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Key Highlights: Investment in Max Gain Fund II Guarantees highest unit price based on the highest NAV for a policy tenure of 10 years.* Condition apply Refund of 60% of total regular premium allocation charge as Guaranteed Addition at maturity Option to select/change premium payment term from 5 to 7 years Flexibility to pay unlimited top-up premium** and make partial withdrawals** Condition Apply Option to choose from 5 investment funds to invest Unlimited free switches in funds other than Max Gain Fund II*** Condition Apply First Name:*   Last Name:*   Mobile No:*   Email ID:*   Date of Birth:*   DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Occupation:*   --Not Selected-- Salaried Gov Salaried Pvt Salaried Pub Self-Employed Professional Others *The objective of the Max Gain Fund II is to provide a participation in the upside of the equity market while guaranteeing the highest unit price recorded during the policy term at maturity. The renewal premium and the top up premium can be invested in the Max Gain Fund II provided the fund has been chosen at inception as per the chosen premium apportionment rate. Any redemption of units before the maturity date shall be encashed at the prevailing unit price. ** To know more about Top-Up premium & partial withdrawals please read sales brochure *** Switching in to Max Gain Fund II is not allowed. However switching out of Max Gain Fund II is allowed anytime after the 5th policy year.   ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------     Risk Factors and Warning Statements: Bajaj Allianz Life Insurance Company Limited and Bajaj Allianz Max Advantage Insurance Plan are the names of the company and the product respectively and do not in any way indicate the quality of the product and its future prospects or returns. In this product the investment risk in investment portfolio is borne by the policyholder. Unlike traditional products Max Advantage Insurance Plan is a Unit Linked Insurance Plan (ULIP) and is subject to investment risks associated with capital markets and the NAV of the unit may fluctuate based on the performance of funds. The policy holder is solely responsible for his/her decisions while investing in ULIPs. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale. Tax-benefits are as per the Income Tax Act, 1961which may be subject to amendments from time to time. All charges applicable shall be levied. Insurance is the subject matter of the solicitation. Bajaj Allianz Life Insurance Co. Ltd. Regd. Address: G.E Plaza, Airport Road, Yerawada, Pune - 411006, Reg. No.: 116. Product UIN: 116L095V01     ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------     Insurance is the subject matter of solicitation. BJAZ-O-0353/23-Sep-10