RENEWAL PREMIUM RECEIPT

Name of Policy Holder

Name of Life Assured

Mr. Mani Maruvada ..

Pay Premiums Automatically

Set up Standing Instrunctions (SI) using

your credit card while paying your premium
online.

Mr. Mani Maruvada ..

Save Time
Avoid Late Charges
Its Free, No Documentation
Required

Visit www.iciciprulife.com/si to set up

Standing Instructions now!

RENEWAL PREMIUM RECEIPT

Receipt
Date

Receipt
Number

Policy
Number

Product Name / Riders

UIN#

25/03/2015 94108628 13598831 105L105V01 ICICI Pru Ace

From 17/03/2015 to 17/04/2015

Premium
Amount
Rs.

Service Tax*

Education

Rs.

Cess*

Rs.

Reinstatement
Amount
Rs.

2000.00

TOTAL

Balance in
Deposit**
Rs.
0.00

2000.00

0.00

CONSOLIDATED REVENUE STAMP DUTY PAID : NOTIFICATION NO - MUDRANK 0715/0001994074201415/CR-322/M1-13/10/2014

# UIN-Unique Identification NO. Specified by IRDAI.
*For Ulip Policies,Service Tax and Education Cess are deducted by way of cancellation of Units.
**The amount indicated as balance in deposit(if any) will be adjusted towards future premium. No interest will be payable on Balance in Deposit