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

0474055803

RENEWAL PREMIUM RECEIPT Policy Number : 0105571631 Policy Holder Name : MR RAVI KUMAR

Address : ,#103,3RD FLOOR12TH MAIN~1ST STAGE,B T M OPP TO WATER TANK BANGALORE KARNATAKA 560029

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 1100001895 11/08/2008 11/08/2018 Half Yearly

0474055803 MR RAVI KUMAR 12500

Payment Date

10/9/2012

Twelve Thousand Five Hundred Only Online Credit Card(Trans ID-MHCC2806492393) 12500 CENTURY PLUS MR RAVI KUMAR 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

1000678930

NEXT PREMIUM DUE DATE

11-FEB-2013

MUDRANK No. 55090 Dated 15/04/2011

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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