Bajaj Allianz Life Insurance Co. Ltd.

To,
SURENDRA KUMAR Date :28-11-2023
HNO 108 BIJARKHATA UTTRI 1,
POLICE STATION SUAR TEHSIL SUAR~SUAR,
RAMPUR,
RAMPUR,
UTTAR PRADESH,
IN 244924

Certificate For Premium Paid

(01-04-2020 To 31-03-2021)

Assignee: MR SURENDRA KUMAR

This is to certify that the premium under the following policies taken by the policyholder SURENDRA KUMAR have been
received by Bajaj Allianz Life Insurance Company Limited during the Financial Year 2020-2021

Total
Premium Policy Life Health Care
Premium Due Premium Sum Premium
Policy No. Product Name IP Adjustment installment Insurance Premium
Date Type Assured Amount
Date premium Premium (1) (2)
Received

POS_GOAL_SUR First
0435698667 MR SURENDRA KUMAR 25-01-2021 25-01-2021 150000 15000 15000 15000 0
AKSHA Premium

Total: 15000 15000 15000 0

Note:
This certificate is issued for the purpose of claiming deductions, rebates as per the provisions of Income Tax Act, 1961
1. Receipts issued subject to realization of cheques.

2. Life Insurance Premium is eligible for tax rebate/deduction under Section 80C.
3. HCB/CI/Post Hospitalization/Surgical Benefit Rider Premium is eligible for tax rebate/deduction under Section 80D.
4. Partial Withdrawals, surrender Values, Death Benefit and Maturity Benefit are eligible for Tax Benefit as per Sec 10 (10D) of
Income Tax Act.
5. Policies where the premium exceeds 20% of sum assured with date of commencement prior to 1st April 2012 and the policies
where the premium exceeds 10% of sum assured with date of commencement from 01st April 2012, will not be eligible for tax
benefits u/s 10(10D) and u/s 80C.
6. For your actual eligibility please refer to provisions of IT Act 1961 as modified and consult your tax consultant.

Disclaimer:In compliance of the provisions relating to deduction of tax at source under section 194 DA of Income Tax Act,1961 as introduced by Finance
Act,2014,any payment(except payment exempted u/s 194DA) made by Bajaj Allianz Life Insurance Co Ltd shall be subject to deduction of applicable TDS.In
absence of PAN details,TDS would be deducted @20% instead of 1%(w.e.f 01-June-2016)in case where PAN is provided.TDS once deducted shall not be
refunded.**GST is applicable w.e.f 01-July-2017

Note: This is a computer-generated letter and does not required a signature.

Regd. & Head Office : Bajaj Allianz House, Airport Road, Yerwada, Pune 411 006. Mail us: customercare@bajajallianz.co.in, Call on: Toll free
No. 1800 209 7272, Fax No. 02066026789