Premium Receipt

Dear MR. RAKESH AGGARWAL

118,3RD FLOOR, 2ND CROSS, RELIABLE RESIDENCY PHASE 3,
BEHIND VIBGYOR
BENGALURU
KARNATAKA - 560102

We acknowledge the receipt of payment towards the premium of the following health insurance policy:

Policy Holder's Name Mr. Rakesh Aggarwal Policy Number 31291397202200

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Commencement Date 23/07/2022 Expiry Date 22/07/2023

Plan Opted for HC VARIANT 2 5L NAT 2A

Net Premium/Taxable Value (Rs.) 53,000.00

Integrated Goods and Service Tax (18.00 %) 9,540.00

Central Goods and Service Tax (0.00 %) 0.00

State/Union Territory Goods and Service Tax (0.00 %) 0.00

Loading(Rs.) 0.00

Gross Premium (Rs.) 62,540.00

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Issuance of policy is subject to clearance of premium paid

Details of persons Insured:

Name of Person Insured Age Gender Relationship to policy holder

Mr. Subhash Chand Aggarwal 59 Male Spouse

Mrs. Kamlesh Aggarwal 55 Female Mother

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. For the
purpose of deduction under section 80D of the income Tax Act, 1961, please consult your tax advisor for more details. The benefit shall be as
per the provisions of the Income Tax Act, 1961 and any amendments made thereafter.

In the event of non-realization of premium, Tax benefits cannot be obtained against this premium receipt

GSTI No.: 07AAFCM7916H1ZA SAC Code / Type of Service : 997133 / General Insurance Services

Max Bupa State Code: 7 Customer State Code / Customer GSTI No.: 29 /NA

Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.

Location: New Delhi Director - Operations & Customer Service

Date: 24/07/2020 For and on behalf of Max Bupa Health Insurance Company Limited

Health Companion; UIN: IRDAI/HLT/MBHI/P-H/V.III/2/2017-18