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For the period 09/12/2009 to 09/12/2010


Mr. Ravibhushan Sureshkumar Dubey
D/30/05,VIDHYUT VIHAR
KTPS COLONY, KORADI Policy No : 003620978
NAGPUR - 441111, MAHARASHTRA Life Insurer :Mr. Ravibhushan Sureshkumar Dubey
Mobile No : +919370550873 /
Email details :rbdubey2020@gmail.com Nominee : Mrs Preeti Ravibhushan Dubey
Appointee :
Modal Premium : 50,000.00
Annual Premium : 50,000.00
Payment Mode : Annual

Coverage Information

Coverage Description Sum Assured Issue Date

Platinum Plus - Life Coverage 250,000.00 09/12/2009

Portfolio Details: as on 09/12/2010

Fund Name Number of Units Unit Price Unit Fund Value

Platinum Plus Fund IV 4068.473 11.7897 47,966.08


Total 47,966.08

Current Fund Allocation


Fund Name Allocation %
Platinum Plus Fund IV 100.00

The charges are / shall be subject to applicable taxes, prevailing from time to time, during the validity of the policy
contract. For details regarding charges, please refer to your Policy Contract.

Policy loading fees, as applicable would be deducted upfront as and when premiums are remitted. All other applicable
policy fees and charges would be recovered every month, by cancellation of units from your policy fund irrespective of
premium payment.

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Name : Mr. Ravibhushan Sureshkumar Dubey Policy No : 003620978

Transaction Details
No of units
Premium Loading / Unit Transactio Cumulative
Date Fund Activity Deducted/
Amount Charges Price n Amount Units
Allocated
09/12/2009 Platinum Plus Fund IV Deposit 50,000.00 5,515.00 10.278 44,485.00 4328.261 4328.261

09/01/2010 Platinum Plus Fund IV Charges 0.00 0.00 10.54 -224.84 -21.331 4285.045

09/02/2010 Platinum Plus Fund IV Charges 0.00 0.00 9.694 -225.23 -23.234 4261.811

09/03/2010 Platinum Plus Fund IV Charges 0.00 0.00 10.204 -225.04 -22.053 4239.758

09/04/2010 Platinum Plus Fund IV Charges 0.00 0.00 10.557 -224.91 -21.305 4218.453

09/05/2010 Platinum Plus Fund IV Charges 0.00 0.00 10.284 -225.05 -21.884 4196.569

09/06/2010 Platinum Plus Fund IV Charges 0.00 0.00 10.073 -225.16 -22.353 4174.216

09/07/2010 Platinum Plus Fund IV Charges 0.00 0.00 10.798 -205.81 -19.060 4155.156

09/08/2010 Platinum Plus Fund IV Charges 0.00 0.00 11.07 -205.71 -18.582 4136.574

09/09/2010 Platinum Plus Fund IV Charges 0.00 0.00 11.497 -205.56 -17.879 4118.695

09/10/2010 Platinum Plus Fund IV Charges 0.00 0.00 12.367 -205.22 -16.595 4102.100

09/11/2010 Platinum Plus Fund IV Charges 0.00 0.00 12.672 -205.11 -16.186 4085.914

09/12/2010 Platinum Plus Fund IV Charges 0.00 0.00 11.79 -205.62 -17.441 4068.473

Note for monthly charges: Monthly charges includes Cost of Insurance + Admin Charges + Service Tax

Instruments in which investments are made under each fund option are marked to market therefore are subject to market
volatility. it is advised that the portfolio mix of the policy fund be reviewed by the policyholder and amended as per the risk
appetite at regular intervals. Past performance is not necessarily a guide to the future.

This is computer generated statement, hence does not require signature.

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