Date: 11-Dec-2021

Receipt No.: 23424234 DEC211213

Term Insurance Premium

Receipt
Duration For Which the Premium is Received: 13-DEC-2021 to 13-DEC-2022
Personal Details
Policy Number: 12312312311
Current residential state: Bihar
Policyholder Name: Raj Address:
Mobile No. 8986490886
House#1232, 13th Main
Landline no. Please inform us for regular updates
MC Layout, Vijayanagara
Life Insured Name: MR. Vijay Kumar
Bengaluru123
Karnataka - 560040 PAN Number: 123323232

2018032388.pdf
Email ID:

Policy Details
Plan Name: Max Life Online Term Plan PlusMax Life Waiver Of Premium Plus Rider CO - 104N092V02
Policy Term 36 Years Premium Payment Frequency Yearly
Date of Commencement 13-DEC-2021 Date of Maturity 12-DEC-2057
Last Premium Due Date 13-DEC-2021 Next Due Date 12-JAN-2018
Reinstatement Interest (incl. GST) 0.00 Model Premium (incl. GST) 1,344.60
Total Premium Received (incl. GST)* 1,344.60 Total Sum Assured of base plan and term 1,00,00,000.00
rider (if any)
Agent's Name Coverfox Insurance Brokin Agent's Contact No.
18002005522
Head Office
GST Details
Coverage Type SAC Code GST (INR) GSTIN 27AACCM3201E1Z3
Base 997132 194.83 GST Regd. State Maharashtra
Rider 997132 10.28
Affix
Reinstatement Interest 0.00 Re1
Total 205.11 revenue
stamp

Important Note:
*For payment mode other than in cash, this receipt is conditional upon the credit in our account. Payment of premium amount does not constitute commencement of risk. The risk
commencement starts after acceptance of risk by us. *Amount received would be adjusted against the due premium as per terms and conditions of the policy. *Premium paid would
be eligible for deduction as per the provision of Income Tax Act, 1961. Kindly consult your tax advisor for more information. Tax benefits are liable to change due to changes in
legislation or government notification. *Applicable Taxes, Cesses and Levies, as per prevailing laws, shall be borne by you. *For GST purposes,this premium receipt is Tax
Invoice.Assessable Value in GST for Endowment First Year is 25%, Renewal Year is 12.5%; Single Premium Annuity is 10%; Term and Health is 100%. In case of unit linked
product GST is applicable on charges.

Authorised signatory

PRM20