Max New York Life Insurance Co.

Ltd Operation center, 90-A, Udyog Vihar, Sector 18, Gurgaon -- 122015 Customer Help Line -1800 200 5577 (Toll free from any network) Regd Office: Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India Visit us at: E-mail:

Premium Paid Certificate for the Period 15/02/2011 to 02/01/2012
Policy Number: Name: Address: 838938926 Mr. Altaf Qureshi 43-Jawahir Nagar Partly Post Office Jawahir Nagar Police Station Rajbagh Srinagar - 190008 09419007079, 0194-2311203As on Date Base Life Insured: Your Agent Advisor: Agent Code Your Agent Phone No General Office 02-Jan-2012 Mr. Altaf Qureshi Yes Bank Limited Jammu 392130 Yes Bank Jammu


Dear Mr. Altaf Qureshi, Thank you for being part of the Max New York Life family. This is to acknowledge receipt of your premium for the period 15/02/2011 to 02/01/2012 as per details below. We also take this opportunity to reiterate that we value your patronage and are committed to providing you the best in class service.

Yours Sincerely, for Max New York Life Insurance Co. Ltd.

Authorized Signatory Plan Sum Insured (Rs.) Premium Received # (Rs.) 25,000.00 25,000.00 Current Frequency Effective Date of Coverage Benefit under Income Tax Act 1961, if applicable U/s 80C

Max Mangal Endowment Plan Total Note:




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The total premium amount is inclusive of Service Tax if paid. This certificate is a consolidation of the individual premium receipts sent to you. Subject to realisation of monies.

PRM23 V1.3 12062011



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