Premium Receipt

Receipt No.: 369508908APR2201 | Receipt Date: 08-APR-2022

Personal Details
Policy Number: 369508908 Email ID: sujanaloy37sn@gmail.com
Policyholder Name: Mr. Sujan N PAN Number: FUXPS3511L
Address: CM Luxury Building, Room No -108 Rajiv Gandhi Nagar, HSR Customer GSTIN: Not Available
layout,Sector-7 Current Residential State: Karnataka
Bangaluru- 560102
Karnataka
Mobile Number: 9845709749
Policy Details
Plan Name: Max Life Smart Term Plan Policy Commencement Date: 29-MAR-2021
Life Insured: Mr. Sujan N Policy Term: 38 Years Premium Payment Term: Regular
Premium Payment Frequency: Annual Date of Maturity: 29-MAR-2059 Modal Premium (incl. GST): ` 24,068.55
Late Payment Fee (incl GST): ` 0.00 Premium Received (incl. GST): ` 24,068.55
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (`) Rate Amount (`) Rate Amount (`) Rate Amount (`) Internet Sales
Base 15,000.00 NA 0.00 NA 0.00 18% 2,700.00
Rider 5,397.06 NA 0.00 NA 0.00 18% 971.47
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00 Contact Number
Total GST Value: ` 3,671.47 18601205577
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Mudrank: Paid by e-Stamps Certificate no. 948/Issue Date: 4/04/2022/ Vide Treasury (E-CHALLAN) GRN NO.88821464

Total Sum Assured of base

plan and term rider (if any)

29-MAR-2022 to
` 2,00,00,000.00 ` 24,068.55 28-MAR-2023 29-MAR-2023
*Important Note:
1.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.
2.Amount received would be adjusted against the due premium as per terms and conditions of the policy.
3.Premiums may be eligible for tax benefits under section 80C/80CCC/80D/37(1) of the 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.
4.GST shall comprise CGST, SGST / UTGST or IGST (whichever is applicable) including cesses and levies, if any. All 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%.

Authorised Signatory
PRM21V6.0 09012022 PRODUCT UIN: 104N113V04
E.&O.E 2022-04-08.03.35.14.280981