In this policy, the investment risk in investment portfolio is borne by the policyholder

STATEMENT OF ACCOUNT
Date : 10/08/2021 Page No : 1
Owner : NAJMABIBI JAVEDBHAI MOJANIDAR Contract No : 12215159
Assignee : Mode : YEARLY
Life Assured: NAJMABIBI JAVEDBHAI MOJANIDAR Currency : INR
Basic Sum Assured : *************30,000.00
Top-up Sum assured : ***********************
Address : 3-249 GOHDRA BHAGOL Instalment Premium : **************6,000.00
SANTRAMPUR PANCHMAHAL
GUJARAT
India 389260
India 389260
Statement Period : 01/08/2018 To 10/08/2021
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Premium Paid : 78000.00 Top Up Premium Paid : .00
Allocation Charges : 8400.00 Top Up Charges : .00
Net Premium Allocated : 69600.00 Net Top Up Allocated : .00
No of Fund Switch processed : 0000 Free Fund Switch Balance : 0052
Funds withdrawn ( amount) : .00
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Policy Type : RELIANCE SUPER INVEST ASSURE PLAN 121L031V01
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Transaction Description Amount NAV as Units Total
Date Rs. on Date Units
------------------------------------------------------------------------------------------------
Fund Type : Life Pure Equity Fund 1 ULIF03010/06/08LPUEQUTY01121
14/08/2008 Opening Balance 2952.682
14/08/2018 Invested Premium 5700.00 28.36500 200.952 3153.634
14/08/2018 Invested Premium 3000.00 28.36500 105.764 3255.414
14/08/2019 Invested Premium 5700.00 26.23340 217.280 3448.528
15/10/2019 Cost of Unit Journal 3022.47 27.93370 108.202 3548.080
28/09/2020 Invested Premium 5700.00 28.70110 198.599 3722.348
Funds Allocated 20100.00 722.595 .000
Mortality Charge .000
Policy Admin Fees 1800.00- 62.806- .000
GST 324.00- 11.306- .000
Education Cess .000
10/08/2021 Closing Balance 145433.60 39.26900 3703.521
Total Value of Units as at 10/08/2021 is Rs *******145,433.60
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SUMMARY
Funds Allocated 20100.00
Mortality Charge .00
Policy Admin Fees 1800.00-
Initial Fee by Unit Deduction .00
GST 324.00-
Education Cess .00
Other charges .00
Fund switch fee .00
Partial withdrawal charges .00
Discontinuance charges .00
Misc.charges .00

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PS/Unit statement/Ver1.1/May 2020

 In this policy, the investment risk in investment portfolio is borne by the policyholder
STATEMENT OF ACCOUNT
Date : 10/08/2021 Page No : 2
Owner : NAJMABIBI JAVEDBHAI MOJANIDAR Contract No : 12215159
Assignee : Mode : YEARLY
Life Assured: NAJMABIBI JAVEDBHAI MOJANIDAR Currency : INR
Basic Sum Assured : *************30,000.00
Top-up Sum assured : ***********************
Instalment Premium : **************6,000.00
Policy Type : RELIANCE SUPER INVEST ASSURE PLAN 121L031V01
-----------------------------------------------------------------------------------------------
Transaction Description Amount NAV as Units Total
Date Rs. on Date Units
------------------------------------------------------------------------------------------------
Misc.charges .00
Total Charges 2124.00-
---------------------------------- ---------------------------------- ----------------------------------
Effective 14/07/2021,in accordance with the IRDA guidelines,details of the funds applicable for your
policy are as below :
Existing Fund(s) Name New Fund(s) Name SFIN of New Fund(s)
Please note that above changes do not impact your fund value in any manner and your interest
remains well protected.
-----------------------------------------------------------------------------------------------
Should you require clarification, please do not hesitate to call your agent
Reliance Life Insurance Compan at telephone number
for assistance.
Please quote your policy number in all your correspondence with us.
POLICY ADMINISTRATION DEPARTMENT
Reliance Life Insurance Compan
As this is a computer generated Tax invoice should be digitally or manually signed.
In case of any further clarification, you may call us at 1800-102-1010 or email us
rnlife.customerservice@relianceada.com or log on to www.reliancenipponlife.com.
The Annual Investment Report(The Analyst) is available on our website.
Mortality, Policy Administration charges etc as per the terms and conditions of the policy will
by deducted from the policy be cancellation of units at prevailing unit price.
With effective from July 1st, 2017 % on or after notified date applicable GST
will be levied on application charges.
In respect of valid request received up to 3.00 pm between Monday - Friday by the insurer, the
same days closing NAV shall be applicable.
In respect of valid request received after 3.00 pm between Monday - Friday by the insurer, the
closing NAV of the next day shall be applicable.
In respect of valid request received after 3.00 pm on Friday by the insurer, the closing NAV of
the next business day shall be applicable.
For Further details please refer to the terms and conditions mentioned in the policy document.
For further details on the conditions, exclusions, charges related to
RELIANCE SUPER INVEST ASSURE PLAN
please refer to your policy terms and conditions.
Please visit https://www.reliancenipponlife.com/our-funds to view the annual report which has
details pertaining to fund performance during the preceding financial year as required under
Regulation 47(b)(i) of IRDAI(Unit Linked Insurance Products) Regulations, 2019.
Trade Logo displayed above belongs to M/s Anil Dhirubhai Ambani Ventures Private Limited &
Nippon Life Insurance Company and used by Reliance Nippon Life Insurance Company Limited
under license.

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PS/Unit statement/Ver1.1/May 2020