Max India Joint Venture

Premium Receipt

MR. Vijay Raj A

D-No 11-2-459/6,
Namalagundu,
Sithaphalmandi,
Telangana – 500061.
We acknowledge the receipt of payment towards the premium of the following health insurance policy:

Policy Holder's Name Vijay Raj A Policy Number 801736789315

Plan Opted for Family First Silver 1 Lacs + 8 Lacs Sum Insured (Rs) 10 lacs

Commencement Date 31/10/2022 Expiry date

Net Premium(Rs.) 21,710.00
G.S.T(Rs.) 3907.80
Gross Premium (Rs.) 25,617.80
*Stamp Duty
Details of Persons Insured:

Name of Person Insured Age Gender Relationship to policy holder Individual Cover (Rs.)
(Only In case of Family First)
Vijay Raj A 36 M SELF 1, 00,000

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, the benefit shall be as per the provisions of the
Income Tax Act, 1951 and any amendments made thereafter.
For your eligibility and deductions please refer to provisions of Income Tax Act 1951 as modified and consult your
tax consultant.
For & On behalf of Max Bupa Health Insurance Co. Ltd.

Location: HYDERABAD Ashish Mehrotra

Date: 31/10/2020 Chief Executive Officer