qlaua o (n Union Bank of India

ACKNOWLEDGEMENT
ACK NO: 231015048402
DATE: 15-10-2023 15:36:10

DEAR SIR/MADAM.

SHRI/SMT. SACHIDANANDA SWAIN PF Number - 48402 HAS EXERCISED OPTION TO CONTINUE

WITH THE MEDICAL INSURANCE POLICY FOR RETIREES FOR THE PERIOD OF 01.11.2023 TO
31.10.2024.THE OPTIONEXERCISED IS AS FOLLOWS:

Sum Insured Total Premium

Plan
(Base +Top-Up) Amount (Rs.)

Base-200000.0000 Family Floater-Without Rs.53613.0000

Top-Up - 100000.0000 Domiciliary
THE PRESCRIBEDPREMIUM WILL BE DEDUCTED ON OR BEFORE THE DUE DATE. PLEASE
ENSURE TO MAINTAIN REQUIRED BALANCE IN THE GIVEN ACCOUNT NUMBER 302002070042027
TILL 30-10-2023.NO DEDUCTIONS WILL BE MADE AFTER 30-10-2023.
IN CASE BALANCE IS NOT MAINTAINEDIN THE ACCOUNT, COVERAGE UNDER THE ENSUING
MEDICAL INSURANCE POLICY VWILL NOT BE AVAILABLE. ALSO, IN CASE THE ACCOUNT IS
TO ANY
FROZEN/CLOSED /IN-ACTIVE / THE DEBIT IN THE ACCOUNT HAS BEEN DISABLED DUE
UNDER THE ENSUING
REASON, LEADING TO NON-DEBIT OF INSURANCE PREMIUM, COVERAGE
MEDICAL INSURANCE POLICY WILL NOT BE AVAILABLE.
FUTURE REFERENCE.
PLEASE PRESERVE ACOPY OF THIS ACKNOVWLEDGMENT FOR

SIGNATURE REQUIRED.
*COMPUTER GENERATED ACKNOWLEDGMENT. NO
 GCICI PRUDENTIAL: PREMIUM RECEIPT/TAX INVOICE

11-APR-2023
Sachidananda Swain
S/O NISAMANI SWAIN
INDRAMANI BHABAN

CUTTACK
Orissa-754207
Mobile No: 9438271802

GSTIN Number Policy Number

Name of Policy Holder Name of Policy (as updated by policy hoderj Transaction ld
Savings Suraksha-LP NA
Sachidananda Swain

SUMMARY OF PAYMENT DETAILS

Balance Premium
Premium
Next Premium Payment Mode Due (in ) Balance Deposit
Policy Number Installment &
Date of Receipt Due on (n
Frequency
05-04-2023 38394980 NA 30676 / YEARLY Website Payment

DETAILS OF THE POLICY PREMIUM PAID FOR FINANCIAL YEAR 2023- 2024
Total Premium
Premium CGSTA SGST ^ IGST^ CESS ^ Eiigible fcr
Amount** Paid
@9% @9% (@18% @1% Tax
Policy Product/ in
Receipt no. Rider Name
in (A) In? (B) In (C) In? (D) in (E) Benefit
Number F=iÁ,+Bj+ (C)+ under
(D)+{E)
ICICI Pru
30000 338 338 30676 SEC80 C
38394980 O4331035 Savings
Suraksha-LP
30676
Total Premiun Paid

GSTIN number of company for Odisha : 21AAACI7351P12F

Place of Supply : Odisha
HSN No. -997132 Bhubaneshwar, Orissa, Khurda - 751015
Address of supplier: 2nd floor, City Mart,plot no. 10P &12P,Baraha Munda,

policy u/s 80CCC(1), health policy/ health related ricders (if any) us
"Tax benefit on premium paid towards Life insurance policy u/s 80C, pension
conditions prescribed in the relevant sections of The Income Tax Act, 1961, Tax laws are subject to amendments nade there from
80D as per the
time to time.

**Premnium amount is inclusive of reinstatement charges paid (if any).

^laxes and Cess (if any) is inclusive of tax on reinstatement charges (|f any).

Ple ase note:

" Premium paid in advance will be applied to the policy on premium due date.

" Premium duJë aruount is considered fromn last unpaid premium.

conditional upon credit in company's account bost clearance
If the payment has been made other than in cash, this preniumpaid certificate is
of ne instrument/tacility including electronic mode.
to his Tax consultant.
For aily confimation /impact analysis customer is advised to iefer the naller
CONSOLI: )ATED REVENUE STAMP DUTY PAID: N0TIFICATION NO - MUDRANK CSD/143/2021/4410-29/ 10,2021
laws
.iCds itr Service l ax and cess (it any) v:ll be cha ged as pet opplicable aales and pievailiny lax
ppasaheb Marathe Marg, Prabhadevi, Mubai 4u0025. riey No. l05 CiN No Lo6010MH2000PL':]A3!.nc2b
Rcgtered Adaress: 1039,
Satday, eXCept national holidays). Overseas customeiE Car call us (on 91 22 6l930777 You can email us at itehwtuli:
10aun-/piti, onday
-om. UIN No, 105N135V01 COMP/DOC/Jul2022:19//0806
This is asystem generated document, doesn't require signature
 cICI PRUDENTIAL: PREMIUM RECEIPT/TAX INVoICE

20-APR-2023
Sachidananda Swain
S/O NISAMANISWAIN
INDRAMANI BHABAN
CUTTACK
Orissa-754207
Mobile No: 9433271802

Name of Policy Holder Name of Policy GSTIN Number Policy Number

las updated by policy holder) Transaction ld
Sachidananda Swain IPRULife Time Classic NA 335453 114

SUMMARY OF PAYMENT DETAILS

Premium Balance Premium
Next Premium
Payment Mode Due (In ) Balance Deposit
Date of Receipt Policy Number Installment &
Due on (n
Frequency
19-04-2023 33354535 19-04-2024 50000 / YEARLY Website Payment

DETAILS OF THE POLICY PREMIUM PAID FOR FINANCIAL YEAR 2023- 2024
Premium Total Premium
CGST SGST a IGST CESS ^ Eligible for
Amount** Paid
Policy Product/ @9% @9% @18% @1% In
Tax
Receipt no. In? (A) In (E) Benefit
Number Rider Name In (B) In (C) In (D)
F=(A) +(B) +(C)+ under
(D)+(E)
38354535 04797421
IPRULife 50000 0 50000 SEC8O C
Time Classic
Total Premium Paid ? 50000

GSTIN number of company for Odisha :21AAACI7351P1ZF

Place of Supply: Odisha
HSNNo. -997132
Address of supplier:2nd floor, City Mart,plot no. 10P &12P,Baraha Munda, Bhubaneshwar, Orissa, Khurda- 751015

Tax benefit on premium paid towards Life insurance policy w's 80C, pension policy ws 80CCC(), health policy/ health related riders it any us
80D as per the conditions prescribed in the relevant sections of TheIncome Tax Act, 1961. Tax laws are subject to amendments made there trom
time to time.

*Premium amount is inclusive of reinstatement charges paid (|f any).

^ Taxes and Cess (if any) is inclusive of tax on reinstatement charges (If any).
Please note:
"Premium paid in advance will be applied to the policy on premium due cdate.
"Premium due amount is considered from last unpaid prenmium.
if the payment has been made other than in cash, this premium paicd certificate is conditional upon credit in companvs account post cleatance
of the instrument/facility including electronic mode.
For any confirmation / impact analysis customer is advised to reter the mater to his Tax consultant
CONSOLIDATED REVENUE STAMP DUTY PAID: NOTIFICATION NO -MUDRANK CSD/143/2021/4410-29/10/2021.
Goods and Service Tax and cess (if any) will be charged as per applcable rates and prevailing tax laws.
" Tax is not payable under reverse charge.
Registered Address: 1089. Appasaheh Marathe Marg, Prabhadev1, Munmbai A00025. Heg No 105 CIN No L
ö010MH2000PC1P7S7 Cal us cn 1:860 265 77us
10am-lpm, Monday to Saturda/, except national holidays) . Overseas customers can call us on -9122 619:0777 You can email uc at l'elin irispolite com
or visit us at www.iCicIDrulife com UIN No. 105L155V03 COMPDOCJul/2022 97 0806
This is a system generated document, doesn't require signature
 ACCOUNT STATEMENT
CANARA ROBECO
Mutual Fund
Statement Date: 11 Nov 2023
Folio Number: 10911938741
SACHIDANANDA SWAIN (Mode Of Holding : SINGLE
Po Nischinta Koili
Status : INDIVIDUAL
Badakhir
Od1sha Category : RESIDENT INDIAN
PIN
754027 Multiple bank Registration : No
Mobile 9438271802 IDCW Option NA
E-Mail
swainsachidananda1950@gmail com Agent/Broker/RIA Codo 000000-0/NA
Nominee JALATIKESHARISWAIN-100% -SON |Agent/Broker Name DIRECT
Sub Broker/Branch Code EUIN NO
Redemption Payout RTGS/NEFT

Bank AcCount No 1937101034521 IFSCCode CNRBO01937

Bank Narme CANARA BÁNK AIC Type SAVINGS
Branch KTRACK(MOBILE APP) Branch Address jhadeswarpur \ pojhandeswarpur lvia nischintakol \ urmar 754291
|Account Holder PAN KYC KIN FATCA/ UBO Aadhaar Linking Account Holder PAN KYC KIN FATCA I U80 Aadhaar Linking
Primary Holder AHJPST6200 Yes CompliantNA Linked Joint Holder 2
Joint Holder 1 Guardian
Canara Robeco Equity Tax Saver Fund -Direct Growth(ETDG)-ISIN: INF760K01EL8 NAV :Rs. 143.57 (as on 10 Nov 2023)
Date Transaction Type Amount (Rs.) Price (Rs.) Number of Units Balance Units
10/11/2023 Gross Lateral Shift In
8,341.09
Stamp Duty @ (0.005 %) 0.42
10/11/2023 Net Lateral Shift In 8,340.67 143.5700 58 0950 58 0950
(From Canara Robeco Blue Chip Equity Fund - Regular Growth)

Current Cost Rs.: 8,341.09

Current Value Rs.: 8,340.7o
Lien Units : 0.000 Locked Units: 58.095 Lock Free Units: 0.000
CurentLoadStructure NO Enty Load wet. o108 2009 for allPurchase/Switch-IN and sIP/STP newiy registering Exil Load. Nil. Eigibie for availing tax benefts under Section 20c ot TAG rs61suDeet
toyears
the from
imistheanddatecondtion specited in Section 80C. read with Section 80CCE of the Act under ELSS. 2005 vide notficalions at.03 11 2005 and 13 12 2005 Thisimvestment ssubect to a ock noero t3
of allotment

15G/H status (FY: 01/04/2023-31/03/2024). No

KYCIs cOmpulsory for all investments (including Micro SIP investments) w.e.f 01st January'2012
The above scheme is an equity oriented scheme and Securities Transaction Tax (STT) has been paid by seller on the sale of units to the fund.

The above investment in Canara Robeco Equity Tax Saver Fund is eligible for availing tax benefits under Section 80C of the Income-tax Act, 1961
Note: For investors invested under IDCW (Dividend) option only:
1 For Resioent individuais in the IDC option, TDs @10% is applicable on dividend distribution. Such TDS willbecome applicable when tne dvidend baic. zer PAN reacnes
threshoid of Rs 4,000 in a Financial Year TDS will be deducted on the entire amount of Dividend paid til that tume
2. in case PAN is not provided TDS will be deducted at 20% for each dividend distribution, irrespective of the amount.

Thank you for investing in Canara Robeco Mutual Fund

(For complete scheme name, refer transaction table) SIPISTP/SWP
Type Scheme Amount (INR) From-To Number of Top-up Amount Pause Duration & Registration Date Status
Code Frequency / Cycle Date Period Installments URN /UMRN
Date
Frequency Period Cancellation Date
1,000.00 05/10/2021
SIP LCGP 05/12/2099 05/02/2023
Monthly/5 Perpetual 05/07/2023
26/08/2021 Live SIP

1.000 00 15/12/2021
SIP LCGP 15/12/2099 23/11/202 1 CNRBO000000011
Monthly | 15 Perpetual 14/12/2021 081876
Terminateg

Summary of your investments

Scherie Details Amount IDCW till date Current Value
Balance Units
lnvested (Rs) (Rs)
Paid (Rs) Re-invested (Rs)
Canara Robeco Equity Tax Saver Fund-ET-DG 58 095 8,341.09 0.00 0.00 8.340.7O

Canara Robeco Blue Chip Equity Fund-LC-GP 0 000 0 00 0. 00 0 00

Total: 58.095 8,341.09 0.00 0.00 8,340.7O

 Folio Number : 10015214 Page 2 of 4
Sachidananda Swain
Statement Period:01-APR-2023 to 10-NOV-2023
|SMFGD-Union SmallCap Fund Direct Plan-Growth NAV :INR 42.71 (as on 09/11/2023 )
INF582M01BU9
Date Price No.of Units Balance Units
Type Of transaction Amount NAV
(INR) (INR) (INR)
0.000
Opening Balance
Unit Balance 0.000 Current Cost INR O.00 Current Value : INR O.00

46h Effec! Cror 01 O6 2020L08d Struetre -Entn lo83 N/ Et Lo9d t %tunts are rodeened ov stohod out on or beforo complelon of 15 days hom the dale ol
elotmenf fredeemed or swtohed t afer oomoetor of 15 days rom the date of aotment of wnits, MM
Note The evt rete levred a' the tine of rodeoton Setoh out wI be the rate prevait1ng at the ime of ntotment o/ thecorospondng un1ts Customars may roguestfor
seOrete Evt Lo8c 4oplionbity Reoort bycalMg OUr Toll Free numbers or hom any of our Customer Sorvico Contes
TSDP-Union Tax Saver (ELSs) Fund IDCW" Payout - NAV: INR 27.72 (as on 09/11/2023 )
Regular Plan - INF58 2MO1328
Date Type Of transaction Amount NAV Price No.of Units Balance Units
(INR) (INR) (INR)

Opening Balance 1,281.155

li/07/2023 Stt Qut To Union Tex Saver (EL SS) FundR- GR. (33,500.00) 26.30 26.30 (1,273.777), 7.378
VE YCAAMS MOble Aoo less STT
(0.34)
Current Value: 1NR 204.52 IDCW: INR 0.00
Unit Balance 7.378 Current Cost : INR 100.05

The Redemotion / Svitch anount requested by you has been grossed upward to provide for the deductkon of STT.
*/DCAmeans Income Distnbution cum caoitel withdrawal option nvestment in this scheme guailies for dadclhon Urs 80C of /TAct 1961 Entry Lo9d NIL Eit Load NI
WEF01. 04 2023 scheme name chenged from Long Term Equity Fund lo Tax saver Fund
TSG-Union Tax Saver (ELSS) Fund Growth Regular Plan NAV: INR 49.58 (as on 09/11/2023 )
INF582M01302 Price No.of Units Balance Units
Type Of transaction Amount NAV
Date
(INR) (INR) (INR)

Opening Balance 5,800.291

33,498.33 47.03 47.03 712.276 6,512.567
11/07/2023 Switch in From UnIon Tex Saver (El SS)-RP IDCW Pay.
Via myCAMS Mobile App
Gross Amount Rs 33500/- Slamp Duty cherges Levied 167
:6,512.567 Current Cost: INR 178,400.00 Current Value: INR 322,893.07
Unit Balance

WEF 01 04 2023 scheme name changed rom Long Term Egunty

Investrent in this scheme gualities for dedvction Is BOC of ITAct 1961, Entry Load NIL. Ei Lo8d WIL.
|Fund to Tax saer Fund
TSGD-Union Tax Saver (ELSS) Fund Growth - Direct Plan - NAV: INR 53.03 (as on 09/11/2023 )
INF582M01765
Amount NAV Price No.of Units Balance Units
Date Type Of transaction
(INR) (INR) (INR)
0.000
Opening Balance 473.372 473.372
24,998.75 52.81 52.81
06/10/2023 Swntch-n - From Union Small Cap Reqular Gr - via
myCAMS Mobile Aop
Gross Amount Rs 250001- Slamp Duty charges Leveod 1.25

Current Cost: INR 25,000.00 Current Value: INR 25,102.92

Unit Balance 473.372

Ws B0C of ITAct 1961 EntryLoad NIZ. Ext Load NIL WEF 01 04 2023 scheme name canged rom Log em Sunty
Investment in thus scheme quelities or deduction
Fund to Tax saVer Fund
other information printed in this statement. In case of any discrepancy
Please verify yOur Name & Address, Broker details, Bank details and
uk@camsonline.com/investorcare@unionmf.com or contact us through the Toll Free No. 18002002268
please inform US by e-Mail to eng
18005722268.

Summary of Investment
IDCW IDCW Earned
Cost of for Statement NAV 8alance Units Current Value
Amount
Scheme Option Investment
Reinveted Period

Union Tax Saver (ELSS) Fund Growth -Reqular 49.58 6,512.567 322,893.07
178,400.00 0.00 0.00
Plan
0.00 0.00 53.03 473.372 25,102.92
Union Tax Saver (ELSS) Fund Growth -Direct Plan 25,000.00
0.00 0.00 39.47 246.470 9,728.17
Union Small Cap Fund Regular Plan - Growth 6,619.69
27.72 7.378 20-4.52
Union Tax Saver (EISS) Fund IDCW Payout 100.05 0.00 0.00
Regular Plan
357,928.68
Total 210,119.74

One Time Mandate [0TM] Registrations

From Date To Date Upper Limits Status
Bank A/C No. UMRN
Bank Name Active
02-Feb-2016 31-Dec-2099 2000
XXXXXXXXXXXX027 33119
Union Bank of India

Your Nearest Branch Details

Centre Point, Sriyà Talkies Road, Kharvel Nagar, Unit-3, Bhubaneswar - 751001
CAMS CSC, Bhubaneswar, Plot No-501/1741/1846, Office No:-203 (2nd Floor),
 ACCOUNT STATEMENT CANARA ROBeCO
Mutual fand
Folio Number: 10911938741 Staterment Date: 11 Nov 2023

SACHIDANANDA SWAIN Mode Of Holdina SINGLE

Po Nischinta Koil Status
Badakhir :INDIVIDUAL
Odisha Category :RESIDENT INDIAN
PIN 754027 Multiple bank Registration : No
Mobile 9438271802
E-Mail IDCW Option NA
swainsachidananda1950@gmail com Agen/Brokor/RIA Code 000000-0/NA
Nominee JAI ATIKESHAR SWAIN-100% - SON AgontVBroker Name DIRECT
Sub Broker/Branch Code EUIN N
Redemption Payout RTGS/NEFT

Bank Account No 1937101034521 IFSCCode CNPBOO01937

Bank Name CANARA BANK AIC Type SAVINGS
Branch :KTRACK(MOBILE APP) Branch Address jhadeswarpur \ pojhandeswarpur Ivia nischintakol\ urnar 754291
Account Holder PAN KYC KIN
FATCA /UBO Aadhaar Linking Account Holder PAN KYC KIN FATCA IUB0 Aadhaar Linking
Primary Holder AHJPST6200 Yes CompliantNA Linked Joint Holder 2
Joint Holder
Guardian

Canara Robeco Equity Tax Saver Fund -Direct Growth(ETDG) -ISIN: INF760K01EL8 NAV: Rs. 143.57 (as on 1O Nov 2023)
Date Transaction Type Amount (Rs.) Price (Rs.) Number of Units Balance Units
10/11/2023 Gross Lateral Shift In 8,341.09
Stamp Duty @ (0.005 %) 0.42
10/11/2023 Net Lateral Shift In 8,340 67 143.5700 58 0950 52 0950
(From Canara Robeco Blue Chip Equity Fund - Regular Growth)

Current Cost Rs.: 8,341.09 Current Value Rs.: 8,340.7O

Lien Units : 0.000 Locked Units : 58.095 Lock Free Units: 0.000
Current Load Structure: NO Entry Load wef., 01.08.2009 for allPurchase/Switch-IN and SIPISTP newly registering. Exit Load: Nil. Eligible for availing tax benefts under Section 80C of IT At, 1961 sucec
to the limits and condition specified in Section 80C, read with Section 80CCE of the Act under ELSS.20 videenotifications
jons dt. 03.11.2005 and 13.12 2005. This investment is subject to a lock in period cf 3
years from the date of allotment

15G/H status (FY 01/04/2023-31/03/2024): No

KYC is compulsory for all investments (including Micro SIP investments) w.e.f. 01st January'2012
The above scheme is an equity oriented scheme and Securities Transaction Tax (STT) has been paid by seller on the sale of units to the fund.

The above investment in Canara Robeco Equity Tax Saver Fund is eligible for availing tax benefits under Section 80C of the Income-tax Act, 1961
Note: For investors invested under lDCW (Dividend) option only:
1.For Resident Individuals in the "IDCW option, TDS @10% is applicable on dividend distribution. Such TDS will become applicable when the dividend paid. per PAN reaches
threshold of Rs 4,000 in a Financial Year. TDS willbe deducted on the entire amount of Dividend paid till that time.
2 In case PAN is not provided TDS will be deducted at 20% for each dividend distribution, irrespective of the amount.
Thank you for investing in Canara Robeco Mutual Fund
(For complete scheme name, refer transaction table.)
SIP/STP/SWP

Type Scheme Amount (INR) From-To Number of Top-up Amount Pause Duration & Registration Date URN /UMRN Status
Code Frequency / Cycle Date Period Installments Frequency Period Cancellation Date
Date
1.000.00 05/10/2021
05/12/2099 05/02/2023 Live SIP
SIP LCGP Perpetual 26/08/2021
Monthly / 5 05/07/2023
1,000 00 15/12/2021
23/11/2021 CNRBOO00000011
SIP LCGP 15/12/2099 Perpetual 14/12/2021 081876
Terminaled
Monthly / 15

Summary of your investments

Amount IDCW till date Current Value
Scheme Details Balance Units
Invested (Rs) (Rs)
Paid (Rs) Re-invested (Rs)

Canara Robeco Equity Tax Saver Fund-ET-DG 58.095 8,341 09 0.00 0.00 8,340.70

Canara Robeco Blue Chip Equity Fund-LC-GP 0.000 0.00 000 0 00 0 00

58.095 8,341.09 0.00 0.00 8.340.70

Total:
 gêas I
qtaaa do( nUnion Bank

SIGI REI/ Branch

NG Hi/ Date
2
au/sG GIGI /afsZ SÄ./
SBICA/OD/CC/RD/TL/DL A/c No./Credit Card No.

IN/ A/ Name.
6IR °I6FIQISR °/ . Ä. / HIST 0. / Tel.
No./Mobile No.
iê hH / Amount
U EY
Y/Rupees in words
Cheque No.JDate/Name of Bank &Branch

6FI6Y ct/Total
BIalfmri /Officer/ 6alkYG/Cashier/ TOLL FREE NO.
1800 22 2244