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Premium Receipt
(3irr Mr. Mtn Bansal

M.alla Kat, Singh Ma Ana

Meerut,
UttarPradesh-250401
VVe acknoviledge the receipt of pawnent tow:ads the premium of the intoning heath nsurance policy.
PolicyHolder's Name Mr.NrtinSense! PolicyNumber 3020'3660201300

P. Opted Su Family Fi. Silver 5 lees • 151. Sun Insured (Rs) 40.00.000

CommencementDate.18/04/2013 Expirydate 17/04/2014

Net Premiurna ,s.) 45,897 00
Service Ta.Rs.) 5,508.00
EducationCess(Rs.) 110.00
Secondary 8Higher EducetionC esS 0,8) 5600
Gross Premiurn 9 s.) ,
51,571 00

Stan,
issuanceofpokyis sotakt toclearanceofpremium paid
Details ot persons Insured
Mime of person Insured Age Gender Relationship to policy holder Coverffitl
,Ortyincase ofFamily first)
Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are consicered
Mr. Nitin
null and Ban. 35
void. For the purpose of deduction under section 800,kthe
igican t
benett 5,00,000 of the Income
shall ce as per the provisions
Tax
Ms. Act , 1961 and any amendments made 23 thereater. Spouse 5, 00.
In
Mr.the eve. of non-reatization
Puru.ortam Dass of premium
62, Tax benetts can. be obtained
Father again. this premium receipt.
5,00,000
For you eligibdity and deductions please refer to pronsions of Income Tax Act 1961 as modiled and eons. your tax
Mr.DarshBansal Son 5,00,000
consult..
Ms. Ma. Bans. 55 Mother 5,00.000
SeNce tax Regi..on nun ber AAFCM7916HST001
FOf On behalf of Max Sups Health Inn/ante Co. Ltd.

M ins. PA shra Chid

Executve Officer

LocatorsNewDelhi
Dace: 2501/2014