(LOGO) AIA Co., Ltd.

AIA Tower 181 Surawong Road,

Bangrak District, Bangkok 10500
Tel. (66) 2634 8888
Fax. (66) 2783 4818
AIA.CO.TH
Taxpayer no. 0100544007629
PRMCT/IN-AGT/25E/05479/0000612937 Dated 5th June, 2020
Dear OM PRAKASH PRAJAPATI
755 Village no. 19 Danchange Sub-District Policy no. T220012205
Danchange District, Supanburi Province Commencement date 2nd June, 2020
Beneficiary OM PRAKASH PRAJAPATI
Identification no. P8620915
The insurance claiming term is in the type of 10 years or above
Insurance premium payment certification

According to the information of the information from 1 st January, 2020 until 5th June, 2020, the company has
received the insurance premium of the aforementioned policy as per the details as follows:

Policy year Payment due date Payment received date Receipt no.

001 2nd June, 2020 4th June, 2020 Q107588

Insurance premium (BAHT)
** Life insurance ** Additional Health insurance Total insurance premium
47,600.00 22,060.00 75,135.00
47,600.00 22,,060.00 75,135.00

Total premium used as a reference for reducing the tax payment rate

Yours Sincerely,
-Signature-
Jeera Wongpanich
The Senior Manager of Insurance Operation and Support Division
(In the case that there is the interest return and/or loan return, it shall not be specified in this certification)

NOTE
* The premium used as a reference to reduce the personal tax under the Notification of the Director-General of
the Revenue Department no. 172
** The additional health insurance premium used as a reference to reduce the personal tax under the
Notification of the Director-General of the Revenue Department no. 315.
*** Total premium including other insurance premium that cannot be used to reduce the tax payment (if any).

WARNING * The certificate is printed automatically for benefits related to tax, so please check your name, surname, and
identification number whether it is correct or not before filing for the tax payment.
If there is no identification number on the certification, the additional health insurance premium shall not be able to be
used for the tax reduction. Pleas contact your agent or AIA Call center 1581 and submit a copy of identification card for
improving your policy information correctly to issue the complete version of certification according to the Revenue
Department’s condition.
This letter and my signatory are printed from the company system IN-AGT-06052563-0711

E-Policy Service
Policy no. T220012205 Beneficiary OM PRAKASH PRAJAPATI
Information on 06/05/2020
Details of the policy
Policy’s status : The policy is effective
Date of the insurance policy : 06/02/2020 The date of receiving the insurance premium receiving application form: 06/02/2020
The commencement date of insurance making: 06/02/20202 Selling channel: Life Insurance agent
The due date of the insurance contract: 06/02/2030 Approval date: 06/04/2020
Premium payment method: Normal method Free Look receiving date: -
Term of premium payment: yearly Previous payment of the premium: 75,135.00
Latest premium receiving date: 06/04/2020
Latest special and additional premium receiving date: -
Due date of the premium payment: 06/02/2021
Insurance premium: 75,135.00 Baht

Dividend options : Policy in the type of no dividend

Accumulated dividend: 0.00 Baht Outstanding payment loan: 0.00 Baht
Interest from the dividend* : 0.00 Baht Loan interest : 0.00 Baht
Total accumulated dividend: 0.00 Baht Total loan interest: 0.00 Baht

Return option under the condition: No accumulated return

Accumulated return under the condition: 0.00 Baht Total loanable amount: 0.00 Baht
Interest of the return under the condition: 0.00 Baht Total policy return amount: 74,517.45 Baht
(Including all benefits deducted debts (if any))
Due date of return payment under the condition: -
Policy Year 2021
Next return under the condition: 0.00 Baht
Before deducted debt (if any)

Agent
First sell agent/ service agent (1): 05479-612937 Korakot Chailak First sell agent/ service agent (2):
Details of the beneficiary
Name-surname: OM PRAKASH PRAJAPATI
Identification no: P862XXXX
Date of birth: 01/09/1969
Gender: Male
Age while making the insurance: 51 years old
Contact address: 755 Village no. 19 Danchange Sub-District, Danchang, Supanburi Province 72180
Phone no. 0870557883
eMail: -

Insurance type and additional contract

No. Name of insurance type and Beneficiary Next premium Status Effective date *** Last premium payment
additional contract receiving/ payment date
benefits
1 Fix-term insurance for 10 years 3,500,000.00 47,600.00 effective 06/20/2020 06/20/2030
– 10TBND
2 Accident (A.D.B.) – ADBN7 1,100,000.00 1,650.00 effective 06/20/2020 06/20/2030
3 Additional memo for accident 1,100,000.00 825.00 effective 06/20/2020 06/20/2030
(A.D.B.) -ADBRCC7-ADBRCC