Declaration of sole proprietorship Date: To, Kotak Mahindra Life Insurance Limited Kotak Towers, 7" Floor, Zone | Building No.21, Infinity park, Off Western Express Highway, Malad (E), Mumbai- 400097 Dear Sir/ Madam, This has reference to my proposal application bearing no. for (write the name of the plan) I, Mr/Ms/Mrs._ hereby declare: that, is a sole proprietorship concern owned by me and premium towards this proposal is being paid through the account of this proprietary concern. This is for your information and record. Name of the Proposer: Shree Goga Ji Industries (Signature of the Proposer) prop, (Aifix ‘Rubber Stamp’ of the proprietary concern along with the signature) Declaration by Scribe: (in case the proposer is iterate or has signed in vernacular, following declaration hhas to be signed by the scribe): hereby dectare that | have explained the contents of the Declaration to the client in his/her language and that | have read out to the client the declaration and recorded his/her answers to the questions and the client has affixed his/her thumb impression/signature in vernacular to the questionnaire after fully understanding the contents thereof Signature of the SCHDG......cessserstssseseeeseeseeneesss DAO: esses seesetseePlAG®!