Date: 30-SEP-2021

Premium Paid Certificate

Duration For Which the Premium is Received: 01/04/2021 to 30/09/2021
Personal Details
Policy Number: 345307847 Current residential state: Andhra Pradesh
Policyholder Name: Mr. Dodla Venkata Sudheer Mobile No. 9886653488
Commuinication Address: DOOR NO 4-5-60/3 2ND Landline no. Please inform us for regular updates
CROSS Life Insured Name: Mr. Dodla Venkata Sudheer
SAIBABA ROAD PAN Number: AIJPD3005D
guntur
Guntur - 522006
Email ID: venkat@dvts.in

Policy Details
Plan Name: Max Life Smart Term Plan - 104N113V03
Policy Term 46 Years Premium Payment Frequency Annual
Date of Commencement 25-SEP-2020 Date of Maturity 25-SEP-2066
Last Premium Due Date 25-SEP-2021 Next Due Date 25-SEP-2022
Reinstatement Interest (incl. ` 0.00 Model Premium (incl. GST) ` 23,541.00
GST/S.Tax)
Total Premium Received (incl. ` 23,541.00 Total Sum Assured of base plan and term ` 50,00,000.00
GST/S.Tax)* rider (if any)
Agent's Name Axis Bank Ltd Agent's Contact No.
Lakshmipuram

GST Details
Coverage Type SAC Code CGST/SGST/ GSTIN 37AACCM3201E1Z2
S.Tax (INR) GST Regd. State Andhra Pradesh
Base 997132 ` 3,591.00
Rider 997132 ` 0.00
Reinstatement Interest ` 0.00
Total ` 3,591.00

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. *Premiums may be
eligible for tax benefits under section 80C/80CCC/80D/37(1) of the 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. GST shall comprise of CGST, SGST/UTGST or IGST (whichever is applicable) including cesses and levies, if any. All 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%.

Authorised signatory

PRM23 V2.9 01082019