Bajaj Allianz Life Insurance Company Limited GE Plaza, Ground Floor Airport Road Yerwada, Pune-411006

0408154421

RENEWAL PREMIUM RECEIPT Policy Number : 0177320841 Policy Holder Name : MR M GNANASEKARAN

Address : #17, EDA STREETKEEZH BHUVANAGIRI~ CHIDAMBARAM VILUPPURAM TAMIL NADU 608601

Receipt No. Received with thanks from Gross Amount (in Rs.) Amount in Rs.(in Words) Mode of payment Premium Amount Rs. Product Name Name of Life Assured Date Of Commencement Date Of Maturity Mode Late Fees STM CODE 1100198031 26/06/2010 26/06/2030 Annual

0408154421

Payment Date

5/9/2011

MR M GNANASEKARAN 12500 Twelve Thousand Five Hundred Only Online Credit Card(Trans ID-572320) 12500 NEW UNITGAIN II MISS G LAKSHMIPRABA Deposit B/F Deposit C/F X Change B/F N/A N/A 0.0 Service Tax Education Cess Higher Edu. Cess 0.0 0.0 0.0

I.C Code

1001047498

NEXT PREMIUM DUE DATE

26-JUN-2012

MUDRANK No. 21686 Dated 24/09/2010

Utilization shall be done as per applicable IRDA Guideliness in this regards Advance premium collected shall be utilized on premium due date.Amount held in deposit will not attract any interest.For eligibility under applicable sections of Income Tax Act 1961. Please refer relavant provisions and rules.

Visit our website: Email Us:

www.bajajallianzlife.co.in renewalvertical@bajajallianzlife.co.in or life@bajajallianzlife.co.in

BSNL: Bharti:

1800 233 5858, 1800 103 7272,

Tata:

1800 209 7272

Reliance: 1800 3000 7272

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