December 15, 2023 Product UIN : 122L111V02

Suchismita Shasini Agent Code : 60202244

W/O-Mrutyunjay Satapathy, Duplex No-68 Sai Paradise
Daruthenga Patia Bhubaneswar
Nr KISH Jagannath Temple 751024
Orissa
India

Acknowledgement of Premium Receipt for December 06, 2023

POLICY DETAILS
Policy Number 10474550 Risk Commencement Date December 06, 2021

Policyholder Name Suchismita Shasini Life Assured Name Suchismita Shasini

Product Name AVIVA Affluence Sum Assured (₹) 20,00,000

Frequency Annual Premium Payment Mode Online

Date of premium payment December 15, 2023 Premium received including 2,00,000.00
Interest + Revival fee, if any
(₹ in figs.)

Premium received including Interest + Revival fee, Rupees Two Hundred Thousand only.
if any (in words)

As per IRDAI Guidelines, the Renewal Premium is adjusted on the due date even if it has been received in advance. Hence, your premium
receipt will be available only post the due date. You can also generate the receipt for the premium payment through the e-statement
option on Aviva’s Customer Portal‐ My Aviva, post the due date.

Please Note:

1. Validity of the payment is subject to realization.

2. Tax benefits are available Under Section 10(10D) and Section 80C of the Income Tax Act 1961, as amended from time to time.
3. Tax benefits are liable to change due to change in Legislation or Government notification. Aviva does not give any warranties on the
benefits available under the Income Tax Act, 1961 inforce currently or as amended.
4. GST or any other applicable taxes will be charged and/or deducted on/from the premium/unit account at the prevailing rate. Tax laws
are subject to change.

This is a computer generated statement, hence does not require signature