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January 09, 2012 AMIT CHAUHAN BA CONTINUUN SOLUTIONS TOWER-I PHASE-II LVEL-II BUMBAI 400072 MAHARASHTRA 400072 07760636676

Plan Dream Life Pension Regular Policy Number 500-1014082 Life Assured AMIT CHAUHAN

Premium

Premium Certificate For the Period April 01, 2011 - January 09, 2012

Policy Details
Plan Type Sum Assured Issue Date Policy Effective Date
Apr 09 2008 Apr 09 2008 Unit Linked Regular Pay Pension Plan

Payment Details
Semi-Annual 12,000.00 24,000.00

Payment Mode Renewal Premium Amount Total Renewal Premium Received Total Top Up Premium Received Total Premium Received

24,000.00

This is to certify that the above mentioned premium amount has been received and adjusted towards premium.

Note:
Income tax benefits are as per Income Tax Act,1961 and are subject to conditions mentioned therein and amendments made thereto from time to time Service tax and education cess shall be applicable as per prevailing tax laws Service Tax Registration No. AACCB7227PST001, Service Type:-Life insurance service If the payment has been made by cheque, this receipt is conditional upon the clearance of the cheque In case of premium/s paid towards reinstatement of a policy, the cover shall comense from the date of acceptanace of risk by the Insurance company

This is a computer generated statement and does not require a signature.


Bharti AXA Life Insurance Company Ltd. Registered Office:Unit 601 & 602, 6th Floor, Raheja Titanium, Off Western Express Highway, Goregaon (E), Mumbai - 400 063
Toll free Customer Care No.: 1800 102 4444, SMS : SERVICE to 56677, Email : service@bharti-axalife.com. Visit us at : www.bharti-axalife.com, Registration Number: 130.

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