An Medi Assist Premium Paid Certificate Payee: Mr. Shridhant Pati House No B302 Bren Champion Square St No. 91, 92, Sarjapur - Marathahalli Rd, Carmelaram, Ambedkar Nagar, Chikkabellandur, Bengaluru, Karnataka 560035 Date: 19-Oct-2022 Nominee: Himanshu Shekhar Age: 61 years Menaka Pati Age: 56 years Ref: Policy No. 39165848 Coverage Face Amount Modal Premium Coverage Status Parental Policy 1000000 49625 Premium paying (One-Time) This is to certify that the following amounts have been received towards premium for the above policy for the period 19-Oct-2022 to 18-Oct-2023. Effective Date of Deposit_| Premium (Rs) 19-Oct-22 49625 This letter is based on our understanding of current tax laws prevailing in India. These laws are subject to change and any such change could have a retrospective effect. This letter should not be construed as tax, legal or investment opinion forums. For specific suitability, you are requested to consult your tax advisor. ‘THIS IS A COMPUTER GENERATED STATEMENT AND DOES NOT REQUIRE A SIGNATURE