Max Life Insurance Co. Ltd.

Operation Center, 90-A, Udyog Vihar, Sector 18, Gurgaon -- 122015

Customer Help Line -1800 200 5577 (Toll free from any network)
Regd Office: Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India
Visit us at: www.maxlifeinsurance.com E-mail: service.helpdesk@maxlifeinsurance.com
www.maxlifeinsurance.com

Premium Paid Certificate for the Period 01/04/2013 to 31/12/2013

Policy Number: 498051983 As on Date 31-Dec-2013

Name: Mr. Bhushan Ashok Joshi Base Life Insured: Mr. Bhushan Ashok Joshi
Address: Room No- 1 Om Narmada CHS, Your Agent Advisor: Mr. Gaurav Kumar Singh
Ahilya Bai Chowk, Agent Code 450256
Kalyan West Your Agent Phone No
Thane - 421301
General Office Max Life Agency Distribution Direct Sales
Office (Mumbai 2)
Telephone 9967761283-

Dear Mr. Bhushan Ashok Joshi,

Thank you for being part of the Max Life Insurance family. This is to acknowledge receipt of your premium for the period 01/04/2013 to 31/12/2013
as per details below.

We also take this opportunity to reiterate that we value your patronage and are committed to providing you the best in class service.

Yours Sincerely,

for Max Life Insurance Co. Ltd.

Authorized Signatory

Plan Annual Target Current Frequency Effective Date of

Premium Received / Coverage
Top Up#
(Rs.)
Max Life Life Maker Premium Unit Linked 45,000.00 Quarterly 03-Sep-2008
Investment 10 Yr.5 Pay Plan Premium
Total 45,000.00

Note: || # Subject to realisation of monies. || The total premium amount is inclusive of Service Tax if paid. || This certificate is a consolidation of the individual premium
receipts sent to you. || All premiums will be eligible for tax benefits (under section 80C/80CCC/80D/37(1) of Income Tax Act 1961, as per applicability) and subject to
levies under prevailing Tax Laws (including Service Tax Laws). || As per the recent Union Budget 2013 proposals, effective April 1, 2013, your Policy may be entitled to
certain tax benefits or subject to deductions . We request you to please consult with your tax consultant for more information.

URM23 V1.5 21072013 31-Dec-2013

E.&O.E.