Max India Joint Venture

Premium Receipt

NAGULLA SANKAR
H NO:2-64,TAMIRISA,NANDIVADA(MANDAL),
KRISHNA DIST-521327.

We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policy Holder’s Name NAGULLA VENKATESWARAMMA Policy Number 1698764513541

Plan Opted for Family First Silver 1 Lacs +4 Lacs Sum Insured (Rs) 5 lacs

Commencement Date 09/08/2022 Expiry date 08/08/2023

Net Premium(Rs.) 20,582.00
G.S.T(Rs.) 4,518.00
Education Cess(Rs.)
Secondary & Higher Education cess(Rs.)
Gross Premium (Rs.) 25,100.00
*Stamp Duty

Details of persons Insured:

Name of person Insured Age Gender Relationship to proposer Individual Cover (Rs.)
(only In case of Family First)
NAGULLA VENKATESWARAMMA 53 M MOTHER 5, 00,000

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null
and void. For the purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax
Act, 1961 and any amendments made thereafter.
For your eligibility and deductions please refer to provisions of Income Tax Act 1961 as modified and consult your tax
consultant.

G.S.T Number: 07AAFCM7916H2Z9

THIS IS A COMPUTER GENERATED STATEMENT AND DOES NOT REQUIRE A SIGNATURE

For & On behalf of Max Bupa Health Insurance Co.Ltd.

Ashish Mehrotra
Chief Executive Officer

Location: New Delhi

Date: 09/08/2022