Premium Receipt

Receipt No.: 370127029APR2201 | Receipt Date: 20-APR-2023

Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-APR-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-MAY-2023 20-MAY-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: 104N118V02
E.&O.E 2023-04-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029AUG2205 | Receipt Date: 21-AUG-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh India
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-AUG-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-SEP-2023 20-SEP-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: 104N118V02
E.&O.E 2023-08-21.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029DEC2209 | Receipt Date: 20-DEC-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh India
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Ms. Anjana Kumari Pandit
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
8097950352
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-DEC-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-JAN-2024 20-JAN-2024

*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: 104N118V02
E.&O.E 2023-12-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029JAN2310 | Receipt Date: 17-JAN-2024
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh India
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Ms. Anjana Kumari Pandit
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
8097950352
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

17-JAN-2024 to
₹ 2,00,00,000.00 ₹ 5,565 16-FEB-2024 20-FEB-2024

*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%.
5. I/We hereby declare that though our turnover is more than the turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the said sub-rule.

Authorised Signatory
PRM21V6.1 19012023 PRODUCT UIN: 104N118V02
E.&O.E 2024-01-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029JUL2204 | Receipt Date: 20-JUL-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh India
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-JUL-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-AUG-2023 20-AUG-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: 104N118V02
E.&O.E 2023-07-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029JUN2203 | Receipt Date: 20-JUN-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-JUN-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-JUL-2023 20-JUL-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: 104N118V02
E.&O.E 2023-06-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029MAY2202 | Receipt Date: 20-MAY-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-MAY-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-JUN-2023 20-JUN-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: 104N118V02
E.&O.E 2023-05-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029NOV2208 | Receipt Date: 20-NOV-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh India
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-NOV-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-DEC-2023 20-DEC-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: 104N118V02
E.&O.E 2023-11-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029OCT2207 | Receipt Date: 20-OCT-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh India
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-OCT-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-NOV-20223 20-NOV-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: 104N118V02
E.&O.E 2023-10-20.03.35.14.280981
 Premium Receipt
Receipt No.: 370127029SEP2206 | Receipt Date: 20-SEP-2023
Personal Details
Policy Number: 370127029 Email ID: ajaythakur4841@gmail.com
Policyholder Name: Mr. Ajay Pratap Singh PAN Number: EALPS1142C
Address: 117, Veg Nagar Railway Road Customer GSTIN: Not Available
Near Ravi Sheraton Hotel Current Residential State: Uttar Pradesh
Etah- 207001
Uttar Pradesh India
Mobile Number: 7827797477
Policy Details
Plan Name: Max Life Smart Secure Plus Plan Policy Commencement Date: 20-AUG-2021
Life Insured: Mr. Ajay Pratap Singh Policy Term: 40 Years Premium Payment Term: 30 Years
Premium Payment Frequency: Monthly Date of Maturity: 20-AUG-2061 Modal Premium (incl. GST): ₹ 5,565
Late Payment Fee (incl GST): ₹ 0.00 Premium Received (incl. GST): ₹ 5,565
GST Details Connect for more details
Coverage Taxable SGST/UTGST CGST IGST Name
Type Value (₹) Rate Amount (₹) Rate Amount (₹) Rate Amount (₹) Internet Sales
Base 4,563.30 NA 0.00 NA 0.00 18% 1001.70
Rider 0.00 NA 0.00 NA 0.00 18% 0.00
Contact Number
Late Payment 0.00 NA 0.00 NA 0.00 18% 0.00
18601205577
Total GST Value: ₹ 1001.70
GSTIN: 06AACCM3201E1Z7 GST Regd. State: Haryana SAC CODE: 997132

Total Sum Assured of base

plan and term rider (if any)

20-SEP-2023 to
₹ 2,00,00,000.00 ₹ 5,565 19-OCT-2023 20-OCT-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: 104N118V02
E.&O.E 2023-09-20.03.35.14.280981