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Date: 12/12/2011 Mr. ANURAG SHARMA FLATNO 214 PATRAKAR PARISAR SECTOR 5 VASUNDHARA ..

GHAZIABAD Uttar Pradesh 201012

PREMIUM PAID CERTIFICATE FOR THE YEAR 2011-2012


This is to certify that as per our records the following payments have been received by us to effect or keep "In Force" Life Insurance Policies held by Mr. ANURAG SHARMA Life Assured's Name: ANURAG, SHARMA Policy No.: 15460648 Benefits/Rider ICICI Pru Life Stage Wealth I Sum Assured 1,000,000.00

Plan Name:ICICI Pru Life Stage Wealth II Coverage SEC 80 C Premium Amount 52,000.00 Premium Due 0.00 Policy Total Amount in Suspense Total Premium Premium Due UIN 105L118V01 52,000.00 0.00

52,000.00 19,500.00

Premium Paid to avail Income Tax Benefits Under:

SEC 80 CCC(1) SEC 80 C SEC 80 D Total

0.00 52,000.00 0.00 52,000.00

Please note the mortality charges under the base plan as well as riders (if any) would be recovered every month as per the Terms and Conditions of the Policy. The above mortality charges are the actual charges recovered till date. The recovery of such charges would be subject to change on monthly basis. This is a computer generated statement and does not require any signature.

ICICI Prudential Life Insurance Company Limited. Communication Address:Vinod Silk Mills Compound,Chakravarthy Ashok Road, Ashok Nagar,Kandivali(E), Mumbai-400 101 Registered Office:ICICI Prulife Towers,1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025 Page 1

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