BNG MINH HA QUYN LI BO HIM Ph-An Gia Thnh TiTHNG TIN DOANH NGHIP Cng ty TNHH BHNT Prudential Vit Nam; Giy php: 15/GPKDBH do B Ti chnh cp ngy 15/11/2004; Vn iu l: 75 triu -la M; Tr s chnh: Tng 25, TTTM Si Gn, 37 Tn c Thng, Qun 1, TP. H Ch Minh; in thoi: (08) 39100999; Fax: (08) 39100899; Website: http://www.prudential.com.vn THNG TIN KHCH HNG H v tn Bn mua bo him: Ngi c bo him chnh (NBH chnh): Ngi c bo him b sung 1 (NBHBS 1): Ngi c bo him b sung 2 (NBHBS 2)/Ngi th hng Quyn li hc vn: a ch lin h: THNG TIN SN PHM BO HIMSn phm Sn phm chnh Ph-An Gia Thnh Ti (La chn 2) Ph gim cho hp ng c s tin bo him ln: Ph bo him sau khi gim: Sn phm b tr 1 TLR1 Bo him nhn th c k hn 2 HSR4 Bo him chm sc sc khe (*) 3 OPW3 Bo him t b thu ph ngi hn phi 4 DSR2 Bo him h tr ti chnh ngi hn phi 5 TLR3 Bo him nhn th c k hn (dnh cho tr em) Tng ph bo him ca sn phm chnh v (cc) sn phm b tr Ngi c bo him Thi hn hp ng

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THNG TIN I L BO HIM H v tn: TEST in thoi: .. M s i l: 88888888 Nhm ngh nghip 2 2 2 n v tnh: ngThi hn ng ph S tin bo him Ph bo him hng nm

Gii tnh N Nam N

Tui 27 32 1

CMND/H chiu/ Khai sinh

Ng Huy Manh Nguyen Thi Dao Nguyen Huy Manh Ng Ha Linh.

NBH chnh

21

17

60.000.000

3.990.000 (180.000) 3.810.000

NBH chnh NBHBS 1 NBHBS 2

17 17 17 17 17

17 17 17 17 17

40.000.000 200.000 6.000.000 40.000.000

168.400 420.000 110.200 149.400 156.000 4.814.000

Tng ph bo him theo nh k:

Nm 4.814.000

Na nm 2.551.500

Qu 1.348.000

Ghi ch: (*) Ph bo him ca (cc) sn phm ny c th thay i theo s chp thun ca B Ti chnh. Ph bo him ca (cc) sn phm cn li c m bo trong sut thi hn hp ng. Ph bo him c trnh by trn y l ph tnh cho ngi c sc khe trung bnh theo tiu chun ca Prudential. Ph bo him thc t s da trn kt qu thm nh ca Prudential.

Bn mua bo him: Ngi c bo him chnh:

Ng Huy Manh Nguyen Thi Dao

Minh ha s: i l bo him:

84001000001 TEST

Phin bn: Ngy:

PruQuote v2.1B -PTE 04/02/2012 16:54:13

BNG MINH HA QUYN LI BO HIM Ph-An Gia Thnh TiTHNG TIN V QUYN LI CA HP NG BO HIM A. QUYN LI BO HIM CA HP NG (C M BO)SN PHM Dnh cho Ngi c bo him chnh: NGUYEN THI DAO Ph-An Gia Thnh Ti (La chn 2) 1 Bo him nhn th c k hn T vong Thng tt ton b v vnh vin T vong Thng tt ton b v vnh vin Nm vin 2 Bo him chm sc sc khe Nm vin ti khoa chm sc c bit Phu thut Dnh cho Ngi c bo him b sung 1: NGUYEN HUY MANH 3 4 Bo him t b thu ph ngi hn phi Bo him h tr ti chnh ngi hn phi T vong hoc Thng tt ton b v vnh vin T vong hoc Thng tt ton b v vnh vin 60.000.000 60.000.000 40.000.000 40.000.000 200.000 400.000 1.000.000 S KIN BO HIM QUYN LI BO HIM

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n v tnh: ngGHI CH

c chi tr thnh 10 ln trong 10 nm c chi tr thnh 10 ln trong 10 nm Cho mi Ngy nm vin; c chi tr ti a 100 Ngy nm vin cng dn trong mt Nm hp ng Cho mi Ngy nm vin ti khoa chm sc c bit; c chi tr ti a 30 Ngy nm vin cng dn trong mt Nm hp ng Cho mt ca phu thut

Min ng ph trong tng lai cho ton b hp ng 6.000.000 c chi tr vo mi Ngy k nim nm hp ng cho n ngy o hn

Dnh cho Ngi c bo him b sung 2/Ngi th hng Quyn li hc vn: NG HA LINH. 5 Bo him nhn th c k hn (dnh cho tr em) T vong Thng tt ton b v vnh vin 40.000.000 40.000.000 c chi tr thnh 10 ln trong 10 nm

Ghi ch: Chi tit v quyn li ca (cc) sn phm bo him nu trn c quy nh c th trong Quy tc, iu khon ca sn phm. (Cc) Sn phm b tr trn y l (cc) sn phm bo him khng c bo tc.

Bn mua bo him: Ngi c bo him chnh:

Ng Huy Manh Nguyen Thi Dao

Minh ha s: i l bo him:

84001000001 TEST

Phin bn: Ngy:

PruQuote v2.1B -PTE 04/02/2012 16:54:13

BNG MINH HA QUYN LI BO HIM Ph-An Gia Thnh TiB. MINH HA QUYN LI CA SN PHM CHNHNm hp ng 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Tui NBH chnh 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Ph bo him hng nm Tng ph bo him ng 3.810.000 7.620.000 11.430.000 15.240.000 19.050.000 22.860.000 26.670.000 30.480.000 34.290.000 38.100.000 41.910.000 45.720.000 49.530.000 53.340.000 57.150.000 60.960.000 64.770.000 Quyn li bo him m bo (a) 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 60.000.000 QUYN LI BO HIM MINH HA Li chia cui Bo tc hp ng tch ly (c) (b) 1.950.000 3.963.400 6.042.200 8.188.600 10.404.700 12.692.900 15.055.400 17.494.700 20.013.300 22.613.700 25.298.600 28.070.800 30.933.100 33.888.400 36.939.800 40.090.300 ^ 43.343.200 ^ 21.600.000 QUYN LI HC VN M BO (d)

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n v tnh: ngQUYN LI HC VN MINH HA Tng Quyn li Tng Quyn li Bo tc tch ly v Li chia cui hp ng hc vn hc vn tch ly (e) = (^b) + (^c) (f) = (d) + (e) (g) GI TR HON LI MINH HA Nu nhn Nu tch ly Quyn li hc vn Quyn li hc vn (h) (i) = (h) + (g) - (f) 666.100 3.150.400 7.662.200 10.554.200 15.462.400 19.422.300 23.791.900 28.614.100 35.821.600 42.023.200 48.871.000 56.434.000 64.788.900 77.917.600 88.661.200 119.169.800 94.966.600 75.284.000 54.001.200 30.988.700 666.100 3.150.400 7.662.200 10.554.200 15.462.400 19.422.300 23.791.900 28.614.100 35.821.600 42.023.200 48.871.000 56.434.000 64.788.900 77.917.600 88.661.200 119.169.800 128.434.300 138.416.800 149.172.300 160.761.200

3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000 3.810.000

18.000.000 12.000.000 12.000.000 12.000.000 18.000.000

12.988.600 12.988.600 12.988.600 12.988.600 12.988.600

30.988.600 24.988.600 24.988.600 24.988.600 30.988.600

30.988.600 58.456.300 88.121.400 120.159.700 160.761.100

Quyn li hc vn (lun c chi tr tr trng hp Hp ng b hy) Quyn li m bo: Bo tc tch ly v Li chia cui hp ng minh ha: Li tch ly minh ha (nu tch ly Quyn li hc vn): Tng:

Nu nhn Quyn li hc vn 72.000.000 64.943.000 136.943.000

Nu tch ly Quyn li hc vn 72.000.000 64.943.000 23.818.100 160.761.100

Ghi ch: Tng Quyn li hc vn nu tch ly nh minh ha ct (g) bao gm li tch ly khi khch hng li Quyn li hc vn Cng ty. Li tch ly c minh ha mc li sut 8% v khng c m bo. Gi tr hon li ( bao gm Quyn li hc vn ca nm tng ng) nu trn KHNG C M BO. Gi tr hon li c tnh da trn mc Bo tc minh ha. Bo tc tch ly c cng b hng nm. Bo tc tch ly nh minh ha ct (b) KHNG C M BO; tuy nhin, mt khi Bo tc tch ly c cng b th s c m bo v lm tng gi tr ca hp ng. Li chia cui hp ng (KHNG C M BO) c chi tr khi c s kin bo him hoc khi o hn. Li chia cui hp ng khi c cng b ch c gi tr cho nm cng b, khng c tch ly v c th tng hoc gim hng nm. Bo tc tch ly v Li chia cui hp ng thc t c cng b da trn kt qu hot ng ca Qu Ch hp ng - hnh thnh t ngun ph bo him - trong sut thi hn ca hp ng. Bo tc tch ly v Li chia cui hp ng thc t c th cao (hoc thp) hn Bo tc tch ly v Li chia cui hp ng minh ha trong trng hp li sut u t thc t t hot ng u t ti sn ca qu cao (hoc thp) hn mc mong i. Tuy nhin, mc tiu ca Prudential l khng bo tc hng nm bin ng qu ln. Cc s liu minh ha trn y ch mang tnh tham kho vi gi nh ton b ph bo him c ng y v khng c giao dch no lm thay i gi tr hp ng. Ton b ni dung minh ha ny l mt phn ca hp ng bo him. XC NHN CA I L BO HIM Ti gii thch y cho Bn mua bo him v Quyn li v cc Quy tc, iu khon ca (cc) sn phm bo him nu trn. i l bo him k tn: XC NHN CA BN MUA BO HIM Ti, Bn mua bo him, c bng minh ha ny v c i Bn mua bo him k tn: l bo him t vn r rng cc chi tit ca bng minh ha cng nh cc Quy tc, iu khon ca (cc) sn phm bo him ghi trn. Ti ng tham gia (cc) sn phm bo him nu trn. H v tn: Ng Huy Manh Ngy: _________________

H v tn: TEST M s i l: 88888888 Ngy: 04/02/2012 BNG MINH HA NY L MT PHN CA HP NG BO HIM V CH C GI TR PHP L KHI C Y S TRANG

Bn mua bo him: Ngi c bo him chnh:

Ng Huy Manh Nguyen Thi Dao

Minh ha s: i l bo him:

84001000001 TEST

Phin bn: Ngy:

PruQuote v2.1B -PTE 04/02/2012 16:54:13