Ready Reckoner - OrientCare Plus (37 Illnesses) PREMIUM TARIFF (AED) POLICY TERM : 5 YEARS TO 10 YEARS

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3 Sum Assured (AED) , ,129 1,785 1 Cancer 100, ,103 2,153 3,465 2 Heart attack 150, ,601 3,176 5,145 3 Stroke 200,000 1,260 2,100 4,200 6,825 4 Coronary Artery Bypass surgery 250,000 1,549 2,599 5,224 8,505 5 Kidney failure 300,000 1,838 3,098 6,248 10,185 6 Major organ transplant 350,000 2,126 3,596 7,271 11,865 7 Heart valve surgery 500,000 3,255 5,355 10,605 15,855 8 Aorta graft surgery 750,000 4,830 7,980 15,855 23,730 9 Multiple Sclerosis 1,000,000 5,880 10,080 20,580 29, Parkinson s disease 1,250,000 7,324 12,574 25,699 36, Motor neurone disease 1,500,000 8,768 15,068 30,818 44, Paralysis 1,750,000 10,211 17,561 35,936 51, Loss of limbs 1,840,000 10,731 18,459 37,779 54, Blindness Sum Assured (USD) Ready Reckoner - OrientCare Plus (37 Illnesses) PREMIUM TARIFF (AED) POLICY TERM : 5 YEARS TO 10 YEARS COMPLETED AGE (YEARS) PREMIUM TARIFF (USD) POLICY TERM : 5 YEARS TO 10 YEARS COMPLETED AGE (YEARS) 15 Coma 16 Loss of hearing 17 Loss of speech 18 Severe burns Loss of one limb and loss of one eye. 25, Benign brain tumour 50, ,055 1, HIV through blood transfusion 75, ,568 2, Occupationally acquired HIV 100, ,029 2,079 3, Poliomyelitis 125, ,279 2,591 4, Meningitis 150, ,528 3,103 5, Encephalitis 175,000 1,043 1,778 3,615 5, Cardiomypathy 200,000 1,292 2,132 4,232 6, Aplastic anemia 250,000 1,607 2,657 5,282 7, Primary pulmonary hypertension 300,000 1,764 3,024 6,174 8, Systemic Lupus Erythematosus 350,000 2,053 3,523 7,198 10, Major head trauma 400,000 2,342 4,022 8,222 11, End stage lung disease 450,000 2,630 4,520 9,245 13, Terminal liver insufficiency 500,000 2,919 5,019 10,269 14, Creutzfeld-Jacob disease KEY FEATURES OF THE PLAN* >>> Premiums shown are inclusive of VAT (Value added 5%<<< >>> No Medical Check-up required for Sum Assured up to AED 350,000/ USD 100,000 <<< >>> Instant Cash on diagonosis of the covered Critical Illness <<< >>> No Bills required for Claim Settlement <<< >>> Worldwide coverage; Protect you even if you leave the country <<< 34 Progressive Scleroderma 35 Apallic syndrome 36 Severe myocarditis 37 Critical Illnesses Covered under CritiCare Plan Progressive Supranuclear Palsy resulting in permanent symptoms P.O. Box 27966, Dubai, UAE Orient Building, Dubai Festival City Toll Free: 800-ORIENT (674368) Fax: orient.service@alfuttaim.ae *: Conditions apply PR701V3

4 Lifestyle Protection Plus (Application Form for Salaried Customers in UAE) PROPOSER DETAILS: Applicant s Name (as per passport)*: Date of Birth [DD/MM/YYY]: Mailing Address: P.O. Emirate: Telephone: Employer Name: Mobile Number: With Current Company less than 6 months more than 6 months Please attach copy of: Emirates ID or Passport with Visa Page BENEFICIARY DETAILS Full name (as per passport) Relation Share (%) Total =100% PLAN DETAILS Choose your plan: Category / Premium: Bronze AED 350 Silver AED 588 Gold AED 972 Platinum AED 1704 Mode Payment: Credit Card* Account Debit* Others (Please specify: *: Please attach original Credit Card Authorization Form along with front page of Credit card or Standing Order/ Direct Debit form for Account Debits Benefit Description/ Plan Category Bronze Silver Gold Platinum 1. Accidental Death 70, , , , Life Style Benefits in case of Death due to Sickness and Accident House Rent (per month, up to 3 months) 3,000 6,000 12,000 35,000 School Fees (per child, per month up to 3 months for 3 children, maximum) 1,000 1,500 2,500 10,500 Utility Bills (per month, up to 3 months) 1,250 2,500 4,000 11,000 Essential Cash Due to Death (per month, up to 3 months) 1,250 2,500 4,000 11,000 Shipping Personal things to Home Country 2,500 5,000 5,000 10,000 Flying Mortal Remains to Home Country 2,500 5,000 5,000 10, Essential Cash due to ILOE (per month, up to 3 months) 1,000 2,000 3,500 4, Second Medical Opinion from P.O. the Box USA 27966, Dubai, UAE Orient Building, Yes Dubai Festival City Yes Yes Yes Total Benefits for Death due to Sickness (AED) Toll Free: 800-ORIENT (674368) 30,500 56,500 92, ,500 Total Benefits for Death due to Accident orient.service@alfuttaim.com (AED) 100, , , ,500 Annual Premium (AED) ,704 A115V2DF Page 1 of 2

5 1. DECLARATION AND DISCLAIMER Orient Insurance PJSC You must immediately inform the Company, if any of the information stated in your policy schedule is incorrect. Failure to do so may invalidate your policy. The policy in force shall be automatically renewed each calendar year, at our discretion of the Company and at the premium rate in force at the time of renewal, but always subject to payment of premium on time, unless cancelled in writing by the insured person/us. For full terms conditions and exclusions, please refer to the policy terms and conditions. Involuntary Loss of Employment cover is valid for working residents of the United Arab Emirates only. 10 % discount offer is valid on the current years premium only Customer - I have read and accepted the terms and conditions of the policy. - I understand that this plan has a free look up option. I can choose to cancel the plan within 30 days from the date of the policy and get a full refund of the premium subject to no claims being made. - I understand and accept to pay all the premiums on time and are aware that no claim will be paid if payments are not received. - I consent to share my credit card information to Orient Insurance PJSC. I hereby agree to the terms and conditions of LifeStyle Protection Plus Plan and also confirm that all details provided by me are true. I also acknowledge and confirm that I have been explained/ understood all the features and benefits of the plan. I also hereby authorize the distributing Bank, intermediary or Orient Insurance PJSC (as per the agreement between the parties) to charge my credit card or debit my Bank Account (for the initial premium and for renewal premiums according to the premium payment frequency and the amount selected in Section 3 towards the LifeStyle Protection Plus Plan. Insurance coverage is governed by the policy terms and conditions, exclusions, and limitations. It is acknowledged and understood that this Policy is sold under the laws of United Arab Emirates. Signature (Insured Person) Place Date For internal use only Existing Policy Reference no DF Reference no. Policy No Sales Person s Details Name Code Emirate/Branch Department Signature P.O. Box 27966, Dubai, UAE Orient Building, Dubai Festival City Toll Free: 800-ORIENT (674368) orient.service@alfuttaim.com A115V2DF Page 2 of 2