RENEWAL LIFE INSURANCE PREMIUM RECEIPT

Insured Name : KABUL DAS Policy No : U037463885

Policyowner : KABUL DAS Receipt Date : 2013/11/12
Agent/Broker Code : 004005113
Agent/Broker Name : Tata Aia
Siliguri

Payment Mode Payment Method Basic Plan Name Premium due Period
Annual Cash/Cheque Tata AIA Life InvestAssure Future (110L057V01) From 2013/11/11 to 2014/11/11

Modal Premium Service Tax* Amount Due Amount Received

` 15,000.00 ` 0.00 ` 15,000.00 ` 15,000.00

Temporary Receipt No Date Amount ₹

V0019612 2013/11/12 ` 15,000.00

Excess as on date (if any) : ` 0.00

Next Premium Due on : 2014/11/11

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. Any excess
premium will be deposited in Future Policy Deposit Fund (FPDF). The amount lying in FPDF shall not bear any interest.

Tax benefits ** on Life Insurance Policies are available u/s 80C, on Pension u/s 80CCC & Health policies / Riders u/s 80D of Income tax
Act, 1961 Tax benefit u/s 80D is not available for premium payment in cash.
Tax benefits u/s 80CCC and 80D are not available for premium payment through automatic loans from Cash Value of the policy if any, as
per the policy provisions
This is a computer-generated receipt and does not require signature.
This receipt is null and void ab initio, if the cheque / any other valid negotiable instrument as per the Negotiable Instruments Act,1881, as receipted by the
Company vide this receipt , is reported as dishonoured by the Company bank or any other Financial Institution on which the Negotiable instrument is drawn
or is not acceptable to the Company due to any reason deemed fit by the company.

* Service tax is applicable as per governing laws and the same shall be borne by the policyholder. Tata AIA Life Insurance Company Limited reserves the right to recover from the
policyholder, any levies and duties (including service tax), as imposed by the government from time to time.
Service tax Registration Number: AABCT3784CST001
Category of Service: Life Insurance Service and / or Management of investment under ULIP Services
** Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfillment of conditions stipulated therein. Tata AIA Life Insurance Company Ltd. does
not assume responsibility on tax implication mentioned anywhere in this document. Please consult your own tax consultant to know the tax benefits available to you.
Consolidated Revenue stamp duty paid: Notification No. Mudrank 2013/621/PR.KR.144/M-1-18/03/2013 vide receipt No. 37240 dated 02-Feb-2013
Tata AIA Life Insurance Company Ltd. (Reg. No. 110)
Registered & Corporate Office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai
400013 For more Information, contact your advisor or call on our Helpline No's 1-800-267-9966 (toll free) or at 1-860-
266-9966
(local charges apply) or SMS “Service” to 58888 or e-mail us at customercare@tataaia.com. Version 3.0/FCI

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