassurance.com | Website: www.unionassurance.com Page 1 of 4 Union Life Plus Quotation Date of Issue : 29/11/2023 Quote No. : 0000004140428 FNA No. : 0000004498336 1. Personal Details Date of Birth Age Gender Main Life MR. UDAYANGA 07/08/1987 36 Male 2. About Your Plan Primary Need : Retirement Basic Sum Assured : Rs. 750,000 Term of the policy (for Main Life & Spouse) : 30 Years Basic Annual Premium : Rs. 75,000 Deductible Option : 1 ( 0 ) 3. Illustrated Maturity Benefit ( Illustrative Investment Account Value at Maturity with Loyalty ) based on Premium Paying Frequency Premium Paying Frequency Assumed Annual Dividend Rate of 8% (Rs.) Assumed Annual Dividend Rate of 10% (Rs.) Assumed Annual Dividend Rate of 12% (Rs.) Yearly 7,118,950 10,191,906 14,748,109 Half Yearly 6,999,065 9,974,531 14,369,624 Quarterly 6,938,796 9,865,663 14,180,420 Monthly 6,899,087 9,794,021 14,056,058 Page 2 of 4 4. Protection Benefits Benefits for MR. UDAYANGA Rider Sum Assured (Rs.) Term Mode Premium (Rs.) Additional Life Protection Benefits Accidental Death Benefit 1,500,000 30 2,625 Total for Life Protection Benefits 2,625 Disability Benefits Total Permanent Disability due to Accidents 750,000 30 938 Total Permanent Disability due to Accidents & Sickness 750,000 30 1,500 Waiver of Premium Benefit N/A 30 4,516 Total for Disability Benefits 6,954 Health Benefits Hospital Cash Benefit 7,500 per day 30 12,438 Suwamaga Benefit (Critical Illness Cover) 750,000 30 15,260 Union Health 360 (Individual - Sri Lanka) 750,000 30 39,599 Total for Health Benefits 67,297 Total Premium for additional benefits of Main Life 76,876 Death Benefits Amount payable on Natural Death : Basic Sum Assured of Rs. 750,000 or Investment Account Value whichever is higher Amount payable on Accidental Death : Basic Sum Assured of Rs. 750,000 or Investment Account Value whichever is higher , Accidental Death Cover of Rs. 1,500,000 5. Premium details of your Plan Category Yearly (Rs.) Half Yearly (Rs.) Quarterly (Rs.) Monthly (Rs.) Basic Sum Assured 75,000 39,000 19,875 6,750 Additional Life Protection Benefits 2,625 1,313 657 219 Disability Benefits & Waiver of Premium 6,954 3,553 1,796 606 Health Benefits 67,297 34,441 17,420 5,874 Policy Fee 50 32 19 7 Total Premium 151,926 78,339 39,767 13,456 6. Illustration of Investment Account Values Page 3 of 4 Assumed Annual Dividend Rate of 8% (Rs.) Assumed Annual Dividend Rate of 10% (Rs.) Assumed Annual Dividend Rate of 12%(Rs.) Year Annual Premium Amount payable on death Investment Account Value Amount payable on death Investment Account Value Amount payable on death Investment Account Value 1 75,000 750,000 14,966 750,000 15,254 750,000 15,542 2 75,000 750,000 50,956 750,000 52,224 750,000 53,504 3 75,000 750,000 113,478 750,000 116,976 750,000 120,538 4 75,000 750,000 198,809 750,000 206,323 750,000 214,047 5 75,000 750,000 290,178 750,000 303,789 750,000 317,933 6 75,000 750,000 387,927 750,000 409,994 750,000 433,193 7 75,000 750,000 492,624 750,000 525,872 750,000 561,257 8 75,000 750,000 604,832 750,000 652,387 750,000 703,641 9 75,000 750,000 725,333 790,797 790,797 862,115 862,115 10 75,000 854,240 854,240 941,373 941,373 1,037,593 1,037,593 11 75,000 992,088 992,088 1,105,378 1,105,378 1,232,199 1,232,199 12 75,000 1,139,498 1,139,498 1,284,008 1,284,008 1,448,015 1,448,015 13 75,000 1,297,405 1,297,405 1,478,955 1,478,955 1,687,880 1,687,880 14 75,000 1,465,992 1,465,992 1,690,901 1,690,901 1,953,364 1,953,364 15 75,000 1,646,272 1,646,272 1,921,747 1,921,747 2,247,786 2,247,786 16 75,000 1,839,056 1,839,056 2,173,181 2,173,181 2,574,299 2,574,299 17 75,000 2,045,643 2,045,643 2,447,676 2,447,676 2,937,313 2,937,313 18 75,000 2,266,128 2,266,128 2,746,010 2,746,010 3,338,983 3,338,983 19 75,000 2,501,905 2,501,905 3,070,950 3,070,950 3,784,433 3,784,433 20 75,000 2,754,037 2,754,037 3,424,868 3,424,868 4,278,436 4,278,436 21 75,000 3,024,294 3,024,294 3,811,343 3,811,343 4,827,783 4,827,783 22 75,000 3,312,659 3,312,659 4,231,288 4,231,288 5,435,508 5,435,508 23 75,000 3,621,024 3,621,024 4,688,683 4,688,683 6,109,474 6,109,474 24 75,000 3,950,778 3,950,778 5,186,868 5,186,868 6,856,899 6,856,899 25 75,000 4,304,313 4,304,313 5,730,978 5,730,978 7,688,181 7,688,181 26 75,000 4,681,460 4,681,460 6,322,114 6,322,114 8,607,680 8,607,680 27 75,000 5,084,767 5,084,767 6,965,966 6,965,966 9,627,403 9,627,403 28 75,000 5,516,047 5,516,047 7,667,236 7,667,236 10,758,273 10,758,273 29 75,000 5,978,503 5,978,503 8,433,248 8,433,248 12,016,137 12,016,137 30 75,000 6,471,773 6,471,773 9,265,369 9,265,369 13,407,372 13,407,372 Note : Fund accumulations are based on Yearly Premium Paying Frequency (Actual maturity value will depend on the actual dividends declared and date of premium payment) The fund accumulations shown are after deducting the applicable allocations charges, Fund Management Fees and Cover charges 7. Union Assurance Dividend Declaration Year 2016 2017 2018 2019 2020 2021 2022 Average Life Fund Yield 11.65% 12.48% 11.57% 11.24% 10.62% 10.92% 12.73% Distributable Dividend Rate 10.50% 10.25% 10.00% 10.00% 09.00% 08.00% 10.00% Guaranteed interim dividend rate for 2023 - 9% Page 4 of 4 Stated premium is subject to revision based on the declarations made in the Insurance Proposal Form and the reports of the medical examination / laboratory tests where applicable. This quotation is valid only for 15 days and any alterations made on this quotation are invalid. The selected deductible option will be applicable on individual/floater basis to all the members covered under Union Health 360. The selected deductible option will be applicable on individual/floater basis to all the members covered under Union Health 360. The opted deductible amount cannot be removed during the term of the benefit. This Maternity Benefit can only be availed at the time of commencement of the policy and the age of the assured must be less than Forty (40) years and the benefit is ceased upon attaining age Forty Five (45). Special Features of Union Health 360 * Wellbeing, Outpatient and Ayurvedic Hospitalization Benefit, Routine Dental Benefit, Critical Illness Reimbursement covers are inbuild to UH360 Benefits. Maternity & Routine Optical Benefits are optional benefits (For Life Assured & Spouse) * Routine Dental Benefit, Critical Illness Reimbursement covers are inbuild to UH360 Benefit (For Children) 5 countries - Sri Lanka, India, Singapore , Thailand and Malaysia Worldwide cover - Worldwide Excluding USA and Canada Authorized Signature : Date : Adviser's Name : ANDRDI W.M.D.H. Adviser's Code : AG000230 Quotation No : 0000004140428 For Office Use: Main Life Spouse SAR Medical 1,125,000 0 SAR Financial 750,000 0 Medical Requirements Financial Requirements N/A N/A Occupation Category ADMINISTRATION OFFICER / Non Smoker Main Life Spouse BSA HCB ADB EPD TPA TPS LTB FEB FIB SMB CSB WP HEALTH360 OPTICAL OPD MATERNITY USHP HCB SPB SMB CSB HEALTH360 OPTICAL OPD MATERNITY USHP 0 0 0 - 0 0 - - - 0 - 0 0 - 0 - - - - - - - - - - -