Ref.

: RICB/LIFE/2021/2018-DC143580 Date:19/01/2021

Life Insurance Premium Certificate

This is to certify that

KARMA YIDEN

is a Life Insurance Policy holder with Royal Insurance Corporation of Bhutan Ltd

The details of policy are as follows:

Sl.No. Particulars Details

1. Name : KARMA YIDEN

2. Address : DRUK GYP PRODUCTS AND CHEMICALS LIMITED

NGANGLAM
MOB# 17604661 CID# 11106003200

3. Citizenship ID Card No. : 11106003200

The details of policy are as follows:

Sl# Type of Policy Policy Number Premium Paid(Nu.)

1 Millennium Education Scheme III ME-NV III/2018/27542 11,580.00
Total 11,580.00

Note::: This computer generated Life Insurance Premium Certificate is meant solely for the purpose of filing Personal Income Tax (PIT) for the
income year 2020 with the Department of Revenue and Customs (DRC), Ministry of Finance, Royal Government of Bhutan. The final authority
to scrutinize and accept this document rests with the concerned Agency(DRC) at the time of compiling PIT. Royal Insurance Corporation of
Bhutan shall not be responsible for misuse of this document or alteration or distortion of information contained in this document by respective
policy holders or by any third party. The DRC may verify the authenticity of the document with the nearest RICB Office incase of any suspicion.

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