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February 27, 2012 KESAVA NAGESWARA RAO AKKALA D NO-23-19-2/A JALLAVARI STREET SATYANARAYANA PURAM VIJAYAWADA 520011 ANDHRA

PRADESH 520011 09848248937

Plan Dream Life Pension PLUS Policy Number 500-6167174

Regular Premium

Life Assured KESAVA NAGESWARA RAO AKKALA

Premium Certificate For the Period April 01, 2011 - February 27, 2012

Policy Details
Plan Type Sum Assured Issue Date Policy Effective Date
Aug 23 2010 Aug 21 2010 Bharti AXA Life Dream Life Pension Plus

Payment Details
Quarterly 12,500.00 50,000.00

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

50,000.00

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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