Date: 30-NOV-2021

Premium Paid Certificate

Duration For Which the Premium is Received: 20/04/2015 to 30/11/2021
Personal Details
Policy Number: 261158786 Current residential state: Gujarat
Policyholder Name: Mr. Bhavik Dipakkumar Thaker Mobile No. 9099919359
Commuinication Address: 5/B RAJESHWARI SOC Landline no. Please inform us for regular updates
. Life Insured Name: Mrs. Jankiben Bhavik Thaker
OPP. S.T. PAN Number: AICPT1804D
NAGAR,KAPADWANJ
ROAD,NADIAD
KHEDA - 387001
Email ID: bhavikthaker85@hotmail.com

Policy Details
Plan Name: Max Life Life Gain Premier - 104N079V01
Policy Term 20 Years Premium Payment Frequency Monthly
Date of Commencement 20-APR-2015 Date of Maturity 20-APR-2035
Last Premium Due Date 20-APR-2021 Next Due Date 20-MAY-2021
Reinstatement Interest (incl. ` 2,437.57 Model Premium (incl. GST) ` 0.00
GST/S.Tax)
Total Premium Received (incl. ` 3,73,658.63 Minimum Guaranteed Death Benefit / ` 4,08,906.84
GST/S.Tax)* Death Benefit of base plan and term rider
(if any)
Agent's Name Customer Services Agent's Contact No.

GST Details
Coverage Type SAC Code CGST/SGST/ GSTIN 24AACCM3201E1Z9
S.Tax (INR) GST Regd. State Gujarat
Base 997132 ` 8,660.09
Rider 997132 ` 0.00
Reinstatement Interest ` 371.84
Total ` 9,031.93

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