Date: 06-Oct-2017

Receipt No.: 831450283OCT201701

Life Insurance Premium Receipt

Duration For Which the Premium is Received: 06-OCT-17 to 05-OCT-2018
Personal Details
Policy Number: 831450283 Current residential state: Haryana
Policyholder Name: Mr. Satpal Singh Mobile No. 8010254427
Commuinication Address: 402-D Dabua Colony Landline no. Please inform us for regular updates
Nit Faridabad Life Insured Name: Mr. Manoj Kumar
Faridabad - 121001 PAN Number:
Email ID: SATYPAL1958@GMAIL.COM
Policy Details
Plan Name: Max Life Life Partner Plus Limited Pay Endowment to Age 75 Plan - 104N029V01
Policy Term 52 Years Premium Payment Frequency Annual
Date of Commencement 06-OCT-2010 Date of Maturity 06-OCT-2062
Last Premium Due Date 06-OCT-17 Next Due Date 06-OCT-2018
Reinstatement Interest (incl. GST) ` 0.00 Model Premium (incl. GST) ` 12,200.20
Total Premium Received (incl. GST)* ` 12,200.20 Total Sum Assured of base plan and term ` 1,70,146.00
rider (if any)
Agent's Name Mr. Shyam Sunder Sharma Agent's Contact No. 9266071441

GST Details
Coverage Type SAC Code GST (INR) GSTIN 06AACCM3201E1Z7
Base 997132 ` 254.78 GST Regd. State Haryana
Rider 997132 ` 94.92
Reinstatement Interest ` 0.00
Total ` 349.70

Important Note:
*For payment mode other than in cash, this receipt is conditional upon the credit in our account. Payment of premium amount does not constitute commencement of risk. The risk
commencement starts after acceptance of risk by us. *Amount received would be adjusted against the due premium as per terms and conditions of the policy. *Premium paid would be
eligible for deduction as per the provision of Income Tax Act, 1961. Kindly consult your tax advisor for more information. Tax benefits are liable to change due to changes in legislation
or government notification. *Applicable Taxes, Cesses and Levies, as per prevailing laws, shall be borne by you. *For GST purposes,this premium receipt is Tax Invoice.Assessable
Value in GST for Endowment First Year is 25%, Renewal Year is 12.5%; Single Premium Annuity is 10%; Term and Health is 100%. In case of unit linked product GST is applicable
on charges.

Authorised signatory

PRM21 V4.8 01072017 2017-10-06.03.35.14.280981