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T10100358161216161711314128
RefNo: 10100358
27614 27614 0
Name of Policy No. Date of Sum Premium Frequency Number of Number of Amount Amount Total Relationshi
the Commence Assured Amt Installment Installment Paid on or Payable on Amount FY p
Insurance ment Paid on or Payable on after 1st or before 16-17 (Paid
Company (dd/mm/yy after 1st or before Apr 16 31st Mar Amt
yy) Apr 16 31st Mar (Amt) 17(Amt) +Payable
(Count) 17 (Count) Amt)
LIC 846026981 20/11/2014 500000 27614 Yearly 1 0 27614 0 27614 Self
12000 12000 0
Name of the Investor Name of Girl Child Post Office / Bank Name Account No Amount
16 Dec 2016
Employee Code:11314128
Allsec SmartPay Services
Page 2 Of 3
April May June July August September October November December January February March
Cleared 0 0 0 0 0 0 0 0 0 0 0 0
H.no #10,4th H.no #10,4th H.no #10,4th H.no #10,4th H.no #10,4th
floor,SGR floor,SGR floor,SGR floor,SGR floor,SGR
Address dental college dental college dental college dental college dental college
road,martaha road,martaha road,martaha road,martaha road,martaha
City Select Select Select Select Select Select Select Bangalore Bangalore Bangalore Bangalore Bangalore
P. P. P. P. P.
Landlord
Venkateswarl Venkateswarl Venkateswarl Venkateswarl Venkateswarl
Name u u u u u
H.no #10,1st H.no #10,1st H.no #10,1st H.no #10,1st H.no #10,1st
Landlord floor,SGR floor,SGR floor,SGR floor,SGR floor,SGR
Address dental college dental college dental college dental college dental college
road,martaha road,martaha road,martaha road,martaha road,martaha
Landlord
PAN
I certify that the payments listed above has been made by me out of my income chargeable to Income-tax during the financial year 2016 - 2017.
I undertake that I will be depositing those premium / investment / rent payments that are due for payment after the cut-off dates laid out for proof
submission and obtain the receipts as per the due dates or by 31st March 2017 .
I therefore request you to consider the same for the tax computation purpose for the financial year 2016 - 2017. I will be held responsible for any
consequences of not remitting these payments and any liabilities arise out of this.
Signature :
Date : 16 Dec 2016
16 Dec 2016
Employee Code:11314128
Allsec SmartPay Services
Page 3 Of 3
Place : Bangalore
Date : 16/12/2016 (Signature of the employee)
Designation : 11 Full Name: Subrahmanyam Sudi
16 Dec 2016
Employee Code:11314128