PA01010104442449

04-09-2021

Mr Pankaj Laxman Dhage

Anuska Park, Budhe Vasti
Shikrapue, Pune 412208
Pune - 412208

EXIDE LIFE INSURANCE COVER NOTE

Dear Pankaj Laxman Dhage,

Thank you for choosing Exide Life Insurance Company Limited as your preferred insurance solution provider.

We confirm the receipt of your proposal form and would like to inform you that the risk coverage on the Life
Assured shall commence after acceptance of the risk by the company.

Summary of Proposed Policy:

Proposal No. 04442449

Name of the Proposed Life Assured Pankaj Laxman Dhage
E-mail Address pankajldhage2156@gmail.com
Telephone Number(s) 9881648031
Date of Birth of Life Assured 15-08-1982
Name of the Nominee(s) Rupali Pankaj Dhage

Premium
Policy payment Modal
Sum Premium Payment
Plan Name term Term Premium
Assured (`) (`) Frequency
(Years) Frequency- (Yearly) (`)
(Years)
T35-Exide Life Smart Term
2000000 30 30 19482.98 Yearly 18644
Edge - Classic RP
Agent Code:60318296 Agent Telephone: Agent Name: Vidya Sahakari BankLtd

Call : 1800 419 8228 (TOLL FREE); +91 80 4134 5444 Email : care@exidelife.in Visit : exidelife.in

Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001.
IRDAI Registration No. 114 CIN: U66010KA2000PLC028273
 PA01010104442449

Payment Summary:
Receipt No(s): 38603885
Mode of payment Demand Draft
Amount `19490
Demand Draft No. 013269
Demand Draft Date 17-08-2021
Bank Name Vidya Sahakari Bank Ltd
Total amount in words `19490 Nineteen Thousand Four
Indian Rupees Hundred and Ninety

Please get in touch with us for any further assistance.

We hope to serve you again.

Yours sincerely,

Customer Services Team

Exide Life Insurance Company Limited

This is a system generated letter and requires no signature.

Points to remember:

1. This cover note is an acknowledgment of your proposal for Exide Life Insurance Company Limited Policy and shall be
valid till the acceptance / rejection of the risk by the company.
2. Acceptance of your proposal is subject to the verification of the documents submitted and on confirmation of the
details as stated by you in the proposal form. The company reserves the right to call for additional documents /
information from you if deemed necessary.
3. Please note that the original policy bond shall be dispatched to you after the acceptance of the risk by the company.
If you do not receive the Policy bond within 30 days from the date of this cover note, contact your advisor or visit the
nearest branch of Exide Life Insurance Company Limited to know the status of your proposal.
4. If you have opted for/hold an e-insurance account/policy, your new policy details will be automatically linked to your
existing e-insurance account. Physical copy of Policy Bond will not be issued. To view policy details login to your
e-insurance account.
5. In case the Policy gets cancelled, the premium amount paid by you towards the proposed policy shall be refunded
without any interest.
6. In case of dishonor of the premium cheque or non- production of information or production of incorrect information
or requirement for any additional documents, this document automatically stands cancelled from inception.
7. Premium amount provided to you may vary after underwriting evaluation of all the information provided to us.
8. Goods & Services Tax (GST) or any other form of taxes including applicable cess or charges will be additionally
charged as per prevailing tax laws and regulations notified by the Government of India from time to time.

Call : 1800 419 8228 (TOLL FREE); +91 80 4134 5444 Email : care@exidelife.in Visit : exidelife.in

Registered Office: Exide Life Insurance Company Limited, 3rd Floor, JP Techno Park, No.3/1, Millers Road, Bengaluru - 560 001.
IRDAI Registration No. 114 CIN: U66010KA2000PLC028273