Date: 13-Dec-2017

Receipt No.: 139684310 DEC201701

Life Insurance Premium Receipt

Duration For Which the Premium is Received: 2022 -2023
Personal Details
Policy Number: 139684310
Current residential state: Telangana
Policyholder Name: Mr. L.V Chandra Shekar
Mobile No. 8986490888
Communication Address: Lacasa k Apt flat no3B
Landline no. Please inform us for regular updates
Banjara hill road no 11 Life Insured Name: Lanka Pravallika
Hyderabad 500034 PAN Number: ANEPL6474D
Email ID: lankachand@GMAIL.COM

Policy Details
Plan Name: Max Life Online Term Plan PlusMax Life Waiver Of Premium Plus Rider CO - 104N092V02
Policy Term 40 Years Premium Payment Frequency Annul/Yearly
Date of Commencement 12-DEC-2022 Date of Maturity 12-DEC-2057
Last Premium Due Date 12-DEC-2022 Next Due Date 12-JAN-2024
Reinstatement Interest (incl. GST) ` 0.00 Model Premium (incl. GST) ` 55000
Total Premium Received (incl. GST)* 55000 Total Sum Assured of base plan and term ` 1,00,00,000.00
rider (if any)
Agent's Name Coverfox Insurance Brokin Agent's Contact No.
18002005522
Head Office
GST Details
Coverage Type SAC Code GST (INR) GSTIN 27AACCM3201E1Z3
Base 997132 ` 194.83 GST Regd. State Telangana
Rider 997132 ` 10.28
Affix
Reinstatement Interest ` 0.00 Re1
Total ` 205.11 revenue
stamp

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. *Premium paid would
be eligible for deduction as per the provision of 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. *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%. In case of unit linked
product GST is applicable on charges.

Authorised signatory

PRM20